WorldWideScience

Sample records for relative cost escalation

  1. Cost escalation in nuclear power

    International Nuclear Information System (INIS)

    Montomery, W.D.; Quirk, J.P.

    1978-01-01

    This report is concerned with the escalation of capital costs of nuclear central station power plants between the early 1960s and the present. The report presents an historical overview of the development of the nuclear power industry and cost escalation in the industry, using existing data on orders and capital costs. New data are presented on regulatory delays in the licensing process, derived from a concurrent study being carried on in the Social Science group at Caltech. The conclusions of the study are that nuclear capital costs have escalated more rapidly than the GNP deflator or the construction industry price index. Prior to 1970, cost increases are related to bottleneck problems in the nuclear construction and supplying industries and the regulatory process; intervenors play only a minor role in cost escalation. After 1970, generic changes introduced into the licensing process by intervenors (including environmental impact reviews, antitrust reviews, more stringent safety standards) dominate the cost escalation picture, with bottlenecks of secondary importance. Recent increases in the time from application for a construction permit to commercial operation are related not only to intervenor actions, but also to suspensions, cancellations or postponements of construction by utilities due to unfavorable demand or financing conditions

  2. Error Cost Escalation Through the Project Life Cycle

    Science.gov (United States)

    Stecklein, Jonette M.; Dabney, Jim; Dick, Brandon; Haskins, Bill; Lovell, Randy; Moroney, Gregory

    2004-01-01

    It is well known that the costs to fix errors increase as the project matures, but how fast do those costs build? A study was performed to determine the relative cost of fixing errors discovered during various phases of a project life cycle. This study used three approaches to determine the relative costs: the bottom-up cost method, the total cost breakdown method, and the top-down hypothetical project method. The approaches and results described in this paper presume development of a hardware/software system having project characteristics similar to those used in the development of a large, complex spacecraft, a military aircraft, or a small communications satellite. The results show the degree to which costs escalate, as errors are discovered and fixed at later and later phases in the project life cycle. If the cost of fixing a requirements error discovered during the requirements phase is defined to be 1 unit, the cost to fix that error if found during the design phase increases to 3 - 8 units; at the manufacturing/build phase, the cost to fix the error is 7 - 16 units; at the integration and test phase, the cost to fix the error becomes 21 - 78 units; and at the operations phase, the cost to fix the requirements error ranged from 29 units to more than 1500 units

  3. Revisiting the cost escalation curse of nuclear power. New lessons from the French experience

    International Nuclear Information System (INIS)

    Escobar Rangel, Lina; Leveque, Francois

    2012-01-01

    Since the first wave of nuclear reactors in 1970 to the construction of Generation III+ reactors in Finland and France in 2005 and 2007 respectively, nuclear power seems to be doomed to a cost escalation curse. In this paper we reexamine this issue for the French nuclear power fleet. Using the construction costs from the Cour des Comptes report, that was publicly available in 2012, we found that previous studies overestimated the cost escalation. Although, it is undeniable that the scale-up ended up in more costly reactors, we found evidence of a learning curve within the same size and type of reactors. This result confirms that standardization is a good direction to look, in order to overcome the cost escalation curse. (authors)

  4. Cost escalation in health - care technology possible solutions | Járos ...

    African Journals Online (AJOL)

    Solutions to cost escalation due to health-care technology are proposed. It is argued that proper systems analysis, technology assessment, and planning would result in net savings and itnproved cost-benefits. Identification of needs early in the technological life cycle can positively influence the final form of the chosen ...

  5. Impact of cost escalation on nuclear plant financing

    International Nuclear Information System (INIS)

    Sherman, R.J.

    1979-01-01

    The extreme degree of plant cost increases in the recent years results from a combination of ten years of inflation in the overall economy, the adoption of more stringent statutory and regulatory requirements, and delays resulting from both regulation and intervention. Since different energy forms are competitive, cost and cost changes associated with any form have to be evaluated as - ''compared to what.'' Costs and changes in costs of nuclear and coal fired generation in the United States are reviewed. Reference to specific cost estimates of nuclear and coal plants of equivalent capacity enables separation of the cost effects of the three factors inflation, regulation and delay. In this analysis per kilowatt costs of two 1200 MW nuclear units are compared to those of three 800 MW bituminous coal units. At last various methods to finance new facilities are discussed. (author)

  6. Two views of the comparative escalation of nuclear and coal-fired power plant costs

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    Doan L. Phung critiques Charles Komanoff's 1981 book Power Plant Cost Escalation, which compares new nuclear plant costs unfavorably with those of new coal plants because of the increase in capital costs. Phung blames prophets of doom who ignore the escalating costs throughout the economy and now focus their anti-nuclear attacks in economic terms. Proposals by Alvin Weinberg and others to concentrate on reactor-safety improvements are used to conclude that these efforts will further expand the capital costs of nuclear plants and make them noncompetitive. Phung questions whether Komanoff's modeling considers enough of the political, regulatory, and technological factors to determine future costs. Komanoff replies by explaining his method of analysis and denying a bias against nuclear power. A postscript by Phung reiterates his criticism of simplistic calculations and extrapolations. 17 references

  7. Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Directory of Open Access Journals (Sweden)

    MUHAMMAD AZAM ISHAQUE CHAUDHARY

    2017-07-01

    Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

  8. Report on waste burial charges: Escalation of decommissioning waste disposal costs at low-level waste burial facilities

    International Nuclear Information System (INIS)

    1988-07-01

    One of the requirements placed upon nuclear power reactor licensees by the US Nuclear Regulatory Commission (NRC) is for the licensees to periodically adjust the estimate of the cost of decommissioning their plant, in dollars of the current year, as part of the process to provide reasonable assurance that adequate funds for decommissioning will be available when needed. This report, which is scheduled to be revised annually, contains the development of a formula for escalating decommissioning cost estimates that is acceptable to the NRC, and contains values for the escalation of radioactive waste burial costs, by site and by year. The licensees may use the formula, the coefficients, and the burial escalation factors from this report in their escalation analysis, or may use an escalation rate at least equal to the escalation approach presented herein. 4 refs., 2 tabs

  9. Cost escalation in health-care technology - possible solutions

    African Journals Online (AJOL)

    and its application to rural health care is cited as an exaIllple ofa ... other sources of information in our health-care planning process. ... chances with unproven devices from unknown manufac- turers. ... ment, and the high training level and relatively large number of ... would provide jobs and also stimulate the economy. It.

  10. When Action-Inaction Framing Leads to Higher Escalation of Commitment: A New Inaction-Effect Perspective on the Sunk-Cost Fallacy.

    Science.gov (United States)

    Feldman, Gilad; Wong, Kin Fai Ellick

    2018-04-01

    Escalation of commitment to a failing course of action occurs in the presence of (a) sunk costs, (b) negative feedback that things are deviating from expectations, and (c) a decision between escalation and de-escalation. Most of the literature to date has focused on sunk costs, yet we offer a new perspective on the classic escalation-of-commitment phenomenon by focusing on the impact of negative feedback. On the basis of the inaction-effect bias, we theorized that negative feedback results in the tendency to take action, regardless of what that action may be. In four experiments, we demonstrated that people facing escalation-decision situations were indeed action oriented and that framing escalation as action and de-escalation as inaction resulted in a stronger tendency to escalate than framing de-escalation as action and escalation as inaction (mini-meta-analysis effect d = 0.37, 95% confidence interval = [0.21, 0.53]).

  11. Report on waste burial charges. Escalation of decommissioning waste disposal costs at low-level waste burial facilities, Revision 4

    International Nuclear Information System (INIS)

    1994-06-01

    One of the requirements placed upon nuclear power reactor licensees by the U.S. Nuclear Regulatory Commission (NRC) is for the licensees to periodically adjust the estimate of the cost of decommissioning their plants, in dollars of the current year, as part of the process to provide reasonable assurance that adequate funds for decommissioning will be available when needed. This report, which is scheduled to be revised periodically, contains the development of a formula for escalating decommissioning cost estimates that is acceptable to the NRC. The sources of information to be used in the escalation formula are identified, and the values developed for the escalation of radioactive waste burial costs, by site and by year, are given. The licensees may use the formula, the coefficients, and the burial escalation factors from this report in their escalation analyses, or they may use an escalation rate at least equal to the escalation approach presented herein. This fourth revision of NUREG-1307 contains revised spreadsheet results for the disposal costs for the reference PWR and the reference BWR and the ratios of disposal costs at the Washington, Nevada, and South Carolina sites for the years 1986, 1988, 1991 and 1993, superseding the values given in the May 1993 issue of this report. Burial cost surcharges mandated by the Low-Level Radioactive Waste Policy Amendments Act of 1985 (LLRWPAA) have been incorporated into the revised ratio tables for those years. In addition, spreadsheet results for the disposal costs for the reference reactors and ratios of disposal costs at the two remaining burial sites in Washington and South Carolina for the year 1994 are provided. These latter results do not include any LLRWPAA surcharges, since those provisions of the Act expired at the end of 1992. An example calculation for escalated disposal cost is presented, demonstrating the use of the data contained in this report

  12. Regional-employment impact of rapidly escalating energy costs. [Riverside-San Bernardino SMSA

    Energy Technology Data Exchange (ETDEWEB)

    Kolk, D X

    1983-04-01

    This paper presents a methodology for incorporating price-induced technological substitution into a regional input-output forecasting model. The model was used to determine the employment impacts of rapidly escalating energy costs on the Riverside-San Bernardino (California) SMSA. The results indicate that the substitution effect between energy and other goods was dominated by the income effect. A reallocation of consumer expenditures from labor-intensive to energy-intensive goods occurred, resulting in a two- to threefold increase in the unemployment rate among low-skilled individuals. 18 references, 5 tables.

  13. Can naturopathy provide answers to the escalating health care costs in India?

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2015-04-01

    Full Text Available There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.

  14. The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study

    Science.gov (United States)

    2016-03-01

    standard practice is to deflate costs to constant dollars (the dependent variable in the analogous regression) using a previously determined price ...I N S T I T U T E F O R D E F E N S E A N A L Y S E S IDA Document D-5489 March 2016 The Role of Inflation and Price Escalation Adjustments in...DFARS 252.227-7013 (a)(16) [Jun 2013]. The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study

  15. Stemming the Escalating Cost of Prescription Drugs: A Position Paper of the American College of Physicians.

    Science.gov (United States)

    Daniel, Hilary

    2016-03-29

    This American College of Physicians position paper, initiated and written by its Health and Public Policy Committee and approved by the Board of Regents on 16 February 2016, reports policy recommendations from the American College of Physicians to address the escalating costs of prescription drugs in the United States. Prescription drugs play an important part in treating and preventing disease. However, the United States often pays more for some prescription drugs than other developed countries, and the high price and increasing costs associated with prescription medication is a major concern for patients, physicians, and payers. Pharmaceutical companies have considerable flexibility in how they price drugs, and the costs that payers and patients see are dependent on how payers are able to negotiate discounts or rebates. Beyond setting list prices are issues of regulatory approval, patents and intellectual property, assessment of value and cost-effectiveness, and health plan drug benefits. These issues are linked, and comprehensive efforts will be needed to affect how drugs are priced in the United States.

  16. Controlling cost escalation of healthcare: making universal health coverage sustainable in China

    Science.gov (United States)

    2012-01-01

    An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China. There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable. PMID:22992484

  17. The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study

    Science.gov (United States)

    2016-04-30

    qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = The Role of Inflation and Price Escalation Adjustments in Properly...The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study Stanley Horowitz, Assistant Division...Graduate School of Engineering and Management, Air Force Institute of Technology Cost and Price Collaboration Venkat Rao, Professor, Defense

  18. Promoting de-escalation of commitment: a regulatory-focus perspective on sunk costs.

    Science.gov (United States)

    Molden, Daniel C; Hui, Chin Ming

    2011-01-01

    People frequently escalate their commitment to failing endeavors. Explanations for such behavior typically involve loss aversion, failure to recognize other alternatives, and concerns with justifying prior actions; all of these factors produce recommitment to previous decisions with the goal of erasing losses and vindicating these decisions. Solutions to escalation of commitment have therefore focused on external oversight and divided responsibility during decision making to attenuate loss aversion, blindness to alternatives, and justification biases. However, these solutions require substantial resources and have additional adverse effects. The present studies tested an alternative method for de-escalating commitment: activating broad motivations for growth and advancement (promotion). This approach should reduce concerns with loss and increase perceptions of alternatives, thereby attenuating justification motives. In two studies featuring hypothetical financial decisions, activating promotion motivations reduced recommitment to poorly performing investments as compared with both not activating any additional motivations and activating motivations for safety and security (prevention).

  19. Combating the Military's Escalating Pharmacy Costs: A Lean Six Sigma Approach

    National Research Council Canada - National Science Library

    Nuce, James; Robinson, Lydia; Sikora, Tom

    2008-01-01

    The pharmacy operations of three military, Medical Treatment Facilities (MTF) were observed, to determine possible process improvements and cost saving mechanisms that may be achieved through Lean Six Sigma methodologies...

  20. YAEC's view of the cause and control of escalating nuclear plant O and M costs

    International Nuclear Information System (INIS)

    Haseltine, J.D.; Lessard, L.P.

    1990-01-01

    This paper provides insights on this issue in terms of both the genesis and effective long-term control of O and M costs. Yankee Atomic Electric Company's (YAEC's) insights stem not only from an analysis of certain industry data, but also from its unique position within the nuclear industry in terms of its age, plant size, and organization. First, at 30 yr of age, the YAEC plant has endured the full swing of the regulatory/institutional pendulum and the associated impact on O and M costs. Second, with a size of only 185 MW(electric), YAEC's imperative since start-up has been the strict control of O and M costs while still achieving operational excellence. Finally, YAEC is an organization strictly focused on nuclear power operations and has not been distracted by fossil plant operations or other utility requirements like distribution, retail sales, etc., that may have plagued other plant operators

  1. Combating the Military’s Escalating Pharmacy Costs: A Lean Six Sigma Approach

    Science.gov (United States)

    2008-12-01

    without illustrating anything that can essentially go wrong. Not surprisingly, not everyone shares the belief that Lean Six Sigma is a cure all for cost...or absenteeism ; however, these factors are discussed in the conclusion found in Chapter VIII. The resources are also only available during

  2. Project Plans, Constraints to Growth and the Impact of Cost Escalation through The Middle East and North Africa (MENA) Prism

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    MENA national oil companies (NOCs) are targeting ambitious energy expansion, with mid-term plans for a 5.8 million b/d net boost to crude capacity, 1.9 million b/d more NGLs and 400 Bcm/year more gas, alongside significant refining and LNG additions. Nevertheless, a review of historical project delivery sounds a note of caution over timing - with a number of countries prone to delays and others, outright deferrals, even if market leaders, Saudi Arabia and Qatar, remain more resolutely on course. Cost escalation since 2002 has compounded the regional tendency towards delays, although the impact on project delivery has been moderated by a willingness to increase budgets where project economics remain sound. That leaves political factors as the principal constraint to regional expansion, complicated in part by increasing pluralism in political participation and valid concerns about the management of resources for long-term sustainability, rather than near-term profit. With most constraints to development expected to remain at the political level, there is a clear case for consumers to be more explicit about future needs. There is also a need to engage with growing constituencies in some states favouring a 'go slow' approach to hydrocarbon development where policymakers have made the case for considered expansion.

  3. Maintenance and Safety Practices of Escalator in Commercial Buildings

    Science.gov (United States)

    Afida Isnaini Janipha, Nurul; Nur Aina Syed Alwee, Sharifah; Ariff, Raihan Mohd; Ismail, Faridah

    2018-02-01

    The escalator is very crucial to transport a person from one place to another. Nevertheless, there are many cases recorded the accidents in relation to escalator. These may occur due to lack of maintenance which leads to systems breakdown, poor safety practices, wear and tear, users’ negligence and others. Thus, proper maintenance systems need to be improvised to prevent and reduce escalator accident in future. This research was aimed to determine the escalator maintenance activities and safety practices in a commercial building. Three case studies were selected within Selangor area. Semi-structured interviews were conducted for collecting data from these three case studies. To achieve the aim of this research, the study was carried out on the maintenance activities, safety practices and cost related to escalator maintenance. As one of the important means of access in building, it is very crucial to increase effectiveness of escalator particularly in commercial building. It is expected that readers will get clear information on the maintenance activities and safety practices of escalator in commercial building.

  4. Dose Escalation and Healthcare Resource Use among Ulcerative Colitis Patients Treated with Adalimumab in English Hospitals: An Analysis of Real-World Data.

    Directory of Open Access Journals (Sweden)

    Christopher M Black

    Full Text Available To describe the real-world use of adalimumab for maintenance treatment of ulcerative colitis (UC and associated healthcare costs in English hospitals.Retrospective cohort study.Analysis of NHS Hospital Episode Statistics linked with pharmacy dispensing data in English hospitals.Adult UC patients receiving ≥240mg during adalimumab treatment induction, subsequently maintained on adalimumab.Frequency and pattern of adalimumab use and dose escalation during maintenance treatment and associated healthcare costs (prescriptions and hospital visits.191 UC patients completed adalimumab treatment induction. 83 (43.46% dose escalated during maintenance treatment by ≥100% (equivalent to weekly dosing (median time to dose escalation: 139 days. 56 patients (67.47% subsequently de-escalated by ≥50% (median time to dose de-escalation: 21 days. Mean all-cause healthcare costs for all patients ≤12 months of index were £13,892. Dose escalators incurred greater mean healthcare costs than non-escalators ≤12 months of index (£14,596 vs. £13,351. Prescriptions accounted for 96.49% of UC-related healthcare costs (£11,090 of £11,494 in all patients.Within the cohort, 43.46% of UC patients escalated their adalimumab dose by ≥100% and incurred greater costs than non-escalators. The apparent underestimation of adalimumab dose escalation in previous studies may have resulted in underestimated costs in healthcare systems.

  5. Escalating risk and the moderating effect of resistance to peer influence on the P200 and feedback-related negativity.

    Science.gov (United States)

    Kiat, John; Straley, Elizabeth; Cheadle, Jacob E

    2016-03-01

    Young people frequently socialize together in contexts that encourage risky decision making, pointing to a need for research into how susceptibility to peer influence is related to individual differences in the neural processing of decisions during sequentially escalating risk. We applied a novel analytic approach to analyze EEG activity from college-going students while they completed the Balloon Analogue Risk Task (BART), a well-established risk-taking propensity assessment. By modeling outcome-processing-related changes in the P200 and feedback-related negativity (FRN) sequentially within each BART trial as a function of pump order as an index of increasing risk, our results suggest that analyzing the BART in a progressive fashion may provide valuable new insights into the temporal neurophysiological dynamics of risk taking. Our results showed that a P200, localized to the left caudate nucleus, and an FRN, localized to the left dACC, were positively correlated with the level of risk taking and reward. Furthermore, consistent with our hypotheses, the rate of change in the FRN was higher among college students with greater self-reported resistance to peer influence. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  6. Words of Violence: “Fear Speech,” or How Violent Conflict Escalation Relates to the Freedom of Expression

    NARCIS (Netherlands)

    Buyse, Antoine|info:eu-repo/dai/nl/258219327

    2014-01-01

    The limits of the freedom of expression are a perennial discussion in human rights discourse. This article focuses on identifying yardsticks to establish the boundaries of freedom of expression in cases where violence is a risk. It does so by using insights from the social sciences on the escalation

  7. Escalation of Commitment in the Surgical ICU.

    Science.gov (United States)

    Braxton, Carla C; Robinson, Celia N; Awad, Samir S

    2017-04-01

    Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU. We hypothesize that factors previously identified in business and organizational psychology literature including self-justification, accountability, sunk costs, and cognitive dissonance result in escalation of commitment behavior in the surgical ICU setting resulting in increased utilization of resources and cost. A descriptive case study that illustrates common ICU narratives in which escalation of commitment can occur. In addition, we describe factors that are thought to contribute to escalation of commitment behaviors. Escalation of commitment behavior was observed with self-justification, accountability, and cognitive dissonance accounting for the majority of the behavior. Unlike in business decisions, sunk costs was not as evident. In addition, modulating factors such as personality, individual experience, culture, and gender were identified as contributors to escalation of commitment. Escalation of commitment occurs in the surgical ICU, resulting in significant expenditure of resources despite a predicted and often known poor outcome. Recognition of this phenomenon may lead to actions aimed at more rational decision making and may contribute to lowering healthcare costs. Investigation of objective measures that can help aid decision making in the surgical ICU is warranted.

  8. Relative costs to nuclear plants: international experience

    International Nuclear Information System (INIS)

    Souza, Jair Albo Marques de

    1992-03-01

    This work approaches the relative costs to nuclear plants in the Brazil. It also presents the calculation methods and its hypothesis to determinate the costs, and the nacional experience in costs of investment, operating and maintenance of the nuclear plants

  9. Uncertainty in relative cost investigation

    International Nuclear Information System (INIS)

    Bunn, D.; Viahos, K.

    1989-01-01

    One of the consequences of the privatization of the Central Electricity Generating Board has been a weakening of the economic case for nuclear generation over coal. Nuclear has higher capital, but lower operating costs than coal and is therefore favoured in capital budgeting by discounting at lower rates of return. In the Sizewell case (in 1987), discounting at the public sector rate of 5 per cent favoured nuclear. However, the private sector will require higher rates of return, thus rendering nuclear less attractive. Hence the imposition by the government of a diversity constraint on the privatized industry to ensure that contracts are made for a minimum fraction of non-fossil (essentially nuclear) energy. An electricity capacity planning model was developed to estimate the costs of imposing various non-fossil energy constraints on the planning decision of a privatized electricity supply industry, as a function of various discount rates. Using a large-scale linear programming technique, the model optimizes over a 50 year horizon the schedule of installation, and mix of generating capacity, both with and without a minimum non-fossil constraint. The conclusion is that the opportunity cost of diversity may be a complex joint substation of more than one type of plant (eg coal and gas) depending on the discount rate. (author)

  10. Probabilistic escalation modelling

    Energy Technology Data Exchange (ETDEWEB)

    Korneliussen, G.; Eknes, M.L.; Haugen, K.; Selmer-Olsen, S. [Det Norske Veritas, Oslo (Norway)

    1997-12-31

    This paper describes how structural reliability methods may successfully be applied within quantitative risk assessment (QRA) as an alternative to traditional event tree analysis. The emphasis is on fire escalation in hydrocarbon production and processing facilities. This choice was made due to potential improvements over current QRA practice associated with both the probabilistic approach and more detailed modelling of the dynamics of escalating events. The physical phenomena important for the events of interest are explicitly modelled as functions of time. Uncertainties are represented through probability distributions. The uncertainty modelling enables the analysis to be simple when possible and detailed when necessary. The methodology features several advantages compared with traditional risk calculations based on event trees. (Author)

  11. E4 - Energy efficient elevators and escalators. Elevators and escalators in Germany from an energy perspective

    Energy Technology Data Exchange (ETDEWEB)

    Hirzel, Simon; Fleiter, Tobias; Rosende, Daniel

    2010-01-31

    This report aims to provide a brief introduction to the German elevator and escalator market, and gives an aggregated view of current and future developments focusing on energy consumption and energy-related emissions. This update report of January 2010 is an extended version of a report published in April 2009 before the final results from a monitoring campaign carried out within the project were available. During this campaign, 81 installations (74 elevators and 7 escalators) were monitored in terms of energy consumption. In the first section, the structure of the installed German elevator and escalator capacity is presented. The estimates1 were provided courtesy of the two main associations representing elevators and escalators in Germany: the VDMA (Verband Deutscher Maschinen- und Anlagenbau - German Engineering Federation) and the VFA-Interlift e.V. -Verband fuer Aufzugstechnik (Association for Lift Technology). This section is followed by a short description of the German construction sector and its implications for elevators and escalators. The third section describes German electricity production in terms of its environmental impact with the main focus on the carbon dioxide emissions of the national power plants. Then the energy consumption of elevators and escalators in Germany is analyzed, comparing the results to total energy production in Germany.2 The final section summarizes the different aspects and derives indications about the future development of the total energy consumption of elevators and escalators in Germany. (orig.)

  12. Friends' Alcohol-Related Social Networking Site Activity Predicts Escalations in Adolescent Drinking: Mediation by Peer Norms.

    Science.gov (United States)

    Nesi, Jacqueline; Rothenberg, W Andrew; Hussong, Andrea M; Jackson, Kristina M

    2017-06-01

    Adolescents' increased use of social networking sites (SNS) coincides with a developmental period of heightened risk for alcohol use initiation. However, little is known regarding associations between adolescents' SNS use and drinking initiation nor the mechanisms of this association. This study examined longitudinal associations among adolescents' exposure to friends' alcohol-related SNS postings, alcohol-favorable peer injunctive norms, and initiation of drinking behaviors. Participants were 658 high-school students who reported on posting of alcohol-related SNS content by self and friends, alcohol-related injunctive norms, and other developmental risk factors for alcohol use at two time points, 1 year apart. Participants also reported on initiation of three drinking behaviors: consuming a full drink, becoming drunk, and heavy episodic drinking (three or more drinks per occasion). Probit regression analyses were used to predict initiation of drinking behaviors from exposure to alcohol-related SNS content. Path analyses examined mediation of this association by peer injunctive norms. Exposure to friends' alcohol-related SNS content predicted adolescents' initiation of drinking and heavy episodic drinking 1 year later, controlling for demographic and known developmental risk factors for alcohol use (i.e., parental monitoring and peer orientation). In addition, alcohol-favorable peer injunctive norms statistically mediated the relationship between alcohol-related SNS exposure and each drinking milestone. Results suggest that social media plays a unique role in contributing to peer influence processes surrounding alcohol use and highlight the need for future investigative and preventive efforts to account for adolescents' changing social environments. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  13. 29 CFR 1917.116 - Elevators and escalators.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 7 2010-07-01 2010-07-01 false Elevators and escalators. 1917.116 Section 1917.116 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) MARINE TERMINALS Terminal Facilities § 1917.116 Elevators and escalators. (a) “Elevator” means a permanent hoisting and lowering...

  14. Nuclear deterrence: Inherent escalation?

    International Nuclear Information System (INIS)

    Bergbauer, J.R. Jr.

    1993-01-01

    Despite 40 years of peace between the super powers, there is increasing clamor to the effect that nuclear war between the super powers is imminent; or could occur through escalation from a minor conflict; or could result from harsh rhetoric (but only on the part of the U.S.) in the super power dialogue. The factor that is ignored is that a massive nuclear attack would be rational ONLY if that attack could inflict such damage that the other super power could not launch a significant retaliatory nuclear attack. ONLY in this circumstance would there be any profit in launching an initial Strategic Nuclear Attack. This First Strike capability is not now possessed nor projected to be developed by either super power. As long as ANY possible Strategic Nuclear Attack against the national territory of one super power would be insufficient to prevent an equally destructive retaliatory attack, then a Strategic Nuclear Attack would inevitably result in the destruction of both and would be profitless, hence, pointless. This situation describes Mutually Assured Destruction (MAD), the governing conflict paradigm applicable to both super powers. The only convential attack that would even remotely rival the national-destruction potential of a Strategic Nuclear Attack and could cause the attacked power to consider launching a retaliatory Strategic Nuclear Attack would be a massive land-air invasion/occupation of one super power by the other. Since neither super power can successfully execute such a conventional invasion/occupation, this situation is moot. The geo-political environments of the two super powers are so asymmetrical and their military positions so symmetrical that the probability of ANY forseeable situation resulting in their resorting to a Strategic Nuclear Exchange is vanishingly small. It is possible escape the Chicken-Little syndrome and, instead, devote energy to ensuring the maintenance of this favorable, but fragile, world system

  15. Strategy of Using Intratreatment Hypoxia Imaging to Selectively and Safely Guide Radiation Dose De-escalation Concurrent With Chemotherapy for Locoregionally Advanced Human Papillomavirus–Related Oropharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nancy, E-mail: leen2@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Schoder, Heiko [Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Beattie, Brad [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lanning, Ryan; Riaz, Nadeem; McBride, Sean [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Katabi, Nora [Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Li, Duan [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yarusi, Brett; Chan, Susie; Mitrani, Lindsey [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Pfister, David G.; Sherman, Eric; Baxi, Shrujal [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Boyle, Jay; Morris, Luc G.T.; Ganly, Ian; Wong, Richard [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Humm, John [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2016-09-01

    Purpose: To report a small substudy of an ongoing large, multi-arm study using functional imaging to assess pre-/intratreatment hypoxia for all head and neck cancer, in which we hypothesized that pre- and early-treatment hypoxia assessment using functional positron emission tomography (PET) imaging may help select which human papillomavirus (HPV)-positive (HPV{sup +}) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials: Patients with HPV{sup +} oropharyngeal carcinoma were enrolled on an institutional review board–approved prospective study of which de-escalation based on imaging response was done for node(s) only. Pretreatment {sup 18}F-fluorodeoxyglucose and dynamic {sup 18}F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on{sup 18}F-FMISO PET (defined as a >1.2 tumor to muscle standard uptake value ratio), a repeat scan was done 1 week after chemoradiation. Patients without pretreatment hypoxia or with resolution of hypoxia on repeat scan received a 10-Gy dose reduction to metastatic lymph node(s). The 2-year local, regional, distant metastasis–free, and overall survival rates were estimated using the Kaplan-Meier product-limit method. A subset of patients had biopsy of a hypoxic node done under image guidance. Results: Thirty-three HPV{sup +} OPC patients were enrolled in this pilot study. One hundred percent showed pretreatment hypoxia (at primary site and/or node[s]), and among these, 48% resolved (at primary site and/or node[s]); 30% met criteria and received 10-Gy reduction to the lymph node(s). At the median follow-up of 32 months (range, 21-61 months), the 2-year locoregional control rate was 100%. One patient failed distantly with persistence of hypoxia on {sup 18}F-FMISO PET. The 2-year distant metastasis–free rate was 97%. The 2-year OS rate was 100%. Hypoxia on imaging was

  16. Strategy of Using Intratreatment Hypoxia Imaging to Selectively and Safely Guide Radiation Dose De-escalation Concurrent With Chemotherapy for Locoregionally Advanced Human Papillomavirus–Related Oropharyngeal Carcinoma

    International Nuclear Information System (INIS)

    Lee, Nancy; Schoder, Heiko; Beattie, Brad; Lanning, Ryan; Riaz, Nadeem; McBride, Sean; Katabi, Nora; Li, Duan; Yarusi, Brett; Chan, Susie; Mitrani, Lindsey; Zhang, Zhigang; Pfister, David G.; Sherman, Eric; Baxi, Shrujal; Boyle, Jay; Morris, Luc G.T.; Ganly, Ian; Wong, Richard; Humm, John

    2016-01-01

    Purpose: To report a small substudy of an ongoing large, multi-arm study using functional imaging to assess pre-/intratreatment hypoxia for all head and neck cancer, in which we hypothesized that pre- and early-treatment hypoxia assessment using functional positron emission tomography (PET) imaging may help select which human papillomavirus (HPV)-positive (HPV"+) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials: Patients with HPV"+ oropharyngeal carcinoma were enrolled on an institutional review board–approved prospective study of which de-escalation based on imaging response was done for node(s) only. Pretreatment "1"8F-fluorodeoxyglucose and dynamic "1"8F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on"1"8F-FMISO PET (defined as a >1.2 tumor to muscle standard uptake value ratio), a repeat scan was done 1 week after chemoradiation. Patients without pretreatment hypoxia or with resolution of hypoxia on repeat scan received a 10-Gy dose reduction to metastatic lymph node(s). The 2-year local, regional, distant metastasis–free, and overall survival rates were estimated using the Kaplan-Meier product-limit method. A subset of patients had biopsy of a hypoxic node done under image guidance. Results: Thirty-three HPV"+ OPC patients were enrolled in this pilot study. One hundred percent showed pretreatment hypoxia (at primary site and/or node[s]), and among these, 48% resolved (at primary site and/or node[s]); 30% met criteria and received 10-Gy reduction to the lymph node(s). At the median follow-up of 32 months (range, 21-61 months), the 2-year locoregional control rate was 100%. One patient failed distantly with persistence of hypoxia on "1"8F-FMISO PET. The 2-year distant metastasis–free rate was 97%. The 2-year OS rate was 100%. Hypoxia on imaging was confirmed pathologically

  17. 42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing in beneficiary education and enrollment-related costs. 423.6 Section 423.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... BENEFIT General Provisions § 423.6 Cost-sharing in beneficiary education and enrollment-related costs. The...

  18. Unpaid ecological costs related to emissions in the air

    International Nuclear Information System (INIS)

    Moreau, Sylvain; Bottin, Anne; Nauroy, Frederic; Boitard, Corinne; Bird, Geoffrey; David, Michel; Greffet, Pierre; Mordant, Guillaume; Moreau, Sylvain; Nirascou, Francoise; Le Moullec, Aurelie; Berthier, Jean-Pierre; Hassan, Marie-Elizabeth; Curri-Lemaitre, Elen; Lagarenne, Christine; Devaux, Jeremy; Nicklaus, Doris; Puydarrieux, Philippe; Vanoli, Andre; Schucht, Simone

    2014-05-01

    This study proposes an analysis of unpaid ecological terms based on the use of new economic indicators related to sustainable development (going beyond the GDP, adjusted accounting aggregates, accounting unpaid ecological costs), an analysis of unpaid ecological costs related to climate change (context, used results and data, definitions of trajectories associated with greenhouse gas emissions, cost to be applied to emissions to get rid of, assessment of unpaid ecological costs), and an analysis of unpaid ecological costs related to air pollution (objectives, standard to be adopted, towards more ambitious emission reduction and re-assessed costs, unpaid ecological costs in 2010)

  19. Evaluation of activity-based costing versus resource-based relative value costing.

    Science.gov (United States)

    Berlin, Mark F; Smith, Tommy H

    2004-01-01

    Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided.

  20. Dose-escalated intensity-modulated radiotherapy and irradiation of subventricular zones in relation to tumor control outcomes of patients with glioblastoma multiforme

    Directory of Open Access Journals (Sweden)

    Kusumawidjaja G

    2016-03-01

    Full Text Available Grace Kusumawidjaja,1 Patricia Zhun Hong Gan,1 Whee Sze Ong,2 Achiraya Teyateeti,3 Pittaya Dankulchai,3 Daniel Yat Harn Tan,1 Eu Tiong Chua,1 Kevin Lee Min Chua,1 Chee Kian Tham,4 Fuh Yong Wong,1 Melvin Lee Kiang Chua1,5 1Division of Radiation Oncology, National Cancer Centre, Singapore; 2Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore; 3Department of Radiology, Division of Radiation Oncology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand; 4Division of Medical Oncology, National Cancer Centre, Singapore; 5Duke-NUS Graduate Medical School, Singapore Background: Glioblastoma multiforme (GBM is the most aggressive primary brain tumor with high relapse rate. In this study, we aimed to determine if dose-escalated (DE radiotherapy improved tumor control and survival in GBM patients. Methods: We conducted a retrospective analysis of 49 and 23 newly-diagnosed histology-proven GBM patients, treated with DE radiotherapy delivered in 70 Gy (2.33 Gy per fraction and conventional doses (60 Gy, respectively, between 2007 and 2013. Clinical target volumes for 70 and 60 Gy were defined by 0.5 and 2.0 cm expansion of magnetic resonance imaging T1-gadolinium-enhanced tumor/surgical cavity, respectively. Bilateral subventricular zones (SVZ were contoured on a co-registered pre-treatment magnetic resonance imaging and planning computed tomography dataset as a 5 mm wide structure along the lateral margins of the lateral ventricles. Survival outcomes of both cohorts were compared using log-rank test. Radiation dose to SVZ in the DE cohort was evaluated. Results: Median follow-up was 13.6 and 15.1 months for the DE- and conventionally-treated cohorts, respectively. Median overall survival (OS of patients who received DE radiotherapy was 15.2 months (95% confidence interval [CI] =11.0–18.6, while median OS of the latter cohort was 18.4 months (95% CI =12.5–31.4, P=0.253. Univariate analyses of

  1. International cost relations in electric power generation

    International Nuclear Information System (INIS)

    Schmitt, D.; Duengen, H.; Wilhelm, M.

    1986-01-01

    In spite of the fact that analyses of the cost of electric power generation as the result of international comparative evaluations are indisputably relevant, problems pending in connection with the costs of representative power plant technologies are of the methodological bind. German authors have hitherto also been failing to clear up and consider all aspects connected with the problems of data acquisition and the adequate interpretation of results. The analysis presented by the paper abstracted therefore aims at the following: 1) Systematization of the different categories of cost relevant in connection with international comparative evaluation. Classification into different categories of decision making and development of standards meeting the requirements of international comparative evaluation. 2) Calculation of relevant average financial costs of Western German, America and French fossil-fuel and nuclear power plants by means of adequate calculation models, that is the assessment of costs with regard to countries and power plant technologies which are relevant to the Federal Republic of Germany. 3) Analysis of the resulting differences and determinantal interpretation. (orig./UA) [de

  2. Energy efficient elevators and escalators

    Energy Technology Data Exchange (ETDEWEB)

    Patrao, Carlos; Fong, Joao; Almeida, Anibal de (Dep. Electrical Engineering, Univ. of Coimbra, Coimbra (Portugal)); Rivet, Luc

    2009-07-01

    Elevators and escalators are the crucial element that makes it practical to live and work several floors above ground - more than 4,3 million units are installed in Europe. Due to ageing of the European population the installation of elevators in single family houses is experiencing a significant growth, as well as equipping existing buildings. Elevators use about 4% of the electricity in tertiary sector buildings. High untapped saving potentials exist with respect to energy-efficient technologies, investment decisions and behavioural approaches, in these sectors. This paper presents preliminary results from the IEE project E4, whose overall objective is the improvement of the energy performance of elevators and escalators, in tertiary sector buildings and in multi family residential buildings. The project is characterizing people conveyors electricity consumption in the tertiary sector and in residential buildings in the EU. The installed park is characterised by a survey among elevators national associations in each country. An assessment of the barriers has been made in the first phase of the project and will be presented. Monitoring campaigns in elevators and escalators are being conducted in each country according to a common developed methodology. More than fifty elevators and escalators will be audited. This will allow the collection of load curves (start up, travel up and down, travel full and empty), including the characterization of standby consumption. Standby consumption of an elevator can represent up to 80% of the total energy consumed per year, and can be drastically reduced. This paper presents the preliminary results of the first ten audits performed in Portugal by Isr-UC.

  3. De-Escalating the IT-Projects

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2007-12-01

    Full Text Available Escalation stickins with an ailing project beyond rational justifications. This happens because in the face of negative feedback, decision makers are strangled between whether to stick with or quit the dying project. Environmental uncertainty has been identified as the root cause of the escalatory behavior. This uncertainty emanates from several sources relating to individual, group, organization and broader environmental factors. This paper argues the premise that effective communication can help create an environment whereby workforce can develop an organized action thereby distributing the responsibility across the whole workforce and not the individuals – leading to the possible reduction of escalatory behavior in IT projects.

  4. The de-escalation of nuclear crises

    International Nuclear Information System (INIS)

    Nation, J.E.

    1992-01-01

    Whether and by what means nations can successfully de-escalate nuclear crises - and avoid the disastrous effects of nuclear war - will remain two of the most critical challenges facing humankind. Whatever the future of superpower relations, the United States, the Soviet Union, and other nations will undoubtedly continue to possess and to threaten the use of nuclear weapons. Moreover, the number of nations with nuclear weapons seems likely to increase. This examines how nations in crises might successfully move back from the brink of nuclear war - and how confidence-building measures might help and hinder the de-escalatory process

  5. A phase 1/2, dose-escalation trial of deferasirox for the treatment of iron overload in HFE-related hereditary hemochromatosis.

    Science.gov (United States)

    Phatak, Pradyumna; Brissot, Pierre; Wurster, Mark; Adams, Paul C; Bonkovsky, Herbert L; Gross, John; Malfertheiner, Peter; McLaren, Gordon D; Niederau, Claus; Piperno, Alberto; Powell, Lawrie W; Russo, Mark W; Stoelzel, Ulrich; Stremmel, Wolfgang; Griffel, Louis; Lynch, Nicola; Zhang, Yiyun; Pietrangelo, Antonello

    2010-11-01

    Hereditary hemochromatosis (HH) is characterized by increased intestinal iron absorption that may result in iron overload. Although phlebotomy is widely practiced, it is poorly tolerated or contraindicated in patients with anemias, severe heart disease, or poor venous access, and compliance can vary. The once-daily, oral iron chelator, deferasirox (Exjade) may provide an alternative treatment option. Patients with HH carrying the HFE gene who were homozygous for the Cys282Tyr mutation, serum ferritin levels of 300-2000 ng/mL, transferrin saturation ≥ 45%, and no known history of cirrhosis were enrolled in this dose-escalation study to characterize the safety and efficacy of deferasirox, comprising a core and an extension phase (each 24 weeks). Forty-nine patients were enrolled and received starting deferasirox doses of 5 (n = 11), 10 (n = 15), or 15 (n = 23) mg/kg/day. Adverse events were generally dose-dependent, the most common being diarrhea, headache, and nausea (n = 18, n = 10, and n = 8 in the core and n = 1, n = 1, and n = 0 in the extension, respectively). More patients in the 15 mg/kg/day than in the 5 or 10 mg/kg/day cohorts experienced increases in alanine aminotransferase and serum creatinine levels during the 48-week treatment period; six patients had alanine aminotransferase > 3 × baseline and greater than the upper limit of normal range, and eight patients had serum creatinine > 33% above baseline and greater than upper limit of normal on two consecutive occasions. After receiving deferasirox for 48 weeks, median serum ferritin levels decreased by 63.5%, 74.8%, and 74.1% in the 5, 10, and 15 mg/kg/day cohorts, respectively. In all cohorts, median serum ferritin decreased to < 250 ng/mL. Deferasirox doses of 5, 10, and 15 mg/kg/day can reduce iron burden in patients with HH. Based on the safety and efficacy results, starting deferasirox at 10 mg/kg/day appears to be most appropriate for further study in this patient population.

  6. [Relating costs to activities in hospitals. Use of internal cost accounting].

    Science.gov (United States)

    Stavem, K

    1995-01-10

    During the last few years hospital cost accounting has become widespread in many countries, in parallel with increasing cost pressure, greater competition and new financing schemes. Cost accounting has been used in the manufacturing industry for many years. Costs can be related to activities and production, e.g. by the costing of procedures, episodes of care and other internally defined cost objectives. Norwegian hospitals have lagged behind in the adoption of cost accounting. They ought to act quickly if they want to be prepared for possible changes in health care financing. The benefits can be considerable to a hospital operating in a rapidly changing health care environment.

  7. Dose escalation of a curcuminoid formulation

    Directory of Open Access Journals (Sweden)

    Crowell James

    2006-03-01

    Full Text Available Abstract Background Curcumin is the major yellow pigment extracted from turmeric, a commonly-used spice in India and Southeast Asia that has broad anticarcinogenic and cancer chemopreventive potential. However, few systematic studies of curcumin's pharmacology and toxicology in humans have been performed. Methods A dose escalation study was conducted to determine the maximum tolerated dose and safety of a single dose of standardized powder extract, uniformly milled curcumin (C3 Complex™, Sabinsa Corporation. Healthy volunteers were administered escalating doses from 500 to 12,000 mg. Results Seven of twenty-four subjects (30% experienced only minimal toxicity that did not appear to be dose-related. No curcumin was detected in the serum of subjects administered 500, 1,000, 2,000, 4,000, 6,000 or 8,000 mg. Low levels of curcumin were detected in two subjects administered 10,000 or 12,000 mg. Conclusion The tolerance of curcumin in high single oral doses appears to be excellent. Given that achieving systemic bioavailability of curcumin or its metabolites may not be essential for colorectal cancer chemoprevention, these findings warrant further investigation for its utility as a long-term chemopreventive agent.

  8. Relational Climate and Health Care Costs: Evidence From Diabetes Care.

    Science.gov (United States)

    Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K

    2018-01-01

    Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.

  9. Comparisons of hypertension-related costs from multinational clinical studies.

    Science.gov (United States)

    Mullins, C Daniel; Sikirica, Mirko; Seneviratne, Viran; Ahn, Jeonghoon; Akhras, Kasem S

    2004-01-01

    This study identifies and compares the individual cost components of hospital and ambulatory services that manage the care of hypertensive patients in eight countries: the US, the UK, France, Spain, Germany, Italy, Canada and Australia. Hypertension-related costs are classified according to four major cardiovascular events: (i) acute myocardial infarction; (ii) congestive heart failure; (iii) stroke; and (iv) renal failure, which was subdivided into renal failure treated by dialysis and renal failure treated by kidney transplantation. To make cross-country costs comparisons, we used the DRG codes used in the US and DRG-like codes from each country. US cost information was obtained from hypertension data available from the literature and health economics researchers. For costs in other countries, we consulted with national health economics experts in each country, used analyses by the Research Triangle Institute, and performed Medline and international literature searches. When available, we obtained information from the countries' public and private nationally representative data sources. For cross-country currency adjustments, all currencies were converted using the Purchasing Power Parities from the Organisation for Economic Cooperation and Development, and then converted into inflation-adjusted year 2000 US dollars. There exists considerable variation in hypertension-related costs from multinational clinical studies. This study documents that costs are generally higher in the US than in other countries; however, this is not always true. In particular, costs of treating heart failure in France and the costs of renal failure without transplantation in Germany and the UK are relatively high. While analysing multinational hypertensive cost data, this study also addresses the impact of cross-country cost variations on cost analyses. During the last decade, drug-development researchers have drawn extensively upon multinational trials to resolve enrollment problems and

  10. FORMALIZING PRODUCT COST DISTORTION: The Impact of Volume-Related Allocation Bases on Cost Information

    Directory of Open Access Journals (Sweden)

    Johnny Jermias

    2003-09-01

    Full Text Available The purpose o f this study is to formally analyze product cost distortions resulting from the process of allocating costs to products based on Activity-Based Costing (ABC and the conventional product costing systems. The model developed in this paper rigorously shows the impact of treating costs that are not volume related as if they are. The model demonstrates that the source of product cost distortion is the difference between the proportion of driver used by each product in ABC and the proportion of the base used by the same product in the conventional costing systems. The difference arises because the conventional costing systems ignore the existence of batch-related and product-related costs. The model predicts a positive association between volume and size diversity with product cost distortions. When interaction between volume and size diversity exists, the distortion is either mitigated or exacerbated. The magnitude of the distortion is jointly determined by the size of the differences and the size of the total indirect costs.

  11. Nuclear fuel pellet transfer escalator

    International Nuclear Information System (INIS)

    Huggins, T.B. Sr.; Roberts, E.; Edmunds, M.O.

    1991-01-01

    This patent describes a nuclear fuel pellet escalator for loading nuclear fuel pellets into a sintering boat. It comprises a generally horizontally-disposed pellet transfer conveyor for moving pellets in single file fashion from a receiving end to a discharge end thereof, the conveyor being mounted about an axis at its receiving end for pivotal movement to generally vertically move its discharge end toward and away from a sintering boat when placed below the discharge end of the conveyor, the conveyor including an elongated arm swingable vertically about the axis and having an elongated channel recessed below an upper side of the arm and extending between the receiving and discharge ends of the conveyor; a pellet dispensing chute mounted to the arm of the conveyor at the discharge end thereof and extending therebelow such that the chute is carried at the discharge end of the conveyor for generally vertical movement therewith toward and away from the sintering boat

  12. Elevator and Escalator Safety Education for Older Adults.

    Science.gov (United States)

    Hanks, Roma Stovall

    1996-01-01

    In eight focus groups in five cities, older adults identified their concerns about safety on elevators and escalators, often related to misunderstanding of the equipment. Their preferences for delivery of safety information included video/television, pamphlets, discussions, and posters. Educational interventions and modifications for disabilities…

  13. Manifestation of conflict escalation in natural resource management

    NARCIS (Netherlands)

    Yasmi, Y.; Schanz, H.; Salim, A.

    2006-01-01

    Conflict escalation is one of the important aspects to be understood for constructive conflict management. It has been widely discussed in many fields of social study, in particular as it relates inter-individual conflicts. However, this is not the case for natural resource management (NRM). This

  14. Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder.

    Science.gov (United States)

    Marcks, Brook A; Woods, Douglas W

    2007-11-01

    Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.

  15. Nuclear power generating costs

    International Nuclear Information System (INIS)

    Srinivasan, M.R.; Kati, S.L.; Raman, R.; Nanjundeswaran, K.; Nadkarny, G.V.; Verma, R.S.; Mahadeva Rao, K.V.

    1983-01-01

    Indian experience pertaining to investment and generation costs of nuclear power stations is reviewed. The causes of investment cost increases are analysed and the increases are apportioned to escalation, design improvements and safety related adders. The paper brings out the fact that PHWR investment costs in India compare favourably with those experienced in developed countries in spite of the fact that the programme and the unit size are relatively much smaller in India. It brings out that in India at current prices a nuclear power station located over 800 km from coal reserves and operating at 75% capacity factor is competitive with thermal power at 60% capacity factor. (author)

  16. The health-related social costs of alcohol in Belgium.

    Science.gov (United States)

    Verhaeghe, Nick; Lievens, Delfine; Annemans, Lieven; Vander Laenen, Freya; Putman, Koen

    2017-12-16

    Alcohol is associated with adverse health effects causing a considerable economic impact to society. A reliable estimate of this economic impact for Belgium is lacking. This is the aim of the study. A prevalence-based approach estimating the direct, indirect and intangible costs for the year 2012 was used. Attributional fractions for a series of health effects were derived from literature. The human capital approach was used to estimate indirect costs, while the concept of disability-adjusted life years was used to estimate intangible costs. Sensitivity and scenario analyses were conducted to assess the uncertainty around cost estimates and to evaluate the impact of alternative modelling assumptions. In 2012, total alcohol-attributable direct costs were estimated at €906.1 million, of which the majority were due to hospitalization (€743.7 million, 82%). The indirect costs amounted to €642.6 million, of which 62% was caused by premature mortality. Alcohol was responsible for 157,500 disability-adjusted life years representing €6.3 billion intangible costs. Despite a number of limitations intrinsic to this kind of research, the study can be considered as the most comprehensive analysis thus far of the health-related social costs of alcohol in Belgium.

  17. Costs and revenues of investment in enterprise-related schooling.

    NARCIS (Netherlands)

    Hartog, J.; Groot, W.J.N.; Oosterbeek, H.

    1994-01-01

    In this paper, a general specification of the wage equation is used to derive a marginal revenue equation for enterprise-related schooling. The optimal amount of investment in enterprise-related schooling is found by equating the marginal revenues and marginal costs. For the empirical analysis, the

  18. Relational Benefits & Costs in Social Media Brand Pages

    OpenAIRE

    Tsimonis, Georgios; Dimitriadis, Sergios

    2014-01-01

    Attracted by the rapid penetration of social media into society, firms are increasingly using them to offer interactive services to their customers, and to create or enhance their relationships with them. As the number of consumers who join brand pages on social media platforms raises, it brings to the front a new question: What relational benefits and costs arise from customer interactions with brands in social media? Thus, this study is an attempt to identify what benefits and costs users p...

  19. Alcohol- and drug-related absenteeism: a costly problem.

    Science.gov (United States)

    Roche, Ann; Pidd, Ken; Kostadinov, Victoria

    2016-06-01

    Absenteeism related to alcohol and other drug (AOD) use can place a substantial burden on businesses and society. This study estimated the cost of AOD-related absenteeism in Australia using a nationally representative dataset. A secondary analysis of the 2013 National Drug Strategy Household Survey (n=12,196) was undertaken. Two measures of AOD-related absenteeism were used: participants' self-reported absence due to AOD use (M1); and the mean difference in absence due to any illness/injury for AOD users compared to abstainers (M2). Both figures were multiplied by $267.70 (average day's wage in 2013 plus 20% on-costs) to estimate associated costs. M1 resulted in an estimation of 2.5 million days lost annually due to AOD use, at a cost of more than $680 million. M2 resulted in an estimation of almost 11.5 million days lost, at a cost of $3 billion. AOD-related absenteeism represents a significant and preventable impost upon Australian businesses. Workplaces should implement evidence-based interventions to promote healthy employee behaviour and reduce AOD-related absenteeism. © 2015 Public Health Association of Australia.

  20. Agricultural Terrorism (Agroterror) and Escalation Theory

    National Research Council Canada - National Science Library

    Gooding, Aeneas R

    2007-01-01

    ... credibility terrorist groups must demonstrate a continued ability to conduct operations and inflict significant numbers of casualties on their enemy, maintaining a consistent, if not escalating, level of violence. This thesis uses E...

  1. E4 - Energy efficient elevators and escalators. Barriers to and strategies for promoting energy-efficient lift and escalator technologies

    Energy Technology Data Exchange (ETDEWEB)

    Duetschke, Elisabeth; Hirzel, Simon

    2010-02-25

    According to prior findings of the E4 project, considerable savings potential exists both for lifts and escalators that could be realized if appropriate technology is implemented. However, energy-efficient technology is slowly diffusing the market - a phenomenon that could be explained by barriers present in the market. A barrier is defined as a mechanism that inhibits a decision or behavior that appears to be both energy-efficient and economically efficient and thereby prevents investment in energy-efficient technologies. This document has two aims. First, it will identify influential barriers in the European lift and escalator market. This analysis is based on the literature as well as a study including interviews as well as group discussions with relevant stakeholders. Second, strategies and measures to overcome the barriers identified in the first step are outlined. Major barriers to the penetration of energy-efficient technologies identified in this paper include a lack of monitoring energy consumption of installations and a lack of awareness of as well as knowledge about energy-efficient technology. Thus, installations and components are usually chosen without a (comprehensive) assessment of their energy consumption and without considering life-cycle approaches. On top of this, split incentives are a regularly occurring barrier. Various stakeholders are influential in the decisionmaking process about an installation or its components. However, those who will later pay for the energy consumption often are not involved in this process. Moreover, it is important to keep in mind that the number of new lifts and escalators installed each year is relatively low compared to the existing stock. Thus, it is very important to discuss enhancement of energy efficiency also for the existing stock. Based on our analyses, several recommendations are developed in this paper that could contribute to a market transformation in the lift and escalator market. First of all, a

  2. Studying the efficacy of escalated dose conformal radiation therapy in prostate carcinoma – Pakistan experience

    Directory of Open Access Journals (Sweden)

    Asad Zamir

    2017-11-01

    Conclusion: Our data were comparable to international studies of dose escalation using 3D and beneficial as compared to conventional radiation therapy delivered by 2D in terms of biochemical failure rate and treatment related toxicity.

  3. Reply to: Mounting evidence indicates that escalating doses of allopurinol are unnecessary for cardiovascular protection.

    Science.gov (United States)

    Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R

    2018-05-08

    We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  4. Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn's patients

    NARCIS (Netherlands)

    Baert, Filip; Glorieus, Elien; Reenaers, Cathérine; D'Haens, Geert; Peeters, Harald; Franchimont, Dennis; Dewit, Olivier; Caenepeel, Philippe; Louis, Edouard; van Assche, Gert; D'Heygere, F.; George, C.; van Hootegem, P.; Ilegems, S.; Fontaine, F.; Colard, A.; Schoofs, N.; Belaiche, J.; Louis, E.; Reenaers, C.; van Kemseke, C.; Coche, J. C.; Dewit, O.; Rahier, J. F.; de Reuck, M.; Baert, F.; Decaestecker, J.; de Wulf, D.; Amininejad, L.; Franchimont, D.; van Gossum, A.; Du Ville, L.; Hendrickx, K.; Lepoutre, L.; Vandervoort, J.; van der Spek, P.; Sprengers, D.; van de Mierop, F.; Potvin, P.; Bontems, P.; Moreels, T.; van Outryve, M.; Mana, F.; de Looze, D.; de Vos, M.; Peeters, H.; Ferrante, M.; Rutgeerts, P.; van Assche, G.; Vermeire, S.

    2013-01-01

    Adalimumab is efficacious in inducing and maintaining remission in Crohn's disease but dose escalation is needed in 30-40% after 1 year. Attempts for dose de-escalation have not been studied. This study aimed to assess the need for, predictors, and outcome of dose escalation and de-escalation in a

  5. 78 FR 17300 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Science.gov (United States)

    2013-03-21

    ... and II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and... Relating to Grants and Cooperative Agreements; Cost Principles and Administrative Requirements (Including...

  6. Relative Greenhouse Gas Abatement Cost Competitiveness of Biofuels in Germany

    Directory of Open Access Journals (Sweden)

    Markus Millinger

    2018-03-01

    Full Text Available Transport biofuels derived from biogenic material are used for substituting fossil fuels, thereby abating greenhouse gas (GHG emissions. Numerous competing conversion options exist to produce biofuels, with differing GHG emissions and costs. In this paper, the analysis and modeling of the long-term development of GHG abatement and relative GHG abatement cost competitiveness between crop-based biofuels in Germany are carried out. Presently dominant conventional biofuels and advanced liquid biofuels were found not to be competitive compared to the substantially higher yielding options available: sugar beet-based ethanol for the short- to medium-term least-cost option and substitute natural gas (SNG for the medium to long term. The competitiveness of SNG was found to depend highly on the emissions development of the power mix. Silage maize-based biomethane was found competitive on a land area basis, but not on an energetic basis. Due to land limitations, as well as cost and GHG uncertainty, a stronger focus on the land use of crop-based biofuels should be laid out in policy.

  7. Learning to make collective decisions: the impact of confidence escalation.

    Science.gov (United States)

    Mahmoodi, Ali; Bang, Dan; Ahmadabadi, Majid Nili; Bahrami, Bahador

    2013-01-01

    Little is known about how people learn to take into account others' opinions in joint decisions. To address this question, we combined computational and empirical approaches. Human dyads made individual and joint visual perceptual decision and rated their confidence in those decisions (data previously published). We trained a reinforcement (temporal difference) learning agent to get the participants' confidence level and learn to arrive at a dyadic decision by finding the policy that either maximized the accuracy of the model decisions or maximally conformed to the empirical dyadic decisions. When confidences were shared visually without verbal interaction, RL agents successfully captured social learning. When participants exchanged confidences visually and interacted verbally, no collective benefit was achieved and the model failed to predict the dyadic behaviour. Behaviourally, dyad members' confidence increased progressively and verbal interaction accelerated this escalation. The success of the model in drawing collective benefit from dyad members was inversely related to confidence escalation rate. The findings show an automated learning agent can, in principle, combine individual opinions and achieve collective benefit but the same agent cannot discount the escalation suggesting that one cognitive component of collective decision making in human may involve discounting of overconfidence arising from interactions.

  8. Elephant invasion and escalated depletion of environmental ...

    African Journals Online (AJOL)

    For decades, elephants' invasion is known to be associated with severe environmental consequences leading to escalated depletion o environmental resources (plants, water, wildlife and soil). This paper examined the effects of elephants' activity on the environmental resources inHong and Gombi Local Government areas ...

  9. Escalated convergent artificial bee colony

    Science.gov (United States)

    Jadon, Shimpi Singh; Bansal, Jagdish Chand; Tiwari, Ritu

    2016-03-01

    Artificial bee colony (ABC) optimisation algorithm is a recent, fast and easy-to-implement population-based meta heuristic for optimisation. ABC has been proved a rival algorithm with some popular swarm intelligence-based algorithms such as particle swarm optimisation, firefly algorithm and ant colony optimisation. The solution search equation of ABC is influenced by a random quantity which helps its search process in exploration at the cost of exploitation. In order to find a fast convergent behaviour of ABC while exploitation capability is maintained, in this paper basic ABC is modified in two ways. First, to improve exploitation capability, two local search strategies, namely classical unidimensional local search and levy flight random walk-based local search are incorporated with ABC. Furthermore, a new solution search strategy, namely stochastic diffusion scout search is proposed and incorporated into the scout bee phase to provide more chance to abandon solution to improve itself. Efficiency of the proposed algorithm is tested on 20 benchmark test functions of different complexities and characteristics. Results are very promising and they prove it to be a competitive algorithm in the field of swarm intelligence-based algorithms.

  10. 18 CFR Table 1 to Part 301 - Functionalization and Escalation Codes

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Functionalization and Escalation Codes 1 Table 1 to Part 301 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST...

  11. Evaluation methodology for tariff design under escalating penetrations of distributed energy resources

    NARCIS (Netherlands)

    Abdelmotteleb, I.I.A.; Gómez, Tomás; Reneses, Javier

    2017-01-01

    As the penetration of distributed energy resources (DERs) escalates in distribution networks, new network tariffs are needed to cope with this new situation. These tariffs should allocate network costs to users, promoting an efficient use of the distribution network. This paper proposes a

  12. ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Rodda, Sree; Tyldesley, Scott; Morris, W. James; Keyes, Mira; Halperin, Ross; Pai, Howard; McKenzie, Michael; Duncan, Graeme; Morton, Gerard; Hamm, Jeremy; Murray, Nevin

    2017-01-01

    Purpose: To report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer. Methods and Materials: ASCENDE-RT (Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy) enrolled 398 men, median age 68 years, who were then randomized to either a standard arm that included 12 months of androgen deprivation therapy and pelvic irradiation to 46 Gy followed by a dose-escalated external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost. At clinic visits, investigators recorded GU and GI morbidity and information on urinary continence, catheter use, and erectile function. Exclusion of 15 who received nonprotocol treatment and correction of 14 crossover events left 195 men who actually received a DE-EBRT boost and 188, an LDR-PB boost. Median follow-up was 6.5 years. Results: The LDR-PB boost increased the risk of needing temporary catheterization and/or requiring incontinence pads. At 5 years the cumulative incidence of grade 3 GU events was 18.4% for LDR-PB, versus 5.2% for DE-EBRT (P<.001). Compared with the cumulative incidence, the 5-year prevalence of grade 3 GU morbidity was substantially lower for both arms (8.6% vs 2.2%, P=.058). The 5-year cumulative incidence of grade 3 GI events was 8.1% for LDR-PB, versus 3.2% for DE-EBRT (P=.124). The 5-year prevalence of grade 3 GI toxicity was lower than the cumulative incidence for both arms (1.0% vs 2.2%, respectively). Among men reporting adequate baseline erections, 45% of LDR-PB patients reported similar erectile function at 5 years, versus 37% after DE-EBRT (P=.30). Conclusions: The incidence of acute and late GU morbidity was higher after LDR-PB boost, and there was a nonsignificant trend for worse GI morbidity. No differences in the frequency of

  13. ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rodda, Sree [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Tyldesley, Scott [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Morris, W. James, E-mail: jmorris@bccancer.bc.ca [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Keyes, Mira [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Halperin, Ross [Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia (Canada); Pai, Howard [Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); BC Cancer Agency, Vancouver Island Centre, Victoria, British Columbia (Canada); McKenzie, Michael; Duncan, Graeme [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Morton, Gerard [Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Hamm, Jeremy [Department of Population Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Murray, Nevin [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Medicine, University of British Columbia, Vancouver, British Columbia (Canada)

    2017-06-01

    Purpose: To report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer. Methods and Materials: ASCENDE-RT (Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy) enrolled 398 men, median age 68 years, who were then randomized to either a standard arm that included 12 months of androgen deprivation therapy and pelvic irradiation to 46 Gy followed by a dose-escalated external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost. At clinic visits, investigators recorded GU and GI morbidity and information on urinary continence, catheter use, and erectile function. Exclusion of 15 who received nonprotocol treatment and correction of 14 crossover events left 195 men who actually received a DE-EBRT boost and 188, an LDR-PB boost. Median follow-up was 6.5 years. Results: The LDR-PB boost increased the risk of needing temporary catheterization and/or requiring incontinence pads. At 5 years the cumulative incidence of grade 3 GU events was 18.4% for LDR-PB, versus 5.2% for DE-EBRT (P<.001). Compared with the cumulative incidence, the 5-year prevalence of grade 3 GU morbidity was substantially lower for both arms (8.6% vs 2.2%, P=.058). The 5-year cumulative incidence of grade 3 GI events was 8.1% for LDR-PB, versus 3.2% for DE-EBRT (P=.124). The 5-year prevalence of grade 3 GI toxicity was lower than the cumulative incidence for both arms (1.0% vs 2.2%, respectively). Among men reporting adequate baseline erections, 45% of LDR-PB patients reported similar erectile function at 5 years, versus 37% after DE-EBRT (P=.30). Conclusions: The incidence of acute and late GU morbidity was higher after LDR-PB boost, and there was a nonsignificant trend for worse GI morbidity. No differences in the frequency of

  14. Technology, safety and costs of decommissioning a reference pressurized water reactor power station: Technical support for decommissioning matters related to preparation of the final decommissioning rule

    International Nuclear Information System (INIS)

    Konzek, G.J.; Smith, R.I.

    1988-07-01

    Preparation of the final Decommissioning Rule by the Nuclear Regulatory Commission (NRC) staff has been assisted by Pacific Northwest Laboratory (PNL) staff familiar with decommissioning matters. These efforts have included updating previous cost estimates developed during the series of studies on conceptually decommissioning reference licensed nuclear facilities for inclusion in the Final Generic Environmental Impact Statement (FGEIS) on decommissioning; documenting the cost updates; evaluating the cost and dose impacts of post-TMI-2 backfits on decommissioning; developing a revised scaling formula for estimating decommissioning costs for reactor plants different in size from the reference pressurized water reactor (PWR) described in the earlier study; defining a formula for adjusting current cost estimates to reflect future escalation in labor, materials, and waste disposal costs; and completing a study of recent PWR steam generator replacements to determine realistic estimates for time, costs and doses associated with steam generator removal during decommissioning. This report presents the results of recent PNL studies to provide supporting information in four areas concerning decommissioning of the reference PWR: updating the previous cost estimates to January 1986 dollars; assessing the cost and dose impacts of post-TMI-2 backfits; assessing the cost and dose impacts of recent steam generator replacements; and developing a scaling formula for plants different in size than the reference plant and an escalation formula for adjusting current cost estimates for future escalation

  15. Escalating energy costs threaten health care for critically ill and homebound seniors: home care nurses, aides and therapists drive 4.8 billion miles per year to reach shut-in patients.

    Science.gov (United States)

    2008-08-01

    The rapidly rising cost of fuel has had a profound impact on the home care and hospice industry. In an effort to quantify the increased burden, the National Association for Home Care & Hospice's (NAHC) Foundation for Hospice and Home Care conducted a study showing that home care and hospice providers drive over 5 billion miles per year to deliver services --about two-and-a-half times the number driven by United Parcel Service, the international delivery service. The findings garnered significant interest by the media and elected officials. Reprinted in this issue of CARING Magazine are the press release that NAHC issued regarding the study, as well as a graphic representation of the study's findings that was circulated to the National Conference of State Legislatures at its most recent meeting in July. Also represented on these pages is a reprint from the Congressional Record of July 11, 2008, in which Senator Debbie Stabenow (D-MI), one of the highest ranking Democrats in the US. Senate, entered into the record an article from the front page of the New York Times of July 5, 2008, that covered the mileage study.

  16. Technology, safety and costs of decommissioning a refernce boiling water reactor power station: Technical support for decommissioning matters related to preparation of the final decommissioning rule

    International Nuclear Information System (INIS)

    Konzek, G.J.; Smith, R.I.

    1988-07-01

    Preparation of the final Decommissioning Rule by the Nuclear Regulatory Commission (NRC) staff has been assisted by Pacific Northwest Laboratory (PNL) staff familiar with decommissioning matters. These efforts have included updating previous cost estimates developed during the series of studies of conceptually decommissioning reference licensed nuclear facilities for inclusion in the Final Generic Environmental Impact Statement (FGEIS) on decommissioning; documenting the cost updates; evaluating the cost and dose impacts of post-TMI-2 backfits on decommissioning; developing a revised scaling formula for estimating decommissioning costs for reactor plants different in size from the reference boiling water reactor (BWR) described in the earlier study; and defining a formula for adjusting current cost estimates to reflect future escalation in labor, materials, and waste disposal costs. This report presents the results of recent PNL studies to provide supporting information in three areas concerning decommissioning of the reference BWR: updating the previous cost estimates to January 1986 dollars; assessing the cost and dose impacts of post-TMI-2 backfits; and developing a scaling formula for plants different in size than the reference plant and an escalation formula for adjusting current cost estimates for future escalation

  17. Evaluation methodology for tariff design under escalating penetrations of distributed energy resources

    OpenAIRE

    Abdelmotteleb, I.I.A.; Gómez, Tomás; Reneses, Javier

    2017-01-01

    As the penetration of distributed energy resources (DERs) escalates in distribution networks, new network tariffs are needed to cope with this new situation. These tariffs should allocate network costs to users, promoting an efficient use of the distribution network. This paper proposes a methodology to evaluate and compare network tariff designs. Four design attributes are proposed for this aim: (i) network cost recovery; (ii) deferral of network reinforcements; (iii) efficient consumer resp...

  18. Report on estimated nuclear energy related cost for fiscal 1991

    International Nuclear Information System (INIS)

    1991-01-01

    The report first describes major actions planned to be taken in Japan in fiscal 1991 in the field of nuclear energy utilization. Major activities to be made for comprehensive strengthening of safety assurance measures are described, focusing on improvement of nuclear energy related safety regulations, promotion of research for safety assurance, improvement and strengthening of disaster prevention measures, environmental radioactivity surveys, control of exposure of workers engaged in radioactivity related jobs, etc. The report then describes actions required for the establishment of a nuclear fuel cycle, focusing on the procurement of uranium resources, establishment of a uranium enrichment process, reprocessing of spent fuel, application of recovered uranium, etc. Other activities are required for the development of new type reactors, effective application of plutonium, development of basic techniques, international contributions, cooperation with the public. Then, the report summarizes estimated costs required for the activities to be performed by the Japan Atomic Energy Research Institute, Power Reactor and Nuclear Fuel Development Corporation, National Institute of Radiological Sciences, Institute of Physical and Chemical Research. (N.K.)

  19. Modelling the implications of reducing smoking prevalence: the benefits of increasing the UK tobacco duty escalator to public health and economic outcomes.

    Science.gov (United States)

    Knuchel-Takano, Andre; Hunt, Daniel; Jaccard, Abbygail; Bhimjiyani, Arti; Brown, Martin; Retat, Lise; Brown, Katrina; Hinde, Sebastian; Selvarajah, Chit; Bauld, Linda; Webber, Laura

    2017-12-06

    Taxing tobacco is one of the most effective ways to reduce smoking prevalence, mitigate its devastating consequential health harms and progress towards a tobacco-free society. This study modelled the health and economic impacts of increasing the existing cigarette tobacco duty escalator (TDE) in the UK from the current 2% above consumer price inflation to 5%. A two-stage modelling process was used. First, a non-linear multivariate regression model was fitted to cross-sectional smoking data, creating longitudinal projections from 2015 to 2035. Second, these projections were used to predict the future incidence, prevalence and cost of 17 smoking-related diseases using a Monte Carlo microsimulation approach. A sustained increase in the duty escalator was evaluated against a baseline of continuing historical smoking trends and the existing duty escalator. A sustained increase in the TDE is projected to reduce adult smoking prevalence to 6% in 2035, from 10% in a baseline scenario. After increasing the TDE, only 65% of female and 60% of male would-be smokers would actually be smoking in 2035. The intervention is projected to avoid around 75 200 new cases of smoking-related diseases between 2015 and 2035. In 2035 alone, £49 m in National Health Service and social care costs and £192 m in societal premature mortality and morbidity costs are projected to be avoided. Increasing the UK TDE to 5% above inflation could effectively reduce smoking prevalence, prevent diseases and avoid healthcare costs. It would deliver substantial progress towards a tobacco-free society and should be implemented by the UK Government with urgency. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. A systematic methodology review of phase I radiation dose escalation trials

    International Nuclear Information System (INIS)

    Pijls-Johannesma, Madelon; Mastrigt, Ghislaine van; Hahn, Steve M.; De Ruysscher, Dirk; Baumert, Brigitta G.; Lammering, Guido; Buijsen, Jeroen; Bentzen, Soren M.; Lievens, Yolande; Kramar, Andrew; Lambin, Philippe

    2010-01-01

    Background and purpose: The purpose of this review is to evaluate the methodology used in published phase I radiotherapy (RT) dose escalation trials. A specific emphasis was placed on the frequency of reporting late complications as endpoint. Materials and methods: We performed a systematic literature review using a predefined search strategy to identify all phase I trials reporting on external radiotherapy dose escalation in cancer patients. Results: Fifty-three trials (phase I: n = 36, phase I-II: n = 17) fulfilled the inclusion criteria. Of these, 20 used a modified Fibonacci design for the RT dose escalation, but 32 did not specify a design. Late toxicity was variously defined as >3 months (n = 43) or > 6 months (n = 3) after RT, or not defined (n = 7). In only nine studies the maximum tolerated dose (MTD) was related to late toxicity, while only half the studies reported the minimum follow-up period for dose escalation (n = 26). Conclusion: In phase I RT trials, late complications are often not taken into account and there is currently no consensus on the methodology used for radiation dose escalation studies. We therefore propose a decision-tree algorithm which depends on the endpoint selected and whether a validated early surrogate endpoint is available, in order to choose the most appropriate study design.

  1. State-Level Estimates of Cancer-Related Absenteeism Costs

    Science.gov (United States)

    Tangka, Florence K.; Trogdon, Justin G.; Nwaise, Isaac; Ekwueme, Donatus U.; Guy, Gery P.; Orenstein, Diane

    2016-01-01

    Background Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. Methods In analyses of data from the 2004–2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. Results We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. Conclusions The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. PMID:23969498

  2. De-escalating and escalating treatments for early-stage breast cancer

    DEFF Research Database (Denmark)

    Curigliano, G; Burstein, H J; P Winer, E

    2017-01-01

    The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escal...

  3. Workplace smoking related absenteeism and productivity costs in Taiwan.

    Science.gov (United States)

    Tsai, S P; Wen, C P; Hu, S C; Cheng, T Y; Huang, S J

    2005-06-01

    To estimate productivity losses and financial costs to employers caused by cigarette smoking in the Taiwan workplace. The human capital approach was used to calculate lost productivity. Assuming the value of lost productivity was equal to the wage/salary rate and basing the calculations on smoking rate in the workforce, average days of absenteeism, average wage/salary rate, and increased risk and absenteeism among smokers obtained from earlier research, costs due to smoker absenteeism were estimated. Financial losses caused by passive smoking, smoking breaks, and occupational injuries were calculated. Using a conservative estimate of excess absenteeism from work, male smokers took off an average of 4.36 sick days and male non-smokers took off an average of 3.30 sick days. Female smokers took off an average of 4.96 sick days and non-smoking females took off an average of 3.75 sick days. Excess absenteeism caused by employee smoking was estimated to cost USD 178 million per annum for males and USD 6 million for females at a total cost of USD 184 million per annum. The time men and women spent taking smoking breaks amounted to nine days per year and six days per year, respectively, resulting in reduced output productivity losses of USD 733 million. Increased sick leave costs due to passive smoking were approximately USD 81 million. Potential costs incurred from occupational injuries among smoking employees were estimated to be USD 34 million. Financial costs caused by increased absenteeism and reduced productivity from employees who smoke are significant in Taiwan. Based on conservative estimates, total costs attributed to smoking in the workforce were approximately USD 1032 million.

  4. Research on the waiting time of passengers and escalator energy consumption at the railway station

    Energy Technology Data Exchange (ETDEWEB)

    Ma, Wei-wu; Liu, Xiao-yan; Li, Liqing; Shi, Xiangnan; Zhou, Chenn Q. [School of Energy Science and Engineering, Central South University, Changsha 410083 (China)

    2009-12-15

    Based on the Little Formula and the classical queuing model of multi-channel M vertical stroke D vertical stroke n, the relation of the average queue length, the maximum waiting time and the escalator service intensity were identified and the waiting time simulation model was established. With the passenger delivery data at A railway station in China and the probability distribution model of waiting time, a detailed analysis was made on the escalator allocation, power and energy consumption on holidays, ordinary working days and the largest-passengers-volume days; meanwhile, the fixed and variable energy consumption were compared and studied when the waiting time are 5, 10 and 30 s. The result shows that the waiting time settings affect the allocation and the energy consumption of the escalators and the fixed energy consumption takes 70%. (author)

  5. On the relation between cost and service models for general inventory systems

    NARCIS (Netherlands)

    Houtum, van G.J.J.A.N.; Zijm, W.H.M.

    2000-01-01

    In this paper, we present a systematic overview of possible relations between cost and service models for fairly general single- and multi-stage inventory systems. In particular, we relate various types of penalty costs in pure cost models to equivalent types of service measures in service models.

  6. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true FEHBP public relations and... COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-70 FEHBP public relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP...

  7. In-depth investigation of escalator riding accidents in heavy capacity MRT stations.

    Science.gov (United States)

    Chi, Chia-Fen; Chang, Tin-Chang; Tsou, Chi-Lin

    2006-07-01

    In 2000, the accident rate for escalator riding was about 0.815 accidents per million passenger trips through Taipei Metro Rapid Transit (MRT) heavy capacity stations. In order to reduce the probability and severity of escalator riding accidents and enhance the safety of passengers, the Drury and Brill model [Drury, C.G., Brill, M., 1983. Human factors in consumer product accident investigation. Hum. Factors 25 (3), 329-342] for in-depth investigation was adopted to analyze the 194 escalator riding accidents in terms of victim, task, product and environment. Prevention measures have been developed based on the major causes of accidents and other related contributing factors. The results from the analysis indicated that the majority of the escalator riding accidents was caused by passengers' carrying out other tasks (38 cases, including carrying luggage 24 cases, looking after accompany persons 9 cases, and 5 others), loss of balance (26 cases, 13.4%), not holding the handrail (20 cases, 10.3%), unhealthy passengers (18 cases, 9.3%), followed by people struck by other passenger (16 cases, 8.2%). For female passengers aged 15-64 years, their rushing for trains accidents could have been prevented by wearing safer footwear or by appropriate signing being provided indicating the location and traveling direction of escalators. Female passengers aged 65 years and above whose accidents were caused by loss of balance, should be encouraged to take the elevator instead. To prevent entrapment injuries, following a stricter design code can be most effective. Further in-depth accident investigation is suggested to cover the activity of the victim prior to the accident, any involved product, the location of the accident on the escalator, any medical treatment, what went wrong, opinion of the respondent on the causes of the accident, and personal characteristics of the passengers. Also, management must trade off productivity and safety appropriately to prevent "Organizational

  8. Cost of work-related injuries in insured workplaces in Lebanon.

    OpenAIRE

    Fayad, Rim; Nuwayhid, Iman; Tamim, Hala; Kassak, Kassem; Khogali, Mustafa

    2003-01-01

    OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. FINDINGS: ...

  9. Cost related to nuclear power plants: the international experience

    International Nuclear Information System (INIS)

    1995-03-01

    This report about the international costs of nuclear electricity generations is divided in two distinct parts: the first one shows the competitiveness of the main sources of electricity generation for base load operation according to studies carried on by OECD and UNIPEDE since 1983; the second one discusses the most recent OECD study about the different types of power plants to be constructed in its number states, based on the experience of each country and the technology evolution of the different fuels used. (F.E.). 4 refs, 2 figs, 27 tab

  10. Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and Realities.

    Science.gov (United States)

    Rubin, Geoffrey D

    2017-02-01

    Costs direct decisions that influence the effectiveness of radiology in the care of patients on a daily basis. Yet many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported. In the United States, recent payment trends directing value-based payments for bundles of care advance the imperative for radiology providers to articulate their value. This begins with the development of an understanding of the providers' own costs, as well as the complex interrelationships and imaging-associated costs of other participants across the imaging value chain. Controlling the costs of imaging necessitates understanding them at a procedural level and quantifying the costs of delivering specific imaging services. Effective product-level costing is dependent on a bottom-up approach, which is supported through recent innovations in time-dependent activity-based costing. Once the costs are understood, they can be managed. Within the high fixed cost and high overhead cost environment of health care provider organizations, stakeholders must understand the implications of misaligned top-down cost management approaches that can both paradoxically shift effort from low-cost workers to much costlier professionals and allocate overhead costs counterproductively. Radiology's engagement across a broad spectrum of care provides an excellent opportunity for radiology providers to take a leading role within the health care organizations to enhance value and margin through principled and effective cost management. Following a discussion of the rationale for measuring costs, this review contextualizes costs from the perspectives of a variety of stakeholders (relativity), discusses core concepts in how costs are classified (rudiments), presents common and improved methods for measuring

  11. 48 CFR 231.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Public relations and... PROCEDURES Contracts With Commercial Organizations 231.205-1 Public relations and advertising costs. (e) See... public relations and advertising costs also include monies paid to the Government associated with the...

  12. An analysis of relative costs in drilling deep wells

    International Nuclear Information System (INIS)

    Anderson, E.E.; Cooper, G.A.; Maurer, W.C.; Westcott, P.A.

    1991-01-01

    The search for new sources of oil, and particularly gas, is leading the industry to drill ever deeper wells. A depth of 15,000 ft was first passed in 1938, 20,000 ft was reached in 1939, followed by 25,000 ft in 1958, and 30,000 ft in 1972. The current US record depth is 31,441 ft. As the total depth increases, not only does the rock to be drilled become stronger, but increasing pressure and temperature induce plasticity and chip hold-down effects that make it more difficult to remove cuttings from the workfront. In addition to the reduction in rate of the drilling process itself, other activities become more complex and time-consuming, for example, tripping, running and cementing casing, and logging and coring activities. This paper analyzes the different tasks involved in drilling deep wells, in order to identify those activities that contribute most to the overall cost. These are therefore expected to be the activities where future efforts in research and development should provide the greatest reductions in total cost

  13. Costs related to radioactive residues from nuclear power

    International Nuclear Information System (INIS)

    1988-06-01

    The nuclear power enterprises are responsible for proper actions for safe handling and final storage of spent nuclear fuel and radioactive waste from Swedish nuclear power facilities. The most important actions are to plan, build and operate necessary plants and systems. The nuclear power enterprises have designated Swedish Nuclear Fuel and Waste Management Co., (SKB), to perform these tasks. In this report calculations concerning costs to carry out these tasks are presented. The calculations are based upon a plan prepared by SKB. The plan is described in the report. As final storage of the long lived and highly radioactive waste is planned to take place in the 21st century continuing research and development may indicate new methods which may affect system design as well as costs in a simplifying way. Plants and systems already operational are: Transport systems for radioactive waste products; A central temporary storage for spent nuclear fuel, 'CLAB'; A final storage for radioactive waste from operating nuclear facilities, 'SFR 1'. (L.F.)

  14. 77 FR 17360 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...

    Science.gov (United States)

    2012-03-26

    ... II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...; cost principles and administrative requirements (including Single Audit Act). The original comment...-idx?c=ecfr&tpl=/ecfrbrowse/Title02/2cfrv1_02.tpl . The Cost Principles for Hospitals are in the...

  15. 77 FR 11778 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Science.gov (United States)

    2012-02-28

    ... and II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and... available on OMB's Web site at http://www.whitehouse.gov/omb/circulars_default/ . The Cost Principles for... E (Principles for Determining Costs Applicable to Research and Development Under Grants and...

  16. 78 FR 7282 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Science.gov (United States)

    2013-02-01

    ... II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and... further review, the Cost Principles for Hospitals at 45 CFR Part 74, Appendix E. The proposal consolidates... instructed the OMB Director to ``review and where appropriate revise guidance concerning cost principles...

  17. Transaction-cost Expenditures and the Relative Performance of Mutual Funds

    OpenAIRE

    John M.R. Chalmers; Roger M. Edelen; Gregory B. Kadlec

    1999-01-01

    We directly estimate annual trading costs for a sample of equity mutual funds and find that these costs are large and exhibit substantial cross sectional variation. Trading costs average 0.78% of fund assets per year and have an inter-quartile range of 0.59%. Trading costs, like expense ratios, are negatively related to fund returns and we find no evidence that on average trading costs are recovered in higher gross fund returns. We find that our direct estimates of trading costs have more exp...

  18. Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

    Science.gov (United States)

    Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

    2014-11-13

    The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

  19. PR for Pennies: Low-Cost Library Public Relations.

    Science.gov (United States)

    Baeckler, Virginia Van Wynen

    This manual is designed to demystify a number of public relations techniques for those who wish to start producing their own materials with a minimum of time and money. Chapters focus on public relations; the library stereotype; words, ideas, and pictures; offset printing; creative print distribution; exhibits and posters; public speaking; and the…

  20. Cost Consequences of a Port-Related Supply Chain Disruption

    Directory of Open Access Journals (Sweden)

    Hui Shan LOH

    2015-09-01

    Full Text Available Port functionality is a significant and important aspect of cargo transportation. Previous studies have identified a list of port-related supply chain disruption threats and developed a management model that seeks to address these threats. This paper adds value to these related studies by comparing four consequences of an example of these threats: (1 avoidance of disruption, (2 mitigation of disruption, (3 deviation of transportation plan and (4 delays and deviation of transportation plan. The impact of these consequences is simulated in a case study using data from a chemical manufacturer based in Singapore. This paper quantitatively measures the impact of a port-related threat on supply chains and thus highlights the importance of port-related supply chain disruption management.

  1. Cost Consequences of a Port-Related Supply Chain Disruption

    OpenAIRE

    Hui Shan LOH; Vinh Van THAI

    2015-01-01

    Port functionality is a significant and important aspect of cargo transportation. Previous studies have identified a list of port-related supply chain disruption threats and developed a management model that seeks to address these threats. This paper adds value to these related studies by comparing four consequences of an example of these threats: (1) avoidance of disruption, (2) mitigation of disruption, (3) deviation of transportation plan and (4) delays and deviation of transportation plan...

  2. Cost-related implications of retrieval: Who should pay? Who should assess the cost/benefit?

    International Nuclear Information System (INIS)

    Soederberg, O.

    2000-01-01

    This paper contains an analysis of three different cases when a retrieval operation could take place. For each of the cases, the analysis covers three conceivable reasons for the retrieval. This means a total of nine scenarios to be analysed. One requirement for the analysis should be observed. That requirement is that there is, in a country, a system where assets are set aside today to cover such costs in the future which are caused by the current production of nuclear power. Within this framework, the analysis focuses on the financial implications of costs in connection with retrieval. (Consequences on the total national economy of such a financing system and of a retrieval operation are not discussed.) A financing system along these lines is consistent with two generally acknowledged principles: the polluter pays principle and the principle of not imposing undue burdens on future generations. But how are these principles applicable if, in the future, spent nuclear fuel were to be retrieved? Different time-horizons for a retrieval operation might produce different answers and these answers might also differ depending on the reasons for retrieval. The three chosen approximate times for retrieval are retrieval after a 10 year demonstration period (case 1), retrieval after the repository has ended its operating period but before final sealing has been carried out (case 2) and retrieval after about 50 years from sealing (case 3). The three reasons, which could be relevant in all three cases, can briefly be summarised as ''the solution is not safe enough'', ''the solution is safe enough but a better method than the chosen one has been developed and should be applied'' and ''what was considered as nuclear waste when disposed of now represents an economic asset which should be used by man''. (author)

  3. Mitigation of fire damage and escalation by fireproofing: A risk-based strategy

    International Nuclear Information System (INIS)

    Tugnoli, Alessandro; Cozzani, Valerio; Di Padova, Annamaria; Barbaresi, Tiziana; Tallone, Fabrizio

    2012-01-01

    Passive fire protection by the application of fireproofing materials is a crucial safety barrier in the prevention of the escalation of fire scenarios. Fireproofing improves the capacity of process items and of support structures to maintain their structural integrity during a fire, preventing or at least delaying the collapse of structural elements. Maintenance and cost issues require, however, to apply such protection only where an actual risk of severe fire scenarios is present. Available methodologies for fireproofing application in on-shore installation do not consider the effect of jet-fires. In the present study, a risk-based methodology aimed at the protection from both pool fire and jet fire escalation was developed. The procedure addresses both the prevention of domino effect and the mitigation of asset damage due to the primary fire scenario. The method is mainly oriented to early design application, allowing the identification of fireproofing zones in the initial phases of lay-out definition.

  4. Costs of Maternal Health-related Complications in Bangladesh

    Science.gov (United States)

    Powell-Jackson, Timothy; Dasgupta, Sushil Kanta; Chowdhury, Mahbub Elahi; Koblinsky, Marge

    2012-01-01

    This paper assesses both out-of-pocket payments for healthcare and losses of productivity over six months postpartum among women who gave birth in Matlab, Bangladesh. The hypothesis of the study objective is that obstetric morbidity leads women to seek care at which time out-of-pocket expenditure is incurred. Second, a woman may also take time out from employment or from doing her household chores. This loss of resources places a financial burden on the household that may lead to reduced consumption of usual but less important goods and use of other services depending on the extent to which a household copes up by using savings, taking loans, and selling assets. Women were divided into three groups based on their morbidity patterns: (a) women with a severe obstetric complication (n=92); (b) women with a less-severe obstetric complication (n=127); and (c) women with a normal delivery (n=483). Data were collected from households of these women at two time-points—at six weeks and six months after delivery. The results showed that maternal morbidity led to a considerable loss of resources up to six weeks postpartum, with the greatest financial burden of cost of healthcare among the poorest households. However, families coped up with loss of resources by taking loans and selling assets, and by the end of six months postpartum, the households had paid back more than 40% of the loans. PMID:22838162

  5. The Relative Efficiency of Charter Schools: A Cost Frontier Approach

    Science.gov (United States)

    Gronberg, Timothy J.; Jansen, Dennis W.; Taylor, Lori L.

    2012-01-01

    Charters represent an expansion of public school choice, offering free, publicly funded educational alternatives to traditional public schools. One relatively unexplored research question concerning charter schools asks whether charter schools are more efficient suppliers of educational services than are traditional public schools. The potential…

  6. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Public relations and... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 2131.205-1 Public relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the following...

  7. Comparing the relative cost-effectiveness of diagnostic studies: a new model

    International Nuclear Information System (INIS)

    Patton, D.D.; Woolfenden, J.M.; Wellish, K.L.

    1986-01-01

    We have developed a model to compare the relative cost-effectiveness of two or more diagnostic tests. The model defines a cost-effectiveness ratio (CER) for a diagnostic test as the ratio of effective cost to base cost, only dollar costs considered. Effective cost includes base cost, cost of dealing with expected side effects, and wastage due to imperfect test performance. Test performance is measured by diagnostic utility (DU), a measure of test outcomes incorporating the decision-analytic variables sensitivity, specificity, equivocal fraction, disease probability, and outcome utility. Each of these factors affecting DU, and hence CER, is a local, not universal, value; these local values strongly affect CER, which in effect becomes a property of the local medical setting. When DU = +1 and there are no adverse effects, CER = 1 and the patient benefits from the test dollar for dollar. When there are adverse effects effective cost exceeds base cost, and for an imperfect test DU 1. As DU approaches 0 (worthless test), CER approaches infinity (no effectiveness at any cost). If DU is negative, indicating that doing the test at all would be detrimental, CER also becomes negative. We conclude that the CER model is a useful preliminary method for ranking the relative cost-effectiveness of diagnostic tests, and that the comparisons would best be done using local values; different groups might well arrive at different rankings. (Author)

  8. Innovation in technology for the least product price and cost - a new minimum cost relation for reductions during technological learning

    International Nuclear Information System (INIS)

    Duffey, R.B.

    2004-01-01

    By analogy with the concepts of human learning, we show and introduce a new method to obtain least product cost and price that includes the effect of innovation and technological learning in manufacturing and production. This key result is a new paradigm instead of the usual economic 'power law' formulation. The new analysis is based on extensive analysis of many technological systems, and is directly related to the presence of learning as experience is accumulated. The results agree with the observed data. By using a consistent basis, the method replaces previous empirical 'power law' descriptions of the technological learning curve with a new 'marginal minimum cost equation' (MCE). (author)

  9. Validation of generic cost estimates for construction-related activities at nuclear power plants: Final report

    International Nuclear Information System (INIS)

    Simion, G.; Sciacca, F.; Claiborne, E.; Watlington, B.; Riordan, B.; McLaughlin, M.

    1988-05-01

    This report represents a validation study of the cost methodologies and quantitative factors derived in Labor Productivity Adjustment Factors and Generic Methodology for Estimating the Labor Cost Associated with the Removal of Hardware, Materials, and Structures From Nuclear Power Plants. This cost methodology was developed to support NRC analysts in determining generic estimates of removal, installation, and total labor costs for construction-related activities at nuclear generating stations. In addition to the validation discussion, this report reviews the generic cost analysis methodology employed. It also discusses each of the individual cost factors used in estimating the costs of physical modifications at nuclear power plants. The generic estimating approach presented uses the /open quotes/greenfield/close quotes/ or new plant construction installation costs compiled in the Energy Economic Data Base (EEDB) as a baseline. These baseline costs are then adjusted to account for labor productivity, radiation fields, learning curve effects, and impacts on ancillary systems or components. For comparisons of estimated vs actual labor costs, approximately four dozen actual cost data points (as reported by 14 nuclear utilities) were obtained. Detailed background information was collected on each individual data point to give the best understanding possible so that the labor productivity factors, removal factors, etc., could judiciously be chosen. This study concludes that cost estimates that are typically within 40% of the actual values can be generated by prudently using the methodologies and cost factors investigated herein

  10. Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease.

    Science.gov (United States)

    Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

    2010-11-01

    Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year. Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on

  11. Strategies for Biologic Image-Guided Dose Escalation: A Review

    International Nuclear Information System (INIS)

    Sovik, Aste; Malinen, Eirik; Olsen, Dag Rune

    2009-01-01

    There is increasing interest in how to incorporate functional and molecular information obtained by noninvasive, three-dimensional tumor imaging into radiotherapy. The key issues are to identify radioresistant regions that can be targeted for dose escalation, and to develop radiation dose prescription and delivery strategies providing optimal treatment for the individual patient. In the present work, we review the proposed strategies for biologic image-guided dose escalation with intensity-modulated radiation therapy. Biologic imaging modalities and the derived images are discussed, as are methods for target volume delineation. Different dose escalation strategies and techniques for treatment delivery and treatment plan evaluation are also addressed. Furthermore, we consider the need for response monitoring during treatment. We conclude with a summary of the current status of biologic image-based dose escalation and of areas where further work is needed for this strategy to become incorporated into clinical practice

  12. The cost of nuclear electricity: France after Fukushima

    International Nuclear Information System (INIS)

    Boccard, Nicolas

    2014-01-01

    The Fukushima disaster has lead the French government to release novel cost information relative to its nuclear electricity program allowing us to compute a levelized cost. We identify a modest escalation of capital cost and a larger than expected operational cost. Under the best scenario, the cost of French nuclear power over the last four decades is 59€/MWh (at 2010 prices) while in the worst case it is 83€/MWh. On the basis of these findings, we estimate the future cost of nuclear power in France to be at least 76€/MWh and possibly 117€/MWh. A comparison with the US confirms that French nuclear electricity nevertheless remains cheaper. Comparisons with coal, natural gas and wind power are carried out to find the advantage of these. - Highlights: • We compute the levelized cost of French nuclear power over 40 years using a novel court of audit report. • We include R and D, technology development, fissile fuel, financing cost, decommissioning and the back-end cycle. • We find a mild capital cost escalation and a high operation cost driven by a low fleet availability. • The levelized cost ranges between 59 and 83€/MWh (at 2010 prices) and compares favorably to the US. • A tentative cost for future nuclear power ranges between 76 and 117€/MWh and compares unfavorably against alternative fuels

  13. Conflict escalation in paediatric services: findings from a qualitative study

    OpenAIRE

    Forbat, Liz; Teuten, Bea; Barclay, Sarah

    2015-01-01

    Objective To explore clinician and family experiences of conflict in paediatric services, in order to map the trajectory of conflict escalation. Design Qualitative interview study, employing extreme-case sampling. Interviews were analysed using an iterative thematic approach to identify common themes regarding the experience and escalation of conflict. Participants Thirty-eight health professionals and eight parents. All participants had direct experience of conflict, including physical assau...

  14. Deterrence Adrift Mapping Conflict and Escalation in South Asia

    Science.gov (United States)

    2016-06-21

    will paralyze India’s political leadership from authorizing Cold Start in the first place , or at the very least, force India to drastically curb its...Pakistan believes that its willingness to escalate will either deter New Delhi from cross-border adventurism in the first place or achieve some...difficulty calibrating a limited ground offensive in a way that does not precipitate an escalation spiral. In es- sence , India’s quandary reflects one of

  15. Managing Conflict: Examining Recent PLA Writings on Escalation Control

    Science.gov (United States)

    2016-02-01

    Cleared for Public Release Managing Conflict: Examining Recent PLA Writings on Escalation Control Alison A. Kaufman, Daniel...ANSI Std. Z39.18 i Abstract This study examines how people in China’s People’s Liberation Army ( PLA ) think about and discuss...escalation control in their public writings. It draws on over two dozen PLA writings, most issued since 2008, to explore the current state of PLA

  16. The hospital costs of treating work-related sawmill injuries in British Columbia.

    Science.gov (United States)

    Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

    2007-05-01

    This study estimates the hospital costs of treating work-related injury among a cohort of sawmill workers in British Columbia. Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5,876 actively employed sawmill workers. Injury cases were identified as work-related from these records using ICD-9 external cause of injury codes that indicate place of occurrence and the responsibility of payment schedule that identifies workers' compensation as being responsible for payment. The hospitals in British Columbia have a standard ward rate chart prepared annually by the provincial Ministry of Health to bill and collect payment from agency like workers' compensation agency. Costs were calculated from the hospital perspective using this billing chart. All costs were expressed in 1995 Canadian dollars. The workers' compensation claim records for this study population were extracted and matched with the hospitalised work-related injury records. Costs were also calculated for work-related hospitalisations that the hospital did not appear to be reimbursed for by the workers' compensation system. There were 173 injuries requiring hospitalisation during the 10-year followup period. The median stay in hospitals was 3 days and the median hospital costs were $847. The most costly cause of injury categories were fire, flame, natural and environmental and struck against with median costs of $10,575 and $1,206, respectively, while the least costly category was cutting and piercing with median costs of $296. The most costly nature of injury categories were burns and fracture of lower limb with median costs of $10,575 and $1,800, respectively, while the least costly category was dislocation, sprains and strains with median costs of $437. The total hospital costs for all the work-related injuries were $434,990. Out of a total hospital cost of $434,990 for the 173 work-related injuries, the provincial compensation agency apparently did not compensate $50,663 (12

  17. Soviet declaratory policy regarding the controllability of escalation

    International Nuclear Information System (INIS)

    Prewitt, J.L.

    1991-01-01

    Three variables were examined for their affect on Soviet views regarding the controllability of escalation. The first was bureaucratic affiliation. It was hypothesized that individuals affiliated with groups which directly controlled weapons would be more likely to support the controllability of escalation than those who were members of groups which did not control weapons. This hypothesis could not be rejected. The second variable was a commentator's rank. It was hypothesized that rank would act in two ways: (1) ideas regarding controlled escalation would appear at lower ranks first; and (2) unique views would be produced by specialized ranks within groups. The rank hypothesis could not be rejected. Certain escalation themes appeared to be presented first by military and civilian writers before being presented by the political leadership. The third variable, image of the West, did not appear to function as theorized. It was hypothesized that hard images of the West would be associated with the rejection of controlled escalation, whereas soft images would be associated with positions suggesting that escalation was controlled through joint US-Soviet cooperation

  18. Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Wallman, Johan K; Eriksson, Jonas K; Nilsson, Jan-Åke

    2016-01-01

    between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs. RESULTS: Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work......OBJECTIVE: To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA). METHODS: Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005-2010. Health Assessment...... Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare...

  19. 48 CFR 31.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Public relations and... Organizations 31.205-1 Public relations and advertising costs. (a) Public relations means all functions and...; or (2) Maintaining or promoting reciprocal understanding and favorable relations with the public at...

  20. Project schedule and cost estimate report

    International Nuclear Information System (INIS)

    1988-03-01

    All cost tables represent obligation dollars, at both a constant FY 1987 level and an estimated escalation level, and are based on the FY 1989 DOE Congressional Budget submittal of December 1987. The cost tables display the total UMTRA Project estimated costs, which include both Federal and state funding. The Total Estimated Cost (TEC) for the UMTRA Project is approximately $992.5 million (in 1987 escalated dollars). Project schedules have been developed that provide for Project completion by September 1994, subject to Congressional approval extending DOE's authorization under Public Law 95-604. The report contains site-specific demographic data, conceptual design assumptions, preliminary cost estimates, and site schedules. A general project overview is also presented, which includes a discussion of the basis for the schedule and cost estimates, contingency assumptions, work breakdown structure, and potential project risks. The schedules and cost estimates will be revised as necessary to reflect appropriate decisions relating to relocation of certain tailings piles, or other special design considerations or circumstances (such as revised EPA groundwater standards), and changes in the Project mission. 27 figs', 97 tabs

  1. Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland.

    Directory of Open Access Journals (Sweden)

    Themba G Ginindza

    Full Text Available Human papillomavirus (HPV has proven to be the cause of several severe clinical conditions on the cervix, vulva, vagina, anus, oropharynx and penis. Several studies have assessed the costs of cervical lesions, cervical cancer (CC, and genital warts. However, few have been done in Africa and none in Swaziland. Cost analysis is critical in providing useful information for economic evaluations to guide policymakers concerned with the allocation of resources in order to reduce the disease burden.A prevalence-based cost of illness (COI methodology was used to investigate the economic burden of HPV-related diseases. We used a top-down approach for the cost associated with hospital care and a bottom-up approach to estimate the cost associated with outpatient and primary care. The current study was conducted from a provider perspective since the state bears the majority of the costs of screening and treatment in Swaziland. All identifiable direct medical costs were considered for cervical lesions, cervical cancer and genital warts, which were primary diagnoses during 2015. A mix of bottom up micro-costing ingredients approach and top-down approaches was used to collect data on costs. All costs were computed at the price level of 2015 and converted to dollars ($.The total annual estimated direct medical cost associated with screening, managing and treating cervical lesions, CC and genital warts in Swaziland was $16 million. The largest cost in the analysis was estimated for treatment of high-grade cervical lesions and cervical cancer representing 80% of the total cost ($12.6 million. Costs for screening only represented 5% of the total cost ($0.9 million. Treatment of genital warts represented 6% of the total cost ($1million.According to the cost estimations in this study, the economic burden of HPV-related cervical diseases and genital warts represents a major public health issue in Swaziland. Prevention of HPV infection with a national HPV immunization

  2. Temperature escalation in PWR fuel rod simulators due to the zircaloy/steam reaction ESSI-4 ESSI-11

    International Nuclear Information System (INIS)

    Hagen, S.; Kapulla, H.; Malauscheck, H.; Wallenfels, K.P.; Buescher, B.J.

    1985-03-01

    The tests had the initial heatup rate as main parameter. The experimental arrangement consisted of a fuel rod simulator (central tungsten heater, UO 2 ring pellets and zircaloy cladding), a zircaloy shroud and the fiber ceramic insulation. A steam flow of ca. 20 g/min was introduced at the lower end of the bundle. A temperature escalation was observed in every test. The maximum cladding surface temperature in the single rod tests never exceeded 2200 0 C. The escalation began in the upper region of the rods and moved down the rods, opposite to the direction of steam flow. For fast initial heatup rates, the runoff of molten zircaloy was a limiting process for the escalation. For slow heatup rates, the formation of a protective oxide layer reduced the reaction rate. The test with less insulation thickness showed a reduction of the escalation. A stronger influence was found for the gap between shroud and insulation. This is caused by convection heat losses to the steam circulating in this gap by natural convection. Removal of the gap between shroud and insulation in essentially the same experimental arrangement produced a faster escalation. The posttest appearance of the fuel rod simulators showed that, at slow heatup rates oxidation of the cladding was complete, and the fuel rod was relatively intact. Conversely, at fast heatup rates, relatively little cladding oxidation with extensive dissolution of the UO 2 pellets and runoff of molten cladding was observed. (orig./HP) [de

  3. Cost-effectiveness of single versus double embryo transfer in IVF in relation to female age

    NARCIS (Netherlands)

    van Loendersloot, Laura L.; Moolenaar, Lobke M.; van Wely, Madelon; Repping, Sjoerd; Bossuyt, Patrick M.; Hompes, Peter G. A.; van der Veen, Fulco; Mol, Ben Willem J.

    2017-01-01

    Objective: To evaluate the cost-effectiveness of single embryo transfer followed by an additional frozen thawed single embryo transfer, if more embryos are available, as compared to double embryo transfer in relation to female age. Study design: We used a decision tree model to evaluate the costs

  4. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    Science.gov (United States)

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  5. The Relationship Between Job Satisfaction and Productivity-Related Costs: A Longitudinal Analysis.

    Science.gov (United States)

    Arnold, Amélie E; Coffeng, Jennifer K; Boot, Cécile R L; van der Beek, Allard J; van Tulder, Maurits W; Nieboer, Dagmar; van Dongen, Johanna M

    2016-09-01

    The aim of this study was to examine the longitudinal relationship between job satisfaction and total productivity-related costs, and between job satisfaction and absenteeism and presenteeism costs separately. A secondary aim was to explore whether these relationships differed across job types. Linear generalized estimating equation analyses were used to explore the longitudinal relationships. To explore whether the relationships differed across job types, stratified analyses were performed. A significant relationship was found between job satisfaction and total productivity-related costs [β = &OV0556;-273; 95% confidence interval (95% CI): -407 to -200] and between job satisfaction and presenteeism costs (β = &OV0556;-276; 95% CI: -367 to -235), but not between job satisfaction and absenteeism costs. These relationships differed across job types. Higher levels of job satisfaction were longitudinally related to lower total productivity-related costs and presenteeism costs, but not to lower absenteeism costs. These relationships seem to differ across job types.

  6. [Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].

    Science.gov (United States)

    Liang, Sen; Zhang, Shun-xiang; Ma, Qi-shan; Xiao, He-wei; Lü, Qiu-ying; Xie, Xu; Mei, Shu-jiang; Hu, Dong-sheng; Zhou, Bo-ping; Li, Bing; Chen, Jing-fang; Cui, Fu-qiang; Wang, Fu-zhen; Liang, Xiao-feng

    2010-12-01

    To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the

  7. A cost summary applicable to seismic construction and maintenance of nuclear safety related piping

    International Nuclear Information System (INIS)

    Stevenson, J.D.

    1995-01-01

    This paper presents a summary of costs applicable to nuclear power plant piping for an earthquake defined as 0.2 SSE-PGA as a function of three eras of initial construction: 1967--1974, 1974--1981 and 1981--1990. Costs have been presented for both new construction and maintenance in operating plants using both the original PSAR-FSAR design criteria and current SRP requirements. It is recommended that the cost information contained in this report be considered in evaluating the cost benefit relationships associated with current and proposed future changes in seismic design procedures applicable to safety-related piping systems

  8. The effects of age, gender, and crash types on drivers' injury-related health care costs.

    Science.gov (United States)

    Shen, Sijun; Neyens, David M

    2015-04-01

    There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

    KAUST Repository

    Mahayni, Malek A.

    2011-01-01

    developed to solve the optimal paths problem with different kinds of graphs. An algorithm that solves the problem of paths’ optimization in directed graphs relative to different cost functions is described in [1]. It follows an approach extended from

  10. Human health risks analysis: assessment of health costs of energy related pollutants

    International Nuclear Information System (INIS)

    Ginevan, M.E.; Grahn, D.; Lundy, R.T.; Brown, C.D.; Curtiss, J.B.

    1979-01-01

    This section contains a summary of research on the assessment of health costs of energy related pollutants. It includes the development of new statistical methodology, mathematical models, and data bases relevant to the assessment

  11. Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

    KAUST Repository

    Abubeker, Jewahir Ali; Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail

    2011-01-01

    This paper is devoted to the consideration of an algorithm for sequential optimization of paths in directed graphs relative to di_erent cost functions. The considered algorithm is based on an extension of dynamic programming which allows

  12. Data Flow in Relation to Life-Cycle Costing of Construction Projects in the Czech Republic

    Science.gov (United States)

    Biolek, Vojtěch; Hanák, Tomáš; Marović, Ivan

    2017-10-01

    Life-cycle costing is an important part of every construction project, as it makes it possible to take into consideration future costs relating to the operation and demolition phase of a built structure. In this way, investors can optimize the project design to minimize the total project costs. Even though there have already been some attempts to implement BIM software in the Czech Republic, the current state of affairs does not support automated data flow between the bill of costs and applications that support building facility management. The main aim of this study is to critically evaluate the current situation and outline a future framework that should allow for the use of the data contained in the bill of costs to manage building operating costs.

  13. The indirect costs of cancer-related absenteeism in the workplace in Poland.

    Science.gov (United States)

    Macioch, Tomasz; Hermanowski, Tomasz

    2011-12-01

    The aim of this study was to evaluate cancer-related absenteeism costs in Poland. Data on sickness absences and disability were retrieved from the Department of Statistics of the Social Insurance Institution. The cost of lost productivity owing to premature death was estimated from data retrieved from the Polish National Cancer Registry. Absenteeism costs were estimated on the basis of the measure of gross value added per employee. The costs of lost productivity owing to sick leave, disability, and premature death were estimated to be 1.572 billion EUR, 0.504 billion EUR, and 0.535 billion EUR, respectively, in 2009. The indirect costs of lost productivity owing to cancer-related sick leave, disability, and premature death have a substantial effect on the Polish economy. In 2009, they accounted for more than 0.8% of GDP.

  14. Sequential optimization of matrix chain multiplication relative to different cost functions

    KAUST Repository

    Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail

    2011-01-01

    In this paper, we present a methodology to optimize matrix chain multiplication sequentially relative to different cost functions such as total number of scalar multiplications, communication overhead in a multiprocessor environment, etc. For n matrices our optimization procedure requires O(n 3) arithmetic operations per one cost function. This work is done in the framework of a dynamic programming extension that allows sequential optimization relative to different criteria. © 2011 Springer-Verlag Berlin Heidelberg.

  15. Conflict escalation in paediatric services: findings from a qualitative study.

    Science.gov (United States)

    Forbat, Liz; Teuten, Bea; Barclay, Sarah

    2015-08-01

    To explore clinician and family experiences of conflict in paediatric services, in order to map the trajectory of conflict escalation. Qualitative interview study, employing extreme-case sampling. Interviews were analysed using an iterative thematic approach to identify common themes regarding the experience and escalation of conflict. Thirty-eight health professionals and eight parents. All participants had direct experience of conflict, including physical assault and court proceedings, at the interface of acute and palliative care. Two teaching hospitals, one district general hospital and two paediatric hospices in England, in 2011. Conflicts escalate in a predictable manner. Clearly identifiable behaviours by both clinicians and parents are defined as mild, moderate and severe. Mild describes features like the insensitive use of language and a history of unresolved conflict. Moderate involves a deterioration of trust, and a breakdown of communication and relationships. Severe marks disintegration of working relationships, characterised by behavioural changes including aggression, and a shift in focus from the child's best interests to the conflict itself. Though conflicts may remain at one level, those which escalated tended to move sequentially from one level to the next. Understanding how conflicts escalate provides clinicians with a practical, evidence-based framework to identify the warning signs of conflict in paediatrics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. E4 - Energy efficient elevators and escalators. Monitoring campaign - Germany

    Energy Technology Data Exchange (ETDEWEB)

    Hirzel, Simon; Boege, Christian

    2009-12-15

    A monitoring campaign was carried out within the E4 project as a contribution to improving the understanding of energy consumption and energy efficiency of elevators and escalators in Europe. The aim of this campaign is to broaden the empirical base on the energy consumption of elevators and escalators, to provide publicly available monitoring data and to find hints on system configurations using little energy. Originally, 50 installations were planned to be monitored within the project. In the end, 74 elevators and 7 escalators, i.e. a total of 81 installations, were analyzed in the four countries under study: Portugal, Poland, Italy and Germany. The aim of this document is to summarize the results of the German monitoring campaign with its 14 installations (13 elevators, 1 escalator) and to provide interested readers with some additional information on the campaign. This document has six parts: Second, after the introductory section, some general information on the monitoring methodology is provided as a background for understanding and interpreting the subsequent results. In the third part, information on the monitored elevator installations and their characteristics is given. Part four is concerned with presenting and discussing the results of the monitoring campaign for the elevators while part five shortly presents the results for the monitored escalator. Finally, some conclusions are found in the last part. (orig.)

  17. Costs and compensation of work‐related injuries in British Columbia sawmills

    Science.gov (United States)

    Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

    2007-01-01

    Objective To estimate the costs of work‐related injury in a cohort of sawmill workers in British Columbia from the perspective of the workers' compensation system. Methods Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5786 actively employed sawmill workers. A total of 173 work‐related injury cases were identified from these records using the International classification of diseases—ninth revision (ICD‐9) external cause of injury codes and the responsibility of payment schedule. Workers' compensation records were extracted and matched with hospital records by dates and ICD‐9 diagnosis codes. All costs were converted into 1995 constant Canadian dollars using the Provincial General Consumer Price Index for the non‐healthcare costs and Medical Consumer Price Index for the healthcare costs. A 5% discounting rate was applied to adjust for the time value of money. For the uncompensated cases, costs were imputed from the compensated cases using the median cost for a similar nature of injury. Results 370 hospitalisation events due to injury were captured, and by either of the two indicators (E Codes or payment schedules), 173 (47%) hospitalisation events due to injury, were identified as work related. The median healthcare cost was $4377 and the median non‐healthcare cost was $16 559 for a work‐related injury. The median non‐healthcare and healthcare costs by injury were falls, $19 978 and $5185; struck by falling object, $32 398 and $8625; struck against, $12 667 and $5741; machinery related, $26 480 and $6643; caught in or between, $24 130 and $4389; and overexertion, $7801 and $2710. The total cost was $10 374 115 for non‐healthcare and $1 764 137 for healthcare. The compensation agency did not compensate $874 871 (8.4%) of the non‐healthcare costs and $200 588 (11.4%) of the healthcare costs. Conclusion Eliminating avoidable work‐related injury events can save valuable resources. PMID:17053018

  18. Costs and compensation of work-related injuries in British Columbia sawmills.

    Science.gov (United States)

    Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

    2007-03-01

    To estimate the costs of work-related injury in a cohort of sawmill workers in British Columbia from the perspective of the workers' compensation system. Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5786 actively employed sawmill workers. A total of 173 work-related injury cases were identified from these records using the International classification of diseases-ninth revision (ICD-9) external cause of injury codes and the responsibility of payment schedule. Workers' compensation records were extracted and matched with hospital records by dates and ICD-9 diagnosis codes. All costs were converted into 1995 constant Canadian dollars using the Provincial General Consumer Price Index for the non-healthcare costs and Medical Consumer Price Index for the healthcare costs. A 5% discounting rate was applied to adjust for the time value of money. For the uncompensated cases, costs were imputed from the compensated cases using the median cost for a similar nature of injury. 370 hospitalisation events due to injury were captured, and by either of the two indicators (E Codes or payment schedules), 173 (47%) hospitalisation events due to injury, were identified as work related. The median healthcare cost was 4377 dollars and the median non-healthcare cost was 16,559 dollars for a work-related injury. The median non-healthcare and healthcare costs by injury were falls, 19,978 dollars and 5185 dollars; struck by falling object, 32,398 dollars and 8625 dollars; struck against, 12,667 dollars and 5741 dollars; machinery related, 26,480 dollars and 6643 dollars; caught in or between, 24,130 dollars and 4389 dollars; and overexertion, 7801 dollars and 2710 dollars. The total cost was 10,374,115 dollars for non-healthcare and 1,764,137 dollars for healthcare. The compensation agency did not compensate 874,871 dollars (8.4%) of the non-healthcare costs and 200,588 dollars (11.4%) of the healthcare costs. Eliminating avoidable work-related injury events

  19. Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. The Alteplase Dose Assessment for Pleural Infection Therapy Project.

    Science.gov (United States)

    Popowicz, Natalia; Bintcliffe, Oliver; De Fonseka, Duneesha; Blyth, Kevin G; Smith, Nicola A; Piccolo, Francesco; Martin, Geoffrey; Wong, Donny; Edey, Anthony; Maskell, Nick; Lee, Y C Gary

    2017-06-01

    Intrapleural therapy with a combination of tissue plasminogen activator (tPA) 10 mg and DNase 5 mg administered twice daily has been shown in randomized and open-label studies to successfully manage over 90% of patients with pleural infection without surgery. Potential bleeding risks associated with intrapleural tPA and its costs remain important concerns. The aim of the ongoing Alteplase Dose Assessment for Pleural infection Therapy (ADAPT) project is to investigate the efficacy and safety of dose de-escalation for intrapleural tPA. The first of several planned studies is presented here. To evaluate the efficacy and safety of a reduced starting dose regimen of 5 mg of tPA with 5 mg of DNase administered intrapleurally for pleural infection. Consecutive patients with pleural infection at four participating centers in Australia, the United Kingdom, and New Zealand were included in this observational, open-label study. Treatment was initiated with tPA 5 mg and DNase 5 mg twice daily. Subsequent dose escalation was permitted at the discretion of the attending physician. Data relating to treatment success, radiological and systemic inflammatory changes (blood C-reactive protein), volume of fluid drained, length of hospital stay, and treatment complications were extracted retrospectively from the medical records. We evaluated 61 patients (41 males; age, 57 ± 16 yr). Most patients (n = 58 [93.4%]) were successfully treated without requiring surgery for pleural infection. Treatment success was corroborated by clearance of pleural opacities visualized by chest radiography (from 42% [interquartile range, 22-58] to 16% [8-31] of hemithorax; P < 0.001), increase in pleural fluid drainage (from 175 ml in the 24 h preceding treatment to 2,025 ml [interquartile range, 1,247-2,984] over 72 h of therapy; P <  0.05) and a reduction in blood C-reactive protein (P < 0.05). Seven patients (11.5%) had dose escalation of tPA to 10 mg. Three patients underwent

  20. Planning ahead: Improving escalation plans before the weekend.

    Science.gov (United States)

    Zarkali, Angeliki; Black, Duncan; Smee, Elizabeth; Deshraj, Anshul; Smallwood, Nicholas

    2014-01-01

    Handover is the system by which responsibility for patient care is transferred between healthcare professionals. A significant aspect of handover is the existence of an escalation plan for each patient in case of deterioration over the weekend. According to the Royal College of Physicians, all patients should have a clear escalation plan documented in the notes before a weekend, since parent medical teams (Consultant team in charge of care) are best placed to make these decisions. If left to on-call teams, at a time of deterioration over a weekend, they might not have all available information, the patient might be unable to be involved in the decisions, and the family might not be consulted. With this is mind, we decided to analyse the existing handover process in a medium sized district general hospital, with the aim of improving the process and the documentation of escalation plans. The results from our retrospective analysis of the system in place revealed a significant lack of documentation of escalation plans in the medical notes. Three sample wards were selected to analyse the current handover system and test proposed measures before hospital-wide implementation. After trialling of a physical handover meeting in addition to the existing intranet system and a proforma for the Friday ward round, the documentation of escalation plans in the patients' notes improved from 9.1% to 41.1%. Based on these results, as well as formal feedback from junior doctors and informal feedback from other staff, the physical handover meeting and Friday ward round proforma will be implemented throughout the Trust. Our interventions led to an improvement in the documentation of escalation plans in our hospital, thus saving precious time in the event of a patient's deterioration. This also ensures that families and patients are involved in the decision making process and kept informed, and reduces the burden for the weekend on-call teams.

  1. Cost of tobacco-related diseases, including passive smoking, in Hong Kong.

    Science.gov (United States)

    McGhee, S M; Ho, L M; Lapsley, H M; Chau, J; Cheung, W L; Ho, S Y; Pow, M; Lam, T H; Hedley, A J

    2006-04-01

    Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking. To estimate the health-related costs of tobacco from both active and passive smoking. Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of USD 1.3 million for a life lost. In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was USD 532 million for active smoking and USD 156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to USD 9.4 billion. The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere.

  2. Dose Escalation Methods in Phase I Cancer Clinical Trials

    OpenAIRE

    Le Tourneau, Christophe; Lee, J. Jack; Siu, Lillian L.

    2009-01-01

    Phase I clinical trials are an essential step in the development of anticancer drugs. The main goal of these studies is to establish the recommended dose and/or schedule of new drugs or drug combinations for phase II trials. The guiding principle for dose escalation in phase I trials is to avoid exposing too many patients to subtherapeutic doses while preserving safety and maintaining rapid accrual. Here we review dose escalation methods for phase I trials, including the rule-based and model-...

  3. Allocation to reproduction and relative reproductive costs in two species of dioecious Anacardiaceae with contrasting phenology.

    Science.gov (United States)

    Matsuyama, Shuhei; Sakimoto, Michinori

    2008-06-01

    The cost of reproduction in dioecious plants is often female-biased. However, several studies have reported no difference in costs of reproduction between the sexes. In this study, the relative reproductive allocation and costs at the shoot and whole-plant levels were examined in woody dioecious Rhus javanica and R. trichocarpa, in order to examine differences between types of phenophase (i.e. physiological stage of development). Male and female Rhus javanica and R. trichocarpa were sampled and the reproductive and vegetative allocation of the shoot were estimated by harvesting reproductive current-year shoots during flowering and fruiting. Measurements were made of the number of reproductive and total current-year shoots per whole plant, and of the basal area increment (BAI). The numbers of reproductive and total current-year shoots per 1-year-old shoot were counted in order to examine the costs in the following year at the shoot level. A female-biased annual reproductive allocation was found; however, the ratio of reproductive current-year shoots per tree and the BAI did not differ between sexes in Rhus javanica and R. trichocarpa. The percentage of 1-year-old shoots with at least one reproductive current-year shoot was significantly male-biased in R. trichocarpa, but not in R. javanica, indicating that there was a relative cost at the shoot level only in R. trichocarpa. The female-biased leaf mass per shoot, an indicator of compensation for costs, was only found in R. javanica. Relative reproductive costs at the shoot level were detected in Rhus trichocarpa, which has simultaneous leafing and flowering, but not in R. javanica, which has leafing followed by flowering. However, the costs for the whole-plant level were diminished in both species. The results suggest that the phenophase type may produce the different costs for R. javanica and R. trichocarpa through the development of a compensation mechanism.

  4. Risk, innovation, electricity infrastructure and construction cost overruns: Testing six hypotheses

    International Nuclear Information System (INIS)

    Sovacool, Benjamin K.; Gilbert, Alex; Nugent, Daniel

    2014-01-01

    This study investigates the frequency and magnitude of cost and time overruns occurring during the construction of 401 electricity projects built between 1936 and 2014 in 57 countries. In aggregate, these projects required approximately $820 billion in investment, and amounted to 325,515 MW of installed capacity and 8495 km of transmission lines. We use this sample of projects to test six hypotheses about construction cost overruns related to (1) diseconomies of scale, (2) project delays, (3) technological learning, (4) regulation and markets, (5) decentralization and modularity, and (6) normalization of results to scale. We find that nuclear reactors are the riskiest technology in terms of mean cost escalation as a percentage of budget and frequency; that hydroelectric dams stand apart for their mean cost escalation in total dollars; that many of the hypotheses grounded in the literature appear wrong; and that financing, partnerships, modularity, and accountability may have more to do with overruns than technology. - Highlights: • Many hypotheses about construction overruns grounded in the literature appear wrong. • Nuclear reactors are the most prone to cost overruns as a percentage of budget and frequency. • Hydroelectric dams stand apart for their mean cost escalation in total dollars. • Solar and wind energy systems are least at risk to cost overruns

  5. Evolution of investment costs related to wood energy collective installations (2000-2006). Final report - Synthesis

    International Nuclear Information System (INIS)

    2009-04-01

    Based on a survey on 90 French projects, and on a comparison with 76 German projects and 36 Austrian projects, this document proposes a synthesis of a study which aimed at identifying and analysing the evolution of investment costs for wood collective heating systems between 2000 and 2006. Data are analysed and commented while stressing their limitations which are related to their quality, to project heterogeneity, to economic value scattering. The evolution of investment costs of French projects is analysed in terms of global cost, and of items (heat production, public works, studies and construction, item ratios)

  6. Cost-of-illness and disease burden of food-related pathogens in the Netherlands, 2011

    NARCIS (Netherlands)

    Mangen, Marie Josée J; Bouwknegt, Martijn; Friesema, Ingrid H M; Haagsma, Juanita A.; Kortbeek, Laetitia M.; Tariq, Luqman; Wilson, Margaret; van Pelt, Wilfrid; Havelaar, Arie H.|info:eu-repo/dai/nl/072306122

    2015-01-01

    To inform risk management decisions on control and prevention of food-related disease, both the disease burden expressed in Disability Adjusted Life Years (DALY) and the cost-of-illness of food-related pathogens are estimated and presented. Disease burden of fourteen pathogens that can be

  7. Relating cost-benefit analysis results with transport project decisions in the Netherlands

    NARCIS (Netherlands)

    Annema, Jan Anne; Frenken, Koen|info:eu-repo/dai/nl/207145253; Koopmans, Carl; Kroesen, Maarten

    2017-01-01

    This paper relates the cost-benefit analysis (CBA) results of transportation policy proposals in the Netherlands with the decision to implement or abandon the proposal. The aim of this study is to explore the relation between the CBA results and decision-making. Multinomial logit regression models

  8. Relating cost-benefit analysis results with transport project decisions in the Netherlands

    NARCIS (Netherlands)

    Annema, J.A.; Frenken, Koen; Koopmans, Carl; Kroesen, M.

    2017-01-01

    This paper relates the cost-benefit analysis (CBA) results of transportation policy proposals in the Netherlands with the decision to implement or abandon the proposal. The aim of this study is to explore the relation between the CBA results and decision-making. Multinomial logit regression

  9. Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results from a Pilot Study

    Science.gov (United States)

    Patel, Minal R.; Resnicow, Kenneth; Lang, Ian; Kraus, Kathleen; Heisler, Michele

    2018-01-01

    Background: Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. Aims: We developed a financial burden resource tool and examined its acceptability and the preliminary effects on…

  10. The social process of escalation: a promising focus for crisis management research

    Directory of Open Access Journals (Sweden)

    Bergström Johan

    2012-06-01

    Full Text Available Abstract Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved. However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

  11. Effect of a simple dose-escalation schedule on tramadol tolerability : assessment in the clinical setting.

    Science.gov (United States)

    Tagarro, I; Herrera, J; Barutell, C; Díez, M C; Marín, M; Samper, D; Busquet, C; Rodríguez, M J

    2005-01-01

    To assess the effect of a very simple dose-escalation schedule on tramadol tolerability in clinical practice. This schedule consists of starting treatment with sustained-release tramadol 50mg twice daily, and escalating the dose around 7 days later to 100mg twice daily. Data from 1925 outpatients with non-malignant chronic pain were collected in this multicentre, prospective, comparative, non-randomised, open, observational study. A total of 1071 patients (55.6%) were included in the dose-escalation group (50mg group) and 854 patients (44.4%) in the control group (sustained-release tramadol 100mg twice daily; 100mg group). The proportion of patients who interrupted tramadol treatment due to the occurrence of adverse reactions was significantly lower in the 50mg group (5.6%) than in the 100mg group (12.6%) [p = 0.001]. In line with this, the proportion of patients who experienced at least one adverse reaction was significantly lower in the 50mg group (18.4%) than in the 100mg group (30.4%) [p = 0.001] and, interestingly, the two most frequently reported adverse reactions, nausea and dizziness, were found with a significantly lower frequency in the 50mg group (p < 0.001). Multivariate analysis showed that the risk of safety-related treatment cessations was 2.3 times higher in the 100mg group than in the 50mg group, and 2.2 times higher in females than in males. The two treatments were equally effective in reducing pain intensity (p = 0.121), measured as a reduction in pain score obtained by means of a visual analogue scale. The instauration of tramadol treatment, starting with sustained-release 50mg capsules twice daily and escalating the dose some days later to 100mg twice daily, was shown to be an effective and easy way to improve tramadol tolerability in clinical practice, whilst maintaining its analgesic efficacy.

  12. City-scale analysis of water-related energy identifies more cost-effective solutions.

    Science.gov (United States)

    Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

    2017-02-01

    Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This

  13. What Causes Cost Overrun in Transport Infrastructure Projects?

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

    cost escalation for three types of project ownership - private, state-owned enterprise and other public ownership - it is shown that the oft-seen claim that public ownership is problematic and private ownership effective in curbing cost escalation is an oversimplification. Type of accountability......This article presents results from the first statistically significant study of causes of cost escalation in transport infrastructure projects. The study is based on a sample of 258 rail, bridge, tunnel and roads projects worth US$90 billion. The focus is on the dependence of cost escalation on (1......) length of project implementation phase, (2) size of project and (3) type of project ownership. First, it is found with very high statistical significance that cost escalation is strongly dependent on length of implementation phase. The policy implications are clear: Decision makers and planners should...

  14. Induction-related cost of patients with acute myeloid leukaemia in France.

    Science.gov (United States)

    Nerich, Virginie; Lioure, Bruno; Rave, Maryline; Recher, Christian; Pigneux, Arnaud; Witz, Brigitte; Escoffre-Barbe, Martine; Moles, Marie-Pierre; Jourdan, Eric; Cahn, Jean Yves; Woronoff-Lemsi, Marie-Christine

    2011-04-01

    The economic profile of acute myeloid leukaemia (AML) is badly known. The few studies published on this disease are now relatively old and include small numbers of patients. The purpose of this retrospective study was to evaluate the induction-related cost of 500 patients included in the AML 2001 trial, and to determine the explanatory factors of cost. "Induction" patient's hospital stay from admission for "induction" to discharge after induction. The study was performed from the French Public Health insurance perspective, restrictive to hospital institution costs. The average management of a hospital stay for "induction" was evaluated according to the analytical accounting of Besançon University Teaching Hospital and the French public Diagnosis-Related Group database. Multiple linear regression was used to search for explanatory factors. Only direct medical costs were included: treatment and hospitalisation. Mean induction-related direct medical cost was estimated at €41,852 ± 6,037, with a mean length of hospital stay estimated at 36.2 ± 10.7 days. After adjustment for age, sex and performance status, only two explanatory factors were found: an additional induction course and salvage course increased induction-related cost by 38% (± 4) and 15% (± 1) respectively, in comparison to one induction. These explanatory factors were associated with a significant increase in the mean length of hospital stay: 45.8 ± 11.6 days for 2 inductions and 38.5 ± 15.5 if the patient had a salvage course, in comparison to 32.9 ± 7.7 for one induction (P cost for patients with AML.

  15. Indirect, out-of-pocket and medical costs from influenza-related illness in young children.

    Science.gov (United States)

    Ortega-Sanchez, Ismael R; Molinari, Noelle-Angelique M; Fairbrother, Gerry; Szilagyi, Peter G; Edwards, Kathryn M; Griffin, Marie R; Cassedy, Amy; Poehling, Katherine A; Bridges, Carolyn; Staat, Mary Allen

    2012-06-13

    Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. Using a population-based surveillance network, we evaluated a representative group of children aged accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination. Published by Elsevier Ltd.

  16. Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research.

    Science.gov (United States)

    van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

    2018-01-01

    The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2) developing a costing tool to support reviewers of grant proposals in assessing whether the proposed budget is realistic. For granted study proposals from the Netherlands Organization for Health Research and Development (ZonMw), type of study, potential cost drivers, proposed budget, and general characteristics were extracted. Regression analysis was conducted in an attempt to generate a 'predicted budget' for certain combinations of cost drivers, for implementation in the costing tool. Of 133 drug-related research grant proposals, 74 were included for complete data extraction. Because an association between cost drivers and budgets was not confirmed, we could not generate a predicted budget based on regression analysis, but only historic reference budgets given certain study characteristics. The costing tool was designed accordingly, i.e. with given selection criteria the tool returns the range of budgets in comparable studies. This range can be used in VOI analysis to estimate whether the expected net benefit of sampling will be positive to decide upon the net value of future research. The absence of association between study characteristics and budgets may indicate inconsistencies in the budgeting or granting process. Nonetheless, the tool generates useful information on historical budgets, and the option to formally relate VOI to budgets. To our knowledge, this is the first attempt at creating such a tool, which can be complemented with new studies being granted, enlarging the underlying database and keeping estimates up to date.

  17. The relation of potassium and sodium intakes to diet cost among U.S. adults.

    Science.gov (United States)

    Drewnowski, A; Rehm, C D; Maillot, M; Monsivais, P

    2015-01-01

    The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.

  18. Dose escalation methods in phase I cancer clinical trials.

    Science.gov (United States)

    Le Tourneau, Christophe; Lee, J Jack; Siu, Lillian L

    2009-05-20

    Phase I clinical trials are an essential step in the development of anticancer drugs. The main goal of these studies is to establish the recommended dose and/or schedule of new drugs or drug combinations for phase II trials. The guiding principle for dose escalation in phase I trials is to avoid exposing too many patients to subtherapeutic doses while preserving safety and maintaining rapid accrual. Here we review dose escalation methods for phase I trials, including the rule-based and model-based dose escalation methods that have been developed to evaluate new anticancer agents. Toxicity has traditionally been the primary endpoint for phase I trials involving cytotoxic agents. However, with the emergence of molecularly targeted anticancer agents, potential alternative endpoints to delineate optimal biological activity, such as plasma drug concentration and target inhibition in tumor or surrogate tissues, have been proposed along with new trial designs. We also describe specific methods for drug combinations as well as methods that use a time-to-event endpoint or both toxicity and efficacy as endpoints. Finally, we present the advantages and drawbacks of the various dose escalation methods and discuss specific applications of the methods in developmental oncotherapeutics.

  19. An Intelligent System for Aggression De-escalation Training

    NARCIS (Netherlands)

    Bosse, T.; Gerritsen, C.; de Man, J.

    2016-01-01

    Artificial Intelligence techniques are increasingly being used to develop smart training applications for professionals in various domains. This paper presents an intelligent training system that enables professionals in the public domain to practice their aggression de-escalation skills. The system

  20. Escalator: An Autonomous Scheduling Scheme for Convergecast in TSCH

    Directory of Open Access Journals (Sweden)

    Sukho Oh

    2018-04-01

    Full Text Available Time Slotted Channel Hopping (TSCH is widely used in the industrial wireless sensor networks due to its high reliability and energy efficiency. Various timeslot and channel scheduling schemes have been proposed for achieving high reliability and energy efficiency for TSCH networks. Recently proposed autonomous scheduling schemes provide flexible timeslot scheduling based on the routing topology, but do not take into account the network traffic and packet forwarding delays. In this paper, we propose an autonomous scheduling scheme for convergecast in TSCH networks with RPL as a routing protocol, named Escalator. Escalator generates a consecutive timeslot schedule along the packet forwarding path to minimize the packet transmission delay. The schedule is generated autonomously by utilizing only the local routing topology information without any additional signaling with other nodes. The generated schedule is guaranteed to be conflict-free, in that all nodes in the network could transmit packets to the sink in every slotframe cycle. We implement Escalator and evaluate its performance with existing autonomous scheduling schemes through a testbed and simulation. Experimental results show that the proposed Escalator has lower end-to-end delay and higher packet delivery ratio compared to the existing schemes regardless of the network topology.

  1. Escalator: An Autonomous Scheduling Scheme for Convergecast in TSCH.

    Science.gov (United States)

    Oh, Sukho; Hwang, DongYeop; Kim, Ki-Hyung; Kim, Kangseok

    2018-04-16

    Time Slotted Channel Hopping (TSCH) is widely used in the industrial wireless sensor networks due to its high reliability and energy efficiency. Various timeslot and channel scheduling schemes have been proposed for achieving high reliability and energy efficiency for TSCH networks. Recently proposed autonomous scheduling schemes provide flexible timeslot scheduling based on the routing topology, but do not take into account the network traffic and packet forwarding delays. In this paper, we propose an autonomous scheduling scheme for convergecast in TSCH networks with RPL as a routing protocol, named Escalator. Escalator generates a consecutive timeslot schedule along the packet forwarding path to minimize the packet transmission delay. The schedule is generated autonomously by utilizing only the local routing topology information without any additional signaling with other nodes. The generated schedule is guaranteed to be conflict-free, in that all nodes in the network could transmit packets to the sink in every slotframe cycle. We implement Escalator and evaluate its performance with existing autonomous scheduling schemes through a testbed and simulation. Experimental results show that the proposed Escalator has lower end-to-end delay and higher packet delivery ratio compared to the existing schemes regardless of the network topology.

  2. Escalating Commitment to a Relationship: The Sexual Harassment Trap.

    Science.gov (United States)

    Williams, Karen B.; Cyr, Ramona R.

    1992-01-01

    Studies divergent sexual harassment perceptions in a case of a perpetrator's gradual sexual advancements and a target's escalating commitment to their relationship, using 60 male and 60 female undergraduates. Males' ratings of sexual harassment decreased when female target participated in increasingly informal friendly interactions. Females'…

  3. Economic Consequences and Potentially Preventable Costs Related to Osteoporosis in the Netherlands.

    Science.gov (United States)

    Dunnewind, Tom; Dvortsin, Evgeni P; Smeets, Hugo M; Konijn, Rob M; Bos, Jens H J; de Boer, Pieter T; van den Bergh, Joop P; Postma, Maarten J

    2017-06-01

    Osteoporosis often does not involve symptoms, and so the actual number of patients with osteoporosis is higher than the number of diagnosed individuals. This underdiagnosis results in a treatment gap. To estimate the total health care resource use and costs related to osteoporosis in the Netherlands, explicitly including fractures, and to estimate the proportion of fracture costs that are linked to the treatment gap and might therefore be potentially preventable; to also formulate, on the basis of these findings, strategies to optimize osteoporosis care and treatment and reduce its related costs. In this retrospective study, data of the Achmea Health Database representing 4.2 million Dutch inhabitants were used to investigate the economic consequence of osteoporosis in the Netherlands in 2010. Specific cohorts were created to identify osteoporosis-related fractures and their costs. Besides, costs of pharmaceutical treatment regarding osteoporosis were included. Using data from the literature, the treatment gap was estimated. Sensitivity analysis was performed on the base-case results. A total of 108,013 individuals with a history of fractures were included in this study. In this population, 59,193 patients were using anti-osteoporotic medication and 86,776 patients were using preventive supplements. A total number of 3,039 osteoporosis-related fractures occurred. The estimated total costs were €465 million. On the basis of data presented in the literature, the treatment gap in our study population was estimated to vary from 60% to 72%. The estimated total costs corrected for treatment gap were €1.15 to €1.64 billion. These results indicate room for improvement in the health care policy against osteoporosis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. The cost of HIV/AIDS-related morbidity and mortality to households: Preliminary estimates for Soweto

    Directory of Open Access Journals (Sweden)

    V Naidu

    2014-06-01

    Full Text Available This article has two main aims: to provide data on the cost of HIV/AIDS to urban South African households and to contribute to the development of a methodology that could be used in later studies. Data on the costs of HIV/AIDS-related morbidity and mortality were collected from a purposively selected sample of households in Soweto on four occasions between September 2002 and August 2003. The sample comprised 61 affected households, which had at least one member with a CD4 count of 200 or less at the start of the study, and 52 non-affected households. Three types of costs were examined – financial, economic and the present value of lost future earnings. The data suggest that the financial costs of morbidity and mortality were three and two times greater, respectively, for affected households than for those non-affected households that reported disease and/or death. Mortality costs far exceeded morbidity costs. The present value of lost future earnings, where the deceased had previously been an income earner, proved to be the major cost incurred by an affected household.

  5. [Costs of temporary disability in Spain related to diabetes mellitus and its complications].

    Science.gov (United States)

    Vicente-Herrero, M Teófila; Terradillos García, M Jesús; Capdevila García, Luisa M; Ramírez Iñiguez de la Torre, M Victoria; López-González, Angel Arturo

    2013-10-01

    To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. In 2011, diabetes and its complications were related to 2.567 TD processes, which resulted in the loss of 154.214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297.095.3 €, with an estimated cost per patient and year of 141 €. These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  6. Procedures’ costs related to outpatient chemotherapy treatment of women suffering from breast cancer

    Directory of Open Access Journals (Sweden)

    Caroline Rife Nobrega

    2014-08-01

    Full Text Available To identify the direct cost of procedures related to an outpatient chemotherapy treatment for women with breast cancer. Method: This is a quantitative research, using the case study methodology, performed in an outpatient chemotherapy of a private hospital. The total cost was calculated by multiplying the time spent by professionals involved in therapeutic procedures, the unit cost of direct labor, adding to the cost of materials, drugs and solutions. For performing the calculations, we used the Brazilian currency (R$. Results: The average total cost per chemotherapy session corresponded to R$ 1,783.01 (100%, being R$ 1,671.66 (93,75% spent with drugs, R$ 74,98 (4.21% with materials, R$ 28.49 (1.60% with labor and R$ 7.88 (0.44% with solutions. Conclusion: The results may support discussions and decision making for the management of costs related to chemotherapy aimed at reducing expenses and eliminating waste without harm to the care provided.

  7. Length of stay and associated costs of obesity related hospital admissions in Ireland.

    LENUS (Irish Health Repository)

    Vellinga, Akke

    2008-01-01

    BACKGROUND: Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem. METHODS: To estimate the length of stay and associated hospital costs for obesity related illnesses a cost of illness study was set up. All discharges from all acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected.A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care. RESULTS: The discharge frequency of obesity related conditions increased from 1.14 in 1997 to 1.49 in 2004 for adults and from 0.81 to 1.37 for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults.Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase. CONCLUSION: The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda.

  8. Health-related economic costs of the Three-Mile Island accident.

    Science.gov (United States)

    Hu, T W; Slaysman, K S

    1984-01-01

    On March 1979, a nuclear power station at Three-Mile Island (TMI) near Harrisburg, Pennsylvania, had a major breakdown. During the two-week period of the accident, about 150,000 residents were evacuated for reasons associated with safety and health. Many residents during and after the accident, regardless of whether they left or stayed, made mental and physical adjustments due to this accident. This paper is to estimate the economic costs incurred by individuals or communities as a result of a change in physical or mental health status and/or a change in health care services due to the TMI accident. The findings indicate that stress symptoms caused by the accident did affect the health-related behaviors of area residents. Of the costs examined, the economic costs of work days lost and physician visits are the largest cost items. There were some increases in consumption of alcohol, cigarettes, and tranquilizers immediately following the accident.

  9. Parameters of Dismantling Techniques Related to Costs for Decommissioning of Nuclear Facilities

    International Nuclear Information System (INIS)

    Jeong, Kwanseong; Moon, Jeikwon; Choi, Byungseon

    2012-01-01

    Reliable cost estimating is one of the most important elements of decommissioning operation. Reliable cost estimating is one of the most important elements of decommissioning planning. Alternative technologies may be evaluated and compared on their efficiency and effectiveness, and measured against a baseline cost as to the feasibility and benefit derived from the technology. This principle ensures that the cost consideration is economically sound and practical for funding. This paper provides a list with basic review of cutting and dismantling techniques, including some typical characteristics if available, as well as aspects of implementation, parameters of cutting and dismantling techniques in decommissioning costing. This paper gives an overview of the principles of the unit factor approach and its implementation in costing in relation to dismantling activities. In general, proper evaluation of decommissioning costs is important for following issues and relevant measures for achieving the listed aspects are: · Selection of a decommissioning strategy and activities: several decommissioning options should be evaluated: · Support to a cost-benefit analysis to ensure that the principle of optimization and reasonably practicable measures are applied: the extent of evaluated decommissioning options should cover all possible scenarios for dismantling activities; · Estimate of required financial resources for the selected strategy: the selected option should involve the dismantling activities in a structure and extent relevant to real procedure of dismantling activities; · Preparation of the project schedule, workforce requirements and phased funding needs: dismantling activities should be structured according to the tasks of the decommissioning schedule; · Definition of measures for proper management and maintenance of resources for safe and timely decommissioning: the time distribution and safety related parameters of dismantling activities should be known

  10. Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

    KAUST Repository

    Mahayni, Malek A.

    2011-07-01

    Finding optimal paths in directed graphs is a wide area of research that has received much of attention in theoretical computer science due to its importance in many applications (e.g., computer networks and road maps). Many algorithms have been developed to solve the optimal paths problem with different kinds of graphs. An algorithm that solves the problem of paths’ optimization in directed graphs relative to different cost functions is described in [1]. It follows an approach extended from the dynamic programming approach as it solves the problem sequentially and works on directed graphs with positive weights and no loop edges. The aim of this thesis is to implement and evaluate that algorithm to find the optimal paths in directed graphs relative to two different cost functions ( , ). A possible interpretation of a directed graph is a network of roads so the weights for the function represent the length of roads, whereas the weights for the function represent a constraint of the width or weight of a vehicle. The optimization aim for those two functions is to minimize the cost relative to the function and maximize the constraint value associated with the function. This thesis also includes finding and proving the relation between the two different cost functions ( , ). When given a value of one function, we can find the best possible value for the other function. This relation is proven theoretically and also implemented and experimented using Matlab®[2].

  11. Biased information processing in the escalation paradigm: information search and information evaluation as potential mediators of escalating commitment.

    Science.gov (United States)

    Schultze, Thomas; Pfeiffer, Felix; Schulz-Hardt, Stefan

    2012-01-01

    Escalation of commitment denotes decision makers' increased reinvestment of resources in a losing course of action. Despite the relevance of this topic, little is known about how information is processed in escalation situations, that is, whether decision makers who receive negative outcome feedback on their initial decision search for and/or process information biasedly and whether these biases contribute to escalating commitment. Contrary to a widely cited study by E. J. Conlon and J. M. Parks (1987), in 3 experiments, the authors found that biases do not occur on the level of information search. Neither in a direct replication and extension of the original study with largely increased test power (Experiment 1) nor under methodologically improved conditions (Experiments 2 and 3) did decision makers responsible for failure differ from nonresponsible decision makers with regards to information search, and no selective search for information supporting the initial decision or voting for further reinvestment was observed. However, Experiments 3 and 4 show that the evaluation of the previously sought information is biased among participants who were responsible for initiating the course of action. Mediation analyses show that this evaluation bias in favor of reinvestment partially mediated the responsibility effect on escalation of commitment.

  12. Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

    Science.gov (United States)

    Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

    2018-03-20

    No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

  13. Alcohol-related hand injuries: an unnecessary social and economic cost.

    OpenAIRE

    Marston, R. A.

    1992-01-01

    Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were therefore preventable. The economic cost to the unit is discussed.

  14. Impact of quadrivalent influenza vaccine on public health and influenza-related costs in Australia

    Directory of Open Access Journals (Sweden)

    Aurélien Jamotte

    2016-07-01

    Full Text Available Abstract Background Annual trivalent influenza vaccines (TIV containing three influenza strains (A/H1N1, A/H3N2, and one B have been recommended for the prevention of influenza. However, worldwide co-circulation of two distinct B lineages (Victoria and Yamagata and difficulties in predicting which lineage will predominate each season have led to the development of quadrivalent influenza vaccines (QIV, which include both B lineages. Our analysis evaluates the public health benefit and associated influenza-related costs avoided which would have been obtained by using QIV rather than TIV in Australia over the period 2002–2012. Methods A static model stratified by age group was used, focusing on people at increased risk of influenza as defined by the Australian vaccination recommendations. B-lineage cross-protection was accounted for. We calculated the potential impact of QIV compared with TIV over the seasons 2002–2012 (2009 pandemic year excluded using Australian data on influenza circulation, vaccine coverage, hospitalisation and mortality rates as well as unit costs, and international data on vaccine effectiveness, influenza attack rate, GP consultation rate and working days lost. Third-party payer and societal influenza-related costs were estimated in 2014 Australian dollars. Sensitivity analyses were conducted. Results Using QIV instead of TIV over the period 2002–2012 would have prevented an estimated 68,271 additional influenza cases, 47,537 GP consultations, 3,522 hospitalisations and 683 deaths in the population at risk of influenza. These results translate into influenza-related societal costs avoided of $46.5 million. The estimated impact of QIV was higher for young children and the elderly. The overall impact of QIV depended mainly on vaccine effectiveness and the influenza attack rate attributable to the mismatched B lineage. Conclusion The broader protection offered by QIV would have reduced the number of influenza infections

  15. Specific count model for investing the related factors of cost of GERD and functional dyspepsia

    Science.gov (United States)

    Abadi, Alireza; Chaibakhsh, Samira; Safaee, Azadeh; Moghimi-Dehkordi, Bijan

    2013-01-01

    Aim The purpose of this study is to analyze the cost of GERD and functional dyspepsia for investing its related factors. Background Gastro-oesophageal reflux disease GERD and dyspepsia are the most common symptoms of gastrointestinal disorders. Recent studies showed high prevalence and variety of clinical presentation of these two symptoms imposed enormous economic burden to the society. Cost data that related to economics burden have specific characteristics. So this kind of data needs to specific models. Poisson regression (PR) and negative binomial regression (NB) are the models that were used for analyzing cost data in this paper. Patients and methods This study designed as a cross-sectional household survey from May 2006 to December 2007 on a random sample of individual in the Tehran province, Iran to find the prevalence of gastrointestinal symptoms and disorders and its related factors. The Cost in each item was counted. PR and NB were carried out to the data respectively. Likelihood ratio test was performed for comparison between models. Also Log likelihood, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare performance of the models. Results According to Likelihood ratio test and all three criterions that we used to compare performance of the models, NB was the best model for analyzing this cost data. Sex, age and insurance statues were being significant. Conclusion PR and NB models were carried out for this data and according the results improved fit of the NB model over PR, it clearly indicates that over-dispersion is involved due to unobserved heterogeneity and/or clustering. NB model in cost data more appropriate fit than PR. PMID:24834282

  16. Cost effectiveness of pegaptanib for the treatment of age-related macular degeneration in the UK.

    Science.gov (United States)

    Wolowacz, Sorrel E; Roskell, Neil; Kelly, Steven; Maciver, Fiona M; Brand, Chris S

    2007-01-01

    Age-related macular degeneration (AMD) is the primary cause of vision loss in the elderly and results in significant economic and humanistic burden. The selective vascular endothelial growth factor inhibitor, pegaptanib (Macugen) is indicated for patients with neovascular AMD. Guidance is needed regarding the cost effectiveness of treatment, any variation between sub-populations of differing clinical characteristics and the optimum duration of treatment. To estimate the cost effectiveness of pegaptanib versus best supportive care (BSC) for AMD from the perspective of the UK government, and to evaluate the impact of patient characteristics and differing treatment discontinuation scenarios. A cohort of 1000 patients aged >45 years with a best-corrected visual acuity (VA) in their better-seeing eye of age, gender, lesion type or lesion size as covariates. Mortality rates were adjusted for the age, gender and VA of the population. Cost effectiveness was expressed as the incremental cost (IC) per vision-year saved and IC/QALY. Uncertainty was explored by probabilistic and univariate sensitivity analysis. Costs (year 2005 values) and outcomes were discounted at 3.5% per anum. In the base-case analysis, treatment was targeted to patients with a VA of 6/12 to 6/95 and discontinued after 2 years, or earlier if VA fell below 6/95 or by > or =6 lines. The IC/QALY was estimated as 8023 pounds(upper 95% CI 20,641 pounds). Cost effectiveness varied by age (age age > or =75 years = 11,657 pounds/QALY) and by pre-treatment VA (6/12-6/95 = 8023 pounds/QALY; 6/12-6/60 = 6664 pounds/QALY; 6/12-6/24 = 1920 pounds/QALY). Gender and lesion type or size had little effect. Cost effectiveness was not sensitive to precise rules for treatment discontinuation, but was maximised if treatment was discontinued in patients no longer likely to benefit. The results suggest that pegaptanib treatment is likely to be cost effective across all groups studied, and marginally more cost effective in

  17. The Social Costs of Health-related Early Retirement in Germany

    DEFF Research Database (Denmark)

    Hostenkamp, Gisela; Stolpe, Michael

    2012-01-01

    Using data from the German Socio-economic Panel, we study how stratification in health and income contributes to the social cost of health-related early retirement, the balance of lost labour income and health benefits. On average, early retirees improve their health by almost two thirds...... of the loss suffered during the last four working years. We calibrate counterfactual scenarios and find keeping all workers in very good health, the highest of five categories of self-assessed health, would delay the average retirement age by more than three years and reduce the social costs by more than 20...

  18. Clinical benefits of antimicrobial de-escalation in adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia.

    Science.gov (United States)

    Lee, Ching-Chi; Wang, Jiun-Ling; Lee, Chung-Hsun; Hung, Yuan-Pin; Hong, Ming-Yuan; Tang, Hung-Jen; Ko, Wen-Chien

    2017-09-01

    The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no-switch strategy in bacteremic patients. Adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia treated empirically using broad-spectrum beta-lactams, including third-generation cephalosporins (GCs), fourth-GC or carbapenems, were treated definitively with first- or second-GCs (de-escalation group), the same regimens as empirical antibiotics (no-switch group), or antibiotics with a broader-spectrum than empirical antibiotics (escalation group). The eligible 454 adults were categorized as the de-escalation (231 patients, 50.9%), no-switch (177, 39.0%), and escalation (46, 10.1%) groups. Patients with de-escalation therapy were more often female, had less critical illness and fatal comorbidity, and had a higher survival rate than patients in the other two groups. After propensity score matching in the de-escalation and no-switch groups, critical illness at onset (Pitt bacteremia score ≥ 4; 16.5% vs. 12.7%; P = 0.34) or day 3 (2.5% vs. 2.5%; P = 1.00), fatal comorbidity (16.5% vs. 21.5%; P = 0.25), time to defervescence (4.6 vs. 4.7 days; P = 0.89), hospital stays (11.5 vs. 10.3 days; P = 0.13) and 4-week crude mortality rate (4.4% vs. 4.4%; P = 1.00) were similar. However, lower antibiotic cost (mean: 212.1 vs. 395.6 US$, P <0.001) and fewer complications of bloodstream infections due to resistant pathogens (0% vs. 5.1%, P = 0.004) were observed in the de-escalation group. De-escalation to narrower-spectrum cephalosporins is safe and cost-effective for adults with community-onset EKP bacteremia stabilized by empirical broad-spectrum beta-lactams. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  19. "Bending the cost curve" in gastroenterology.

    Science.gov (United States)

    Slattery, E; Harewood, G C; Murray, F; Patchett, S

    2013-12-01

    Increasing attention is being focused on reigning in escalating costs of healthcare, i.e. trying to 'bend the cost curve'. In gastroenterology (GI), inpatient hospital care represents a major component of overall costs. This study aimed to characterize the trend in cost of care for GI-related hospitalizations in recent years and to identify the most costly diagnostic groups. All hospital inpatients admitted between January 2008 and December 2009 with a primary diagnosis of one of the six most common GI-related Diagnosis Related Groups (DRGs) in this hospital system were identified; all DRGs contained at least 40 patients during the study period. Patient Level Costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e.g., radiology, pathology tests) calculated according to an activity-based costing approach; cost of medications were excluded. All costs were discounted to 2009 values. Mean length of stay (LOS) was also calculated for each DRG. Over 2 years, 470 patients were admitted with one of the six most common GI DRGs. Mean cost of care increased from 2008 to 2009 for all six DRGs with the steepest increases seen in 'GI hemorrhage (non-complex)' (31 % increase) and 'Cirrhosis/Alcoholic hepatitis (non-complex)' (45 % increase). No differences in readmission rates were observed over time. There was a strong correlation between year-to-year change in costs and change in mean LOS, r = 0.93. The cost of GI-related inpatient care appears to be increasing in recent years with the steepest increases observed in non-complex GI hemorrhage and non-complex Cirrhosis/Alcoholic hepatitis. Efforts to control the increasing costs should focus on these diagnostic categories.

  20. Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia.

    Science.gov (United States)

    Bellon, Michelle L; Barton, Christopher; McCaffrey, Nikki; Parker, Denise; Hutchinson, Claire

    2017-08-01

    Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable

  1. Returns on investment in electricity producing photovoltaic systems under de-escalating feed-in tariffs. The case of Greece

    International Nuclear Information System (INIS)

    Danchev, Svetoslav; Maniatis, George; Tsakanikas, Aggelos

    2010-01-01

    Under the threat of ballooning energy bills, the Greek legal framework supporting the electricity producing photovoltaic systems (PVS) changed in January 2009 from a fixed to a de-escalating feed-in tariff schedule. In this paper we investigate the internal rate of return (IRR) on investing in PVS under the new regulatory environment. We find that the new scheme favours strongly the early entry in the market. Unless there is a significant decrease in the equipment cost over the next decade, entering the market from 2015 onwards will be prohibitive. The bias of the current policy design towards early entry in a rapidly developing set of technologies entails the risk of a lock-up with sub-optimal technological option. This outlines the importance for policy design of linking the rate of feed-in-tariff de-escalation to more realistic expectations regarding the technology learning curve. (author)

  2. Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria

    Directory of Open Access Journals (Sweden)

    Maria Dimitrova

    2017-08-01

    Full Text Available ObjectiveHCV infection is a leading cause of chronic liver disease with long-term complications—extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital “Queen Joanna-ISUL” for 3-year period (2012–2014.MethodsIt is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital “Queen Joanna-ISUL” for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF, hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal–Wallis, and Friedman tests were used for statistical processing.Results76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839 with an average cost per patient 4,577 BGN (€2,340. Statistically significant correlation was observed between the total cost per patient from the different payers’ perspective and the Child-Pugh cirrhosis score.ConclusionHCV-related

  3. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

    Science.gov (United States)

    Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

    2015-10-01

    Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose

  4. STUDY OF PRIVILEGE ESCALATION ATTACK ON ANDROID AND ITS COUNTERMEASURES

    OpenAIRE

    REJO MATHEW

    2012-01-01

    Android is most commonly used platform for smartphones today which boasts of an advanced security model having MAC and sandboxing. These features allow developers and users to restrict the execution of anapplication to the privileges assigned. The exploitation of vulnerabilities of the program is confined within the privilege boundaries of an applications sandbox. Privilege escalation attacks have grown manifold as the use of android systems have increased. Different kinds of mechanisms have ...

  5. Phylogenetic escalation and decline of plant defense strategies

    Science.gov (United States)

    Agrawal, Anurag A.; Fishbein, Mark

    2008-01-01

    As the basal resource in most food webs, plants have evolved myriad strategies to battle consumption by herbivores. Over the past 50 years, plant defense theories have been formulated to explain the remarkable variation in abundance, distribution, and diversity of secondary chemistry and other defensive traits. For example, classic theories of enemy-driven evolutionary dynamics have hypothesized that defensive traits escalate through the diversification process. Despite the fact that macroevolutionary patterns are an explicit part of defense theories, phylogenetic analyses have not been previously attempted to disentangle specific predictions concerning (i) investment in resistance traits, (ii) recovery after damage, and (iii) plant growth rate. We constructed a molecular phylogeny of 38 species of milkweed and tested four major predictions of defense theory using maximum-likelihood methods. We did not find support for the growth-rate hypothesis. Our key finding was a pattern of phyletic decline in the three most potent resistance traits (cardenolides, latex, and trichomes) and an escalation of regrowth ability. Our neontological approach complements more common paleontological approaches to discover directional trends in the evolution of life and points to the importance of natural enemies in the macroevolution of species. The finding of macroevolutionary escalating regowth ability and declining resistance provides a window into the ongoing coevolutionary dynamics between plants and herbivores and suggests a revision of classic plant defense theory. Where plants are primarily consumed by specialist herbivores, regrowth (or tolerance) may be favored over resistance traits during the diversification process. PMID:18645183

  6. Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

    Science.gov (United States)

    Hoque, Mohammad Enamul; Dasgupta, Sushil Kanta; Naznin, Eva; Al Mamun, Abdullah

    2015-10-01

    This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication. © 2015 John Wiley & Sons Ltd.

  7. Costs of treating patients with schizophrenia who have illness-related crisis events

    Directory of Open Access Journals (Sweden)

    Peng Xiaomei

    2008-08-01

    Full Text Available Abstract Background Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Methods Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18, psychiatric hospitalization in the past 6 months (n = 240, arrest in the past 6 months (n = 56, violent behaviors in the past 4 weeks (n = 62, and diagnosis of a co-occurring substance use disorder (n = 413. Results Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024, followed by persons with psychiatric hospitalization in

  8. Guide to resource conservation and cost savings opportunities in the soap, detergents and related products sector

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    The soaps, detergents and related products sector is an important component of the chemical industry within Ontario, as these products are used for cleaning purposes in industrial, institutional and domestic consumer applications. This guide was prepared to assist the sector with cost savings and resource conservation. The guide highlights opportunities for resource conservation through energy and water efficiency improvements, more efficient utilisation of raw materials, and reduction of environmental releases at source. 54 figs.

  9. Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

    KAUST Repository

    Abubeker, Jewahir Ali

    2011-05-14

    This paper is devoted to the consideration of an algorithm for sequential optimization of paths in directed graphs relative to di_erent cost functions. The considered algorithm is based on an extension of dynamic programming which allows to represent the initial set of paths and the set of optimal paths after each application of optimization procedure in the form of a directed acyclic graph.

  10. Escalation, de-escalation, or reformulation : effective interventions in delayed NPD projects

    NARCIS (Netherlands)

    Oorschot, van K.E.; Langerak, F.; Sengupta, K.

    2011-01-01

    At the start of any project, new product development (NPD) teams must make accurate decisions about development time, development costs, and product performance. Such profit-maximizing decision making becomes particularly difficult when the project runs behind schedule and requires intervention

  11. Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D.

    Science.gov (United States)

    Blumberg, Dana M; Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; De Moraes, C Gustavo

    2015-09-01

    Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. Effect of the implementation of the Medicare Part D drug benefit. The change in cost-related nonadherence and the change in cost-reduction strategies. Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P cost-related nonadherence measures were female sex, younger age, lower income (implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical

  12. Antiepileptic Drug Titration and Related Health Care Resource Use and Costs.

    Science.gov (United States)

    Fishman, Jesse; Kalilani, Linda; Song, Yan; Swallow, Elyse; Wild, Imane

    2018-02-27

    Unexpected breakthrough seizures resulting from suboptimal antiepileptic drug (AED) dosing during the titration period, as well as adverse events resulting from rapid AED titration, may influence the titration schedule and significantly increase health care resource use (HRU) and health care costs. To assess the relationship between AEDs, HRU, and costs during AED titration and maintenance. Practicing neurologists were recruited from a nationwide panel to provide up to 3 patient records each for this retrospective medical chart review. Patients with epilepsy who were aged ≥ 18 years and had initiated an AED between January 1, 2014, and January 1, 2016, were followed for 6 months from AED initiation. Titration duration was the time from AED initiation to the beginning of treatment maintenance as determined by the physician. Outcomes were epilepsy-specific HRU (hospitalizations, emergency department visits, outpatient visits, physician referral, laboratory testing/diagnostic imaging, and phone calls) and related costs that occurred during the titration or maintenance treatment periods. Of 811 patients, 156, 128, 125, 120, 114, 107, and 61 initiated the following AEDs: levetiracetam, lamotrigine, lacosamide, valproate, topiramate, carbamazepine, and phenytoin, respectively. Most patients (619/803 [77.1%] with complete AED data) received monotherapy. Baseline characteristics were similar across AEDs (mean [SD] age, 36.6 [14.4] years; 59.0% male). Kaplan-Meier estimates of titration duration ranged from 3.3 weeks (phenytoin) to 8.1 weeks (lamotrigine). From titration to maintenance, the overall incidence of HRU per person-month decreased 54.5%-89.3% for each HRU measure except outpatient visits (24.6% decrease). Total epilepsy-related costs decreased from $80.48 to $42.77 per person-month, or 46.9% from titration to maintenance. AED titration periods had higher HRU rates and costs than AED maintenance, suggesting that use of AEDs with shorter titration requirements

  13. Dose escalation of cisplatin with 5-fluorouracil in concurrent chemoradiotherapy for esophageal carcinoma

    International Nuclear Information System (INIS)

    Lin Qiang; Gao Xianshu; Qiao Xueying; Zhou Zhiguo; Zhang Jun; Yang Xiangran; Wan Xin

    2006-01-01

    Objective: To define the maximum-tolerated dose (MTD) and observe the side effect of escalating cisplatin with 5-fluorouracil in concurrent chemoradiotherapy for esophageal carcinoma in Chinese, with toxicity studied. Methods: Previously untreated fifteen Chinese patients suffering from esophageal carcinoma received conventional fractionation radiotherapy, with 5 daily fractions of 2.0 Gy per week. The total radiation dose was 60 Gy. Concurrent chemotherapy dose escalation was given by the relatively safe and kidney-sparing modified Fibonacci sequence. The starting dose was cisplatin 37.5 mg/m 2 D1 and 5-fluorouracil 500 mg/m 2 D1-5, respectively. This regimen was repeated 4 times every 28 days. Escalation dose was cisplatin 7.5 mg/m 2 and 5- fluorouracil 100 mg/m 2 . Every. cohort contained at least 3 patients. If no dose-limiting toxicity(DLT) was observed, the next dose level was opened for entry. These courses were repeated until DLT appeared. MTD was declared as one dose level below which DLT appeared. Results: DLT was defined as grade 3 radiation-induced esophagitis at the level of cisplatin 60 mg/m2, 5-fluorouracil 700 mg/m 2 . MTD was defined as cisplatin 52.5 mg/m 2 , 5- fiuorouracil 700 mg/m 2 . The major side effect were radiation-induced esophagitis, leucopenia, nausea, vomiting and anorexia. Conclusion: Maximun tolerated dose of cisplatin with 5-fiuorouracil in concurrent ehemoradiotherapy in the Chinese people with esophageal carcinoma were eisplatin 52.5 mg/m2 D1,5-fluorouracil 700 mg/m 2 D1-5, repeated 4 times every 28 days. (authors)

  14. Cost of osteoporosis-related fracture in Italy. Results of the BLOCK study

    Directory of Open Access Journals (Sweden)

    Luca Degli Esposti

    2011-09-01

    Full Text Available The objectives of the present study were to calculate the cost of illness of osteoporosis and to assess drug utilization patterns in postmenopausal women after a fracture-related hospitalization. The study subjects were enrolled from a large population-based administrative database. Female patients (age ≥ 65 years who were hospitalized for a typical osteoporotic fracture between 1/1/2000 and 31/12/2005 were included. Patients were classified as exposed/unexposed to treatment according to the presence/absence of at least one prescription for an osteoporosis-related medication in the 6 months following the discharge date. Treatment adherence was calculated for patients who were exposed to bisphosphonate therapy and was defined as at least 80% of treatment coverage during the follow-up period of 18 months after the discharge date. Hospitalizations, medications, diagnostic tests, laboratory tests and specialist visits during the 18-month follow-up period were collected and classified as osteoporosis-related or non-related to osteoporosis. A total of 12,376 patients were included in the study (mean age ± SD, 79.1 ± 7.5 years, out of which 97.9% (n = 12,110 were hospitalized due to an osteoporosis-related fracture and only 2.1% (n = 266 had general osteoporosis diagnosis. Among the 12,110 women with a fracture, 15.2% (n = 1,845 had a subsequent fracture-related hospitalization (63.8% of the patients had hip fracture. Only 32.3% (n = 4,001 of all included patients was exposed to osteoporosis-related medications and out of those patients exposed to bisphosphonates (n = 860 only 34.2% (n = 294 was adherent to therapy. The average cost per patient was € 4,481, of which € 1,089 was for osteoporosis-related and € 3,392 for non-osteoporosis-related items. The average cost of a matching cohort of patients without hospitalizations for fracture was € 2,339. Among osteoporosis-related costs, 87.0% was due to hospitalizations for subsequent fractures

  15. Cost-effectiveness of single versus double embryo transfer in IVF in relation to female age.

    Science.gov (United States)

    van Loendersloot, Laura L; Moolenaar, Lobke M; van Wely, Madelon; Repping, Sjoerd; Bossuyt, Patrick M; Hompes, Peter G A; van der Veen, Fulco; Mol, Ben Willem J

    2017-07-01

    To evaluate the cost-effectiveness of single embryo transfer followed by an additional frozen-thawed single embryo transfer, if more embryos are available, as compared to double embryo transfer in relation to female age. We used a decision tree model to evaluate the costs from a healthcare provider perspective and the pregnancy rates of two embryo transfer policies: one fresh single embryo transfer followed by an additional frozen-thawed single embryo transfer, if more embryos are available (strategy I), and double embryo transfer (strategy II). The analysis was performed on an intention-to-treat basis. Sensitivity analyses were carried out to evaluate the robustness of our model and to identify which model parameters had the strongest impact on the results. SET followed by an additional frozen-thawed single embryo transfer if available was dominant, less costly and more effective, over DET in women under 32 years. In women aged 32 or older DET was more effective than SET followed by an additional frozen-thawed single embryo transfer if available but also more costly. SET followed by an additional frozen-thawed single embryo transfer should be the preferred strategy in women under 32 undergoing IVF. The choice for SET followed by an additional frozen-thawed single embryo transfer or DET in women aged 32 or older depends on individual patient preferences and on how much society is willing to pay for an extra child. There is a strong need for a randomized clinical trial comparing the cost and effects of SET followed by an additional frozen-thawed single embryo transfer and DET in the latter category of women. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. The Relation of Design Parameters, Plant Capacity and Processing Costs in Cobalt-60 Sterilization Plants

    International Nuclear Information System (INIS)

    Brown, M.G.

    1967-01-01

    The paper describes the main features of three basic types of cobalt-60 sterilization plants which have been designed to provide a complete range of capacities for radiosterilization of medical products. The smallest plant has a capacity of up to 50 000 cubic feet of medical products a year, the intermediate size plant has a capacity of up to 500 000 cubic feet a year, and the largest plant has a capacity in excess of 1000 000 cubic feet a year. The relations between capital costs, rate of production, efficiency and unit processing costs for each type of plant are discussed. The method of selecting the best type of plant for a particular need will also be outlined. (author)

  17. Stairs or escalator? Using theories of persuasion and motivation to facilitate healthy decision making.

    Science.gov (United States)

    Suri, Gaurav; Sheppes, Gal; Leslie, Sara; Gross, James J

    2014-12-01

    To encourage an increase in daily activity, researchers have tried a variety of health-related communications, but with mixed results. In the present research-using the stair escalator choice context-we examined predictions derived from the Heuristic Systematic Model (HSM), Self Determination Theory (SDT), and related theories. Specifically, we tested whether (as predicted by HSM) signs that encourage heuristic processing ("Take the Stairs") would have greatest impact when placed at the stair/escalator point of choice (when processing time is limited), whereas signs that encourage systematic processing ("Will You Take the Stairs?") would have greatest impact when placed at some distance from the point of choice (when processing time is less limited). We also tested whether (as predicted by SDT) messages promoting autonomy would be more likely to result in sustained motivated behavior (i.e., stair taking at subsequent uncued choice points) than messages that use commands. A series of studies involving more than 9,000 pedestrians provided support for these predictions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  18. The broken escalator phenomenon. Aftereffect of walking onto a moving platform.

    Science.gov (United States)

    Reynolds, R F; Bronstein, A M

    2003-08-01

    We investigated the physiological basis of the 'broken escalator phenomenon', namely the sensation that when walking onto an escalator which is stationary one experiences an odd sensation of imbalance, despite full awareness that the escalator is not going to move. The experimental moving surface was provided by a linear motor-powered sled, moving at 1.2 m/s. Sled velocity, trunk position, trunk angular velocity, EMG of the ankle flexors-extensors and foot-contact signals were recorded in 14 normal subjects. The experiments involved, initially, walking onto the stationary sled (condition Before). Then, subjects walked 20 times onto the moving sled (condition Moving), and it was noted that they increased their walking velocity from a baseline of 0.60 m/s to 0.90 m/s. After the moving trials, subjects were unequivocally warned that the platform would no longer move and asked to walk onto the stationary sled again (condition After). It was found that, despite this warning, subjects walked onto the stationary platform inappropriately fast (0.71 m/s), experienced a large overshoot of the trunk and displayed increased leg electromyographic (EMG) activity. Subjects were surprised by their own behaviour and subjectively reported that the 'broken escalator phenomenon', as experienced in urban life, felt similar to the experiment. By the second trial, most movement parameters had returned to baseline values. The findings represent a motor aftereffect of walking onto a moving platform that occurs despite full knowledge of the changing context. As such, it demonstrates dissociation between the declarative and procedural systems in the CNS. Since gait velocity was raised before foot-sled contact, the findings are at least partly explained by open-loop, predictive behaviour. A cautious strategy of limb stiffness was not responsible for the aftereffect, as revealed by no increase in muscle cocontraction. The observed aftereffect is unlike others previously reported in the

  19. Cost-benefit evaluation of containment related engineered safety features of Indian pressurized heavy water reactors

    International Nuclear Information System (INIS)

    Bajaj, S.S.; Bhawal, R.N.; Rustagi, R.S.

    1984-01-01

    The typical containment system for a commercial nuclear reactor uses several engineered safety features to achieve its objective of limiting the release of radioactive fission products to the environment in the event of postulated accident conditions. The design of containment systems and associated features for Indian Pressurized Heavy Water Reactors (PHWRs) has undergone progressive improvement in successive projects. In particular, the current design adopted for the Narora Atomic Power Project (NAPP) has seen several notable improvements. The paper reports on a cost-benefit study in respect of three containment related engineered safety features and subsystems of NAPP, viz. (i) secondary containment envelope, (ii) primary containment filtration and pump-back system, and (iii) secondary containment filtration, recirculation and purge system. The effect of each of these systems in reducing the environmental releases of radioactivity following a design basis accident is presented. The corresponding reduction in population exposure and the associated monetary value of this reduction in exposure are also given. The costs of the features and subsystem under consideration are then compared with the monetary value of the exposures saved, as well as other non-quantified benefits, to arrive at conclusions regarding the usefulness of each subsystem. This study clearly establishes for the secondary containment envelope the benefit in terms of reduction in public exposure giving a quantitative justification for the costs involved. In the case of the other two subsystems, which involve relatively low costs, while all benefits have not been quantified, their desirability is justified on qualitative considerations. It is concluded that the engineered safety features adopted in the current containment system design of Indian PHWRs contribute to reducing radiation exposures during accident conditions in accordance with the ALARA ('as low as reasonably achievable') principle

  20. Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study.

    Science.gov (United States)

    Patel, Minal R; Resnicow, Kenneth; Lang, Ian; Kraus, Kathleen; Heisler, Michele

    2018-02-01

    Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting. We report a pre-post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool. Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% "learned a lot," 98% "topics relevant" 95% "applicable to their lives," 98% "liked the information"). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p financial management (33.83 to 39.62, p financial burden. A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.

  1. The relative importance of factors that determine log-hauling costs

    Science.gov (United States)

    A. Jeff Martin; A. Jeff Martin

    1971-01-01

    Hauling costs are a major expense to lumbermen, but little is known about which factors affect hauling costs the most. A recent Forest Service study of hauling costs on 34 logging operations sheds light on whmich factors of cost are important and which might require less attention. These results should help lumbermen adopt a cost accounting procedure and help them with...

  2. Environmentally Related Diseases and the Possibility of Valuation of Their Social Costs

    Directory of Open Access Journals (Sweden)

    Ilona Hajok

    2014-01-01

    Full Text Available The risks of the morbidity of the asbestos-related lung cancer was estimated in the general population of Poles as the result of increased exposure to asbestos fibers during the removal of asbestos-cement products and the possibility of the valuation of the social costs related to this risk. The prediction of the new incidences was made using linear regression model. The forecast shows that to the end of 2030 about 3,500 new cases of lung cancer can be expected as a result of occupational exposure to asbestos in the past which makes together with paraoccupational exposure about 14.000 new cases. The forecast shows the increasing number of asbestos-related lung cancer in Poland and indicates the priority areas where preventive action should be implemented.

  3. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A

    2012-03-08

    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  4. The cost of lost productivity due to premature cancer-related mortality: an economic measure of the cancer burden.

    Science.gov (United States)

    Hanly, Paul A; Sharp, Linda

    2014-03-26

    Most measures of the cancer burden take a public health perspective. Cancer also has a significant economic impact on society. To assess this economic burden, we estimated years of potential productive life lost (YPPLL) and costs of lost productivity due to premature cancer-related mortality in Ireland. All cancers combined and the 10 sites accounting for most deaths in men and in women were considered. To compute YPPLL, deaths in 5-year age-bands between 15 and 64 years were multiplied by average working-life expectancy. Valuation of costs, using the human capital approach, involved multiplying YPPLL by age-and-gender specific gross wages, and adjusting for unemployment and workforce participation. Sensitivity analyses were conducted around retirement age and wage growth, labour force participation, employment and discount rates, and to explore the impact of including household production and caring costs. Costs were expressed in €2009. Total YPPLL was lower in men than women (men = 10,873; women = 12,119). Premature cancer-related mortality costs were higher in men (men: total cost = €332 million, cost/death = €290,172, cost/YPPLL = €30,558; women: total cost = €177 million, cost/death = €159,959, cost/YPPLL = €14,628). Lung cancer had the highest premature mortality cost (€84.0 million; 16.5% of total costs), followed by cancers of the colorectum (€49.6 million; 9.7%), breast (€49.4 million; 9.7%) and brain & CNS (€42.4 million: 8.3%). The total economic cost of premature cancer-related mortality in Ireland amounted to €509.5 million or 0.3% of gross domestic product. An increase of one year in the retirement age increased the total all-cancer premature mortality cost by 9.9% for men and 5.9% for women. The inclusion of household production and caring costs increased the total cost to €945.7 million. Lost productivity costs due to cancer-related premature mortality are significant. The higher premature mortality cost in males than

  5. Factors associated with metabolic syndrome and related medical costs by the scale of enterprise in Korea.

    Science.gov (United States)

    Kong, Hyung-Sik; Lee, Kang-Sook; Yim, Eun-Shil; Lee, Seon-Young; Cho, Hyun-Young; Lee, Bin Na; Park, Jee Young

    2013-10-21

    The purpose of this study was to identify the risk factors of metabolic syndrome (MS) and to analyze the relationship between the risk factors of MS and medical cost of major diseases related to MS in Korean workers, according to the scale of the enterprise. Data was obtained from annual physical examinations, health insurance qualification and premiums, and health insurance benefits of 4,094,217 male and female workers who underwent medical examinations provided by the National Health Insurance Corporation in 2009. Logistic regression analyses were used to the identify risk factors of MS and multiple regression was used to find factors associated with medical expenditures due to major diseases related to MS. The study found that low-income workers were more likely to work in small-scale enterprises. The prevalence rate of MS in males and females, respectively, was 17.2% and 9.4% in small-scale enterprises, 15.9% and 8.9% in medium-scale enterprises, and 15.9% and 5.5% in large-scale enterprises. The risks of MS increased with age, lower income status, and smoking in small-scale enterprise workers. The medical costs increased in workers with old age and past smoking history. There was also a gender difference in the pattern of medical expenditures related to MS. Health promotion programs to manage metabolic syndrome should be developed to focus on workers who smoke, drink, and do little exercise in small scale enterprises.

  6. Construction cost impacts related to manpower, material, and equipment factors in contractor firms perspective

    Science.gov (United States)

    Husin, Saiful; Abdullah, Riza, Medyan; Afifuddin, Mochammad

    2017-11-01

    Risk can be defined as consequences which possible happened inscrutably. Although an activity has planned as good as possible, but it keep contains uncertainty. Implementation of construction project was encountering various risk impacts from a number of risk factors. This study was intended to analyze the impacts of construction cost to for contractor firms as construction project executor related to the factors of manpower, material and equipment. The study was using data obtained from questionnaires distributed to 15 large qualification contractor firms. The period of study classified into conflict period (2000-2004), post tsunami disaster rehabilitation and reconstruction period (2005-2009), and post rehabilitation and reconstruction period (2010-present). The statistical analysis of severity index and variance used to analyze the data. The three risk factors reviewed generally affected the cost in a medium impact. The high impact occurred in minor variables, which are `increase in material prices', `theft of materials', and `the fuel scarcity'. In overall, the three risk factors and the observed period contributed significant impact on construction costs.

  7. Sequential Optimization of Global Sequence Alignments Relative to Different Cost Functions

    KAUST Repository

    Odat, Enas M.

    2011-05-01

    The purpose of this dissertation is to present a methodology to model global sequence alignment problem as directed acyclic graph which helps to extract all possible optimal alignments. Moreover, a mechanism to sequentially optimize sequence alignment problem relative to different cost functions is suggested. Sequence alignment is mostly important in computational biology. It is used to find evolutionary relationships between biological sequences. There are many algo- rithms that have been developed to solve this problem. The most famous algorithms are Needleman-Wunsch and Smith-Waterman that are based on dynamic program- ming. In dynamic programming, problem is divided into a set of overlapping sub- problems and then the solution of each subproblem is found. Finally, the solutions to these subproblems are combined into a final solution. In this thesis it has been proved that for two sequences of length m and n over a fixed alphabet, the suggested optimization procedure requires O(mn) arithmetic operations per cost function on a single processor machine. The algorithm has been simulated using C#.Net programming language and a number of experiments have been done to verify the proved statements. The results of these experiments show that the number of optimal alignments is reduced after each step of optimization. Furthermore, it has been verified that as the sequence length increased linearly then the number of optimal alignments increased exponentially which also depends on the cost function that is used. Finally, the number of executed operations increases polynomially as the sequence length increase linearly.

  8. Return on Capital and Cost of Capital: How does their Relation Affect Firm Value?

    OpenAIRE

    Halil D. Kaya; Julia S. Kwok; Elizabeth C. Rabe

    2015-01-01

    The Great Recession of 2008-2009 hurt almost all of the companies’ stock values in the United States. Interestingly, for Starbucks, the deterioration started a few years before the recession. From 2005 to 2007, the company’s stock price declined by approximately 40%. This case encourages students to examine the company’s return on capital, compare it to its cost of capital, and then relate this to the decline in the company’s stock price. First, they will establish a single formula for return...

  9. Milestones of mathematical model for business process management related to cost estimate documentation in petroleum industry

    Science.gov (United States)

    Khamidullin, R. I.

    2018-05-01

    The paper is devoted to milestones of the optimal mathematical model for a business process related to cost estimate documentation compiled during construction and reconstruction of oil and gas facilities. It describes the study and analysis of fundamental issues in petroleum industry, which are caused by economic instability and deterioration of a business strategy. Business process management is presented as business process modeling aimed at the improvement of the studied business process, namely main criteria of optimization and recommendations for the improvement of the above-mentioned business model.

  10. Control of systems with costs related to switching: applications to air-condition systems

    DEFF Research Database (Denmark)

    Thybo (Deng), Honglian; Larsen, Lars Finn Sloth; Stoustrup, Jakob

    2009-01-01

    The objective of this paper is to investigate a low complexity method for controlling systems with binary inputs that have costs related to switching. The control objective for this type of systems is often a trade off between the deviation from the reference and the number of switches (weariness...... energy efficiency etc.). For such systems a steady state solution might never be attained, but rather the optimal behavior might be constituted by a limit cycle. In this paper we consider the problem of finding and controlling the system towards an optimal limit cycle. A low complexity approach giving...

  11. Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

    Science.gov (United States)

    Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

    2017-10-01

    Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

  12. Analysis of medication-related malpractice claims: causes, preventability, and costs.

    Science.gov (United States)

    Rothschild, Jeffrey M; Federico, Frank A; Gandhi, Tejal K; Kaushal, Rainu; Williams, Deborah H; Bates, David W

    2002-11-25

    Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention. We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs. Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64,700-74,200), but costs were considerably greater for preventable inpatient ADEs (mean, $376,500). Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.

  13. A Determination of Military and Civilian Personnel Costs as Related to a Member of Technical Staff

    Science.gov (United States)

    1992-06-01

    Costs, 1986 4 2. Direct Total Manpower Bidget Costs, 1992 5 3. Pay Raises 1985-1992 6 4. Support Costs 9 5. Internal Support Personnel 10 6. External...34 Incremental Costs of Military and Civilian Manpower in the Military Services." This docu- ment provides the basis for this section. The report assesses...6 Aug 91. MTS Workyear Cost Comparison. Internal AFSC paper, 20 November 1990. Palmer, Adele R., Osbaldeston, David J., Incremental Costs of Military

  14. Audit report on GDF Suez's supply costs and non-supply related costs in natural gas regulated sale tariffs - May 2014

    International Nuclear Information System (INIS)

    2014-05-01

    After having recalled the legal context of objectives of this audit performed by the French Commission for Energy Regulation (CRE), this report proposes an analysis of GDF Suez's dissociated accounting which showed that costs are covered by natural gas regulated sale tariffs. In the second part, it comments the current market indexing used in tariff formula, comments current and present negotiations and their consequences for the market indexing share in long term contracts, discusses the issue of tariff volatility related to an increased market indexing share, discusses the possible re-examination of indices at the occasion of formula reviewing, and outlines that the diversified supplier portfolio allows optimisation operations. The third part addresses non-supply related costs: evolution of different infrastructure costs (related to distribution, transport, and storage) to be taken into account in regulated sale tariffs, evolution of commercial costs. Some recommendations are then made regarding the perspective of a tariff formula revision, and the perspectives of evolution of non-supply related costs

  15. Investor’s Commitment Bias and Escalation of Firm’s Investment Decision

    Directory of Open Access Journals (Sweden)

    Anis JARBOUI

    2012-12-01

    Full Text Available This study examines the reasons of perseverance in firm’s investment decision. It shows the possible influence of three closely related features which are: firm’s financial indicators, investor’s risk profile, and investor’s commitment bias, on a firm’s investment decisions escalation. This study aims to provide evidence as to whether investor considers the financial and risk’s perception features (financial strength and risk profile to persevere his initial investment decision while he notes a high level of commitment bias. The proposed model of this paper uses GLM univariate data analyses to examine this relationship. Investor’s risk profile and his commitment bias have been measured by means of a questionnaire comprising several items. As for the selected sample, it has been composed of some 360 Tunisian individual investors. Our results have revealed that investors pay more attention to keep their psychology comfort than their financial comfort. It exposed the importance of the investor’s commitment bias and its risk perception in explaining investment decision escalation. Moreover results shows that there is strong and significant empirical relationship linking the escalatory behavior in investment decision and the interaction effects between the three independent variables. This means that, in practice, investors consider the three factors simultaneously.

  16. Growth trajectories of alcohol information processing and associations with escalation of drinking in early adolescence.

    Science.gov (United States)

    Colder, Craig R; O'Connor, Roisin M; Read, Jennifer P; Eiden, Rina D; Lengua, Liliana J; Hawk, Larry W; Wieczorek, William F

    2014-09-01

    This longitudinal study provided a comprehensive examination of age-related changes in alcohol outcome expectancies, subjective evaluation of alcohol outcomes, and automatic alcohol associations in early adolescence. A community sample (52% female, 75% White/non-Hispanic) was assessed annually for 3 years (mean age at the first assessment = 11.6 years). Results from growth modeling suggested that perceived likelihood of positive outcomes increased and that subjective evaluations of these outcomes were more positive with age. Perceived likelihood of negative outcomes declined with age. Automatic alcohol associations were assessed with an Implicit Association Task (IAT), and were predominantly negative, but these negative associations weakened with age. High initial levels of perceived likelihood of positive outcomes at age 11 were associated with escalation of drinking. Perceived likelihood of negative outcomes was associated with low risk for drinking at age 11, but not with changes in drinking. Increases in positive evaluations of positive outcomes were associated with increases in alcohol use. Overall, findings suggest that at age 11, youth maintain largely negative attitudes and perceptions about alcohol, but with the transition into adolescence, there is a shift toward a more neutral or ambivalent view of alcohol. Some features of this shift are associated with escalation of drinking. Our findings point to the importance of delineating multiple aspects of alcohol information processing for extending cognitive models of alcohol use to the early stages of drinking.

  17. An Hourly Dose-Escalation Desensitization Protocol for Aspirin-Exacerbated Respiratory Disease.

    Science.gov (United States)

    Chen, Justin R; Buchmiller, Brett L; Khan, David A

    2015-01-01

    Aspirin desensitization followed by maintenance therapy effectively improves symptom control in patients with aspirin exacerbated respiratory disease (AERD). The majority of current desensitization protocols use 3-hour dosing intervals and often require 2 to 3 days to complete. We evaluated hourly dose escalations in a subset of patients with chronic rhinosinusitis, nasal polyps, and asthma who historically reacted to aspirin within 1 hour or were avoiding aspirin with the goal of developing a safe and efficient desensitization protocol. Fifty-seven aspirin desensitizations were performed under the hourly protocol. All patients had refractory nasal polyposis as an indication for aspirin desensitization. The clinical characteristics of each subject were analyzed in relation to aspects of his or her reactions during the procedure. Ninety-eight percent of study patients were successfully treated under the hourly protocol, including those with a history of severe reactions and intubation. None required further medication than is available in an outpatient allergy clinic. A total of 96% of reactors recorded a bronchial or naso-ocular reaction within 1 hour of the preceding dose. Of the total patients on this protocol, 40% were able to complete the procedure in a single day, and 60% within 2 days. Patients with AERD who have a history of symptoms less than 1 hour after aspirin exposure can be safely desensitized with a 1-hour dose-escalation protocol that can often be completed in a single day. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Escalation and propagation of thermal detonation in the corium-water systems

    International Nuclear Information System (INIS)

    Melikhov, O.I.; Melikhov, V.I.; Sokolin, A.V.

    2001-01-01

    The thermal detonation taking into account micro-interaction processes model has been applied to study thermal detonation wave escalation and propagation in the corium-water mixture. Transient escalation stage and subsequent steady-state propagation stage of the thermal detonation have been calculated. The essential decrease of the escalation length in comparison with the previous results calculated without micro-interaction concept has been obtained. (authors)

  19. [Prevention of catheter-related infection: usefulness and cost-effectiveness of antiseptic catheters in children].

    Science.gov (United States)

    Lenz, Ana M; Vassallo, Juan C; Moreno, Guillermo E; Althabe, María; Gómez, Silvia; Magliola, Ricardo; Casimir, Lidia; Bologna, Rosa; Barretta, Jorge; Ruffa, Pablo

    2010-06-01

    To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter- related blood stream infections (CR-BSI). Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods. A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic- impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 dayscatheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1- 48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.

  20. Estimating study costs for use in VOI, a study of dutch publicly funded drug related research

    NARCIS (Netherlands)

    Van Asselt, A.D.; Ramaekers, B.L.; Corro Ramos, I.; Joore, M.A.; Al, M.J.; Lesman-Leegte, I.; Postma, M.J.; Vemer, P.; Feenstra, T.F.

    2016-01-01

    Objectives: To perform value of information (VOI) analyses, an estimate of research costs is needed. However, reference values for such costs are not available. This study aimed to analyze empirical data on research budgets and, by means of a cost tool, provide an overview of costs of several types

  1. Measuring the societal burden of cancer: the cost of lost productivity due to premature cancer-related mortality in Europe.

    Science.gov (United States)

    Hanly, Paul; Soerjomataram, Isabelle; Sharp, Linda

    2015-02-15

    Every cancer-related death in someone of working age represents an economic loss to society. To inform priorities for cancer control, we estimated costs of lost productivity due to premature cancer-related mortality across Europe, for all cancers and by site, gender, region and country. Cancer deaths in 2008 were obtained from GLOBOCAN for 30 European countries across four regions. Costs were valued using the human capital approach. Years of productive life lost (YPLL) were computed by multiplying deaths between 15 and 64 years by working-life expectancy, then by country-, age- and gender-specific annual wages, corrected for workforce participation and unemployment. Lost productivity costs due to premature cancer-related mortality in Europe in 2008 were €75 billion. Male costs (€49 billion) were almost twice female costs (€26 billion). The most costly sites were lung (€17 billion; 23% of total costs), breast (€7 billion; 9%) and colorectum (€6 billion; 8%). Stomach cancer (in Southern and Central-Eastern Europe) and pancreatic cancer (in Northern and Western Europe) were also among the most costly sites. The average lost productivity cost per cancer death was €219,241. Melanoma had the highest cost per death (€312,798), followed by Hodgkin disease (€306,628) and brain and CNS cancer (€288,850). Premature mortality costs were 0.58% of 2008 European gross domestic product, highest in Central-Eastern Europe (0.81%) and lowest in Northern Europe (0.51%). Premature cancer-related mortality costs in Europe are significant. These results provide a novel perspective on the societal cancer burden and may be used to inform priority setting for cancer control. © 2014 UICC.

  2. Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas. Results of a prospective phase II study

    International Nuclear Information System (INIS)

    Piroth, M.D.; Pinkawa, M.; Holy, R.; Forschungszentrum Juelich GmbH

    2012-01-01

    Dose escalations above 60 Gy based on MRI have not led to prognostic benefits in glioblastoma patients yet. With positron emission tomography (PET) using [ 18 F]fluorethyl-L-tyrosine (FET), tumor coverage can be optimized with the option of regional dose escalation in the area of viable tumor tissue. In a prospective phase II study (January 2008 to December 2009), 22 patients (median age 55 years) received radiochemotherapy after surgery. The radiotherapy was performed as an MRI and FET-PET-based integrated-boost intensity-modulated radiotherapy (IMRT). The prescribed dose was 72 and 60 Gy (single dose 2.4 and 2.0 Gy, respectively) for the FET-PET- and MR-based PTV-FET (72 Gy) and PTV-MR (60 Gy) . FET-PET and MRI were performed routinely for follow-up. Quality of life and cognitive aspects were recorded by the EORTC-QLQ-C30/QLQ Brain20 and Mini-Mental Status Examination (MMSE), while the therapy-related toxicity was recorded using the CTC3.0 and RTOG scores. Median overall survival (OS) and disease-free survival (DFS) were 14.8 and 7.8 months, respectively. All local relapses were detected at least partly within the 95% dose volume of PTV-MR (60 Gy) . No relevant radiotherapy-related side effects were observed (excepted alopecia). In 2 patients, a pseudoprogression was observed in the MRI. Tumor progression could be excluded by FET-PET and was confirmed in further MRI and FET-PET imaging. No significant changes were observed in MMSE scores and in the EORTC QLQ-C30/QLQ-Brain20 questionnaires. Our dose escalation concept with a total dose of 72 Gy, based on FET-PET, did not lead to a survival benefit. Acute and late toxicity were not increased, compared with historical controls and published dose-escalation studies. (orig.)

  3. Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas. Results of a prospective phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Piroth, M.D.; Pinkawa, M.; Holy, R. [RWTH Aachen University Hospital (Germany). Dept. of Radiation Oncology; Forschungszentrum Juelich GmbH (DE). Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain] (and others)

    2012-04-15

    Dose escalations above 60 Gy based on MRI have not led to prognostic benefits in glioblastoma patients yet. With positron emission tomography (PET) using [{sup 18}F]fluorethyl-L-tyrosine (FET), tumor coverage can be optimized with the option of regional dose escalation in the area of viable tumor tissue. In a prospective phase II study (January 2008 to December 2009), 22 patients (median age 55 years) received radiochemotherapy after surgery. The radiotherapy was performed as an MRI and FET-PET-based integrated-boost intensity-modulated radiotherapy (IMRT). The prescribed dose was 72 and 60 Gy (single dose 2.4 and 2.0 Gy, respectively) for the FET-PET- and MR-based PTV-FET{sub (72 Gy)} and PTV-MR{sub (60 Gy)}. FET-PET and MRI were performed routinely for follow-up. Quality of life and cognitive aspects were recorded by the EORTC-QLQ-C30/QLQ Brain20 and Mini-Mental Status Examination (MMSE), while the therapy-related toxicity was recorded using the CTC3.0 and RTOG scores. Median overall survival (OS) and disease-free survival (DFS) were 14.8 and 7.8 months, respectively. All local relapses were detected at least partly within the 95% dose volume of PTV-MR{sub (60 Gy)}. No relevant radiotherapy-related side effects were observed (excepted alopecia). In 2 patients, a pseudoprogression was observed in the MRI. Tumor progression could be excluded by FET-PET and was confirmed in further MRI and FET-PET imaging. No significant changes were observed in MMSE scores and in the EORTC QLQ-C30/QLQ-Brain20 questionnaires. Our dose escalation concept with a total dose of 72 Gy, based on FET-PET, did not lead to a survival benefit. Acute and late toxicity were not increased, compared with historical controls and published dose-escalation studies. (orig.)

  4. Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars

    DEFF Research Database (Denmark)

    Petersen, Lars Bo; Olsen, Kim Rose; Christensen, Jennifer Heather

    2014-01-01

    resource utilization. Differences in resources used for surgical and post-surgical management were calculated for each patient. Results: Converted to monetary units, the total costs for panoramic imaging equalized (sic)49.29 and for CBCT examination (sic)184.44. Modifying effects on this outcome......Objectives: The aim of this prospective clinical study was to derive the absolute and relative costs of cone beam CT (CBCT) and panoramic imaging before removal of an impacted mandibular third molar. Furthermore, the study aimed to analyse the influence of different cost-setting scenarios...... on the outcome of the absolute and relative costs and the incremental costs related to surgery. Methods: A randomized clinical trial compared complications following surgical removal of a mandibular third molar, where the pre-operative diagnostic method had been panoramic imaging or CBCT. The resources implied...

  5. Cost of care for subjective tinnitus in relation to patient satisfaction.

    Science.gov (United States)

    Goldstein, Eric; Ho, Chuan-Xing; Hanna, Rania; Elinger, Clara; Yaremchuk, Kathleen L; Seidman, Michael D; Jesse, Michelle T

    2015-03-01

    A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures. A retrospective chart review and a patient satisfaction questionnaire. All data were collected from a large Midwestern hospital. Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales. Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453). Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  6. Phosphate rock costs, prices and resources interaction.

    Science.gov (United States)

    Mew, M C

    2016-01-15

    This article gives the author's views and opinions as someone who has spent his working life analyzing the international phosphate sector as an independent consultant. His career spanned two price hike events in the mid-1970's and in 2008, both of which sparked considerable popular and academic interest concerning adequacy of phosphate rock resources, the impact of rising mining costs and the ability of mankind to feed future populations. An analysis of phosphate rock production costs derived from two major industry studies performed in 1983 and 2013 shows that in nominal terms, global average cash production costs increased by 27% to $38 per tonne fob mine in the 30 year period. In real terms, the global average cost of production has fallen. Despite the lack of upward pressure from increasing costs, phosphate rock market prices have shown two major spikes in the 30 years to 2013, with periods of less volatility in between. These price spike events can be seen to be related to the escalating investment cost required by new mine capacity, and as such can be expected to be repeated in future. As such, phosphate rock price volatility is likely to have more impact on food prices than rising phosphate rock production costs. However, as mining costs rise, recycling of P will also become increasingly driven by economics rather than legislation. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Direct diabetes-related costs in young patients with early-onset, long-lasting type 1 diabetes.

    Directory of Open Access Journals (Sweden)

    Christina Bächle

    Full Text Available OBJECTIVE: To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. RESEARCH DESIGN AND METHODS: Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2 years, mean diabetes duration 10.9 (SD 1.9 years, as of 31.12.2007. Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV. Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance. Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. RESULTS: Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881. Costs for glucose self-monitoring were the main cost category (28.5%, followed by costs for continuous subcutaneous insulin infusion (25.0%, diabetes-related hospitalizations (22.1% and insulin (18.4%. Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. CONCLUSIONS: Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

  8. Estimating the costs of work-related accidents and ill-health: An analysis of European data sources

    NARCIS (Netherlands)

    Heuvel, S. van den; Zwaan, L. van der; Dam, L. van; Oude Hengel, K.M.; Eekhout, I.; Emmerik, M.L. van; Oldenburg, C.; Brück, C.; Janowski, P.; Wilhelm, C.

    2017-01-01

    This report presents the results of a survey of national and international data sources on the costs of work-related injuries, illnesses and deaths. The aim was to evaluate the quality and comparability of different sources as a first step towards estimating the costs of accidents and ill-health at

  9. The influence of (toll-related) travel costs in residential location decisions of households : A stated choice approach

    NARCIS (Netherlands)

    Tillema, T.; van Wee, B.; Ettema, D.

    2010-01-01

    In this paper, we investigate the impact of travel costs, in particular toll costs, on the residential location choice of households, using a stated choice survey. Within the stated choice experiment, car drivers that frequently face traffic congestion, traded-off several trip-related (including

  10. The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England.

    Science.gov (United States)

    Mahon, James; Lifschitz, Carlos; Ludwig, Thomas; Thapar, Nikhil; Glanville, Julie; Miqdady, Mohamad; Saps, Miguel; Quak, Seng Hock; Lenoir Wijnkoop, Irene; Edwards, Mary; Wood, Hannah; Szajewska, Hania

    2017-11-14

    To estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents. To estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a 'de novo' analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated. Our calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies. The total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. No costly prosociality among related long-tailed macaques (Macaca fascicularis).

    Science.gov (United States)

    Sterck, Elisabeth H M; Olesen, Caroline U; Massen, Jorg J M

    2015-08-01

    Altruism, benefiting another at a cost to the donor, may be achieved through prosocial behavior. Studies of nonhuman animals typically investigate prosocial behavior with paradigms in which the donor can choose to give a recipient a food item, and the choice does not affect the donor's reward (which is either present or absent). In such tasks, long-tailed macaques (Macaca fascicularis) show prosocial behavior, especially toward kin. Here, we tested captive long-tailed macaques with related recipients in an alternative task, in which the donor had to give up a preferred reward to benefit the recipient; that is, they had to choose a lower valued reward for themselves to provide food to their kin. Overall, the macaques did not provide their kin with food. The task forced the donor to balance its prosocial behavior with its selfish choice for a higher value reward, a balance that turned out to favor selfish motives. Consequently, our study shows that a prosocial tendency is not sufficient to elicit costly prosocial behavior in long-tailed macaques. Subsequently, we feel that tasks in which the donor must choose a lower value reward to benefit another individual may allow the titration of the strength of prosocial behavior, and thus provides interesting possibilities for future comparative studies. (c) 2015 APA, all rights reserved).

  12. [Costs of appendicitis treatment by diagnosis-related groups in a third-level pediatric hospital].

    Science.gov (United States)

    Tlacuilo-Parra, Alberto; Hernández-Hernández, Araceli; Venegas-Dávalos, Martha; Gutiérrez-Hermosillo, Violeta; Guevara-Gutiérrez, Elizabeth; Ambriz-González, Gabriela

    2014-01-01

    Diagnosis-related groups (DRGs) are widely used in Europe. They allow performing comparisons in hospitals and incurrent hospital payment systems, defining the payment categories. We undertook this study to classify children who underwent appendectomy according to DRGs. Cross-sectional study. Comorbidities, length of hospitalization, histopathologic classification, and DRG classifications were analyzed. We included 313 patients, 62% males, with an average age of 8 ± 3 years; 91% were referred by another hospital and 67% were treated at night. Average length of hospitalization was 4 ± 3 days. There were comorbidities in 8% and surgical complications in 11%. According to histopathology, appendicitis was edematous (11%), suppurative (36%), gangrenous (22%), perforated (29%), and abscessed (2%). At discharge, 97% of the patients were healthy. Total cost for DRG 343 was $10,470,173.00 (Mexican pesos), DRG 342 was $1,227,592.00 and DRG 340 was $511,521.00. The global amount was $12,209,286.00 (Mexican pesos). The unitary cost for treatment of appendectomy for DRG 343 was $37,935.00, for DRG 342 was $49,103.00 and for DRG 340 was $42,626.00 (Mexican pesos). Because 88% of the cases of appendicitis were uncomplicated, this amount of money could be spent to treat these patients in a second-level hospital, using reimbursement 343 without generating additional expenses.

  13. Using Automation to Monitor and Report Hazardous Waste Disposal Costs: A Mission-Critical Obligation

    National Research Council Canada - National Science Library

    Hassrick, H

    1996-01-01

    Controlling, monitoring, and reporting hazardous waste disposal costs has become increasingly important as environmental problems arise, costs escalate, and budgets contract. In FY94, the U.S. Army, Europe (USAREUR), spent...

  14. Subgroup analysis of patients with localized prostate cancer treated within the Dutch-randomized dose escalation trial

    International Nuclear Information System (INIS)

    Al-Mamgani, Abrahim; Heemsbergen, Wilma D.; Levendag, Peter C.; Lebesque, Joos V.

    2010-01-01

    Purpose: To investigate the effect of dose escalation within prognostic risk groups in prostate cancer. Patients and methods: Between 1997 and 2003, 664 patients with localized prostate cancer were randomly assigned to receive 68- or 78-Gy of radiotherapy. Two prognostic models were examined: a risk group model (low-, intermediate-, and high-risk) and PSA-level groupings. High-risk patients with hormonal therapy (HT) were analyzed separately. Outcome variable was freedom from failure (FFF) (clinical failure or PSA nadir + 2 μg/L). Results: In relation to the advantage of high-dose radiotherapy, intermediate-risk patients benefited most from dose escalation. However no significant heterogeneity could be demonstrated between the risk groups. For two types of PSA-level groupings: PSA 8 μg/L, the test for heterogeneity was significant (p = 0.03 and 0.05, respectively). Patients with PSA 8-18 μg/L (n = 297, HR = 0.59) derived the greatest benefit from dose escalation. No heterogeneity could be demonstrated for high-risk patients with and without HT. Conclusion: Intermediate-risk group derived the greatest benefit for dose escalation. However, from this trial no indication was found to exclude low-risk or high-risk patients from high-dose radiotherapy. Patients could be selected for high-dose radiotherapy based on PSA-level groupings: for patients with a PSA < 8 μg/L high-dose radiotherapy is probably not indicated, but should be confirmed in other randomized studies.

  15. Increasing Use of Dose-Escalated External Beam Radiation Therapy for Men With Nonmetastatic Prostate Cancer

    International Nuclear Information System (INIS)

    Swisher-McClure, Samuel; Mitra, Nandita; Woo, Kaitlin; Smaldone, Marc; Uzzo, Robert; Bekelman, Justin E.

    2014-01-01

    Purpose: To examine recent practice patterns, using a large national cancer registry, to understand the extent to which dose-escalated external beam radiation therapy (EBRT) has been incorporated into routine clinical practice for men with prostate cancer. Methods and Materials: We conducted a retrospective observational cohort study using the National Cancer Data Base, a nationwide oncology outcomes database in the United States. We identified 98,755 men diagnosed with nonmetastatic prostate cancer between 2006 and 2011 who received definitive EBRT and classified patients into National Comprehensive Cancer Network (NCCN) risk groups. We defined dose-escalated EBRT as total prescribed dose of ≥75.6 Gy. Using multivariable logistic regression, we examined the association of patient, clinical, and demographic characteristics with the use of dose-escalated EBRT. Results: Overall, 81.6% of men received dose-escalated EBRT during the study period. The use of dose-escalated EBRT did not vary substantially by NCCN risk group. Use of dose-escalated EBRT increased from 70.7% of patients receiving treatment in 2006 to 89.8% of patients receiving treatment in 2011. On multivariable analysis, year of diagnosis and use of intensity modulated radiation therapy were significantly associated with receipt of dose-escalated EBRT. Conclusions: Our study results indicate that dose-escalated EBRT has been widely adopted by radiation oncologists treating prostate cancer in the United States. The proportion of patients receiving dose-escalated EBRT increased nearly 20% between 2006 and 2011. We observed high utilization rates of dose-escalated EBRT within all disease risk groups. Adoption of intensity modulated radiation therapy was strongly associated with use of dose-escalated treatment

  16. Cost analysis of procedures related to the management of renal artery stenosis from various perspectives

    International Nuclear Information System (INIS)

    Helvoort-Postulart, Debby van; Dirksen, Carmen D.; Kessels, Alfons G.H.; Kroon, Abraham A.; Leeuw, Peter W. de; Nelemans, Patricia J.; Engelshoven, Jos M.A. van; Myriam Hunink, M.G.

    2006-01-01

    To determine the costs associated with the diagnostic work-up and percutaneous revascularization of renal artery stenosis from various perspectives. A prospective multicenter comparative study was conducted between 1998 and 2001. A total of 402 hypertensive patients with suspected renal artery stenosis were included. Costs were assessed of computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA), and percutaneous revascularization. From the societal perspective, DSA was the most costly (EUR 1,721) and CTA the least costly diagnostic technique (EUR 424). CTA was the least costly imaging procedure irrespective of the perspective used. The societal costs associated with percutaneous renal artery revascularization ranged from EUR 2,680 to EUR 6,172. Overall the radiology department incurred the largest proportion of the total societal costs. For the management of renal artery stenosis, performing the analysis from different perspectives leads to the same conclusion concerning the least costly diagnostic imaging and revascularization procedure. (orig.)

  17. Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System.

    Science.gov (United States)

    Tseng, Phillip; Kaplan, Robert S; Richman, Barak D; Shah, Mahek A; Schulman, Kevin A

    2018-02-20

    Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of

  18. An accelerated dose escalation with a grass pollen allergoid is safe and well-tolerated: a randomized open label phase II trial.

    Science.gov (United States)

    Chaker, A M; Al-Kadah, B; Luther, U; Neumann, U; Wagenmann, M

    2015-01-01

    The number of injections in the dose escalation of subcutaneous immunotherapy (SCIT) is small for some currently used hypoallergenic allergoids, but can still be inconvenient to patients and can impair compliance. The aim of this trial was to compare safety and tolerability of an accelerated to the conventional dose escalation scheme of a grass pollen allergoid. In an open label phase II trial, 122 patients were 1:1 randomized for SCIT using a grass pollen allergoid with an accelerated dose escalation comprising only 4 weekly injections (Group I) or a conventional dose escalation including 7 weekly injections (Group II). Safety determination included the occurrence of local and systemic adverse events. Tolerability was assessed by patients and physicians. Treatment-related adverse events were observed in 22 (36.1 %) patients in Group I and 15 (24.6 %) in Group II. Local reactions were reported by 18 patients in Group I and 11 in Group II. Five Grade 1 systemic reactions (WAO classification) were observed in Group I and 2 in Group II. Grade 2 reactions occurred 3 times in Group I and 2 times in Group II. Tolerability was rated as "good" or "very good" by 53 (86.9 %) patients in Group I and 59 (100 %) in Group II by investigators. Forty-eight patients in Group I (80.0 %) and 54 in Group II (91.5 %) rated tolerability as "good" or "very good". The dose escalation of a grass pollen allergoid can be accelerated with safety and tolerability profiles comparable to the conventional dose escalation.

  19. Modeling residential water and related energy, carbon footprint and costs in California

    International Nuclear Information System (INIS)

    Escriva-Bou, Alvar; Lund, Jay R.; Pulido-Velazquez, Manuel

    2015-01-01

    Graphical abstract: - Highlights: • We model residential water use and related energy and GHG emissions in California. • Heterogeneity in use, spatial variability and water and energy rates are accounted. • Outdoor is more than 50% of water use but 80% of energy is used by faucet + shower. • Variability in water and energy prices affects willingness to adopt conservation. • Targeting high-use hoses and joint conservation policies are effective strategies. - Abstract: Starting from single-family household water end-use data, this study develops an end-use model for water-use and related energy and carbon footprint using probability distributions for parameters affecting water consumption in 10 local water utilities in California. Monte Carlo simulations are used to develop a large representative sample of households to describe variability in use, with water bills for each house for different utility rate structures. The water-related energy consumption for each household realization was obtained using an energy model based on the different water end-uses, assuming probability distributions for hot-water-use for each appliance and water heater characteristics. Spatial variability is incorporated to account for average air and household water inlet temperatures and price structures for each utility. Water-related energy costs are calculated using averaged energy price for each location. CO 2 emissions were derived from energy use using emission factors. Overall simulation runs assess the impact of several common conservation strategies on household water and energy use. Results show that single-family water-related CO 2 emissions are 2% of overall per capita emissions, and that managing water and energy jointly can significantly reduce state greenhouse gas emissions

  20. Experiences related to the role of a cost centre manager in a public ...

    African Journals Online (AJOL)

    A cost centre in a hospital setting is an identifiable department, for example a nursing care unit, which has been practically assigned an account number in the hospital accounting system. The purpose of a cost centre is to control clinical and administrative costs, as well as accumulated expenses by that identified ...

  1. Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research

    NARCIS (Netherlands)

    T. van Asselt (Thea); B.L.T. Ramaekers (Bram); I. Corro Ramos (Isaac); M.A. Joore (Manuela); M.J. Al (Maiwenn); Lesman-Leegte, I. (Ivonne); M.J. Postma (Maarten); P. Vemer (Pepijn); T.L. Feenstra (Talitha)

    2017-01-01

    textabstractBackground: The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. Objective: The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses;

  2. Research Costs Investigated : A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research

    NARCIS (Netherlands)

    van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

    BACKGROUND: The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. OBJECTIVE: The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2)

  3. Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia.

    Science.gov (United States)

    Greenleaf, Erin K; Winder, Joshua S; Hollenbeak, Christopher S; Haluck, Randy S; Mathew, Abraham; Pauli, Eric M

    2018-01-01

    Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM. A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database. The measure of effectiveness was quality-adjusted life years (QALYs) which were estimated from direct elicitation of utility using a visual analog scale. The primary outcome was the incremental cost-effectiveness ratio (ICER). Uncertainty was assessed by bootstrapping the sample and computing the cost-effectiveness acceptability curve (CEAC). Patients treated within an 11-year period (2004-2016) were recruited for participation (20 POEM, 21 LHM). During the index admission, the mean costs for POEM ($8630 ± $2653) and the mean costs for LHM ($7604 ± $2091) were not significantly different (P = 0.179). Additionally, mean QALYs for POEM (0.413 ± 0.248) were higher than that associated with LHM (0.357 ± 0.338), but this difference was also not statistically significant (P = 0.55). The ICER suggested that it would cost an additional $18,536 for each QALY gained using POEM. There was substantial uncertainty in the ICER; there was a 48.25% probability that POEM was cost-effective at the mean ICER. At a willingness-to-pay threshold of $100,000, there was a 68.31% probability that POEM was cost-effective relative to LHM. In the treatment of achalasia, POEM appears to be cost-effective relative to LHM depending on one's willingness-to-pay for an additional QALY.

  4. nuSTORM Costing document

    Energy Technology Data Exchange (ETDEWEB)

    Bross, Alan D. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States)

    2013-10-01

    Detailed costing of the nuSTORM conventional facilities has been done by the Fermilab Facilities Engineering Services Section (FESS) and is reported on in the nuSTORM Project Definition Report (PDR) 6-13-1. Estimates for outfitting the primary proton beam line, the target station, the pion capture/transport line and decay ring are based on either experience from existing Fermilab infrastructure (NuMI) or is based on the detailed costing exercises for DOE CD-1 approval for future experiments (mu2e and LBNE). The detector costing utilized the Euronu costing for the Neutrino Factory Magnetized Iron Neutrino Detector (MIND), extrapolations from MINOS as-built costs and from recent vendor quotes. Costs included all manpower and are fully burdened (FY2013 dollars). The costs are not escalated, however, beyond the 5-year project timeline, since a project start for nuSTORM is unknown. Escalation can be estimated from various models (see Figure 1). LBNE has used the Jacob’s model to determine their cost escalation.

  5. A Comparison of Escalating versus Fixed Reinforcement Schedules on Undergraduate Quiz Taking

    Science.gov (United States)

    Mahoney, Amanda

    2017-01-01

    Drug abstinence studies indicate that escalating reinforcement schedules maintain abstinence for longer periods than fixed reinforcement schedules. The current study evaluated whether escalating reinforcement schedules would maintain more quiz taking than fixed reinforcement schedules. During baseline and for the control group, bonus points were…

  6. Understanding the Emotional Aspects of Escalation of Commitment: The Role of Negative Affect

    Science.gov (United States)

    Wong, Kin Fai Ellick; Yik, Michelle; Kwong, Jessica Y. Y.

    2006-01-01

    Despite the importance of understanding the emotional aspects of organizational decision making, prior research has paid scant attention to the role of emotion in escalation of commitment. This article attempts to fill this gap by examining the relationship between negative affect and escalation of commitment. Results showed that regardless of…

  7. Water and Wastewater Annual Price Escalation Rates for Selected Cities across the United States

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2017-10-27

    Pacific Northwest National Laboratory conducted this study for the Federal Energy Management Program to identify trends in annual water and wastewater price escalation rates across the United States. This study can be used to inform the selection of an appropriate escalation rates for inclusion in LCCA.

  8. Escalation with Overdose Control Using Ordinal Toxicity Grades for Cancer Phase I Clinical Trials

    Directory of Open Access Journals (Sweden)

    Mourad Tighiouart

    2012-01-01

    Full Text Available We extend a Bayesian adaptive phase I clinical trial design known as escalation with overdose control (EWOC by introducing an intermediate grade 2 toxicity when assessing dose-limiting toxicity (DLT. Under the proportional odds model assumption of dose-toxicity relationship, we prove that in the absence of DLT, the dose allocated to the next patient given that the previously treated patient had a maximum of grade 2 toxicity is lower than the dose given to the next patient had the previously treated patient exhibited a grade 0 or 1 toxicity at the most. Further, we prove that the coherence properties of EWOC are preserved. Simulation results show that the safety of the trial is not compromised and the efficiency of the estimate of the maximum tolerated dose (MTD is maintained relative to EWOC treating DLT as a binary outcome and that fewer patients are overdosed using this design when the true MTD is close to the minimum dose.

  9. Implementation of the international structure for decommissioning costing; examples and related IAEA projects - 59313

    International Nuclear Information System (INIS)

    Daniska, Vladimir; Laraia, Michele; O'Sullivan, Patrick

    2012-01-01

    In 1999, IAEA, the OECD Nuclear Energy Agency and the European Commission jointly proposed the standardised listing of decommissioning activities [1] to serve as a general basis for presentation of decommissioning costs and for promoting the harmonisation in decommissioning costing. The standardised listing of activities [1] was developed in three hierarchical levels based on analysis of typical decommissioning activities identified in various decommissioning projects. The structure [1] has been currently updated by the same organisations as the International Structure for Decommissioning Costing (ISDC) based on the experience gained over ten years of use of the original standardised listing [2]. First part of the paper presents the revised ISDC. The principle of the three-level original hierarchical structure has been preserved. Re-definition of the content and re-structuring was done to avoid ambiguity and to ensure comprehensiveness. Paper presents two basic approaches for implementation of the ISDC structure in costing - converting the cost data available in specific cost structures, mostly according the work breakdown structures of decommissioning projects into ISDC and implementation of the ISDC as the cost calculation structure. Examples of the second approach are given to show that this approach is feasible and may have several advantages. An ORACLE based costing model with implemented of the extended ISDC for detailed costing and an Excel based costing model for preliminary costing at IAEA for research reactors are given. (authors)

  10. An Analysis of the Authorities' Expected Costs Related to the Decommissioning Programme

    International Nuclear Information System (INIS)

    Lindskog, Staffan; Borg, Lorens; Lichtenberg, Steen

    2002-05-01

    The analysis serves two general aims. These are: (1) To establish a neutral value of the authorities' total expected future costs arising from the decommissioning programme and identify the related uncertainties and their primary sources. The result is measured as a Net Present Value figure (NPV). (2) To test the suggested procedure under development. The analysis procedure follows the basics of the suggested estimate procedure 1. This analysis deals with a programme of an unusually long duration. The timing itself is highly uncertain. In addition, R and D is still to be finished. (I) Costs from January 1 2003 arising from all necessary activities of SKI and SSI and which directly or indirectly relate to the decommissioning programme: They include activities at the power plants after the operating period and until the end of the decommissioning period, and similar activities at CLAB and other communal or shared facilities, as well as related administration, R and D, etc. (II) Any future 'wage inflation'. (III) Events not known today, as well as effects on the programme of minor and medium-scale unplanned events. (IV) Effects of major force majeure events are excluded, for example, a serious nuclear accident in Sweden or elsewhere. (V) Activities and obligations related to nuclear power plants in operation as well as other applications of nuclear materials (e.g. at hospitals) are excluded from the study. (VI) The price level is SEK as at 2002-01-01. (VII) The discount factor as recommended by KAFS and used in the present decommissioning funding is also used here. Hence, it operates at an annual rate of 4% until 2020, and 2.5% thereafter. (VIII) This analysis is limited to the AUB scenario. The parallel GB estimate can be derived from the results of this estimate, subject to minor adjustments. Our basic findings: The total Net Present Value is calculated at Mean Value(M): 2,912 MSEK Standard Deviation (S): 980 MSEK 1. An estimate procedure for the decommissioning

  11. Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

    Science.gov (United States)

    Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

    2016-09-01

    Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

  12. Escalation research: Providing new frontiers for applying behavior analysis to organizational behavior

    Science.gov (United States)

    Goltz, Sonia M.

    2000-01-01

    Decision fiascoes such as escalation of commitment, the tendency of decision makers to “throw good money after bad,” can have serious consequences for organizations and are therefore of great interest in applied research. This paper discusses the use of behavior analysis in organizational behavior research on escalation. Among the most significant aspects of behavior-analytic research on escalation is that it has indicated that both the patterns of outcomes that decision makers have experienced for past decisions and the patterns of responses that they make are critical for understanding escalation. This research has also stimulated the refinement of methods by researchers to better assess decision making and the role reinforcement plays in it. Finally, behavior-analytic escalation research has not only indicated the utility of reinforcement principles for predicting more complex human behavior but has also suggested some additional areas for future exploration of decision making using behavior analysis. PMID:22478347

  13. An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures.

    Science.gov (United States)

    Nshimyumukiza, Léon; Durand, Audrey; Gagnon, Mathieu; Douville, Xavier; Morin, Suzanne; Lindsay, Carmen; Duplantie, Julie; Gagné, Christian; Jean, Sonia; Giguère, Yves; Dodin, Sylvie; Rousseau, François; Reinharz, Daniel

    2013-02-01

    A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could

  14. LPGC, Levelized Steam Electric Power Generator Cost

    International Nuclear Information System (INIS)

    Coen, J.J.; Delene, J.G.

    1994-01-01

    1 - Description of program or function: LPGC is a set of nine microcomputer programs for estimating power generation costs for large steam-electric power plants. These programs permit rapid evaluation using various sets of economic and technical ground rules. The levelized power generation costs calculated may be used to compare the relative economics of nuclear and coal-fired plants based on life-cycle costs. Cost calculations include capital investment cost, operation and maintenance cost, fuel cycle cost, decommissioning cost, and total levelized power generation cost. These programs can be used for quick analyses of power generation costs using alternative economic parameters, such as interest rate, escalation rate, inflation rate, plant lead times, capacity factor, fuel prices, etc. The two major types of electric generating plants considered are pressurized-water reactor (PWR) and pulverized coal-fired plants. Data are also provided for the Large Scale Prototype Breeder (LSPB) type liquid metal reactor. Costs for plant having either one or two units may be obtained. 2 - Method of solution: LPGC consists of nine individual menu-driven programs controlled by a driver program, MAINPWR. The individual programs are PLANTCAP, for calculating capital investment costs; NUCLOM, for determining operation and maintenance (O and M) costs for nuclear plants; COALOM, for computing O and M costs for coal-fired plants; NFUEL, for calculating levelized fuel costs for nuclear plants; COALCOST, for determining levelized fuel costs for coal-fired plants; FCRATE, for computing the fixed charge rate on the capital investment; LEVEL, for calculating levelized power generation costs; CAPITAL, for determining capitalized cost from overnight cost; and MASSGEN, for generating, deleting, or changing fuel cycle mass balance data for use with NFUEL. LPGC has three modes of operation. In the first, each individual code can be executed independently to determine one aspect of the total

  15. AES, Automated Construction Cost Estimation System

    International Nuclear Information System (INIS)

    Holder, D.A.

    1995-01-01

    A - Description of program or function: AES (Automated Estimating System) enters and updates the detailed cost, schedule, contingency, and escalation information contained in a typical construction or other project cost estimates. It combines this information to calculate both un-escalated and escalated and cash flow values for the project. These costs can be reported at varying levels of detail. AES differs from previous versions in at least the following ways: The schedule is entered at the WBS-Participant, Activity level - multiple activities can be assigned to each WBS-Participant combination; the spending curve is defined at the schedule activity level and a weighing factor is defined which determines percentage of cost for the WBS-Participant applied to the schedule activity; Schedule by days instead of Fiscal Year/Quarter; Sales Tax is applied at the Line Item Level- a sales tax codes is selected to indicate Material, Large Single Item, or Professional Services; a 'data filter' has been added to allow user to define data the report is to be generated for. B - Method of solution: Average Escalation Rate: The average escalation for a Bill of is calculated in three steps. 1. A table of quarterly escalation factors is calculated based on the base fiscal year and quarter of the project entered in the estimate record and the annual escalation rates entered in the Standard Value File. 2. The percentage distribution of costs by quarter for the Bill of Material is calculated based on the schedule entered and the curve type. 3. The percent in each fiscal year and quarter in the distribution is multiplied by the escalation factor for the fiscal year and quarter. The sum of these results is the average escalation rate for that Bill of Material. Schedule by curve: The allocation of costs to specific time periods is dependent on three inputs, starting schedule date, ending schedule date, and the percentage of costs allocated to each quarter. Contingency Analysis: The

  16. Mitigation potential and cost in tropical forestry - relative role for agroforestry

    Energy Technology Data Exchange (ETDEWEB)

    Makundi, Willy R.; Sathaye, Jayant A.

    2004-01-01

    This paper summarizes studies of carbon mitigation potential (MP) and costs of forestry options in seven developing countries with a focus on the role of agroforestry. A common methodological approach known as comprehensive mitigation assessment process (COMAP) was used in each study to estimate the potential and costs between 2000 and 2030. The approach requires the projection of baseline and mitigation land-use scenarios derived from the demand for forest products and forestland for other uses such as agriculture and pasture. By using data on estimated carbon sequestration, emission avoidance, costs and benefits, the model enables one to estimate cost effectiveness indicators based on monetary benefit per t C, as well as estimates of total mitigation costs and potential when the activities are implemented at equilibrium level. The results show that about half the MP of 6.9 Gt C (an average of 223 Mt C per year) between 2000 and 2030 in the seven countries could be achieved at a negative cost, and the other half at costs not exceeding $100 per t C. Negative cost indicates that non-carbon revenue is sufficient to offset direct costs of about half of the options. The agroforestry options analyzed bear a significant proportion of the potential at medium to low cost per t C when compared to other options. The role of agroforestry in these countries varied between 6% and 21% of the MP, though the options are much more cost effective than most due to the low wage or opportunity cost of rural labor. Agroforestry options are attractive due to the large number of people and potential area currently engaged in agriculture, but they pose unique challenges for carbon and cost accounting due to the dispersed nature of agricultural activities in the tropics, as well as specific difficulties arising from requirements for monitoring, verification, leakage assessment and the establishment of credible baselines.

  17. The classification of costs by root vegetables in relation to grower systems

    Directory of Open Access Journals (Sweden)

    Patrik Burg

    2008-01-01

    Full Text Available The work deal with economic classification of two variants of technological process by carrot production. First variants presents raising of carrot on ridge, the second raising of carrot on uphill beds. Datas needed for model calculation were detected by direct metering in real conditions, with investgation by users and producers of machines. With utilization of these statement were with the help of programme AGROTEKIS provided model calculation of operating costs of machines and mechanical tools. These data were exploited for calculation of costs by carrot production in both assessed variants. The results shows about mild growth of costs by growing of carrot on ridge (difference circa 3,5 %. Calculated values by general costs with overhead costs are 80 120–99 772 CZK.ha−1. The biggest costs part falls on soil preparation (25–30 %, harvest and manipulation (43–46 %.

  18. Direct medical cost of influenza-related hospitalizations among severe acute respiratory infections cases in three provinces in China.

    Directory of Open Access Journals (Sweden)

    Lei Zhou

    Full Text Available BACKGROUND: Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. METHODS: Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital's Hospital Information System (HIS and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range and median (interquartile range [IQR] costs were calculated and compared among children (≤15 years, adults (16-64 years and elderly (≥65 years groups. Factors influencing cost were analyzed. RESULTS: A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range direct medical cost was $1,797 ($80-$27,545 for all hospitalizations, and the median (IQR direct medical cost was $231 ($164, $854 ($890, and $2,263 ($7,803 for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. CONCLUSION: Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies.

  19. Sulfur Emissions, Abatement Technologies and Related Costs for Europe in the RAINS Model Database

    OpenAIRE

    Cofala, J.; Syri, S.

    1998-01-01

    This paper describes the part of the Regional Pollution Information and Simulation (RAINS) model dealing with the potential and costs controlling emissions of sulfur dioxide. The paper describes the selected aggregation level of the emission generating activities and reviews the major options for controlling SO2 emissions. An algorithm for estimating emission control costs is presented. The cost calculation distinguishes 'general'(i.e., valid for all countries) and 'country-specific' paramete...

  20. Cost-related model for transit rates in electric power distribution networks

    International Nuclear Information System (INIS)

    Collstrand, F.

    1994-02-01

    The planned deregulation of the swedish electrical power market will require a new structure of the electrical energy rates. In this report different models of transit rates are studied. The report includes studies of literature and a proposal to a rate structure and is made specifically for Malmoe Energi AB. The differences between various methods of calculating the transfer cost are illustrated. Further, the build-up of the tariff structure and its base elements are discussed. The costs are divided on different categories of costumers and shows the cost for each customer. The new regulations should apply simultaneously to all networks, independent of the voltage level. The transit cost should be based on a number of basic elements: capital cost, operation and maintenance, losses, measuring and administration. Capital cost and operation and maintenance should be charged as power fees, the loss cost as an energy fee and the measuring and administration cost as a fixed fee. The customer bill should be split into two parts, one for the transit cost and one for the energy usage. 15 refs., 37 tabs., 6 figs

  1. Social/economic costs and health-related quality of life in patients with spinal muscular atrophy (SMA) in Spain.

    Science.gov (United States)

    López-Bastida, Julio; Peña-Longobardo, Luz María; Aranda-Reneo, Isaac; Tizzano, Eduardo; Sefton, Mark; Oliva-Moreno, Juan

    2017-08-18

    The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) of patients with Spinal Muscular Atrophy (SMA) and their caregivers in Spain. This was a cross-sectional and retrospective study of patients diagnosed with SMA in Spain. We adopted a bottom up, prevalence approach design to study patients with SMA. The patient's caregivers completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and non-healthcare services. Costs were estimated from a societal perspective (including healthcare costs and non-healthcare costs), and health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire. The main caregivers also answered a questionnaire on their characteristics and on their HRQOL. A total of 81 caregivers of patients with different subtypes of SMA completed the questionnaire. Based on the reference unitary prices for 2014, the average annual costs per patient were € 33,721. Direct healthcare costs were € 10,882 (representing around 32.3% of the total cost) and the direct non-healthcare costs were € 22,839 (67.7% of the total cost). The mean EQ-5D social tariff score for patients was 0.16, and the mean score of the EQ-5D visual analogue scale was 54. The mean EQ-5D social tariff score for caregivers was 0.49 and their mean score on the EQ-5D visual analogue scale was 69. The results highlight the burden that SMA has in terms of costs and decreased HRQOL, not only for patients but also for their caregivers. In particular, the substantial social/economic burden is mostly attributable to the high direct non-healthcare costs.

  2. Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

    Science.gov (United States)

    Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

    2016-01-01

    Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation-related

  3. Early termination of prostate cancer hyperfractionated dose escalation study

    International Nuclear Information System (INIS)

    Forman, Jeffrey D; Porter, Arthur T; Kocheril, Paul; Grignon, David; Orton, Colin

    1996-01-01

    Purpose: This study was initiated to determine the maximum tolerable dose of hyperfractionated radiation in patients with locally advanced prostate cancer. Materials and Methods: Forty-nine patients with locally advanced prostate cancer (T3-T4 Nx, 0, 1 M0 and/or Gleason Score ≥ 8) were treated on the first two steps of a prospective dose-escalation study using hyperfractionated conformal radiotherapy. The first 25 patients received a minimum dose of 78Gy to the clinical tumor volume (CTV) including the prostate, seminal vesicle and a 5mm margin at 1.3Gy b.i.d. The second group (24 patients) received a minimum dose to the CTV of 82.8Gy at 1.15Gy b.i.d. Twenty eight patients received neo-adjuvant hormonal therapy in conjunction with their radiation (8 of 25 patients at 78Gy and 20 of 24 patients at 82.8Gy). Toxicity was scored according to the RTOG grading scale. Efficacy was evaluated by PSA levels and ultrasound guided biopsies. Median follow up was 36 and 18 months for the 78Gy and 82.8Gy dose levels, respectively. Results: No grade 3 or 4 gastrointestinal (GI) or genitourinary (GU) toxicity was noted. At 36 months, the actuarial probability of Grade 2 GI and GU toxicity were 16 and 20%, respectively. Twelve to 18 months following radiation, 41 patients (86%) underwent ultrasound guided biopsy. At 78Gy, 60% of 20 patients had a biopsy which was negative or showed a marked therapeutic effect. At 82.8Gy, these combined rates were 95% in the 21 patients who had biopsies. Nine patients (50%) who did not receive neo-adjuvant hormones had positive biopsies. No patient who received neo-adjuvant hormones plus 78Gy (5 patients) or 82.8Gy (18 patients) had a positive biopsy. Conclusion: Proceeding to the next dose level (87.4Gy) was justified by the lack of severe chronic toxicity. However, in view of the high rate of histologic sterilization when hyperfractionated irradiation was given in conjunction with neo-adjuvant hormonal therapy, it was felt to be unethical to

  4. Pharmacokinetics of Escalating Doses of Oral Psilocybin in Healthy Adults.

    Science.gov (United States)

    Brown, Randall T; Nicholas, Christopher R; Cozzi, Nicholas V; Gassman, Michele C; Cooper, Karen M; Muller, Daniel; Thomas, Chantelle D; Hetzel, Scott J; Henriquez, Kelsey M; Ribaudo, Alexandra S; Hutson, Paul R

    2017-12-01

    Psilocybin is a psychedelic tryptamine that has shown promise in recent clinical trials for the treatment of depression and substance use disorders. This open-label study of the pharmacokinetics of psilocybin was performed to describe the pharmacokinetics and safety profile of psilocybin in sequential, escalating oral doses of 0.3, 0.45, and 0.6 mg/kg in 12 healthy adults. Eligible healthy adults received 6-8 h of preparatory counseling in anticipation of the first dose of psilocybin. The escalating oral psilocybin doses were administered at approximately monthly intervals in a controlled setting and subjects were monitored for 24 h. Blood and urine samples were collected over 24 h and assayed by a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for psilocybin and psilocin, the active metabolite. The pharmacokinetics of psilocin were determined using both compartmental (NONMEM) and noncompartmental (WinNonlin) methods. No psilocybin was found in plasma or urine, and renal clearance of intact psilocin accounted for less than 2% of the total clearance. The pharmacokinetics of psilocin were linear within the twofold range of doses, and the elimination half-life of psilocin was 3 h (standard deviation 1.1). An extended elimination phase in some subjects suggests hydrolysis of the psilocin glucuronide metabolite. Variation in psilocin clearance was not predicted by body weight, and no serious adverse events occurred in the subjects studied. The small amount of psilocin renally excreted suggests that no dose reduction is needed for subjects with mild-moderate renal impairment. Simulation of fixed doses using the pharmacokinetic parameters suggest that an oral dose of 25 mg should approximate the drug exposure of a 0.3 mg/kg oral dose of psilocybin. Although doses of 0.6 mg/kg are in excess of likely therapeutic doses, no serious physical or psychological events occurred during or within 30 days of any dose. NCT02163707.

  5. Extent, nature and hospital costs of fireworks-related injuries during the Wednesday Eve festival in Iran.

    Science.gov (United States)

    Alinia, Siros; Rezaei, Satar; Daroudi, Rajabali; Hadadi, Mashyaneh; Akbari Sari, Ali

    2013-01-01

    Fireworks are commonly used in local and national celebrations. The aim of this study is to explore the extent, nature and hospital costs of injuries related to the Persian Wednesday Eve festival in Iran. Data for injuries caused by fireworks during the 2009 Persian Wednesday Eve festival were collected from the national Ministry of Health database. Injuries were divided into nine groups and the average and total hospital costs were estimated for each group. The cost of care for patients with burns was estimated by reviewing a sample of 100 patients randomly selected from a large burn center in Tehran. Other costs were estimated by conducting semi structured interviews with expert managers at two large government hospitals. 1817 people were injured by fireworks during the 2009 Wednesday Eve festival. The most frequently injured sites were the hand (43.3%), eye (24.5%) and face (13.2%), and the most common types of injury were burns (39.9%), contusions/abrasions (24.6%) and lacerations (12.7%). The mean length of hospital stay was 8.15 days for patients with burns, 10.7 days for those with amputations, and 3 days for those with other types of injury. The total hospital cost of injuries was US$ 284 000 and the average cost per injury was US$ 156. The total hospital cost of patients with amputations was US$ 48 598. Most of the costs were related to burns (56.6%) followed by amputations (12.2%). Injuries related to the Persian Wednesday Eve festival are common and lead to extensive morbidity and medical costs. © 2013 KUMS, All rights reserved.

  6. Dose escalation for non-small cell lung cancer: Analysis and modelling of published literature

    International Nuclear Information System (INIS)

    Partridge, Mike; Ramos, Monica; Sardaro, Angela; Brada, Michael

    2011-01-01

    Purpose: To review the published clinical data on non-small cell lung cancer treated with radical radiotherapy to confirm a dose-response relationship as a basis for further dose-escalation trials. Methods: Twenty-four published clinical trials were identified, 16 of which - with 29 different standard, hyper- and hypofractionated treatment schedules - were analysed. Prescription doses were converted to biologically-equivalent dose (BED), with a correction for repopulation. Disease-free survival data were corrected for the stage profile of each cohort to allow better comparison of results. We also analysed moderate (grade II and III) lung and oesophageal acute toxicity related to the corrected BED delivered to the tumour. Results: The clinical data analysed showed good agreement between the observed and modelled disease-free survival at 2 years when compared to the published models of Fenwick (correlation coefficient 0.525, p = 0.003) and Martel (correlation coefficient 0.492, p = 0.007), indicating a clear tumour dose-response. In the normally fractionated treatments (∼2 Gy per fraction), improved disease-free survival was generally observed in the shorter schedules (maximum around 6 weeks). However, the best outcomes were obtained for the hypofractionated schedules. No systematic relationship was seen between prescribed dose and lung or oesophageal acute toxicity, possibly due to dose selection depending on V 20 or MLD in some studies and the diversity of the patients analysed. Conclusions: We have demonstrated a dose-response relationship for NSCLC based on clinical data. The clinical data provide a rational basis for selection of dose escalation schedules to be tested in future randomised trials.

  7. Social/economic costs and health-related quality of life in patients with Duchenne muscular dystrophy in Europe.

    Science.gov (United States)

    Cavazza, Marianna; Kodra, Yllka; Armeni, Patrizio; De Santis, Marta; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Schieppati, Arrigo; Iskrov, Georgi; Péntek, Márta; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Chevreul, Karine; Persson, Ulf; Fattore, Giovanni

    2016-04-01

    The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with Duchenne muscular dystrophy (DMD) in Europe. We conducted a cross-sectional study of patients with DMD from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden, and the UK. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. Costs have been estimated from a societal perspective adopting a bottom-up approach. A total of 422 questionnaires were included in the study; 268 of which were collected from patients with DMD and 154 from caregivers. The average annual cost per person in 2012 ranged from €7657 in Hungary to €58,704 in France. Direct non-healthcare costs are the main component of whole costs and informal care is the main driver of non-healthcare costs. Costs are also shown to differ between children and adults. With regard to HRQOL of adult patients, the EQ-5D VAS score and EQ-5D index scores were 50.5 and 0.24, respectively. The corresponding EQ-5D VAS and EQ-5D index scores for caregivers were 74.7 and 0.71, respectively. We have estimated the average annual cost per patient with DMD in eight European countries adopting a social perspective, and to our knowledge this is the first study with such a wide perspective. The results on costs show a considerable gap between Eastern and Western European countries. Non-healthcare costs range from 64 to 89 % of overall costs and informal care is to a great extent the main driver of this cost category. The HRQOL of people with DMD is much lower than that of the general population.

  8. Fitness cost of incubation in great tits (Parus major) is related to clutch size

    Science.gov (United States)

    de Heij, Maaike E; van den Hout, Piet J; Tinbergen, Joost M

    2006-01-01

    Life-history theory predicts that parents produce the number of offspring that maximizes their fitness. In birds, natural selection on parental decisions regarding clutch size may act during egg laying, incubation or nestling phase. To study the fitness consequences of clutch size during the incubation phase, we manipulated the clutch sizes during this phase only in three breeding seasons and measured the fitness consequences on the short and the long term. Clutch enlargement did not affect the offspring fitness of the manipulated first clutches, but fledging probability of the subsequent clutch in the same season was reduced. Parents incubating enlarged first clutches provided adequate care for the offspring of their first clutches during the nestling phase, but paid the price when caring for the offspring of their second clutch. Parents that incubated enlarged first clutches had lower local survival in the 2 years when the population had a relatively high production of second clutches, but not in the third year when there was a very low production of second clutches. During these 2 years, the costs of incubation were strong enough to change positive selection, as established by brood size manipulations in this study population, into stabilizing selection through the negative effect of incubation on parental fitness. PMID:16928638

  9. Evaluation of Costs in Asparagus Production in Relation to Different Technological Processes in Conditions of Slovak Republic

    Directory of Open Access Journals (Sweden)

    Patrik Burg

    2014-01-01

    Full Text Available This study deals with analysis structure of cost on the production of asparagus in relation to three different technological processes in conditions of Slovak Republic. Obtained results can be used as a template to prepare budgets and make production decisions to estimate potential returns and to analyze investment and financial analysis decisions in the asparagus cultivation. Production practices used in the budget are based on typical practices for asparagus in this country. From the analysis of the cost structure of assessed variants different technological procedures follows that the largest share of the costs fall to purchased material and labor.

  10. [The US Government's effort in decreasing the cost of sleep-related problems and its outcome].

    Science.gov (United States)

    Song, You Hwi; Nishino, Seiji

    2008-09-01

    Sleepiness and inattention caused by sleep and circadian rhythm disorders or inadequate sleep habits adversely affect workers in many industries as well as the general public, and these disorders are likely to lead to public health and safety problems and adversely affect civilian life. Evidence is accumulating that these sleep related problems are contributing factors not only in many errors of judgement and accidents, but also related to some highly prevalent diseases, such as diabetes, obesity and hypertension. For each of these societal concerns, sleep science must be translated to the general public and to those in policy positions for improving public policy and public health awareness. In the United State, the National Commission for Sleep Disorders Research (established by the US Congress in 1998) completed a comprehensive report of its findings in 1993 to address these problems. The commission estimated that sleep disorders and sleepiness cost the United States $50 billion and called for permanent and concentrated efforts in expanding basic and clinical research on sleep disorders as well as in improving public awareness of the dangers of inadequate sleep hygiene. As a result of these efforts, the number of sleep centers has increased steadily and the total of the NIH (National Institutes of Health) funding for sleep research has also grown. In response to this progress in the US (together with appeals by Japanese Sleep Specialists), the Science Council of Japan published "The Recommendation of Creation of Sleep Science and Progression of Research" in 2002. In this article, we introduce and detail to the Japanese readers the US Government's efforts focusing on the report of the National Commission for Sleep Disorders Research, and we believe that the US Government's effort is a good example for the Japanese society to follow.

  11. The Relative Patient Costs and Availability of Dental Services, Materials and Equipment in Public Oral Care Facilities in Tanzania.

    OpenAIRE

    Nyamuryekung'e, Kasusu K; Lahti, Satu M; Tuominen, Risto J

    2015-01-01

    Background Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. Methods A survey of all dis...

  12. Natural Gas and CO2 Price Variation: Impact on the Relative Cost-Efficiency of LNG and Pipelines

    OpenAIRE

    Øverland, Indra; Ulvestad, Marte

    2012-01-01

    This article develops a formal model for comparing the cost structure of the two main transport options for natural gas: liquefied natural gas (LNG) and pipelines. In particular, it evaluates how variations in the prices of natural gas and greenhouse gas emissions affect the relative cost-efficiency of these two options. Natural gas is often promoted as the most environmentally friendly of all fossil fuels, and LNG as a modern and efficient way of transporting it. Some research has been carri...

  13. 48 CFR 31.205-47 - Costs related to legal and other proceedings.

    Science.gov (United States)

    2010-10-01

    ... ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With..., law or regulation by the contractor (including its agents or employees), or costs incurred in... or void a contract; or (iii) Terminate a contract for default by reason of a violation or failure to...

  14. Relative costs of transporting low-level waste according to four postulated regional-management cases

    International Nuclear Information System (INIS)

    Wilmot, E.L.; Shirley, C.G.

    1982-01-01

    Results presented in this paper show that almost any compact binding states into cooperating regions for disposal of LLW will reduce nationwide transportation costs markedly. As a corollary, the reduction of costs may reflect a two- to four-fold reduction of transportation distances with consequent reduction of risk to the public since risk generally decreases directly as transport distances decrease

  15. Rethinking the costs related to global warming. A survey of the issues

    International Nuclear Information System (INIS)

    Ekins, P.

    1995-01-01

    One approach to the economic analysis of global warming seeks to balance the costs of damage from or adaptation to it with the costs of mitigating it. The costs of adaptation and damage have been estimated using techniques of environmental evaluation, but are subject to a wide margin of uncertainty. The costs of mitigation, principally by reducing the emissions of CO 2 , have been estimated using different kinds of economic models, some of the results of which have suggested that very little abatement of carbon emissions is justified before the costs of abatement exceed the benefits of it in terms of foregone damage and adaptation costs. The paper analyses the extent to which this conclusion is a function of the modelling assumptions and techniques used, rather than likely practical outcomes, with regard to the models' treatment of unemployed resources, revenue recycling, prior distortions in the economy due to the tax system and possible dynamic effects from the introduction of a carbon-energy tax. It concludes that, with different and arguably more appropriate treatment of the above issues, especially when the secondary benefits of reducing CO 2 emissions are also taken into account, it is not clear that even substantial reductions in the use of fossil fuels will incur net costs, especially if there is the prospect of even moderate costs from global warming. 4 figs., 8 tabs., 95 refs

  16. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Fodor, Andrei; Dell' Oca, Italo; Pasetti, Marcella; Di Muzio, Nadia Gisella [San Raffaele Scientific Institute, Milan (Italy). Dept. of Radiotherapy; Fiorino, Claudio; Broggi, Sara; Cattaneo, Giovanni Mauro; Calandrino, Riccardo [San Raffaele Scientific Institute, Milan (Italy). Medical Physics; Gianolli, Luigi [San Raffaele Scientific Institute, Milan (Italy). Dept. of Nuclear Medicine

    2011-11-15

    To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2-10 weeks. Median overall survival was 8 months (1.2-50.5 months) and 20 months (4.3-33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003). The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection. (orig.)

  17. Factors associated with escalation and problematic approaches toward public figures.

    Science.gov (United States)

    Meloy, J Reid; James, David V; Mullen, Paul E; Pathé, Michele T; Farnham, Frank R; Preston, Lulu F; Darnley, Brian J

    2011-01-01

    Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research. © 2010 American Academy of Forensic Sciences.

  18. Destined to die but not to wage war: how existential threat can contribute to escalation or de-escalation of violent intergroup conflict.

    Science.gov (United States)

    Jonas, Eva; Fritsche, Immo

    2013-10-01

    War means threat to people's lives. Research derived from terror management theory (TMT) illustrates that the awareness of death leads people to defend cultural ingroups and their worldviews to attain a sense of symbolic immortality and thereby buffer existential anxiety. This can result in hostile effects of mortality salience (MS), such as derogation of outgroup members, prejudice, stereotyping, aggression, and racism, which, in turn, can lead to the escalation of violent intergroup conflict and, thus, the escalation of war. Yet, escalation of destructive conflict following MS is not automatic. Instead, research on TMT suggests that MS does not necessarily result in conflict and intolerance but can also foster positive tendencies, such as intergroup fairness or approval of pacifism, depending on how existential threat is perceived, whether the need for symbolic self-transcendence is satisfied, which social norms are salient, and how social situations are interpreted. In the present article, we review current TMT research with the aim of reconciling the seemingly contradictory findings of hostile and peaceful reactions to reminders of death. We present a terror management model of escalation and de-escalation of violent intergroup conflicts, which takes into account the interaction between threat salience and features of the social situation. We also discuss possible intervention strategies to override detrimental consequences of existential threat and argue that war is not the inevitable consequence of threat. PsycINFO Database Record (c) 2013 APA, all rights reserved

  19. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup.

    Science.gov (United States)

    Richmond, Janet S; Berlin, Jon S; Fishkind, Avrim B; Holloman, Garland H; Zeller, Scott L; Wilson, Michael P; Rifai, Muhamad Aly; Ng, Anthony T

    2012-02-01

    Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the "10 domains of de-escalation."

  20. Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases.

    Science.gov (United States)

    Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

    2016-01-01

    In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.

  1. Economic Cost Analysis Related to Complications in General and Digestive Surgery.

    Science.gov (United States)

    Gomez-Rosado, Juan-Carlos; Salas-Turrens, Jose; Olry-de-Labry-Lima, Antonio

    2018-04-21

    The aim was to assess the impact on economic costs and length of stay (LOS) of postoperative complications. 5,822 records from BMDS (2014-2015) are included. A descriptive, univariate and multivariate study evaluated the correlation between complications, Clavien-Dindo grade and vacation periods with LOS and economic costs, based on a full-cost model, aggregated by DRG. Mean cost per stay was €676.71, and €4,309.02 per episode. Complications appeared in 639 patients (11%). Admission to ICU was required in 203 patients, re-operation in 134 and re-admission in 243, while 66 patients died (1.1%). Complications caused significantly longer LOS (20.08 vs 5.48 days) and higher economic cost (€11,670.31 vs €3,354.12); infectious complications were the most frequent and respiratory the most expensive (€20,428.53), together with ICU admission (€20,242.66). Clavien-Dindo grade correlated with greater LOS and costs (except gradev). During vacation periods, complications and LOS are increased, but costs of these complications and LOS did not differ significantly from complications detected in non-vacation periods. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. [Prevention of Occupational Injuries Related to Hands: Calculation of Subsequent Injury Costs for the Austrian Social Occupational Insurance Institution (AUVA)].

    Science.gov (United States)

    Rauner, M S; Mayer, B; Schaffhauser-Linzatti, M M

    2015-08-01

    Occupational injuries cause short-term, direct costs as well as long-term follow-up costs over the lifetime of the casualties. Due to shrinking budgets accident insurance companies focus on cost reduction programmes and prevention measures. For this reason, a decision support system for consequential cost calculation of occupational injuries was developed for the main Austrian social occupational insurance institution (AUVA) during three projects. This so-called cost calculation tool combines the traditional instruments of accounting with quantitative methods such as micro-simulation. The cost data are derived from AUVA-internal as well as external economic data sources. Based on direct and indirect costs, the subsequent occupational accident costs from the time of an accident and, if applicable, beyond the death of the individual casualty are predicted for the AUVA, the companies in which the casualties are working, and the other economic sectors. By using this cost calculation tool, the AUVA classifies risk groups and derives related prevention campaigns. In the past, the AUVA concentrated on falling, accidents at construction sites and in agriculture/forestry, as well as commuting accidents. Currently, among others, a focus on hand injuries is given and first prevention programmes have been initiated. Hand injuries represent about 38% of all casualties with average costs of about 7,851 Euro/case. Main causes of these accidents are cutting injuries in production, agriculture, and forestry. Beside a low, but costly, number of amputations with average costs of more than 100,000 Euro/case, bone fractures and strains burden the AUVA-budget with about 17,500 and 10,500 € per case, respectively. Decision support systems such as this cost calculation tool represent necessary instruments to identify risk groups and their injured body parts, causes of accidents, and economic activities, which highly burden the budget of an injury company, and help derive

  3. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Bahia Luciana

    2012-06-01

    Full Text Available Abstract Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS. Methods Population attributable risk (PAR was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR ≥ 1.20 or RR ≥1.10 and  Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.

  4. Escalation scenarios initiated by gas explosions on offshore installations. Probabilistic cause and consequence modelling

    Energy Technology Data Exchange (ETDEWEB)

    Eknes, Monika Loeland

    1996-12-31

    This Dr. ing. thesis deals with escalation scenarios initiated by gas explosions on offshore installations. Gas explosions is one of the major hazards to such installations. The objectives were to estimate the probability of ignition and frequency of gas explosions for gas leaks on top sides of offshore installations, and to estimate the response and resistance of components that could result in escalation if they failed. Main fields considered cover risk analysis methodology, gas explosions, simplified escalation models, evaluation of structural consequences, case studies, and guidelines. 107 refs., 33 figs., 33 tabs.

  5. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

    Directory of Open Access Journals (Sweden)

    Reynolds Matthew W

    2011-05-01

    Full Text Available Abstract Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions was examined, and hospital costs and length of stay (LOS were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates was 6.0 days and ranged from 1

  6. Cost of presumptive source term Remedial Actions Laboratory for energy-related health research, University of California, Davis

    International Nuclear Information System (INIS)

    Last, G.V.; Bagaasen, L.M.; Josephson, G.B.; Lanigan, D.C.; Liikala, T.L.; Newcomer, D.R.; Pearson, A.W.; Teel, S.S.

    1995-12-01

    A Remedial Investigation/Feasibility Study (RI/FS) is in progress at the Laboratory for Energy Related Health Research (LEHR) at the University of California, Davis. The purpose of the RI/FS is to gather sufficient information to support an informed risk management decision regarding the most appropriate remedial actions for impacted areas of the facility. In an effort to expedite remediation of the LEHR facility, the remedial project managers requested a more detailed evaluation of a selected set of remedial actions. In particular, they requested information on both characterization and remedial action costs. The US Department of Energy -- Oakland Office requested the assistance of the Pacific Northwest National Laboratory to prepare order-of-magnitude cost estimates for presumptive remedial actions being considered for the five source term operable units. The cost estimates presented in this report include characterization costs, capital costs, and annual operation and maintenance (O ampersand M) costs. These cost estimates are intended to aid planning and direction of future environmental remediation efforts

  7. Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe.

    Science.gov (United States)

    Chevreul, Karine; Michel, Morgane; Brigham, Karen Berg; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Schieppati, Arrigo; Iskrov, Georgi; Péntek, Márta; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Persson, Ulf; Fattore, Giovani

    2016-04-01

    Our goal was to provide data on the economic burden and health-related quality of life (HRQOL) of patients with cystic fibrosis (CF) and their caregivers in Europe. A cross-sectional study was carried out on adults and children with CF in eight European countries. Patients completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and presence of a caregiver. Costs were calculated with a bottom-up approach using unit costs from each participating country, and HRQOL was assessed using EQ-5D. The principal caregiver also answered a questionnaire on their characteristics, HRQOL and burden. A total of 905 patients with CF was included (399 adults and 506 children). The total average annual cost per patient varied from €21,144 in Bulgaria to €53,256 in Germany. Adults had higher direct healthcare costs than children, but children had much higher informal care costs (P costs increased with patients' level of dependence. In adults, mean utility fell between 0.640 and 0.870, and the visual analogue scale ranged from 46.0 to 69.7. There was no difference in caregiver HRQOL regardless of whether they cared for an adult or a child. However, caregivers who looked after a child had a significantly higher burden (P = 0.0013). Our study highlights the burden of CF in terms of costs and decreased HRQOL for both patients and their caregivers throughout Europe.

  8. A transaction costs analysis of changing contractual relations in the English NHS.

    Science.gov (United States)

    Marini, Giorgia; Street, Andrew

    2007-09-01

    The English National Health Service has replaced locally negotiated block contracting arrangements with a system of national prices to pay for hospital activity. This paper applies a transaction costs approach to quantify and analyse the nature of how contracting costs have changed as a consequence. Data collection was based on semi-structured interviews with key stakeholders from hospitals and Primary Care Trusts, which purchase hospital services. Replacing block contracting with activity based funding has led to lower costs of price negotiation, but these are outweighed by higher costs associated with volume control, of data collection, contract monitoring, and contract enforcement. There was consensus that the new contractual arrangements were preferable, but the benefits will have to be demonstrated formally in future.

  9. 48 CFR 931.205-47 - Costs related to legal and other proceedings.

    Science.gov (United States)

    2010-10-01

    ... ENERGY GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial... for a covered contractor or subcontractor, funds advanced by the Department may not be used to finance...

  10. Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

    Science.gov (United States)

    Winkelman, Tyler N. A.; Heisler, Michele; Dalton, Vanessa K.

    2018-01-01

    Our objective was to measure obstetric outcomes and delivery-related health care utilization and costs among pregnant women with multiple chronic conditions. We used 2013–2014 data from the National Inpatient Sample to measure obstetric outcomes and delivery-related health care utilization and costs among women with no chronic conditions, 1 chronic condition, and multiple chronic conditions. Women with multiple chronic conditions were at significantly higher risk than women with 1 chronic condition or no chronic conditions across all outcomes measured. High-value strategies are needed to improve birth outcomes among vulnerable mothers and their infants. PMID:29420168

  11. Relative costs of anesthesiologist prepared, hospital pharmacy prepared and outsourced anesthesia drugs.

    Science.gov (United States)

    Jelacic, Srdjan; Craddick, Karen; Nair, Bala G; Bounthavong, Mark; Yeung, Kai; Kusulos, Dolly; Knutson, Jennifer A; Somani, Shabir; Bowdle, Andrew

    2017-02-01

    Anesthesia drugs can be prepared by anesthesia providers, hospital pharmacies or outsourcing facilities. The decision whether to outsource all or some anesthesia drugs is challenging since the costs associated with different anesthesia drug preparation methods remain poorly described. The costs associated with preparation of 8 commonly used anesthesia drugs were analyzed using a budget impact analysis for 4 different syringe preparation strategies: (1) all drugs prepared by anesthesiologist, (2) drugs prepared by anesthesiologist and hospital pharmacy, (3) drugs prepared by anesthesiologist and outsourcing facility, and (4) all drugs prepared by outsourcing facility. A strategy combining anesthesiologist and hospital pharmacy prepared drugs was associated with the lowest estimated annual cost in the base-case budget impact analysis with an annual cost of $225 592, which was lower than other strategies by a margin of greater than $86 000. A combination of anesthesiologist and hospital pharmacy prepared drugs resulted in the lowest annual cost in the budget impact analysis. However, the cost of drugs prepared by an outsourcing facility maybe lower if the capital investment needed for the establishment and maintenance of the US Pharmacopeial Convention Chapter compliant facility is included in the budget impact analysis. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Benign thyroid disorders, radioiodine therapy and diagnosis related groups (DRGs): aspects of cost/benefit

    International Nuclear Information System (INIS)

    Dietlein, M.; Schicha, H.

    2005-01-01

    The increasing prevalence of goiter and thyroid nodules in older patients is accompanied by an increasing frequency of treatment and cost. Cost-effectiveness is given for programs of prophylaxis (primary prevention, e.g. alimentary iodine supplementation), for programs of screening (secondary prevention. e.g. TSH-screening), and for therapeutic strategies to avoid complications of thyroid dysfunction (atrial fibrillation, myocardial infarction, death for cardiac reasons) and to minimize iatrogenic complications (tertiary prevention). Examples of tertiary prevention are radioiodine-therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), radioiodine therapy of ouvert or subclinical hyperthyroidism, and radioiodine therapy of large goiters in older patients or in patients suffering from a relevant co-morbidity. A cost-effectiveness-analysis for different therapeutic strategies of Graves' disease has been published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%. Cost-minimization-analysis, comparing resection of goiter and radioiodine, has shown lower cost of radioiodine therapy for toxic multinodular goiter up to 100 ml and for Graves' disease up to 60 ml goiter volume. Medical aspects (volume of goiter, uptake of nodules, regressive goiter, suspicion on malignancy, patients' age, co-morbidity, patients' decision) remain decisive for the choice of treatment. (orig.)

  13. Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study

    Directory of Open Access Journals (Sweden)

    V. Brown

    2017-05-01

    Full Text Available Abstract Background Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. Methods A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs were reported and results were tested through sensitivity analysis. Results Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings, measured against a comparator of no additional increase in fuel excise. Under “best case” assumptions, the intervention

  14. Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.

    Science.gov (United States)

    Brown, V; Moodie, M; Cobiac, L; Mantilla Herrera, A M; Carter, R

    2017-05-04

    Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under "best case" assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2

  15. Cost-effectiveness of denosumab versus zoledronic acid for preventing skeletal-related events in the Czech Republic.

    Science.gov (United States)

    Cristino, Joaquim; Finek, Jíndřich; Jandova, Petra; Kolek, Martin; Pásztor, Bálint; Giannopoulou, Christina; Qian, Yi; Brezina, Tomas; Lothgren, Mickael

    2017-08-01

    This study assessed the cost-effectiveness of the subcutaneous RANKL inhibitor, denosumab, vs the intravenous bisphosphonate, zoledronic acid, for the prevention of skeletal-related events (SREs) in patients with prostate cancer, breast cancer, and other solid tumors (OST) in the Czech Republic. A lifetime Markov model was developed to compare the effects of denosumab and zoledronic acid on costs (including drug costs and administration, patient management, SREs, and adverse events), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios from a national payer perspective. Different discount rates, time horizons, SRE rates, distributions, and nature (asymptomatic vs all SREs), and the inclusion of treatment discontinuation were considered in scenario analyses. The robustness of the model was tested using deterministic and probabilistic sensitivity analyses. Across tumor types, denosumab was associated with fewer SREs, improved QALYs, and higher total costs over a lifetime. The incremental cost per QALY gained for denosumab vs zoledronic acid was 382,673 CZK for prostate cancer, 408,450 CZK for breast cancer, and 608,133 CZK for OST. Incremental costs per SRE avoided for the same tumor type were 54,007 CZK, 51,765 CZK, and 94,426 CZK, respectively. In scenario analyses, the results remained similar to baseline, when different discount rates and time horizons were considered. At a non-official willingness-to-pay threshold of 1.2 million CZK, the probabilities of denosumab being cost-effective vs zoledronic acid were 0.64, 0.67, and 0.49 for prostate cancer, breast cancer, and OST, respectively. The SRE rates used were obtained from clinical trials; studies suggest rates may be higher in clinical practice. Additional evidence on real-world SRE rates could further improve the accuracy of the modeling. Compared with zoledronic acid, denosumab provides a cost-effective treatment option for the prevention of SREs in patients with prostate cancer

  16. Cost of Lightning Strike Related Outages of Visual Navigational Aids at Airports in the United States

    Science.gov (United States)

    Rakas, J.; Nikolic, M.; Bauranov, A.

    2017-12-01

    Lightning storms are a serious hazard that can cause damage to vital human infrastructure. In aviation, lightning strikes cause outages to air traffic control equipment and facilities that result in major disruptions in the network, causing delays and financial costs measured in the millions of dollars. Failure of critical systems, such as Visual Navigational Aids (Visual NAVAIDS), are particularly dangerous since NAVAIDS are an essential part of landing procedures. Precision instrument approach, an operation utilized during the poor visibility conditions, utilizes several of these systems, and their failure leads to holding patterns and ultimately diversions to other airports. These disruptions lead to both ground and airborne delay. Accurate prediction of these outages and their costs is a key prerequisite for successful investment planning. The air traffic management and control sector need accurate information to successfully plan maintenance and develop a more robust system under the threat of increasing lightning rates. To analyze the issue, we couple the Remote Monitoring and Logging System (RMLS) database and the Aviation System Performance Metrics (ASPM) databases to identify lightning-induced outages, and connect them with weather conditions, demand and landing runway to calculate the total delays induced by the outages, as well as the number of cancellations and diversions. The costs are then determined by calculating direct costs to aircraft operators and costs of passengers' time for delays, cancellations and diversions. The results indicate that 1) not all NAVAIDS are created equal, and 2) outside conditions matter. The cost of an outage depends on the importance of the failed system and the conditions that prevailed before, during and after the failure. The outage that occurs during high demand and poor weather conditions is more likely to result in more delays and higher costs.

  17. Activity-based costing evaluation of [F-18]-fludeoxyglucose production

    NARCIS (Netherlands)

    Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Borght, Thierry Vander

    Introduction As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [F-18]-fludeoxyglucose

  18. Smoking is Associated with Higher Disease-related Costs and Lower Health-related Quality of Life in Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Severs, M.; Mangen, M.J.; Valk, M.E. van der; Fidder, H.H.; Dijkstra, G.; Have, M. van der; Bodegraven, A.A. van; Jong, D.J. de; Woude, C.J. van der; Romberg-Camps, M.J.; Clemens, C.H.; Jansen, J.M.; Meeberg, P.C. van de; Mahmmod, N.; Ponsioen, C.Y.; Vermeijden, J.R.; Jong, A E F de; Pierik, M.; Siersema, P.D.; Oldenburg, B.

    2017-01-01

    Background and Aims: Smoking affects the course of inflammatory bowel disease [IBD]. We aimed to study the impact of smoking on IBD-specific costs and health-related quality-of-life [HrQoL] among adults with Crohn's disease [CD] and ulcerative colitis [UC]. Methods: A large cohort of IBD patients

  19. [Practical and theoretical aspects of cost-benefit relations in viscerosynthesis].

    Science.gov (United States)

    Fuchs, K H; Heimbucher, J; Geiger, D; Thiede, A

    1997-01-01

    The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. Anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as stapling instruments, can be used in a cost saving aspect, if they help to increase anastomotic safety, time saving and expansion of surgical indication. Manual sutures thus represent the cheapest anastomotic technique as continuous sutures would cost between DM 10.- to 20.- and single stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastomotic techniques should only complete the skill for selected indications. The overall staff expenditure for extended operations amounts around DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additional operation. However, a circular stapler anastomosis that costs between DM 650.- to 850.- is twice as expensive as manual sutures notwithstanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mandatory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.

  20. A general theory to explain the relatively high cost of environmental restoration at DOE facilities

    International Nuclear Information System (INIS)

    Sullivan, W.H.

    1995-01-01

    Environmental Restoration costs for Department of Energy (DOE) facilities have been the subject of much scrutiny and concern for several years. General opinion is that DOE clean-up costs are as much as three times higher than costs for similar clean-up projects in the private sector. Consequently, DOE Environmental Restoration professionals are continually under pressure to do more with less, which, ironically, can lead to additional inefficiencies in the system. This paper proposes a general theory as to why DOE costs are higher, explains the reasons why current conditions will make it difficult to realize any pervasive or significant decreases in clean-up costs, and presents some general changes that need to take place in the DOE system in order to bring about conditions that will allow more efficient clean-up to occur. The theory is based on a simple economic model that describes the balance between the resources spent for risk avoidance and the corresponding changes in overall productivity as a function of risk. The elementary concepts illustrated with the economic model, when refined and specifically applied, have the potential to become the catalyst for significant change-change that is absolutely necessary if we truly intend to conduct environmental clean-up with the same efficiencies as private industry

  1. Precision Hypofractionated Radiation Therapy in Poor Performing Patients With Non-Small Cell Lung Cancer: Phase 1 Dose Escalation Trial

    Energy Technology Data Exchange (ETDEWEB)

    Westover, Kenneth D. [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Loo, Billy W. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Gerber, David E. [Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Iyengar, Puneeth; Choy, Hak [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Diehn, Maximilian [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Hughes, Randy; Schiller, Joan; Dowell, Jonathan [Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Wardak, Zabi [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Sher, David [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Christie, Alana; Xie, Xian-Jin [Department of Clinical Science, Southwestern Medical Center, Dallas, Texas (United States); Corona, Irma [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Sharma, Akanksha [School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Wadsworth, Margaret E. [Radiation Oncology of Mississippi, Jackson, Mississippi (United States); Timmerman, Robert, E-mail: Robert.Timmerman@utsouthwestern.edu [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States)

    2015-09-01

    Purpose: Treatment regimens for locally advanced non-small cell lung cancer (NSCLC) give suboptimal clinical outcomes. Technological advancements such as radiation therapy, the backbone of most treatment regimens, may enable more potent and effective therapies. The objective of this study was to escalate radiation therapy to a tumoricidal hypofractionated dose without exceeding the maximally tolerated dose (MTD) in patients with locally advanced NSCLC. Methods and Materials: Patients with stage II to IV or recurrent NSCLC and Eastern Cooperative Oncology Group performance status of 2 or greater and not candidates for surgical resection, stereotactic radiation, or concurrent chemoradiation were eligible. Highly conformal radiation therapy was given to treat intrathoracic disease in 15 fractions to a total of 50, 55, or 60 Gy. Results: Fifty-five patients were enrolled: 15 at the 50-Gy, 21 at the 55-Gy, and 19 at the 60-Gy dose levels. A 90-day follow-up was completed in each group without exceeding the MTD. With a median follow-up of 12.5 months, there were 93 grade ≥3 adverse events (AEs), including 39 deaths, although most AEs were considered related to factors other than radiation therapy. One patient from the 55- and 60-Gy dose groups developed grade ≥3 esophagitis, and 5, 4, and 4 patients in the respective dose groups experienced grade ≥3 dyspnea, but only 2 of these AEs were considered likely related to therapy. There was no association between fraction size and toxicity (P=.24). The median overall survival was 6 months with no significant differences between dose levels (P=.59). Conclusions: Precision hypofractionated radiation therapy consisting of 60 Gy in 15 fractions for locally advanced NSCLC is generally well tolerated. This treatment regimen could provide patients with poor performance status a potent alternative to chemoradiation. This study has implications for the cost effectiveness of lung cancer therapy. Additional studies of long

  2. The cost of nuclear electricity: economic values and political calculations

    International Nuclear Information System (INIS)

    Stauffer, T.

    1985-01-01

    The subject is covered in sections: introduction (monetary inflation; US-style rate-base formula; cost escalation); electricity generation costs (rate-base calculation formula; regulatory versus economic costs; inflationary case; cost-of-service rates versus inflation; first year electricity costs); rate shock (A. comparison with oil; B. nuclear case; C. comparison with coal/nuclear system; vintaged electricity costs versus growth and inflation); conclusions. (U.K.)

  3. Pengaruh Framing Effect Sebagai Determinan Escalation of Commitment Dalam Keputusan Investasi: Dampak Dari Working Experiences

    OpenAIRE

    Yahya, Muhammad Nur; Surya, Jen

    2012-01-01

    The prior of research have shown that the framing effect is one of determinant in explaining decisions to escalate commitment to failing projects. However , have not considered whether experience moderates the framing effect on escalation of commitment. This study reports the results of an experiment in which the effect of decision frame of investment performance with negative feedback informatian on judgment to continue project of experienced subjects is compared to inexperienced subjects. F...

  4. Lean Six Sigma in Healthcare: Combating the Military’s Escalating Pharmacy Costs

    Science.gov (United States)

    2009-04-30

    SYSTEM CMOP CONSOLIDATED MAIL ORDER PHARMACY CTQ CRITICAL TO QUALITY DLA DEFENSE LOGISTICS AGENCY DLI DEFENSE LANGUAGE INSTITUTE DMAIC DEFINE...standard improvement procedure in Six Sigma is DMAIC (Define, Measure, Analyze, Improve and Control). DMAIC is a structured, disciplined, rigorous...and techniques prescribed in the DMAIC methodology (Define, Measure, Analyze, Improve and Control) of Lean Six Sigma. To better understand the

  5. Natural gas and CO2 price variation: impact on the relative cost-efficiency of LNG and pipelines.

    Science.gov (United States)

    Ulvestad, Marte; Overland, Indra

    2012-06-01

    THIS ARTICLE DEVELOPS A FORMAL MODEL FOR COMPARING THE COST STRUCTURE OF THE TWO MAIN TRANSPORT OPTIONS FOR NATURAL GAS: liquefied natural gas (LNG) and pipelines. In particular, it evaluates how variations in the prices of natural gas and greenhouse gas emissions affect the relative cost-efficiency of these two options. Natural gas is often promoted as the most environmentally friendly of all fossil fuels, and LNG as a modern and efficient way of transporting it. Some research has been carried out into the local environmental impact of LNG facilities, but almost none into aspects related to climate change. This paper concludes that at current price levels for natural gas and CO 2 emissions the distance from field to consumer and the volume of natural gas transported are the main determinants of transport costs. The pricing of natural gas and greenhouse emissions influence the relative cost-efficiency of LNG and pipeline transport, but only to a limited degree at current price levels. Because more energy is required for the LNG process (especially for fuelling the liquefaction process) than for pipelines at distances below 9100 km, LNG is more exposed to variability in the price of natural gas and greenhouse gas emissions up to this distance. If the prices of natural gas and/or greenhouse gas emission rise dramatically in the future, this will affect the choice between pipelines and LNG. Such a price increase will be favourable for pipelines relative to LNG.

  6. Economic costs and health-related quality of life for hand, foot and mouth disease (HFMD) patients in China.

    Science.gov (United States)

    Zheng, Yaming; Jit, Mark; Wu, Joseph T; Yang, Juan; Leung, Kathy; Liao, Qiaohong; Yu, Hongjie

    2017-01-01

    Hand, foot and mouth disease (HFMD) is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China. A telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012-2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication), direct non-medical costs (transportation, nutrition, accommodation and nursery), and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS) were used to calculate associated loss in quality adjusted life years (QALYs). The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215), $1072 (95%CI $999, $1144), $3051 (95%CI $2905, $3197) and $2819 (95%CI $2068, $3571) respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9), 6.9 (95%CI 6.4, 7.4) and 13.7 (95%CI 12.9, 14.5) per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss. HFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.

  7. Economic costs and health-related quality of life for hand, foot and mouth disease (HFMD patients in China.

    Directory of Open Access Journals (Sweden)

    Yaming Zheng

    Full Text Available Hand, foot and mouth disease (HFMD is a common illness in China that mainly affects infants and children. The objective of this study is to assess the economic cost and health-related quality of life associated with HFMD in China.A telephone survey of caregivers were conducted in 31 provinces across China. Caregivers of laboratory-confirmed HFMD patients who were registered in the national HFMD enhanced surveillance database during 2012-2013 were invited to participate in the survey. Total costs included direct medical costs (outpatient care, inpatient care and self-medication, direct non-medical costs (transportation, nutrition, accommodation and nursery, and indirect costs for lost income associated with caregiving. Health utility weights elicited using EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS were used to calculate associated loss in quality adjusted life years (QALYs.The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170 severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild inpatients, severe cases and fatal cases were $201 (95%CI $187, $215, $1072 (95%CI $999, $1144, $3051 (95%CI $2905, $3197 and $2819 (95%CI $2068, $3571 respectively. The mean QALY losses per HFMD episode for mild outpatients, mild inpatients and severe cases were 3.6 (95%CI 3.4, 3,9, 6.9 (95%CI 6.4, 7.4 and 13.7 (95%CI 12.9, 14.5 per 1000 persons. Cases who were diagnosed with EV-A71 infection and had longer duration of illness were associated with higher total cost and QALY loss.HFMD poses a high economic and health burden in China. Our results provide economic and health utility data for cost-effectiveness analysis for HFMD vaccination in China.

  8. Measuring PM and related air pollutants using low-cost sensors

    Science.gov (United States)

    Emerging air quality sensors may play a key role in better characterizing levels of air pollution in a variety of settings There are a wide range of low-cost (sensors on the market, but few have been characterized. If accurate, this new generation of inexpensive sens...

  9. Relative cost of capital for marginal firms over the business cycle

    OpenAIRE

    Gikas A. Hardouvelis; Thierry A. Wizman

    1992-01-01

    The authors compare the effects of the business cycle on the cost of capital faced by small, distressed firms and their larger, more financially secure counterparts. The analysis draws on stock market returns data for a broad range of traded companies during the 1963-91 period.

  10. Leaf area compounds height-related hydraulic costs of water transport in Oregon White Oak trees.

    Science.gov (United States)

    N. Phillips; B. J. Bond; N. G. McDowell; Michael G. Ryan; A. Schauer

    2003-01-01

    The ratio of leaf to sapwood area generally decreases with tree size, presumably to moderate hydraulic costs of tree height. This study assessed consequences of tree size and leaf area on water flux in Quercus garryana Dougl. ex. Hook (Oregon White Oak), a species in which leaf to sapwood area ratio increases with tree size. We tested hypotheses that...

  11. Community College Finance: A Cost Analysis of Community College Expenditures Related to Maintenance and Operations

    Science.gov (United States)

    Collins, Michael T.

    2011-01-01

    The purpose of this study is to develop a costing model for maintenance and operations expenditures among 16 single-campus California community college districts and assess the impact of a variety of variables including size of student enrollment, physical plant age, acreage, gross square footage, and general obligation facility bonds on district…

  12. Inactive Lifestyles and Obesity in Chilean Youth: Individual Costs in Health-Related Choices

    Science.gov (United States)

    Correa-Burrows, Paulina; Burrows, Raquel A.

    2014-01-01

    Objective: A recent economic approach suggests that people do not account for the long-term implications of unhealthy behaviours, preventing them from performing a fully rational trade-off between current benefits and future costs, leading to negative health outcomes. We examined whether the current allocation of time to physical activity among…

  13. Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

    Science.gov (United States)

    Hung, Jung-Hua; Chang, Li

    2008-03-01

    Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

  14. Savings in acute care costs if all older adults treated for fall-related injuries completed matter of balance.

    Science.gov (United States)

    Howland, Jonathan; Shankar, Kalpana Narayan; Peterson, Elizabeth W; Taylor, Alyssa A

    Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults, and recruitment usually occurs through direct marketing to the target population, rather than through referrals from healthcare providers. Matter of Balance , a program developed to reduce fear of falling and associated activity restriction in community-dwelling older adults, is currently being delivered in 38 of the 50 United States. In this study, we estimate the one-year medical care cost savings if older adults treated at Massachusetts hospitals for fall-related injuries were referred by healthcare providers to participate in Matter of Balance . Data from several sources were used for this study. We estimated annual cost savings in older adult falls recidivism for a hypothetical 100 patients presenting at an emergency department for a fall-related injury, assuming that all were referred to, and 50 % completed, Matter of Balance . This cost-saving estimate was subsequently expanded based on the actual number (43,931) of older adult patients presenting at, and discharged from Massachusetts emergency departments for all fall-related injuries in 2012. Cost savings were calculated for two additional participation rates: 25 % and 75 %. The return on investment (ROI), was calculated based on the percentage of return per each dollar invested. The calculated ROI for Matter of Balance was 144 %. Statewide savings ranged from $2.79 million assuming a 25 % participation rate to $8.37 million, assuming a 75 % participation rate. Referral to evidence-based falls prevention programs of older adult patients presenting at EDs with a fall-related injury could reduce subsequent falls and associated treatment costs.

  15. The relative cost of bent-hip bent-knee walking is reduced in water.

    Science.gov (United States)

    Kuliukas, Algis V; Milne, Nick; Fournier, Paul

    2009-01-01

    The debate about how early hominids walked may be characterised as two competing hypotheses: They moved with a fully upright (FU) gait, like modern humans, or with a bent-hip, bent-knee (BK) gait, like apes. Both have assumed that this bipedalism was almost exclusively on land, in trees or a combination of the two. Recent findings favoured the FU hypothesis by showing that the BK gait is 50-60% more energetically costly than a FU human gait on land. We confirm these findings but show that in water this cost differential is markedly reduced, especially in deeper water, at slower speeds and with greater knee flexion. These data suggest that the controversy about australopithecine locomotion may be eased if it is assumed that wading was a component of their locomotor repertoire and supports the idea that shallow water might have been an environment favourable to the evolution of early forms of "non-optimal" hominid bipedalism.

  16. Suppression sours sacrifice: emotional and relational costs of suppressing emotions in romantic relationships.

    Science.gov (United States)

    Impett, Emily A; Kogan, Aleksandr; English, Tammy; John, Oliver; Oveis, Christopher; Gordon, Amie M; Keltner, Dacher

    2012-06-01

    What happens when people suppress their emotions when they sacrifice for a romantic partner? This multimethod study investigates how suppressing emotions during sacrifice shapes affective and relationship outcomes. In Part 1, dating couples came into the laboratory to discuss important romantic relationship sacrifices. Suppressing emotions was associated with emotional costs for the partner discussing his or her sacrifice. In Part 2, couples participated in a 14-day daily experience study. Within-person increases in emotional suppression during daily sacrifice were associated with decreases in emotional well-being and relationship quality as reported by both members of romantic dyads. In Part 3, suppression predicted decreases in relationship satisfaction and increases in thoughts about breaking up with a romantic partner 3 months later. In the first two parts of the study, authenticity mediated the costly effects of suppression. Implications for research on close relationships and emotion regulation are discussed.

  17. Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.

    Science.gov (United States)

    Bertch, K E; Hatoum, H T; Willett, M S; Witte, K W

    1988-11-01

    We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Tornadoes and related damage costs: statistical modeling with a semi-Markov approach

    OpenAIRE

    Corini, Chiara; D'Amico, Guglielmo; Petroni, Filippo; Prattico, Flavio; Manca, Raimondo

    2015-01-01

    We propose a statistical approach to tornadoes modeling for predicting and simulating occurrences of tornadoes and accumulated cost distributions over a time interval. This is achieved by modeling the tornadoes intensity, measured with the Fujita scale, as a stochastic process. Since the Fujita scale divides tornadoes intensity into six states, it is possible to model the tornadoes intensity by using Markov and semi-Markov models. We demonstrate that the semi-Markov approach is able to reprod...

  19. Evolving Cuban-CARICOM relations : a comparative cost/benefit analysis

    Directory of Open Access Journals (Sweden)

    Michael Erisman

    1995-01-01

    Full Text Available Survey of the basic developmental dynamics involved in the evolving Cuban-CARICOM relationship. On the basis of a cost-risk/benefit analysis, the author provides some projections regarding the future of this relationship. He concludes that there appear sufficient potential benefits for both sides to deepen the relationship. Cuban-CARICOM integration, however, has no top priority for either partner.

  20. Late Gastrointestinal Toxicity After Dose-Escalated Conformal Radiotherapy for Early Prostate Cancer: Results From the UK Medical Research Council RT01 Trial (ISRCTN47772397)

    International Nuclear Information System (INIS)

    Syndikus, Isabel; Morgan, Rachel C.; Sydes, Matthew R.; Graham, John D.; Dearnaley, David P.

    2010-01-01

    Purpose: In men with localized prostate cancer, dose-escalated conformal radiotherapy (CFRT) improves efficacy outcomes at the cost of increased toxicity. We present a detailed analysis to provide further information about the incidence and prevalence of late gastrointestinal side effects. Methods and Materials: The UK Medical Research Council RT01 trial included 843 men with localized prostate cancer, who were treated for 6 months with neoadjuvant radiotherapy and were randomly assigned to either 64-Gy or 74-Gy CFRT. Toxicity was evaluated before CFRT and during long-term follow-up using Radiation Therapy Oncology Group (RTOG) grading, the Late Effects on Normal Tissue: Subjective, Objective, Management (LENT/SOM) scale, and Royal Marsden Hospital assessment scores. Patients regularly completed Functional Assessment of Cancer Therapy--Prostate (FACT-P) and University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) questionnaires. Results: In the dose-escalated group, the hazard ratio (HR) for rectal bleeding (LENT/SOM grade ≥2) was 1.55 (95% CI, 1.17-2.04); for diarrhea (LENT/SOM grade ≥2), the HR was 1.79 (95% CI, 1.10-2.94); and for proctitis (RTOG grade ≥2), the HR was 1.64 (95% CI, 1.20-2.25). Compared to baseline scores, the prevalence of moderate and severe toxicities generally increased up to 3 years and than lessened. At 5 years, the cumulative incidence of patient-reported severe bowel problems was 6% vs. 8% (standard vs. escalated, respectively) and severe distress was 4% vs. 5%, respectively. Conclusions: There is a statistically significant increased risk of various adverse gastrointestinal events with dose-escalated CFRT. This remains at clinically acceptable levels, and overall prevalence ultimately decreases with duration of follow-up.

  1. Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales.

    Science.gov (United States)

    Mitchell, Rebecca J; Lower, Tony

    2018-04-19

    To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost. © 2018 National Rural Health Alliance Ltd.

  2. Cost evaluation of energy crops at farm gate in different EU countries and related agricultural issues

    International Nuclear Information System (INIS)

    Calliope, P.; Dalianis, C.

    1996-01-01

    Interest on energy crops varies greatly among EU regions. Certain climatic conditions prevailing in the areas, determine the coice of the energy crop which is going to be used as raw material for energy production. Furthermore, energy markets, farm structure and set aside regulations as well as national policy play a critical role to biomass exploitation for energy purposes. A common methodology was developed (Moore, 1996) for comparing costs of different options for ''biomass-to-energy systems'' across six EU countries (figure 1). This methodology was developed in the framework of an AIR Concerted Action financed by DGXII of EU and entitled ''Development of a Standard Methodology for Integrating Non-Food Crops in Rural Areas with Niche Energy Markets''. Cost estimations were done form the first stage of raw material production till the final energy product (kWh of heat and electricity or lt of liquid biofuel. In this paper, only the raw material production cost estimation phase will be presented. (Author)

  3. Clinical and cost effectiveness-related aspects of retransfusion in total hip and knee arthroplasty.

    Science.gov (United States)

    Dobosz, Bartłomiej; Dutka, Julian; Dutka, Lukasz; Maleta, Paweł

    2012-01-01

    An increasing demand for blood products forces the rationalisation of management and conservation of blood. The aim of the study is to evaluate the possibility of retransfusion of blood conservation and the cost-effectiveness of this procedure when employed in Total Hip Replacement and Total Knee Arthroplasty. This prospective cohort study involved two groups of patients. Group I comprised 50 patients who underwent blood retransfusion and in several cases had supplementary allogeneic transfusion. Group II, a control group, consisted of 50 patients who did not receive retransfusion. The retransfusion in Group I enabled the recovery of a mean amount of 364.5 ml (± 52.7) of blood in THR patients and 403.8 ml (± 110.7) in TKA patients. Demand for allogeneic blood transfusions in Group I versus Group II was 46% lower in THR patients and 42% lower in TKA patients. The blood recovered for retransfusion is biologically valuable with regard to cellular elements and plasma chemistries. In the costs evaluation, the total savings in Group I were 5,000 PLN. Retransfusion of recuperated blood from postoperative drainage tubing is a simple and safe method that provides clinical and cost-effectiveness advantages.

  4. Econometric modeling of health care costs and expenditures: a survey of analytical issues and related policy considerations.

    Science.gov (United States)

    Mullahy, John

    2009-07-01

    Econometric modeling of healthcare costs and expenditures has become an important component of decision-making across a wide array of real-world settings. The objective of this article is to provide a brief summary of important conceptual and analytical issues involved in econometric healthcare cost modeling. To this end, the article explores: outcome measures typically analyzed in such work; the decision maker's perspective in econometric cost modeling exercises; specific analytical issues in econometric model specification; statistical goodness-of-fit testing; empirical implications of "upper tail" (or "high cost") phenomena; and issues relating to the reporting of findings. Some of the concepts explored here are illustrated in light of samples drawn from the 2005 Medical Expenditure Panel Survey and the 2005 Nationwide Inpatient Sample. Analysts of healthcare cost data have at their disposal an increasingly sophisticated tool kit for analyzing such data that can in principle and in fact yield increasingly interesting insights into data structures. Yet for such analyses to usefully inform policy decisions, the manner in which such studies are designed, undertaken, and reported must accommodate considerations relevant to the decision-making community. The article concludes with some preliminary thoughts on how such bridges might be constructed.

  5. Hospital treatment, mortality and healthcare costs in relation to socioeconomic status among people with bipolar affective disorder

    Science.gov (United States)

    Yeh, Ling-Ling; Chen, Yu-Chun; Kuo, Kuei-Hong; Chang, Chin-Kuo

    2016-01-01

    Background Evidence regarding the relationships between the socioeconomic status and long-term outcomes of individuals with bipolar affective disorder (BPD) is lacking. Aims We aimed to estimate the effects of baseline socioeconomic status on longitudinal outcomes. Method A national cohort of adult participants with newly diagnosed BPD was identified in 2008. The effects of personal and household socioeconomic status were explored on outcomes of hospital treatment, mortality and healthcare costs, over a 3-year follow-up period (2008–2011). Results A total of 7987 participants were recruited. The relative risks of hospital treatment and mortality were found elevated for the ones from low-income households who also had higher healthcare costs. Low premium levels did not correlate with future healthcare costs. Conclusions Socioeconomic deprivation is associated with poorer outcome and higher healthcare costs in BPD patients. Special care should be given to those with lower socioeconomic status to improve outcomes with potential benefits of cost savings in the following years. Declaration of interest None. Copyright and usage © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703748

  6. Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

    Science.gov (United States)

    Back, Jonathan; Ross, Alastair J; Duncan, Myanna D; Jaye, Peter; Henderson, Katherine; Anderson, Janet E

    2017-11-01

    Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice. This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined"). Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  7. Botulinum Toxin Therapy: Is Syringe Type Related to Cost-Effectiveness?

    Science.gov (United States)

    Foglietti, Mark Anthony; Wright, Lauren; Foglietti-Fostyk, Alanna

    2018-03-01

    Clostridium botulinum toxin is effective through cleaving presynaptic proteins at the neuromuscular junction, which prevents the release of acetylcholine and inhibits muscle contraction. Several serotypes of botulinum toxin (BT) exist; however, only 2 types have been approved by the US Food and Drug Administration for commercial and medical use, A and B. Both types of BT must be administered intramuscularly with a syringe, but the type of syringe is the injector's preference. Which syringe type is most efficient in minimizing product waste and most cost-effective for the patient and provider? We performed a single-center, open-label, analytical study using BT therapy and 2 types of syringes for analytics of cost-effectiveness. OnabotulinumtoxinA was the neuromodulator used in this report. Vials (100 U) of BT A were each reconstituted with 2.5 mL of 0.9% sodium chloride, for a final concentration of 4 U/0.1 mL. High-dead-space syringes are compared with low-dead-space syringes: 1-mL tuberculin (TB) luer slip syringe with detachable 25-gauge needle and 1-mL ultrafine insulin syringe with an attached 31-gauge needle, respectively. After each syringe was evacuated, the TB syringe was noted to contain 0.05 mL of the remaining product in the hub. Providers are discarding approximately 2 U of BT per TB syringe product injection. If the physician uses 30 syringes per day, 3 days a week, for 1 year, it equals to a lost revenue of approximately $155,500 per year. To individualize the cost-effective analysis, average quantity of syringes used per patient and overall patient volume must be considered, with corresponding adjustment of cost and units discarded. The American Society of Plastic Surgeons reported that the use of neuromodulators has increased by approximately 797% from 2000 to 2016. During that period, the price of neuromodulators has also increased by approximately 85%. Considering these statistics, the type of syringe used for BT neuromodular injection is a

  8. Social costs of loss in productivity-related absenteeism in Poland

    Directory of Open Access Journals (Sweden)

    Agnieszka Genowska

    2017-10-01

    Full Text Available Objectives: The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland. Material and Methods: Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII (Zakład Ubezpieczeń Społecznych – ZUS. Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added. Results: Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP (17.09 billion euro. In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro, it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30–39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium – 1.474 billion euro; respiratory diseases – 0.632 billion euro, injuries and poisonings – 0.62 billion euro. In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro and injuries and poisoning (1.251 billion euro. Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro, diseases of the genitourinary system (0.38 billion euro, and neoplasms (0.35 billion euro. At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro, and diseases of musculoskeletal (1.26 billion euro, nervous (0.79 billion euro, circulatory (0.65 billion euro, and digestive (0.41 billion euro systems. Conclusions: Improvement and further development of effective strategies for

  9. Social costs of loss in productivity-related absenteeism in Poland.

    Science.gov (United States)

    Genowska, Agnieszka; Fryc, Justyna; Pinkas, Jarosław; Jamiołkowski, Jacek; Szafraniec, Krystyna; Szpak, Andrzej; Bojar, Iwona

    2017-10-06

    The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland. Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII) (Zakład Ubezpieczeń Społecznych - ZUS). Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added. Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP) (17.09 billion euro). In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro), it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30-39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium - 1.474 billion euro; respiratory diseases - 0.632 billion euro, injuries and poisonings - 0.62 billion euro). In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro) and injuries and poisoning (1.251 billion euro). Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro), diseases of the genitourinary system (0.38 billion euro), and neoplasms (0.35 billion euro). At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro), and diseases of musculoskeletal (1.26 billion euro), nervous (0.79 billion euro), circulatory (0.65 billion euro), and digestive (0.41 billion euro) systems. Improvement and further development of effective strategies for prevention of complications of pregnancy and chronic diseases in the

  10. The potential for reducing atmospheric carbon by large-scale afforestation in China and related cost/benefit analysis

    International Nuclear Information System (INIS)

    Deying Xu

    1995-01-01

    In this paper, the amount of carbon sequestered through large-scale afforestation and related costs and benefits are calculated, assuming that the forests are managed in perpetual rotations. Based on land availability for afforestation, 20 cases are identified in five suitable regions in China. The least expensive way of developing forests for the purpose of sequestering carbon emissions is the case of Pinus massoniana from the initial investment point of view, and then Spruce. The cases of open forest management are relatively less expensive options because of their low initial investment and long rotations, although their annual wood increments are low. Some less productive tree species have higher net costs for carbon sequestering. For most of the agroforestry systems the net costs are low, especially in the south, the southwest, and the north of China, though their initial investments are high. If the total land available is afforested, the net carbon sequestering will be about 9.7 billion tons under perpetual rotations, amounting to 16.3 times the total industrial carbon release in 1988 in China, and the total initial cost for such a programme is estimated at 19.3 billion US$. Some hindrances in developing forests in China are discussed. (Author)

  11. Post-nerve-sparing prostatectomy, dose-escalated intensity-modulated radiotherapy: effect on erectile function

    International Nuclear Information System (INIS)

    Bastasch, Michael D.; Teh, Bin S.; Mai, W.-Y.; Carpenter, L. Steven; Lu, Hsin H.; Chiu, J. Kam; Woo, Shiao Y.; Grant, Walter H.; Miles, Brian J.; Kadmon, Dov; Butler, E. Brian

    2002-01-01

    Purpose: The advent of widespread prostate-specific antigen screening has resulted in more younger, potent men being diagnosed with early-stage, organ-confined prostate cancer amenable to definitive surgery. Nerve-sparing prostatectomy is a relatively new surgical advance in the treatment of prostate cancer. Very few data exist on the effect of postoperative radiotherapy (RT) on erectile function after nerve-sparing prostatectomy. They are based on conventional techniques using moderate doses of radiation, 45-54 Gy. Intensity-modulated RT (IMRT) is becoming more widespread because it allows dose escalation with increased sparing of the surrounding normal tissue. We investigated the effect of postprostatectomy, high-dose IMRT on patients' erectile function. Methods and Materials: A review of patient records found 51 patients treated between April 1998 and December 2000 with IMRT after unilateral or bilateral nerve-sparing prostatectomy. The pathologic disease stage in these patients was T2 in 47.4% and T3 in 52.6%. Postoperatively, 4 patients received hormonal ablation consisting of one injection of Lupron Depot (30 mg) 2 months before RT. The median age was 65 years (range 46-77) at the time of RT. The prescribed dose was 64 Gy (range 60-66). The mean dose was 69.6 Gy (range 64.0-72.3). Erectile function was assessed before and after RT by questionnaires. Sexual potency was defined as erectile rigidity adequate for vaginal penetration. Results: Of the 51 patients, 18 (35.3%) maintained their potency and 33 (64.7%) became impotent after nerve-sparing prostatectomy. Patients who underwent bilateral nerve-sparing prostatectomy had higher rates of postoperative potency than did those who underwent unilateral nerve-sparing surgery (72.2% vs. 27.8%; p=0.025). The follow-up for the entire group was 19.5 months. All 18 patients (100%) who were potent postoperatively remained potent after RT. The median follow-up for the 18 potent patients was 27.2 months, significantly

  12. Sequential Optimization of Global Sequence Alignments Relative to Different Cost Functions

    KAUST Repository

    Odat, Enas M.

    2011-01-01

    The algorithm has been simulated using C#.Net programming language and a number of experiments have been done to verify the proved statements. The results of these experiments show that the number of optimal alignments is reduced after each step of optimization. Furthermore, it has been verified that as the sequence length increased linearly then the number of optimal alignments increased exponentially which also depends on the cost function that is used. Finally, the number of executed operations increases polynomially as the sequence length increase linearly.

  13. A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

    Science.gov (United States)

    Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

    2016-07-27

    Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

  14. Optimizing Collimator Margins for Isotoxically Dose-Escalated Conformal Radiation Therapy of Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Samantha, E-mail: Samantha.warren@oncology.ox.ac.uk [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom); Panettieri, Vanessa [William Buckland Radiotherapy Centre, Alfred Hospital, Commercial Road, Melbourne (Australia); Panakis, Niki; Bates, Nicholas [Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom); Lester, Jason F. [Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff (United Kingdom); Jain, Pooja [Clatterbridge Cancer Centre, Clatterbridge Road, Wirral (United Kingdom); Landau, David B. [Department of Radiotherapy, Guy' s and St. Thomas' NHS Foundation Trust, London (United Kingdom); Nahum, Alan E.; Mayles, W. Philip M. [Clatterbridge Cancer Centre, Clatterbridge Road, Wirral (United Kingdom); Fenwick, John D. [Department of Oncology, Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford (United Kingdom); Oxford Cancer Centre, Oxford University Hospitals, Oxford (United Kingdom)

    2014-04-01

    Purpose: Isotoxic dose escalation schedules such as IDEAL-CRT [isotoxic dose escalation and acceleration in lung cancer chemoradiation therapy] (ISRCTN12155469) individualize doses prescribed to lung tumors, generating a fixed modeled risk of radiation pneumonitis. Because the beam penumbra is broadened in lung, the choice of collimator margin is an important element of the optimization of isotoxic conformal radiation therapy for lung cancer. Methods and Materials: Twelve patients with stage I-III non-small cell lung cancer (NSCLC) were replanned retrospectively using a range of collimator margins. For each plan, the prescribed dose was calculated according to the IDEAL-CRT isotoxic prescription method, and the absolute dose (D{sub 99}) delivered to 99% of the planning target volume (PTV) was determined. Results: Reducing the multileaf collimator margin from the widely used 7 mm to a value of 2 mm produced gains of 2.1 to 15.6 Gy in absolute PTV D{sub 99}, with a mean gain ± 1 standard error of the mean of 6.2 ± 1.1 Gy (2-sided P<.001). Conclusions: For NSCLC patients treated with conformal radiation therapy and an isotoxic dose prescription, absolute doses in the PTV may be increased by using smaller collimator margins, reductions in relative coverage being offset by increases in prescribed dose.

  15. Mechanisms of Contextual Risk for Adolescent Self-Injury: Invalidation and Conflict Escalation in Mother-Child Interactions

    Science.gov (United States)

    Crowell, Sheila E.; Baucom, Brian R.; McCauley, Elizabeth; Potapova, Natalia V.; Fitelson, Martha; Barth, Heather; Smith, Cindy J.; Beauchaine, Theodore P.

    2013-01-01

    OBJECTIVE According to developmental theories of self-injury, both child characteristics and environmental contexts shape and maintain problematic behaviors. Although progress has been made toward identifying biological vulnerabilities to self-injury, mechanisms underlying psychosocial risk have received less attention. METHOD In the present study, we compared self-injuring adolescents (n=17) with typical controls (n=20) during a mother-child conflict discussion. Dyadic interactions were coded using both global and microanalytic systems, allowing for a highly detailed characterization of mother-child interactions. We also assessed resting state psychophysiological regulation, as indexed by respiratory sinus arrhythmia (RSA). RESULTS Global coding revealed that maternal invalidation was associated with adolescent anger. Furthermore, maternal invalidation and coerciveness were both related to adolescent opposition/defiance. Results from the microanalytic system indicated that self-injuring dyads were more likely to escalate conflict, suggesting a potential mechanism through which emotion dysregulation is shaped and maintained over time. Finally, mother and teen aversiveness interacted to predict adolescent resting RSA. Low-aversive teens with highly aversive mothers had the highest RSA, whereas teens in high-high dyads showed the lowest RSA. CONCLUSIONS These findings are consistent with theories that emotion invalidation and conflict escalation are possible contextual risk factors for self-injury. PMID:23581508

  16. Tornadoes and related damage costs: statistical modelling with a semi-Markov approach

    Directory of Open Access Journals (Sweden)

    Guglielmo D’Amico

    2016-09-01

    Full Text Available We propose a statistical approach to modelling for predicting and simulating occurrences of tornadoes and accumulated cost distributions over a time interval. This is achieved by modelling the tornado intensity, measured with the Fujita scale, as a stochastic process. Since the Fujita scale divides tornado intensity into six states, it is possible to model the tornado intensity by using Markov and semi-Markov models. We demonstrate that the semi-Markov approach is able to reproduce the duration effect that is detected in tornado occurrence. The superiority of the semi-Markov model as compared to the Markov chain model is also affirmed by means of a statistical test of hypothesis. As an application, we compute the expected value and the variance of the costs generated by the tornadoes over a given time interval in a given area. The paper contributes to the literature by demonstrating that semi-Markov models represent an effective tool for physical analysis of tornadoes as well as for the estimation of the economic damages to human things.

  17. ASTRID SFR prototype steam generator design evolution related to safety and cost issues - 15236

    International Nuclear Information System (INIS)

    Woaye Hune, A.; Gerber, A.; Pirus, J.P.; Soucille, L.; Rodriguez, G.; Beauchamp, F.

    2015-01-01

    One option of the ASTRID prototype power conversion systems (PCS) is the steam cycle based on the Rankine cycle, which has been implemented in the past in France in the Phenix and Superphenix Sodium Fast Reactors, and is also being implemented in other SFRs in construction in the world (Russia, India, China). This paper is placed in the context of the Rankine cycle ameliorations and in particular on the Steam Generator (SG), developed by AREVA, from the safety point of view without significant penalty on cost. Therefore significant progresses are expected to reduce sodium/water reaction accident scenario impact as much by prevention as by mitigation. ASTRID project performed a thorough comparison of SG designs with regard to these safety requirements but also including increased sodium/water segregation (inlet and outlet of sodium implemented at the bottom of the SG), material issues and cost considerations. The design is based today on a monolithic SG with alloy 800 helical tubes but equipped with geometric specificities necessary for allowing the use of a single component per secondary loop. (authors)

  18. Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States.

    Science.gov (United States)

    Li, Qian; Blume, Steven W; Huang, Joanna C; Hammer, Mette; Ganz, Michael L

    2015-01-01

    This study estimated the economic burden of obesity-related comorbidities (ORCs) in the US, at both the person and population levels. The Geisinger Health System provided electronic medical records and claims between January 2004 and May 2013 for a sample of 153,561 adults (50% males and 97% white). Adults with A total of 21 chronic conditions, with established association with obesity in the literature, were identified by diagnosis codes and/or lab test results. The total healthcare costs were measured in each year. The association between annual costs and ORCs was assessed by a regression, which jointly considered all the ORCs. The per-person incremental costs of a single comorbidity, without any of the other ORCs, were calculated. The population-level economic burden was the product of each ORC's incremental costs and the annual prevalence of the ORC among 100,000 individuals. The prevalence of ORCs was stratified by obesity status to estimate the economic burden among 100,000 individuals with obesity and among those without. This study identified 56,895 adults (mean age = 47 years; mean BMI = 29.6 kg/m(2)). The annual prevalence of ORCs ranged from 0.5% for pulmonary embolism (PE) to 41.8% for dyslipidemia. The per-person annual incremental costs of a single ORC ranged from $120 for angina to $1665 for PE. Hypertensive diseases (HTND), dyslipidemia, and osteoarthritis were the three most expensive ORCs at the population level; each responsible for ≥$18 million annually among 100,000 individuals. HTND and osteoarthritis were much more costly among individuals with obesity than those without obesity. Data were from a small geographic region. ORCs are associated with substantial economic burden, especially for those requiring continuous treatments.

  19. German EstSmoke: estimating adult smoking-related costs and consequences of smoking cessation for Germany.

    Science.gov (United States)

    Sonntag, Diana; Gilbody, Simon; Winkler, Volker; Ali, Shehzad

    2018-01-01

    We compared predicted life-time health-care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines. German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related diseases were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health-care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. Germany. German population of prevalent current, never and ex-smokers in 2009. Life-time cost and outcomes in current, never and ex-smokers. If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life-time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life-time costs between current smokers and ex-smokers by at least €1.7 billion. Modelling suggests that the life-time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health-care expenditures for current smokers by at least 4%. © 2017 Society for the Study of Addiction.

  20. The influence of toxicity constraints in models of chemotherapeutic protocol escalation

    KAUST Repository

    Boston, E. A. J.

    2011-04-06

    The prospect of exploiting mathematical and computational models to gain insight into the influence of scheduling on cancer chemotherapeutic effectiveness is increasingly being considered. However, the question of whether such models are robust to the inclusion of additional tumour biology is relatively unexplored. In this paper, we consider a common strategy for improving protocol scheduling that has foundations in mathematical modelling, namely the concept of dose densification, whereby rest phases between drug administrations are reduced. To maintain a manageable scope in our studies, we focus on a single cell cycle phase-specific agent with uncomplicated pharmacokinetics, as motivated by 5-Fluorouracil-based adjuvant treatments of liver micrometastases. In particular, we explore predictions of the effectiveness of dose densification and other escalations of the protocol scheduling when the influence of toxicity constraints, cell cycle phase specificity and the evolution of drug resistance are all represented within the modelling. For our specific focus, we observe that the cell cycle and toxicity should not simply be neglected in modelling studies. Our explorations also reveal the prediction that dose densification is often, but not universally, effective. Furthermore, adjustments in the duration of drug administrations are predicted to be important, especially when dose densification in isolation does not yield improvements in protocol outcomes. © The author 2011. Published by Oxford University Press on behalf of the Institute of Mathematics and its Applications. All rights reserved.

  1. Avoidance orientation and the escalation of negative communication in intimate relationships.

    Science.gov (United States)

    Kuster, Monika; Bernecker, Katharina; Backes, Sabine; Brandstätter, Veronika; Nussbeck, Fridtjof W; Bradbury, Thomas N; Martin, Mike; Sutter-Stickel, Dorothee; Bodenmann, Guy

    2015-08-01

    Avoidance goals heighten the salience of negative social experiences, and in intimate relationships such an orientation may contribute to communication difficulties and the perpetuation of avoidance. We therefore hypothesized that individuals with stronger avoidance goals would be particularly prone to engage in escalating levels of negative communication with their intimate partner, and we tested this prediction by conducting sequential analyses on videotaped observational data (28,470 observations) collected from 365 heterosexual couples engaging in a relationship-related conflict. While less avoidance-oriented spouses showed a decline in their likelihood of negative communication over the course of the 8-min conflict discussion, the likelihood that more avoidance-oriented spouses would display negative communication behaviors remained at a high level. The likelihood of negative communication even increased when avoidance-oriented spouses were confronted with negative communication behavior of their partners. The effects of avoidance orientation were independent of relationship satisfaction and neuroticism. These findings demonstrate that avoidance goals underlie individuals' heightened reactivity to the partner's negative behavior, while also clarifying 1 possible reason why some individuals engage in communication behaviors that may prove maladaptive to their relationship. (c) 2015 APA, all rights reserved.

  2. The relative patient costs and availability of dental services, materials and equipment in public oral care facilities in Tanzania.

    Science.gov (United States)

    Nyamuryekung'e, Kasusu K; Lahti, Satu M; Tuominen, Risto J

    2015-07-01

    Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. A survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients' relative cost. DRC are the quantified average financial resources required for an adult Tanzanian's overall consumption per day. Tooth extractions were found to cost four times the DRC whereas restorations were 9-10 times the DRC. Studied facilities provided tooth extractions (100%), scaling (86%), fillings (79%), root canal treatment (46%) and fabrication of removable partial dentures (32%). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50% of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use. Dental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.

  3. Etiologic theories of idiopathic scoliosis. Somatic nervous system and the NOTOM escalator concept as one component in the pathogenesis of adolescent idiopathic scoliosis.

    Science.gov (United States)

    Burwell, R G; Dangerfield, P H; Freeman, B J C

    2008-01-01

    There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). In recent years encouraging advances thought to be related to the pathogenesis of AIS have been made in several fields. After reviewing concepts of AIS pathogenesis we formulated a collective model of pathogenesis. The central concept of this collective model is a normal neuro-osseous timing of maturation (NOTOM) system operating in a child's internal world during growth and maturation; this provides a dynamic physiological balance of postural equilibrium continuously renewed between two synchronous, polarized processes (NOTOM escalator) linked through sensory input and motor output, namely: 1) osseous escalator-increasing skeletal size and relative segmental mass, and 2) neural escalator - including the CNS body schema. The latter is recalibrated continuously as the body adjusts to biomechanical and kinematic changes resulting from skeletal enlargement, enabling it to coordinate motor actions. We suggest that AIS progression results from abnormality of the neural and/or osseous components of these normal escalator in time and/or space - as asynchrony and/or asymmetries - which cause a failure of neural systems to control asymmetric growth of a rapidly enlarging and moving adolescent spine. This putative initiating asymmetric growth in the spine is explained in separate papers as resulting from dysfunction of the hypothalamus expressed through the sympathetic nervous system (leptin-sympathetic nervous system concept for AIS pathogenesis). In girls, the expression of AIS may result from disharmony between the somatic and autonomic nervous systems - relative postural maturational delay in the somatic nervous system and hypothalamic dysfunction in the autonomic nervous system, with the conflict being fought out in the spine and trunk of the girl and compounded by biomechanical spinal growth modulation.

  4. Construction costs of nuclear power stations

    Energy Technology Data Exchange (ETDEWEB)

    Mandel, H

    1976-03-01

    It is assumed that the demand for electrical energy will continue to rise and that nuclear power will increasingly supply the base-load of electricity generation in the industrialized world. The author identifies areas where techniques and practices to control costs can be improved. Nuclear power offers an alternative to liquid and gaseous fossil fuels and contributes to a relative stability in the price of electric energy. Nuclear power plants can now generate power more cheaply than other thermal power plants down into the upper middle load sector, as indicated in calculations based on a construction time of six years for nuclear plants and four years for others. Special legal provisions, different conditions of financing and taxation, varying methods of power generation cost accounting, and the nonuniform layout of the plant in the various countries make it difficult to compare power generation costs. The author uses mostly experiences gained in the Federal Republic of Germany for some calculations for comparison; he cites lack of standardization and over-long licensing times as major factors in the recent rapid escalation of nuclear power costs and suggests that adoption of standard reactor designs, encouragement of a vigorous and competitive European nuclear industry, and streamlining of licensing procedures to improve the situation. (MCW)

  5. A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings

    DEFF Research Database (Denmark)

    Berring, Lene Lauge; Hummelvoll, J. K.; Pedersen, Liselotte

    2016-01-01

    De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff memb...... transforming violence management. Neighbouring mental health communities’ involvement strengthened the transformation process and assisted in validating the research results. © 2016, Taylor & Francis Group, LLC.......De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff...... members as co-researchers and knowledge was generated in dynamic research cycles around an extended epistemology of knowing: experiential, presentational, propositional, and practical. Through this process, co-researchers became de-escalation learners, implementing de-escalation practices while...

  6. Avoiding escalation from play to aggression in adult male rats: The role of ultrasonic calls.

    Science.gov (United States)

    Burke, Candace J; Kisko, Theresa M; Pellis, Sergio M; Euston, David R

    2017-11-01

    Play fighting is most commonly associated with juvenile animals, but in some species, including rats, it can continue into adulthood. Post-pubertal engagement in play fighting is often rougher and has an increased chance of escalation to aggression, making the use of play signals to regulate the encounter more critical. During play, both juvenile and adult rats emit many 50-kHz calls and some of these may function as play facilitating signals. In the present study, unfamiliar adult male rats were introduced in a neutral enclosure and their social interactions were recorded. While all pairs escalated their playful encounters to become rougher, only the pairs in which one member was devocalized escalated to serious biting. A Monte Carlo shuffling technique was used for the analysis of the correlations between the overt playful and aggressive actions performed and the types and frequencies of various 50-kHz calls that were emitted. The analysis revealed that lower frequency (20-30kHz) calls with a flat component maybe particularly critical for de-escalating encounters and so allowing play to continue. Moreover, coordinating calls reciprocally, with either the same call mimicked in close, temporal association or with complementary calls emitted by participants as they engage in complementary actions (e.g., attacking the nape, being attacked on the nape), appeared to be ways with which calls could be potentially used to avoid escalation to aggression and so sustain playful interactions. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Cost Effectiveness of G:CSF in Chemotherapy and Transplant-related Neutropenia.

    Science.gov (United States)

    Jacobs, P; Wood, L; Schall, R

    1998-01-01

    Sustained fever over 38°C is potentially lethal when neutrophil counts remain below 0.1 × 10(9)/L. To determine whether the addition of a haematopoietic stimulatory peptide to conventional supportive care and antibiotic management was cost-effective, 74 such episodes were analysed. Group I (5μg/kg G: CSF: n = 41); Group II (10 μg/kg: n = 19) and Group III (controls: n = 14): these were similar in respect of race, gender, age and body weight. The median days and range of neutrophil count below 0.1 × 10(9)/Lw as 6 (0-12), 7 (0-20) and 8 (0-20) and the corresponding figures for 0.5 × 10(9)/L were 8 (0-19), 8 (1-23) and 13.5 (3-30) days respectively, while the median hospital period was 26 (18-49), 30 (9-86) and 35 (13-44). Mean, standard deviation and range for bed costs in Group I was R9,528 (2125:6120-1660), the corresponding figures for Group II were Rll,453 (5570:3060-2924), and for Group III Rll,366 (2755: 4420-1496). The approximate fate of exchange is: Rl = US$5.87. When expenditure for growth factor was integrated these figures were approximately R26,071, R37,787 and R27,376. There were no advantages in 10 over 5 μg/kg G: CSF. More red cell transfusions were needed in Group III. The days requiring antimicrobial therapy were 14, 16 and 20 respectively. It is concluded from this study, carried out in reverse isolation at a University Teaching Hospital, that duration of neutropenic fever was significantly shortened on G: CSF but there was no benefit in using the higher dose. Additionally, at equivalent cost, there was a shorter period of hospitalisation thereby reducing risk of acquiring nosocomial infections. Finally, there was concurrently a decreased exposure to potentially nephrotoxic antibiotics. Accordingly, this regimen can be justified in the routine management of this category of patient.

  8. Review of challenges in the escalation of metal-biosorbing ...

    African Journals Online (AJOL)

    Despite the eminent consequences, wastewaters containing toxic heavy metals are still discharged in the environment without prior treatment, certainly because of the high cost associated with the effective management of these effluents. Difficulties emanated from the fact that most of the technologies available for the ...

  9. Social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain

    Directory of Open Access Journals (Sweden)

    Lopez-Bastida Julio

    2012-09-01

    Full Text Available Abstract Background Cost-of-illness analysis is the main method of providing an overall vision of the economic impact of a disease. Such studies have been used to set priorities for healthcare policies and inform resource allocation. The aim of this study was to determine the economic burden and health-related quality of life (HRQOL in the first, second and third years after surviving a stroke in the Canary Islands, Spain. Methods Cross-sectional, retrospective study of 448 patients with stroke based on ICD 9 discharge codes, who received outpatient care at five hospitals. The study was approved by the Research Ethics Committee of Nuestra Señora de la Candelaria University Hospital. Data on demographic characteristics, health resource utilization, informal care, labor productivity losses and HRQOL were collected from the hospital admissions databases and questionnaires completed by stroke patients or their caregivers. Labor productivity losses were calculated from physical units and converted into monetary units with a human capital-based method. HRQOL was measured with the EuroQol EQ-5D questionnaire. Healthcare costs, productivity losses and informal care costs were analyzed with log-normal, probit and ordered probit multivariate models. Results The average cost for each stroke survivor was €17 618 in the first, €14 453 in the second and €12 924 in the third year after the stroke; the reference year for unit prices was 2004. The largest expenditures in the first year were informal care and hospitalizations; in the second and third years the main costs were for informal care, productivity losses and medication. Mean EQ-5D index scores for stroke survivors were 0.50 for the first, 0.47 for the second and 0.46 for the third year, and mean EQ-5D visual analog scale scores were 56, 52 and 55, respectively. Conclusions The main strengths of this study lie in our bottom-up-approach to costing, and in the evaluation of stroke survivors from a

  10. The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia.

    Science.gov (United States)

    Zapata-Diomedi, Belen; Herrera, Ana Maria Mantilla; Veerman, J Lennert

    2016-11-01

    Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Intangible costs of alcohol dependence from the perspective of patients and their relatives: A contingent valuation study.

    Science.gov (United States)

    Mosquera Nogueira, Jacinto; Rodríguez-Míguez, Eva

    2018-04-15

    Alcohol dependence causes multiple problems not only for the person suffering dependence but also for others. In this study, the contingent valuation method is proposed to measure the intangible effects of alcohol dependence from the perspective of the persons directly involved: the patients and their relatives. Interviews were conducted with 145 patients and 61 relatives. Intangible effects of alcohol dependence were determined based on willingness to pay for a hypothetical treatment for dependence, with different success scenarios (100% and 50%). The mean monthly willingness to pay among the alcohol-dependent population was €129 and €168, respectively, for the treatments with 100% and 50% success. The willingness to pay of relatives was greater in both scenarios (€307 and €420, respectively), which could be explained by their greater perception of the family, labour, and health problems resulting from alcohol dependence. Regression analysis showed that patients' willingness to pay is positively related to treatment efficacy, personal income and moderate health deterioration, and negatively related to feeling discouraged and depressed. The results from this study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence. The intangible costs estimated can be added to the direct and indirect costs commonly used.

  12. Electricity prices and fuel costs. Long-run relations and short-run dynamics

    International Nuclear Information System (INIS)

    Mohammadi, Hassan

    2009-01-01

    The paper examines the long-run relation and short-run dynamics between electricity prices and three fossil fuel prices - coal, natural gas and crude oil - using annual data for the U.S. for 1960-2007. The results suggest (1) a stable long-run relation between real prices for electricity and coal (2) Bi-directional long-run causality between coal and electricity prices. (3) Insignificant long-run relations between electricity and crude oil and/or natural gas prices. And (4) no evidence of asymmetries in the adjustment of electricity prices to deviations from equilibrium. A number of implications are addressed. (author)

  13. OPERATIONAL COSTS OF CANAL COMPANIES AND IRRIGATION DISTRICTS IN THE INTERMOUNTAIN REGION

    OpenAIRE

    Wilkins-Wells, John; Lagae, Hubert J.; Anderson, Raymond L.; Anwer, Muhammad Sarfraz

    1999-01-01

    This study reports on the trends of operational costs of farmer owned and operated irrigation enterprises (irrigation districts and canal companies) in five intermountain states. Administrative costs have risen faster then operation and maintenance costs. While salaries of employees have not risen significantly over time, legal costs have greatly escalated.

  14. Audience reactions to peace journalism: How supporters and critics of the Israeli policy process escalation and de-escalation oriented media frames

    Directory of Open Access Journals (Sweden)

    Stephanie Thiel

    2014-04-01

    Full Text Available This paper reports on an experiment that uses the Israeli-Palestinian conflict as a natural laboratory for studying how recipients make sense of escalation vs. de-escalation oriented news articles. The results of the study indicate that media frames and individual frames have both a direct effect and complex interaction effects on participants’ text understanding. Particularly the effect of media war frames diminishes if they are incongruent with participants’ individual frames, and the propaganda function of reports about violence and human casualties can be neutralized if framed according to a peace frame. If participants had a priori positioned themselves in favor of the perpetrator, they may produce reactance, however.

  15. Out-of-pile bundle temperature escalation under severe fuel damage conditions

    International Nuclear Information System (INIS)

    Hagen, S.; Peck, S.O.

    1983-08-01

    This report provides an overview of the test conduct, results, and posttest appearance of bundle test ESBU-1. The purpose of the test was to investigate fuel rod temperature escalation due to the exothermal zircaloy/steam reaction in a bundle geometry. The 3x3 bundle was surrounded by a zircaloy shroud and 6 mm of fiber ceramic insulation. The center rod escalated to a maximum of 2,250 0 C. Runoff of the melt apparently limited the escalation. Posttest visual examination of the bundle showed that cladding from every rod had melted, liquefied some fuel, flowed down the rod, and frozen in a solid mass that substantially blocked all flow channels. A large amount of powdery rubble, probably fuel that fractured during cooldown, was found on top of the blockage. Metallographic, EMP, and SEM examinations showed that the melt had dissolved both fuel and oxidized cladding, and had itself been oxidized by steam. (orig.) [de

  16. Attachment and Jealousy: Understanding the Dynamic Experience of Jealousy Using the Response Escalation Paradigm.

    Science.gov (United States)

    Huelsnitz, Chloe O; Farrell, Allison K; Simpson, Jeffry A; Griskevicius, Vladas; Szepsenwol, Ohad

    2018-04-01

    Jealousy is a complex, dynamic experience that unfolds over time in relationship-threatening situations. Prior research has used retrospective reports that cannot disentangle initial levels and change in jealousy in response to escalating threat. In three studies, we examined responses to the Response Escalation Paradigm (REP)-a 5-stage hypothetical scenario in which individuals are exposed to increasing levels of relationship threat-as a function of attachment orientations. Highly anxious individuals exhibited hypervigilant, slow escalation response patterns, interfered earlier in the REP, felt more jealousy, sadness, and worry when they interfered, and wanted to engage in more vigilant, destructive, and passive behaviors aimed at their partner. Highly avoidant individuals felt more anger when they interfered in the REP and wanted to engage in more partner-focused, destructive behaviors. The REP offers a dynamic method for inducing and examining jealousy and introduces a novel approach to studying other emotional experiences.

  17. Innovative design for a phase 1 trial with intra-patient dose escalation: The Crotoxin study

    Directory of Open Access Journals (Sweden)

    Jacques Medioni

    2017-09-01

    Full Text Available Introduction: Crotoxin has a broad antitumor activity but has shown frequent neurotoxic toxicity. To induce tolerance and limit this toxicity, we propose a new design with intra-patient dose escalation. Methods: A new Dose Limiting Toxicity definition was used. The concept of Target Ceiling Dose was introduced. Results: Dose Limiting Toxicity was the inability to dose escalate twice. Target Ceiling Dose was the highest planned dose to be administered to a patient and could change for patients along time. Recommended Dose was defined similarly as in a (3 + 3 conventional design. Conclusion: This innovant design was used and the clinical trial is now closed for inclusions. Results will be presented later. Keywords: Clinical trial, Phase 1, Intra-patient dose escalation, Cancer

  18. Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis.

    Science.gov (United States)

    Kruntorádová, Klára; Klimeš, Jiří; Šedová, Liliana; Štolfa, Jiří; Doležal, Tomáš; Petříková, Alena

    2014-09-01

    To determine and compare the impact of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis on work productivity, to calculate the productivity costs (PC), and to map out factors that influence (functional status and disease activity) work productivity. The Work Productivity and Activity Impairment questionnaire was used to evaluate productivity losses of patients with RA (n = 77), AS (n = 230), and psoriasis (n = 93). Demographic data, patient-reported outcomes (PROs) (Health Assessment Questionnaire [HAQ] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and clinical parameters (Disease Activity Score in 28 joints [DAS28], body surface area [BSA], and Psoriasis Area and Severity Index [PASI]) were collected. The correlations among PROs, clinical parameters, and overall productivity loss were examined, and multiple regression models were used to examine relationships among parameters and productivity loss. PC were calculated using the friction cost approach. Mean patient age and disease duration were 47.1 and 15.7 years, respectively. The mean HAQ and DAS28 in patients with RA were 1.22 and 5.6, respectively. The mean BASDAI score in patients with AS was 4.43. The mean BSA and PASI score in patients with psoriasis were 21.1% and 12.9, respectively. The percentage of patients with psoriatic arthritis (in those with psoriasis) was 24.7%. We did not find significant differences in Work Productivity and Activity Impairment domains among various diagnoses. Patients with AS, RA, and psoriasis reported overall work productivity losses of 40.9%, 42.9%, and 42.8%, respectively. Daily activity impairments were approximately 50.0%. Overall work productivity loss strongly correlated with PROs, whereas correlations with clinical parameters were weak. The HAQ and BASDAI were identified as major predictors of productivity impairment. The greatest loss in productivity was in those with psoriatic arthritis; however, it was not significant. In

  19. Cost of preventing workplace heat-related illness through worker breaks and the benefit of climate-change mitigation

    Science.gov (United States)

    Takakura, Jun'ya; Fujimori, Shinichiro; Takahashi, Kiyoshi; Hijioka, Yasuaki; Hasegawa, Tomoko; Honda, Yasushi; Masui, Toshihiko

    2017-06-01

    The exposure of workers to hot environments is expected to increase as a result of climate change. In order to prevent heat-related illness, it is recommended that workers take breaks during working hours. However, this would lead to reductions in worktime and labor productivity. In this study, we estimate the economic cost of heat-related illness prevention through worker breaks associated with climate change under a wide range of climatic and socioeconomic conditions. We calculate the worktime reduction based on the recommendation of work/rest ratio and the estimated future wet bulb glove temperature, which is an index of heat stresses. Corresponding GDP losses (cost of heat-related illness prevention through worker breaks) are estimated using a computable general equilibrium model throughout this century. Under the highest emission scenario, GDP losses in 2100 will range from 2.6 to 4.0% compared to the current climate conditions. On the other hand, GDP losses will be less than 0.5% if the 2.0 °C goal is achieved. The benefit of climate-change mitigation for avoiding worktime loss is comparable to the cost of mitigation (cost of the greenhouse gas emission reduction) under the 2.0 °C goal. The relationship between the cost of heat-related illness prevention through worker breaks and global average temperature rise is approximately linear, and the difference in economic loss between the 1.5 °C goal and the 2.0 °C goal is expected to be approximately 0.3% of global GDP in 2100. Although climate mitigation and socioeconomic development can limit the vulnerable regions and sectors, particularly in developing countries, outdoor work is still expected to be affected. The effectiveness of some adaptation measures such as additional installation of air conditioning devices or shifting the time of day for working are also suggested. In order to reduce the economic impacts, adaptation measures should also be implemented as well as pursing ambitious climate change

  20. Cost-Effectiveness Evaluation of Quadrivalent Human Papilloma Virus Vaccine for HPV-Related Disease in Iran

    Science.gov (United States)

    Khatibi, Mohsen; Rasekh, Hamid Reza; Shahverdi, Zohreh; jamshidi, Hamid Reza

    2014-01-01

    Human Papilloma Virus (HPV) vaccine has been added recently to the Iran Drug List. So, decision makers need information beyond that available from RCTs to recommend funding for this vaccination program to add it to the National Immunization program in Iran. Modeling and economic studies have addressed some of those information needs in foreign countries. In order to determine the long term benefit of this vaccine and impact of vaccine program on the future rate of cervical cancer in Iran, we described a model, based on the available economic and health effects of human papilloma virus (HPV), to estimate the cost-effectiveness of HPV vaccination of 15-year-old girls in Iran. Our objective is to estimate the cost-effectiveness of HPV vaccination in Iran against cervical cancer based on available data; incremental cost-effectiveness ratio (ICER) calculations were based on a model comparing a cohort of 15-year-old girls with and without vaccination. We developed a static model based on available data in Iran on the epidemiology of HPV related health outcome. The model compared the cohort of all 15-year old girls alive in the year 2013 with and without vaccination. The cost per QALY, which was found based on our assumption for the vaccination of 15-years old girl to current situation was 439,000,000 Iranian Rial rate (IRR). By considering the key parameters in our sensitivity analysis, value varied from 251,000,000 IRR to 842,000,000 IRR. In conclusion, quadrivalent HPV vaccine (Gardasil) is not cost-effective in Iran based on the base-case parameters value. PMID:24711850

  1. Partition of aerobic and anaerobic swimming costs related to gait transitions in a labriform swimmer

    DEFF Research Database (Denmark)

    Svendsen, Jon Christian; Tudorache, Christian; Jordan, Anders D.

    2010-01-01

    rate was measured at 1.4, 1.9 and 2.3 L s–1. The presence and magnitude of excess post-exercise oxygen consumption (EPOC) were evaluated after each swimming speed. The data demonstrated that 1.4 L s–1 was below the Up–c, whereas 1.9 and 2.3 L s–1 were above the Up–c. These last two swimming speeds...... included caudal fin propulsion in a mostly steady and unsteady (burst-assisted) mode, respectively. There was no evidence of EPOC after swimming at 1.4 and 1.9 L s–1, indicating that the pectoral–caudal gait transition was not a threshold for anaerobic metabolism. At 2.3 L s–1, E. lateralis switched...... to an unsteady burst and flap gait. This swimming speed resulted in EPOC, suggesting that anaerobic metabolism constituted 25% of the total costs. Burst activity correlated positively with the magnitude of the EPOC. Collectively, these data indicate that steady axial propulsion does not lead to EPOC whereas...

  2. Change in Visual Field Progression Following Treatment Escalation in Primary Open-angle Glaucoma.

    Science.gov (United States)

    Aptel, Florent; Bron, Alain M; Lachkar, Yves; Schweitzer, Cédric

    2017-10-01

    To evaluate the effect of treatment escalation on the rate of visual field progression in patients with primary open-angle glaucoma (POAG). Multicenter database study. We reviewed the electronic records of 171 patients with POAG under medical hypotensive treatment who underwent 5 consecutive visits 6 months apart before and after medical treatment escalation or additive laser trabeculoplasty. We calculated the rate of visual field progression (mean deviation change per year) before and after treatment escalation. The mean duration of follow-up was 5.1±0.5 years and the mean number of visual field examinations was 10.2±0.2. In 139 eyes with medical treatment escalation, the rate of progression was significantly reduced [from -0.57 to -0.29 dB/y; P=0.022; intraocular pressure (IOP) reduction 11.1%]. In detail, the rate of progression was significantly reduced after escalation from mono to dual therapy, dual to triple therapy, and from mono to triple therapy (-0.35 to -0.24 dB/y, P=0.018; -1.01 to -0.48 dB/y, P=0.038; -1.04 to -0.35 dB/y, P=0.020, respectively). In 32 eyes with additive laser trabeculoplasty, the rate of progression was significantly reduced (-0.60 to -0.24 dB/y; P=0.014; IOP reduction 9.4%). Medical treatment escalation or additive laser trabeculoplasty significantly reduced the rate of visual field progression in POAG. Larger IOP reduction has a greater probability of reducing glaucoma progression.

  3. Reducing DNACPR complaints to zero: designing and implementing a treatment escalation plan using quality improvement methodology.

    Science.gov (United States)

    Shermon, Elizabeth; Munglani, Laura; Oram, Sarah; William, Linda; Abel, Julian

    2017-01-01

    Do Not Attempt Resuscitation (DNAR)decisions have traditionally formed the basis of ceiling of care discussions. However, poor quality discussions can lead to high patient and relative dissatisfaction, generating hospital complaints. Treatment escalation plans (TEPs) aim to highlight the wider remit of treatment options with a focus on effective communication. We aimed to improve TEP discussions and documentation at Weston General Hospital by introducing a standardised form. We aimed to develop a TEP document to reduce resuscitation-related complaints by improving communication and documentation. Qualitative and quantitative data were collected over 2 years and used to develop plan-do-study-act (PDSA) cycles using quality improvement methodology. Main barriers to improvement included time constraints and clinician's resistance. Analysis of patient liaison services data showed a progressive reduction in complaints regarding resuscitation, with no complaints having been received for the final six months of the project. Through use of a standardised form including treatment prompts, the quality of discussions and plans improved. Qualitative feedback demonstrated increased patient and relative satisfaction. In addition, junior doctors report the plans are helpful when making out-of-hours decisions. Development of a user-friendly form to document patient-guided TEPs helped junior doctors to lead advanced care planning discussions. The use of PDSA cycles demonstrated improvement in the quality of forms, which in turn improved communication, documentation and satisfaction. Future developments could include involvement of specialist teams to ensure TEP forms remain relevant to all clinical areas. In addition, with widespread use of the TEP forms, the traditional tick-box DNAR could be replaced to focus on patient-led care planning.

  4. Efficiency and abatement costs of energy-related CO2 emissions in China: A slacks-based efficiency measure

    International Nuclear Information System (INIS)

    Choi, Yongrok; Zhang, Ning; Zhou, P.

    2012-01-01

    Highlights: ► We employ a slacks-based DEA model to estimate the energy efficiency and shadow prices of CO 2 emissions in China. ► The empirical study shows that China was not performing CO 2 -efficiently. ► The average of estimated shadow prices of CO 2 emissions is about $7.2. -- Abstract: This paper uses nonparametric efficiency analysis technique to estimate the energy efficiency, potential emission reductions and marginal abatement costs of energy-related CO 2 emissions in China. We employ a non-radial slacks-based data envelopment analysis (DEA) model for estimating the potential reductions and efficiency of CO 2 emissions for China. The dual model of the slacks-based DEA model is then used to estimate the marginal abatement costs of CO 2 emissions. An empirical study based on China’s panel data (2001–2010) is carried out and some policy implications are also discussed.

  5. Attitude Determination Algorithm based on Relative Quaternion Geometry of Velocity Incremental Vectors for Cost Efficient AHRS Design

    Science.gov (United States)

    Lee, Byungjin; Lee, Young Jae; Sung, Sangkyung

    2018-05-01

    A novel attitude determination method is investigated that is computationally efficient and implementable in low cost sensor and embedded platform. Recent result on attitude reference system design is adapted to further develop a three-dimensional attitude determination algorithm through the relative velocity incremental measurements. For this, velocity incremental vectors, computed respectively from INS and GPS with different update rate, are compared to generate filter measurement for attitude estimation. In the quaternion-based Kalman filter configuration, an Euler-like attitude perturbation angle is uniquely introduced for reducing filter states and simplifying propagation processes. Furthermore, assuming a small angle approximation between attitude update periods, it is shown that the reduced order filter greatly simplifies the propagation processes. For performance verification, both simulation and experimental studies are completed. A low cost MEMS IMU and GPS receiver are employed for system integration, and comparison with the true trajectory or a high-grade navigation system demonstrates the performance of the proposed algorithm.

  6. Los Alamos Scientific Laboratory building cost index

    Energy Technology Data Exchange (ETDEWEB)

    Lemon, G.D.; Morris, D.W.; McConnell, P.H.

    1977-11-01

    The Controller's budget request for FY-1979 established guidance for escalation rates at 6 to 8 percent for construction projects beyond FY-1976. The Los Alamos Scientific Laboratory (LASL) has chosen to use an annual construction escalation rate of 10 percent. Results of this study should contribute toward the establishment of realistic construction cost estimate totals and estimates of annual construction funding requirements. Many methods were used to arrive at the LASL escalation rate recommendation. First, a computer program was developed which greatly expanded the number of materials previously analyzed. The program calculated the 1970 to 76 weighted averages for labor, materials, and equipment for the base line project. It also plotted graphs for each category and composite indexes for labor and material/equipment. Second, estimated increases for 1977 were obtained from several sources. The Zia Company provided labor cost estimates. Projected increases for material and equipment were obtained through conversations with vendors and analysis of trade publications. Third, economic forecast reports and the Wall Street Journal were used for source material, narrative, and forecast support. Finally, we compared LASL Building Cost Index with the effects of escalation associated with three recently developed projects at LASL.

  7. Los Alamos Scientific Laboratory building cost index

    International Nuclear Information System (INIS)

    Lemon, G.D.; Morris, D.W.; McConnell, P.H.

    1977-11-01

    The Controller's budget request for FY-1979 established guidance for escalation rates at 6 to 8 percent for construction projects beyond FY-1976. The Los Alamos Scientific Laboratory (LASL) has chosen to use an annual construction escalation rate of 10 percent. Results of this study should contribute toward the establishment of realistic construction cost estimate totals and estimates of annual construction funding requirements. Many methods were used to arrive at the LASL escalation rate recommendation. First, a computer program was developed which greatly expanded the number of materials previously analyzed. The program calculated the 1970 to 76 weighted averages for labor, materials, and equipment for the base line project. It also plotted graphs for each category and composite indexes for labor and material/equipment. Second, estimated increases for 1977 were obtained from several sources. The Zia Company provided labor cost estimates. Projected increases for material and equipment were obtained through conversations with vendors and analysis of trade publications. Third, economic forecast reports and the Wall Street Journal were used for source material, narrative, and forecast support. Finally, we compared LASL Building Cost Index with the effects of escalation associated with three recently developed projects at LASL

  8. 75 FR 19345 - Federal Acquisition Regulation; FAR Case 2009-006, Labor Relations Costs

    Science.gov (United States)

    2010-04-14

    ... manner of exercising, the right to organize and bargain collectively through representatives of the... submit comments only and cite FAR case 2009- 006, in all correspondence related to this case. All... publication schedules, contact the Regulatory Secretariat at (202) 501-4755. Please cite FAR case 2009- 006...

  9. Underestimating Costs in Public Works Projects

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

    2002-01-01

    This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... honest numbers should not trust the cost estimates and cost-benefit analyses produced by project promoters and their analysts. Independent estimates and analyses are needed as are institutional checks and balances to curb deception.......This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... estimates used to decide whether important infrastructure should be built are highly and systematically misleading. The result is continuous cost escalation of billions of dollars. The sample used in the study is the largest of its kind, allowing for the first time statistically valid conclusions regarding...

  10. Cost Underestimation in Public Works Projects

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

    This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... honest numbers should not trust the cost estimates and cost-benefit analyses produced by project promoters and their analysts. Independent estimates and analyses are needed as are institutional checks and balances to curb deception.......This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... estimates used to decide whether important infrastructure should be built are highly and systematically misleading. The result is continuous cost escalation of billions of dollars. The sample used in the study is the largest of its kind, allowing for the first time statistically valid conclusions regarding...

  11. Relation between efficiency and energy cost with coordination in aquatic locomotion.

    Science.gov (United States)

    Figueiredo, Pedro; Toussaint, Huub M; Vilas-Boas, João Paulo; Fernandes, Ricardo J

    2013-03-01

    The aim of this study was to establish the relationships between the intracycle velocity variation (IVV) and Froude efficiency (η(T)), energy cost (C), and index of coordination (IdC) throughout a 200-m freestyle race. Ten male international level swimmers performed a maximum 200 m front crawl swim. Performance was recorded with four below- and two above-water synchronized cameras. Oxygen consumption was measured continuously during the effort, and blood samples were collected before and after the test. IdC, body center of mass' IVV (x, y and z), and η(T) were also calculated. For assessing C swimmers performed also 50, 100 and 150 m at the same pace as in the 200-m splits to capture blood lactate samples after each 50-m lap of the 200-m effort. Swimmers attained a stable IVV (x, y, and z), as fatigue development along the 200-m effort induced a decrease in velocity, stroke length, stroke frequency, η(T), and an increase of IdC. Direct relationships between C and IdC for the second and fourth lap were found: R = 0.63 and R = 0.69 (P < 0.05), respectively. Computing partial correlation, also IdC and η(T) in the first lap were significantly correlated (R = -0.63, P < 0.05). IdC and η(T) showed to be significant for the within-subjects correlation (R = -0.45, P = 0.01), and IdC and C for the between-subjects correlation (R = 0.66, P = 0.04). Patterns of coordination modified during the 200-m event in response to the task constraints, observed by the changes in the other studied parameters, and allowing the IVV stability along the effort.

  12. Societal cost of traumatic brain injury: A comparison of cost-of-injuries related to biking with and without helmet use.

    Science.gov (United States)

    Costa, Camille K; Dagher, Jehane H; Lamoureux, Julie; de Guise, Elaine; Feyz, Mitra

    2015-01-01

    The goal of this study is to determine if a difference in societal costs exists from traumatic brain injuries (TBI) in patients who wear helmets compared to non-wearers. This is a retrospective cost-of-injury study of 128 patients admitted to the Montreal General Hospital (MGH) following a TBI that occurred while cycling between 2007-2011. Information was collected from Quebec Trauma Registry. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated societal costs. The median costs of hospitalization were significantly higher (p = 0.037) in the no helmet group ($7246.67 vs. $4328.17). No differences in costs were found for inpatient rehabilitation (p = 0.525), outpatient rehabilitation (p = 0.192), loss of productivity (p = 0.108) or death (p = 1.000). Overall, the differences in total societal costs between the helmet and no helmet group were not significantly different (p = 0.065). However, the median total costs for patients with isolated TBI in the non-helmet group ($22, 232.82) was significantly higher (p = 0.045) compared to the helmet group ($13, 920.15). Cyclists sustaining TBIs who did not wear helmets in this study were found to cost society nearly double that of helmeted cyclists.

  13. Price control in contracts of heat supply. May no more index be used in automatic price escalator clauses?; Preiskontrolle in Waermeliefervertraegen.. Darf in automatischen Preisgleitklauseln kein Index mehr genutzt werden?

    Energy Technology Data Exchange (ETDEWEB)

    Legler, Dirk [Guenther Heidel Wollenteit Hack Goldmann, Hamburg (Germany)

    2010-03-15

    Automatic price escalator clauses using a price index are AGB legally permissible in heat supply contracts. The fact that such price indices necessarily compound and orient themselves only at its own development of delivery costs is so long innocuous since the selection of these indices essentially can be justified on the basis of objective criteria. However, if the heat supplier as a user of the AGB uses no indices, but passes its costs of acquisition in its price escalator clause simply to 100 %, this evenly can be inadmissible according to paragraph 24 sect. 3, sentence 1 of AVB district heating regulation. This is valid if such a 'servile' passing signifies a neglect of conditions on the market.

  14. Outer planet probe cost estimates: First impressions

    Science.gov (United States)

    Niehoff, J.

    1974-01-01

    An examination was made of early estimates of outer planetary atmospheric probe cost by comparing the estimates with past planetary projects. Of particular interest is identification of project elements which are likely cost drivers for future probe missions. Data are divided into two parts: first, the description of a cost model developed by SAI for the Planetary Programs Office of NASA, and second, use of this model and its data base to evaluate estimates of probe costs. Several observations are offered in conclusion regarding the credibility of current estimates and specific areas of the outer planet probe concept most vulnerable to cost escalation.

  15. Assessing Air Pollutant-Induced, Health-Related External Costs in the Context of Nonmarginal System Changes: A Review.

    Science.gov (United States)

    Bachmann, Till M

    2015-08-18

    Marginal analysis is the usual approach to environmental economic assessment, for instance, of health-related external costs due to energy-associated air pollutant emissions. However, nonlinearity exists in all steps of their assessment, i.e., atmospheric dispersion, impact assessment, and monetary valuation. Dedicated assessments thus appear necessary when evaluating large systems or their changes such as in green accounting or the implications of economy-wide energy transitions. Corresponding approaches are reviewed. Tools already exist that allow assessing a marginal change (e.g., one power plant's emissions) for different background emission scenarios that merely need to be defined and implemented. When assessing nonmarginal changes, the top-down approach is considered obsolete, and four variants of the bottom-up approach with different application domains were identified. Variants 1 and 2 use precalculated external cost factors with different levels of sophistication, suitable for energy systems modeling, optimizing for social (i.e., private and external) costs. Providing more reliable results due to more detailed modeling, emission sources are assessed individually or jointly in variants 3 and 4, respectively. Aiming at considering nonlinearity more fully and simultaneously following marginal analysis principles, I propose a variant 3-based approach, subdividing an aggregate (i.e., a nonmarginal change) into several smaller changes. Its strengths and drawbacks, notably the associated effort, are discussed.

  16. Pluri-annual programming of energy (PPE): an escalation policy

    International Nuclear Information System (INIS)

    Perves, J.P.

    2016-01-01

    Concerning the pluri-annual programming of energy for the 2018-2023 period, the French government proposes to accelerate the deployment of wind and solar energies in order to reach 43.000 - 49.200 MW globally in 2023. To compare wind and solar energies totaled 16.500 MW in 2015. The 2023 level will represent around 70% of the today's nuclear power production. This energy policy will require a huge investment of 60 billions euros by 2023. It appears that offshore wind energy is not favoured because of its important costs and this acceleration will imply more wind turbines installed on land which can have a negative impact on the environment. Furthermore wind and solar energies will require other sources of energy to compensate seasonal effects, the back-up energy may be nuclear but it would increase the kWh cost because nuclear energy will be under-used. The gain in CO_2 will be null because the electricity production in France is largely de-carbonized thanks to the use of nuclear energy. A more progressive deployment of renewable energies in the French energy mix is recommended. (A.C.)

  17. Memory for semantically related and unrelated declarative information: the benefit of sleep, the cost of wake.

    Directory of Open Access Journals (Sweden)

    Jessica D Payne

    Full Text Available Numerous studies have examined sleep's influence on a range of hippocampus-dependent declarative memory tasks, from text learning to spatial navigation. In this study, we examined the impact of sleep, wake, and time-of-day influences on the processing of declarative information with strong semantic links (semantically related word pairs and information requiring the formation of novel associations (unrelated word pairs. Participants encoded a set of related or unrelated word pairs at either 9 am or 9 pm, and were then tested after an interval of 30 min, 12 hr, or 24 hr. The time of day at which subjects were trained had no effect on training performance or initial memory of either word pair type. At 12 hr retest, memory overall was superior following a night of sleep compared to a day of wakefulness. However, this performance difference was a result of a pronounced deterioration in memory for unrelated word pairs across wake; there was no sleep-wake difference for related word pairs. At 24 hr retest, with all subjects having received both a full night of sleep and a full day of wakefulness, we found that memory was superior when sleep occurred shortly after learning rather than following a full day of wakefulness. Lastly, we present evidence that the rate of deterioration across wakefulness was significantly diminished when a night of sleep preceded the wake period compared to when no sleep preceded wake, suggesting that sleep served to stabilize the memories against the deleterious effects of subsequent wakefulness. Overall, our results demonstrate that 1 the impact of 12 hr of waking interference on memory retention is strongly determined by word-pair type, 2 sleep is most beneficial to memory 24 hr later if it occurs shortly after learning, and 3 sleep does in fact stabilize declarative memories, diminishing the negative impact of subsequent wakefulness.

  18. Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men

    NARCIS (Netherlands)

    Vogel, Tanja; Dom, Geert; van de Glind, Geurt; Studer, Joseph; Gmel, Gerhard; Strik, Werner; Moggi, Franz

    2016-01-01

    Young adults with attention deficit/hyperactivity disorder (ADHD) show higher substance use disorder (SUD) prevalence relative to non-ADHD controls; few longitudinal studies have examined the course of substance use with reference to conduct disorder (CD). We compared initiation and escalation of

  19. Reliability of a patient survey assessing cost-related changes in health care use among high deductible health plan enrollees

    Directory of Open Access Journals (Sweden)

    Galbraith Alison A

    2011-05-01

    Full Text Available Abstract Background Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions. Methods We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP with ≥ $500 in annualized out-of-pocket expenditures. Enrollees were asked about their knowledge of their plan, information seeking, behavior change associated with having a deductible, experience of delay in care due in part to cost, and hypothetical delay in care due in part to cost. Initial respondents were mailed a follow-up survey within two weeks of each family returning the original survey. We computed several agreement statistics to measure the test-retest reliability for select questions. We also conducted continuity adjusted chi-square, and McNemar tests in both the original and follow-up samples to measure the degree to which our results could be reproduced. Analyses were stratified by self-reported income. Results The test-retest reliability was moderate for the majority of questions (0.41 - 0.60 and the level of test-retest reliability did not differ substantially across each of the broader domains of questions. The observed proportions of respondents with delayed or foregone pediatric, adult, or any family care were similar when comparing the original and follow-up surveys. In the original survey, respondents in the lower-income group were more likely to delay or forego pediatric care, adult care, or any family care. All of the tests comparing income groups in the follow-up survey produced the same result as in the original survey. Conclusions In this population of HDHP beneficiaries, we found that survey questions concerning plan knowledge, information

  20. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea.

    Science.gov (United States)

    Buono, Jessica L; Carson, Robyn T; Flores, Natalia M

    2017-02-14

    Irritable bowel syndrome (IBS) affects 10-15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population. Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics. In total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p work productivity loss (20.7% vs. 13.2%; p work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.

  1. Predation-related costs and benefits of conspecific attraction in songbirds--an agent-based approach.

    Science.gov (United States)

    Szymkowiak, Jakub; Kuczyński, Lechosław

    2015-01-01

    Songbirds that follow a conspecific attraction strategy in the habitat selection process prefer to settle in habitat patches already occupied by other individuals. This largely affects the patterns of their spatio-temporal distribution and leads to clustered breeding. Although making informed settlement decisions is expected to be beneficial for individuals, such territory clusters may potentially provide additional fitness benefits (e.g., through the dilution effect) or costs (e.g., possibly facilitating nest localization if predators respond functionally to prey distribution). Thus, we hypothesized that the fitness consequences of following a conspecific attraction strategy may largely depend on the composition of the predator community. We developed an agent-based model in which we simulated the settling behavior of birds that use a conspecific attraction strategy and breed in a multi-predator landscape with predators that exhibited different foraging strategies. Moreover, we investigated whether Bayesian updating of prior settlement decisions according to the perceived predation risk may improve the fitness of birds that rely on conspecific cues. Our results provide evidence that the fitness consequences of conspecific attraction are predation-related. We found that in landscapes dominated by predators able to respond functionally to prey distribution, clustered breeding led to fitness costs. However, this cost could be reduced if birds performed Bayesian updating of prior settlement decisions and perceived nesting with too many neighbors as a threat. Our results did not support the hypothesis that in landscapes dominated by incidental predators, clustered breeding as a byproduct of conspecific attraction provides fitness benefits through the dilution effect. We suggest that this may be due to the spatial scale of songbirds' aggregative behavior. In general, we provide evidence that when considering the fitness consequences of conspecific attraction for

  2. Predation-Related Costs and Benefits of Conspecific Attraction in Songbirds—An Agent-Based Approach

    Science.gov (United States)

    Szymkowiak, Jakub; Kuczyński, Lechosław

    2015-01-01

    Songbirds that follow a conspecific attraction strategy in the habitat selection process prefer to settle in habitat patches already occupied by other individuals. This largely affects the patterns of their spatio-temporal distribution and leads to clustered breeding. Although making informed settlement decisions is expected to be beneficial for individuals, such territory clusters may potentially provide additional fitness benefits (e.g., through the dilution effect) or costs (e.g., possibly facilitating nest localization if predators respond functionally to prey distribution). Thus, we hypothesized that the fitness consequences of following a conspecific attraction strategy may largely depend on the composition of the predator community. We developed an agent-based model in which we simulated the settling behavior of birds that use a conspecific attraction strategy and breed in a multi-predator landscape with predators that exhibited different foraging strategies. Moreover, we investigated whether Bayesian updating of prior settlement decisions according to the perceived predation risk may improve the fitness of birds that rely on conspecific cues. Our results provide evidence that the fitness consequences of conspecific attraction are predation-related. We found that in landscapes dominated by predators able to respond functionally to prey distribution, clustered breeding led to fitness costs. However, this cost could be reduced if birds performed Bayesian updating of prior settlement decisions and perceived nesting with too many neighbors as a threat. Our results did not support the hypothesis that in landscapes dominated by incidental predators, clustered breeding as a byproduct of conspecific attraction provides fitness benefits through the dilution effect. We suggest that this may be due to the spatial scale of songbirds’ aggregative behavior. In general, we provide evidence that when considering the fitness consequences of conspecific attraction for

  3. Cost-effectiveness modeling for neuropathic pain treatments: investigating the relative importance of parameters using an open-source model.

    Science.gov (United States)

    Hirst, Matthew; Bending, Matthew W; Baio, Gianluca; Yesufu-Udechuku, Amina; Dunlop, William C N

    2018-06-08

    The study objective was to develop an open-source replicate of a cost-effectiveness model developed by National Institute for Health and Care (NICE) in order to explore uncertainties in health economic modeling of novel pharmacological neuropathic pain treatments. The NICE model, consisting of a decision tree with branches for discrete levels of pain relief and adverse event (AE) severities, was replicated using R and used to compare a hypothetical neuropathic pain drug to pregabalin. Model parameters were sourced from NICE's clinical guidelines and associated with probability distributions to account for underlying uncertainty. A simulation-based scenario analysis was conducted to assess how uncertainty in efficacy and AEs affected the net monetary benefit (NMB) for the hypothetical treatment at a cost-effectiveness threshold of £20,000 per QALY. Relative to pregabalin, an increase in efficacy was associated with greater NMB than an improvement in tolerability. A greater NMB was observed when efficacy was marginally higher than that of pregabalin while maintaining the same level of AEs than when efficacy was equivalent to pregabalin but with a more substantial reduction in AEs. In the latter scenario, the NMB was only positive at a low cost-effectiveness threshold. The replicate model shares the limitations described in the NICE guidelines. There is a lack of support in scientific literature for the assumption that increased efficacy is associated with a greater reduction in tolerability. The replicate model also included a single comparator, unlike the NICE model. Pain relief is a stronger driver of NMB than tolerability at a cost-effectiveness threshold of £20,000 per QALY. Health technology assessment decisions which are influenced by NICE's model may reward efficacy gains even if they are associated with more severe AEs. This contrasts with recommendations from clinical guidelines for neuropathic pain which place more equal weighting on improvements in

  4. Predation-related costs and benefits of conspecific attraction in songbirds--an agent-based approach.

    Directory of Open Access Journals (Sweden)

    Jakub Szymkowiak

    Full Text Available Songbirds that follow a conspecific attraction strategy in the habitat selection process prefer to settle in habitat patches already occupied by other individuals. This largely affects the patterns of their spatio-temporal distribution and leads to clustered breeding. Although making informed settlement decisions is expected to be beneficial for individuals, such territory clusters may potentially provide additional fitness benefits (e.g., through the dilution effect or costs (e.g., possibly facilitating nest localization if predators respond functionally to prey distribution. Thus, we hypothesized that the fitness consequences of following a conspecific attraction strategy may largely depend on the composition of the predator community. We developed an agent-based model in which we simulated the settling behavior of birds that use a conspecific attraction strategy and breed in a multi-predator landscape with predators that exhibited different foraging strategies. Moreover, we investigated whether Bayesian updating of prior settlement decisions according to the perceived predation risk may improve the fitness of birds that rely on conspecific cues. Our results provide evidence that the fitness consequences of conspecific attraction are predation-related. We found that in landscapes dominated by predators able to respond functionally to prey distribution, clustered breeding led to fitness costs. However, this cost could be reduced if birds performed Bayesian updating of prior settlement decisions and perceived nesting with too many neighbors as a threat. Our results did not support the hypothesis that in landscapes dominated by incidental predators, clustered breeding as a byproduct of conspecific attraction provides fitness benefits through the dilution effect. We suggest that this may be due to the spatial scale of songbirds' aggregative behavior. In general, we provide evidence that when considering the fitness consequences of conspecific

  5. Cost-related Nonadherence to Medication Treatment Plans: Native Hawaiian and Pacific Islander National Health Interview Survey, 2014.

    Science.gov (United States)

    McElfish, Pearl A; Long, Christopher R; Payakachat, Nalin; Felix, Holly; Bursac, Zoran; Rowland, Brett; Hudson, Jonell S; Narcisse, Marie-Rachelle

    2018-04-01

    Adherence to medication treatment plans is important for chronic disease (CD) management. Cost-related nonadherence (CRN) puts patients at risk for complications. Native Hawaiians and Pacific Islanders (NHPI) suffer from high rates of CD and socioeconomic disparities that could increase CRN behaviors. Examine factors related to CRN to medication treatment plans within an understudied population. Using 2014 NHPI-National Health Interview Survey data, we examined CRN among a nationally representative sample of NHPI adults. Bonferroni-adjusted Wald test and multivariable logistic regression were performed to examine associations among financial burden-related factors, CD status, and CRN. Across CD status, NHPI engaged in CRN behaviors had, on an average, increased levels of perceived financial stress, financial insecurity with health care, and food insecurity compared with adults in the total NHPI population. Regression analysis indicated perceived financial stress [adjusted odds ratio (AOR)=1.16; 95% confidence intervals (CI), 1.10-1.22], financial insecurity with health care (AOR=1.96; 95% CI, 1.32-2.90), and food insecurity (AOR=1.30; 95% CI, 1.06-1.61) all increase the odds of CRN among those with CD. We also found significant associations between perceived financial stress (AOR=1.15; 95% CI, 1.09-1.20), financial insecurity with health care (AOR=1.59; 95% CI, 1.19-2.12), and food insecurity (AOR=1.31; 95% CI, 1.04-1.65) and request for lower cost medication. This study demonstrated health-related and non-health-related financial burdens can influence CRN behaviors. It is important for health care providers to collect and use data about the social determinants of health to better inform their conversations about medication adherence and prevent CRN.

  6. SYSTEMS-2: A randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    M. Ashton

    2018-01-01

    Full Text Available SYSTEMS-2 is a randomised study of radiotherapy dose escalation for pain control in 112 patients with malignant pleural mesothelioma (MPM. Standard palliative (20 Gy/5# or dose escalated treatment (36 Gy/6# will be delivered using advanced radiotherapy techniques and pain responses will be compared at week 5. Data will guide optimal palliative radiotherapy in MPM.

  7. The NARLAL2 dose escalation trial: dosimetric implications of inter-fractional changes in organs at risk

    DEFF Research Database (Denmark)

    Hoffmann, Lone; Knap, Marianne Marquard; Khalil, Azza Ahmed

    2018-01-01

    and an escalated treatment plan. In the escalated arm, mean doses up to 95 Gy/33 fractions (tumour) and 74 Gy/33 fractions (lymph nodes) are delivered to the most 18fluorodeoxyglucose-positron emission tomography (18FDG PET) active regions. The dose distributions are limited by strict constraints to OARs...

  8. 76 FR 68803 - Escalate Capital Partners SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

    Science.gov (United States)

    2011-11-07

    ... Courtyard Drive, Suite 309, Austin, TX 78730. The financing is contemplated to provide working capital and... SMALL BUSINESS ADMINISTRATION [License No. 06/06-0335] Escalate Capital Partners SBIC I, L.P... Notice is hereby given that Escalate Capital Partners, SBIC I, L.P., 300 W. 6th Street, Suite 2250...

  9. 77 FR 42353 - Escalate Capital Partners SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small...

    Science.gov (United States)

    2012-07-18

    ... Regulations because Escalate Capital Partners SBIC I, L.P. proposes to Finance a small business in which its... SMALL BUSINESS ADMINISTRATION [License No. 06/06-0335] Escalate Capital Partners SBIC I, L.P.; Notice Seeking Exemption Under Section 312 of the Small Business Investment Act, Conflicts of Interest...

  10. An Evaluation of Three Methods of Saying "No" to Avoid an Escalating Response Class Hierarchy

    Science.gov (United States)

    Mace, F. Charles; Pratt, Jamie L.; Prager, Kevin L.; Pritchard, Duncan

    2011-01-01

    We evaluated the effects of three different methods of denying access to requested high-preference activities on escalating problem behavior. Functional analysis and response class hierarchy (RCH) assessment results indicated that 4 topographies of problem behaviors displayed by a 13-year-old boy with high-functioning autism constituted an RCH…

  11. Some Take the Glass Escalator, Some Hit the Glass Ceiling? Career Consequences of Occupational Sex Segregation.

    Science.gov (United States)

    Hultin, Mia

    2003-01-01

    Analysis of Swedish longitudinal data (1,535 men, 1,584 women) showed that men in female-dominated occupations have substantially better internal promotion opportunities than equally qualified women. In male-dominated occupations, men and women have equal internal promotion chances. Results suggest a "glass escalator" advantage for men…

  12. Construcción de una red social segura, fiable y escalable mediante Cloud Computing

    OpenAIRE

    Wagner, Alan

    2014-01-01

    Treball fet a Ciclee Technologies S.L. Desarrollo de un "Social commerce" o marketplace social utilizando el framework de desarrolllo web Django. Diseño de un sistema distribuído escalable, robusto y seguro para la puesta en producción. Utilización de Cloud Computing, AWS.

  13. The Effect of Image Compatibility and Escalation of Commitment on Decision Performance

    Directory of Open Access Journals (Sweden)

    Harris K. Turino

    2012-04-01

    Full Text Available This study aims at empirically examining the extent to which Image Theory, initially developed as a theoretical basis for selecting a strategy or a decision, can be a theoretical basis for predicting a decision performance in two opposite frames: positive and negative. Image compatibility are employed to operationalize such a theory and the decision under study is progress decision represented by escalation of commitment. Thus, this study also empirically examines the connection between image compatibility and escalation of commitment as well as escalation of commitment as a mediator of the relationship between image compatibility and decision performance. The research context is Indonesia Stock Exchange (IDX that suffered from crisis in the past year (negative frame yet has been recovered recently (positive frame. The respondents are 229 individual investors in IDX. They are involved in day-to-day decision making (progress decision making with regard to their investment portofolio. The results of this study show that high image compatibility tends to lead to better decision performance in both frames. However, image compatibility may only positively affect the escalation of commitment in positive frame

  14. [Cost assessment for endoscopic procedures in the German diagnosis-related-group (DRG) system - 5 year cost data analysis of the German Society of Gastroenterology project].

    Science.gov (United States)

    Rathmayer, Markus; Heinlein, Wolfgang; Reiß, Claudia; Albert, Jörg G; Akoglu, Bora; Braun, Martin; Brechmann, Thorsten; Gölder, Stefan K; Lankisch, Tim; Messmann, Helmut; Schneider, Arne; Wagner, Martin; Dollhopf, Markus; Gundling, Felix; Röhling, Michael; Haag, Cornelie; Dohle, Ines; Werner, Sven; Lammert, Frank; Fleßa, Steffen; Wilke, Michael H; Schepp, Wolfgang; Lerch, Markus M

    2017-10-01

    Background  In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. Methods  To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Results  Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. Discussion  For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Dietary standards for school catering in France: serving moderate quantities to improve dietary quality without increasing the food-related cost of meals.

    Science.gov (United States)

    Vieux, Florent; Dubois, Christophe; Allegre, Laëtitia; Mandon, Lionel; Ciantar, Laurent; Darmon, Nicole

    2013-01-01

    To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France. A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals. Food-related cost of meals. Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively. The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes. Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  16. Artificial selection on relative brain size in the guppy reveals costs and benefits of evolving a larger brain.

    Science.gov (United States)

    Kotrschal, Alexander; Rogell, Björn; Bundsen, Andreas; Svensson, Beatrice; Zajitschek, Susanne; Brännström, Ioana; Immler, Simone; Maklakov, Alexei A; Kolm, Niclas

    2013-01-21

    The large variation in brain size that exists in the animal kingdom has been suggested to have evolved through the balance between selective advantages of greater cognitive ability and the prohibitively high energy demands of a larger brain (the "expensive-tissue hypothesis"). Despite over a century of research on the evolution of brain size, empirical support for the trade-off between cognitive ability and energetic costs is based exclusively on correlative evidence, and the theory remains controversial. Here we provide experimental evidence for costs and benefits of increased brain size. We used artificial selection for large and small brain size relative to body size in a live-bearing fish, the guppy (Poecilia reticulata), and found that relative brain size evolved rapidly in response to divergent selection in both sexes. Large-brained females outperformed small-brained females in a numerical learning assay designed to test cognitive ability. Moreover, large-brained lines, especially males, developed smaller guts, as predicted by the expensive-tissue hypothesis, and produced fewer offspring. We propose that the evolution of brain size is mediated by a functional trade-off between increased cognitive ability and reproductive performance and discuss the implications of these findings for vertebrate brain evolution. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Radiobiologically based assessments of the net costs of fractionated radiotherapy

    International Nuclear Information System (INIS)

    Dale, Roger G.; Jones, Bleddyn

    1996-01-01

    Purpose: To examine how the long-term costs of radiation therapy may be influenced by modifications to fractionation schemes, and how any improvements in tumor control might, in principle, be translated into a potential cost saving for the responsible healthcare organization. Methods and Materials: Standard radiobiological modeling based on the linear-quadratic (LQ) model is combined with financial parameters relating to the estimated costs of different aspects of radiotherapy treatment delivery. The cost model includes provision for the long-term costs of treatment failure and enables the extra costs of near optimal radiotherapy to be balanced against suboptimal alternatives, which are more likely to be associated with further radiotherapy, salvage surgery, and continuing care. Results: A number of caveats are essential in presenting a model such as this for the first time, and these are clearly stated. However, a recurring observation is that, in terms of the whole cost of supporting a patient from first radiotherapy treatment onwards, high quality radiotherapy (i.e., based on individual patterns of fractionation that are near optimal for particular subpopulations of tumor) will frequently be associated with the lowest global cost. Conclusions: This work adds weight to the case for identifying fast and accurate predictive assay techniques, and supports the argument that suboptimal radiotherapy is usually more costly in the long term. Although the article looks only at the cost-benefit consequences of altered patterns of fractionation, the method will, in principle, have application to other changes in the way radiotherapy can be performed, e.g., to examining the cost-benefit aspects of tumor dose escalation as a consequence of using advanced conformal treatment planning

  18. {sup 188}Re-HDD/lipiodol therapy for hepatocellular carcinoma: an activity escalation study

    Energy Technology Data Exchange (ETDEWEB)

    Lambert, Bieke; Vos, Filip de; Wiele, Christophe van de [Ghent University Hospital, Nuclear Medicine Division, Gent (Belgium); Bacher, Klaus; Thierens, Hubert [Ghent University, Department of Medical Physics, Gent (Belgium); Defreyne, Luc [Ghent University Hospital, Division of Interventional Radiology, Gent (Belgium); Vlierberghe, Hans van [Ghent University Hospital, Division of Gastroenterology, Gent (Belgium); Jeong, Jae Min [Seoul National University College of Medicine, Department of Nuclear Medicine, Cancer Research Institute, Seoul (Korea); Wang, Rong Fu [Beijing University, Department of Nuclear Medicine, Beijing (China); Meerbeeck, Jan van [Ghent University Hospital, Department of Respiratory Diseases, Gent (Belgium); Smeets, Peter [Ghent University Hospital, Department of Radiology, Gent (Belgium); Troisi, Roberto [Ghent University Hospital, Division of Abdominal Surgery and Liver Transplantation, Gent (Belgium)

    2006-03-15

    The aim of this study was to investigate the feasibility of administering increasing activities of {sup 188}Re-4-hexadecyl-1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol/lipiodol ({sup 188}Re-HDD/lipiodol) for the treatment of hepatocellular carcinoma (HCC) in patients with well-compensated cirrhosis. The activity levels were increased by 1.1 GBq/step after a 6-week interval without unacceptable adverse events in at least five consecutive patients. Absorbed doses to the various organs were calculated according to the MIRD formalism, based on three gamma-scintigraphic studies. Response was assessed by means of MRI and alpha-fetoprotein (AFP) monitoring. Thirty-five treatments were carried out in 28 patients. Activities from 4.8 to 7.0 GBq {sup 188}Re-HDD/lipiodol were administered via a transfemoral catheter. The mean absorbed dose to the liver (including tumour) was 7.6{+-}2.2, 9.8{+-}4.9 and 15.2{+-}4.9 Gy for the 4.8-, 5.9- and 7.0-GBq groups, respectively. Treatment was well tolerated at all activity levels. Further escalation of the administered activity was not feasible owing to limitations related to the radiolabelling procedure. Response assessment on MRI showed partial response, stable disease and disease progression in 1, 28 and 2 assessable treatments, respectively. In 8 of 17 treatment sessions with an initially elevated AFP, a reduction ranging from 19% to 97% was observed 6 weeks later. (orig.)

  19. Topical administration of regorafenib eye drops: phase I dose-escalation study in healthy volunteers.

    Science.gov (United States)

    Zimmermann, Torsten; Höchel, Joachim; Becka, Michael; Boettger, Michael K; Rohde, Beate; Schug, Barbara; Kunert, Kathleen S; Donath, Frank

    2018-05-01

    Regorafenib is a multikinase inhibitor under investigation for use in neovascular age-related macular degeneration. In this phase I study, regorafenib eye drops were administered to healthy volunteers to provide information on safety, tolerability and systemic exposure. This was a single-centre, randomized, double-masked, parallel-group, dose-escalation, placebo-controlled study. Subjects received regorafenib eye drops (30 mg ml -1 , 25 μl) as a 0.75 mg single dose (Cohort 1), 0.75 mg twice daily (bid) or thrice daily (tid) over 14 days (Cohorts 2 and 3, respectively), 1.5 mg tid unilaterally for 3 days, then bilaterally for up to 14 days (Cohort 4), or placebo. Plasma samples were taken to estimate systemic exposure. Safety and functional assessments were performed throughout the study. Thirty-six subjects received regorafenib and 12 received placebo. Regorafenib was safe and well tolerated over the dose range. No pathological changes occurred in the anterior, vitreous or posterior eye compartments. Mild eyelid redness, oedema and conjunctival hyperaemia were observed across all regorafenib cohorts; these were comparable with the effects seen with placebo. Predominant symptoms were blurred vision in the active and placebo groups. Systemic safety evaluations showed no clinically relevant findings. Absolute systemic exposure after multiple administrations of regorafenib eye drops at a dose of 0.75 mg was 600-700-fold lower than after multiple oral administration of 160 mg day -1 , the dose approved in cancer indications. These results indicate a favourable safety and tolerability profile of regorafenib eye drops up to 30 mg ml -1 tid for use in clinical studies. © 2018 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

  20. Phase I Escalating-Dose Trial of CAR-T Therapy Targeting CEA+ Metastatic Colorectal Cancers.

    Science.gov (United States)

    Zhang, Chengcheng; Wang, Zhe; Yang, Zhi; Wang, Meiling; Li, Shiqi; Li, Yunyan; Zhang, Rui; Xiong, Zhouxing; Wei, Zhihao; Shen, Junjie; Luo, Yongli; Zhang, Qianzhen; Liu, Limei; Qin, Hong; Liu, Wei; Wu, Feng; Chen, Wei; Pan, Feng; Zhang, Xianquan; Bie, Ping; Liang, Houjie; Pecher, Gabriele; Qian, Cheng

    2017-05-03

    Chimeric antigen receptor T (CAR-T) cells have shown promising efficacy in treatment of hematological malignancies, but its applications in solid tumors need further exploration. In this study, we investigated CAR-T therapy targeting carcino-embryonic antigen (CEA)-positive colorectal cancer (CRC) patients with metastases to evaluate its safety and efficacy. Five escalating dose levels (DLs) (1 × 10 5 to 1 × 10 8 /CAR + /kg cells) of CAR-T were applied in 10 CRC patients. Our data showed that severe adverse events related to CAR-T therapy were not observed. Of the 10 patients, 7 patients who experienced progressive disease (PD) in previous treatments had stable disease after CAR-T therapy. Two patients remained with stable disease for more than 30 weeks, and two patients showed tumor shrinkage by positron emission tomography (PET)/computed tomography (CT) and MRI analysis, respectively. Decline of serum CEA level was apparent in most patients even in long-term observation. Furthermore, we observed persistence of CAR-T cells in peripheral blood of patients receiving high doses of CAR-T therapy. Importantly, we observed CAR-T cell proliferation especially in patients after a second CAR-T therapy. Taken together, we demonstrated that CEA CAR-T cell therapy was well tolerated in CEA + CRC patients even in high doses, and some efficacy was observed in most of the treated patients. Copyright © 2017 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.

  1. Depression Effects on Hospital Cost of Heart Failure Patients in California: An Analysis by Ethnicity and Gender.

    Science.gov (United States)

    Husaini, Baqar A; Taira, Deborah; Norris, Keith; Adhish, S Vivek; Moonis, Majaz; Levine, Robert

    2018-01-01

    Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost. Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender. Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF +D ) versus HF without depression (HF ND ). HF cases ( n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher ( P diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted.

  2. A Phase I Dose-Escalation Study (ISIDE-BT-1) of Accelerated IMRT With Temozolomide in Patients With Glioblastoma

    International Nuclear Information System (INIS)

    Morganti, Alessio G.; Balducci, Mario; Salvati, Maurizio; Esposito, Vincenzo; Romanelli, Pantaleo; Ferro, Marica; Calista, Franco; Digesu, Cinzia; Macchia, Gabriella; Ianiri, Massimo; Deodato, Francesco; Cilla, Savino; Piermattei, Angelo M.P.; Valentini, Vincenzo; Cellini, Numa; Cantore, Gian Paolo

    2010-01-01

    Purpose: To determine the maximum tolerated dose (MTD) of fractionated intensity-modulated radiotherapy (IMRT) with temozolomide (TMZ) in patients with glioblastoma. Methods and Materials: A Phase I clinical trial was performed. Eligible patients had surgically resected or biopsy-proven glioblastoma. Patients started TMZ (75 mg/day) during IMRT and continued for 1 year (150-200 mg/day, Days 1-5 every 28 days) or until disease progression. Clinical target volume 1 (CTV1) was the tumor bed ± enhancing lesion with a 10-mm margin; CTV2 was the area of perifocal edema with a 20-mm margin. Planning target volume 1 (PTV1) and PTV2 were defined as the corresponding CTV plus a 5-mm margin. IMRT was delivered in 25 fractions over 5 weeks. Only the dose for PTV1 was escalated (planned dose escalation: 60 Gy, 62.5 Gy, 65 Gy) while maintaining the dose for PTV2 (45 Gy, 1.8 Gy/fraction). Dose limiting toxicities (DLT) were defined as any treatment-related nonhematological adverse effects rated as Grade ≥3 or any hematological toxicity rated as ≥4 by Radiation Therapy Oncology Group (RTOG) criteria. Results: Nineteen consecutive glioblastoma were treated with step-and-shoot IMRT, planned with the inverse approach (dose to the PTV1: 7 patients, 60 Gy; 6 patients, 62.5 Gy; 6 patients, 65 Gy). Five coplanar beams were used to cover at least 95% of the target volume with the 95% isodose line. Median follow-up time was 23 months (range, 8-40 months). No patient experienced DLT. Grade 1-2 treatment-related neurologic and skin toxicity were common (11 and 19 patients, respectively). No Grade >2 late neurologic toxicities were noted. Conclusion: Accelerated IMRT to a dose of 65 Gy in 25 fractions is well tolerated with TMZ at a daily dose of 75 mg.

  3. Phase 1 Study of Dose Escalation in Hypofractionated Proton Beam Therapy for Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Swanick, Cameron; Alvarado, Tina; Komaki, Ritsuko; Cox, James D.; Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-15

    Background: Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. Methods and Materials: Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. Results: The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. Conclusion: Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.

  4. Quantifying the demographic cost of human-related mortality to a raptor population

    Science.gov (United States)

    Hunt, W. Grainger; Wiens, David; Law, Peter R.; Fuller, Mark R.; Hunt, Teresa L.; Driscoll, Daniel E.; Jackman, Ronald E.

    2017-01-01

    Raptors are exposed to a wide variety of human-related mortality agents, and yet population-level effects are rarely quantified. Doing so requires modeling vital rates in the context of species life-history, behavior, and population dynamics theory. In this paper, we explore the details of such an analysis by focusing on the demography of a resident, tree-nesting population of golden eagles (Aquila chrysaetos) in the vicinity of an extensive (142 km2) windfarm in California. During 1994–2000, we tracked the fates of >250 radio-marked individuals of four life-stages and conducted five annual surveys of territory occupancy and reproduction. Collisions with wind turbines accounted for 41% of 88 uncensored fatalities, most of which were subadults and nonbreeding adults (floaters). A consistent overall male preponderance in the population meant that females were the limiting sex in this territorial, monogamous species. Estimates of potential population growth rate and associated variance indicated a stable breeding population, but one for which any further decrease in vital rates would require immigrant floaters to fill territory vacancies. Occupancy surveys 5 and 13 years later (2005 and 2013) showed that the nesting population remained intact, and no upward trend was apparent in the proportion of subadult eagles as pair members, a condition that would have suggested a deficit of adult replacements. However, the number of golden eagle pairs required to support windfarm mortality was large. We estimated that the entire annual reproductive output of 216–255 breeding pairs would have been necessary to support published estimates of 55–65 turbine blade-strike fatalities per year. Although the vital rates forming the basis for these calculations may have changed since the data were collected, our approach should be useful for gaining a clearer understanding of how anthropogenic mortality affects the health of raptor populations, particularly those species with delayed

  5. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    Science.gov (United States)

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

  6. Historical construction costs of global nuclear power reactors

    International Nuclear Information System (INIS)

    Lovering, Jessica R.; Yip, Arthur; Nordhaus, Ted

    2016-01-01

    The existing literature on the construction costs of nuclear power reactors has focused almost exclusively on trends in construction costs in only two countries, the United States and France, and during two decades, the 1970s and 1980s. These analyses, Koomey and Hultman (2007); Grubler (2010), and Escobar-Rangel and Lévêque (2015), study only 26% of reactors built globally between 1960 and 2010, providing an incomplete picture of the economic evolution of nuclear power construction. This study curates historical reactor-specific overnight construction cost (OCC) data that broaden the scope of study substantially, covering the full cost history for 349 reactors in the US, France, Canada, West Germany, Japan, India, and South Korea, encompassing 58% of all reactors built globally. We find that trends in costs have varied significantly in magnitude and in structure by era, country, and experience. In contrast to the rapid cost escalation that characterized nuclear construction in the United States, we find evidence of much milder cost escalation in many countries, including absolute cost declines in some countries and specific eras. Our new findings suggest that there is no inherent cost escalation trend associated with nuclear technology. - Highlights: •Comprehensive analysis of nuclear power construction cost experience. •Coverage for early and recent reactors in seven countries. •International comparisons and re-evaluation of learning. •Cost trends vary by country and era; some experience cost stability or decline.

  7. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

  8. An analysis of nuclear power plant operating costs

    International Nuclear Information System (INIS)

    1988-01-01

    This report presents the results of a statistical analysis of nonfuel operating costs for nuclear power plants. Most studies of the economic costs of nuclear power have focused on the rapid escalation in the cost of constructing a nuclear power plant. The present analysis found that there has also been substantial escalation in real (inflation-adjusted) nonfuel operating costs. It is important to determine the factors contributing to the escalation in operating costs, not only to understand what has occurred but also to gain insights about future trends in operating costs. There are two types of nonfuel operating costs. The first is routine operating and maintenance expenditures (O and M costs), and the second is large postoperational capital expenditures, or what is typically called ''capital additions.'' O and M costs consist mainly of expenditures on labor, and according to one recently completed study, the majoriy of employees at a nuclear power plant perform maintenance activities. It is generally thought that capital additions costs consist of large maintenance expenditures needed to keep the plants operational, and to make plant modifications (backfits) required by the Nuclear Regulatory Commission (NRC). Many discussions of nuclear power plant operating costs have not considered these capital additions costs, and a major finding of the present study is that these costs are substantial. The objective of this study was to determine why nonfuel operating costs have increased over the past decade. The statistical analysis examined a number of factors that have influenced the escalation in real nonfuel operating costs and these are discussed in this report. 4 figs, 19 tabs

  9. Improving Escalation of Care: Development and Validation of the Quality of Information Transfer Tool.

    Science.gov (United States)

    Johnston, Maximilian J; Arora, Sonal; Pucher, Philip H; Reissis, Yannis; Hull, Louise; Huddy, Jeremy R; King, Dominic; Darzi, Ara

    2016-03-01

    To develop and provide validity and feasibility evidence for the QUality of Information Transfer (QUIT) tool. Prompt escalation of care in the setting of patient deterioration can prevent further harm. Escalation and information transfer skills are not currently measured in surgery. This study comprised 3 phases: the development (phase 1), validation (phase 2), and feasibility analysis (phase 3) of the QUIT tool. Phase 1 involved identification of core skills needed for successful escalation of care through literature review and 33 semistructured interviews with stakeholders. Phase 2 involved the generation of validity evidence for the tool using a simulated setting. Thirty surgeons assessed a deteriorating postoperative patient in a simulated ward and escalated their care to a senior colleague. The face and content validity were assessed using a survey. Construct and concurrent validity of the tool were determined by comparing performance scores using the QUIT tool with those measured using the Situation-Background-Assessment-Recommendation (SBAR) tool. Phase 3 was conducted using direct observation of escalation scenarios on surgical wards in 2 hospitals. A 7-category assessment tool was developed from phase 1 consisting of 24 items. Twenty-one of 24 items had excellent content validity (content validity index >0.8). All 7 categories and 18 of 24 (P validity. The correlation between the QUIT and SBAR tools used was strong indicating concurrent validity (r = 0.694, P information transfer skills than nurses when faced with a deteriorating patient. A validated tool to assess information transfer for deteriorating surgical patients was developed and tested using simulation and real-time clinical scenarios. It may improve the quality and safety of patient care on the surgical ward.

  10. Army Pacific Pathways: Comprehensive Assessment and Planning Needed to Capture Benefits Relative to Costs and Enhance Value for Participating Units

    Science.gov (United States)

    2016-11-01

    examines the extent to which the Army has (1) assessed the costs and benefits of Pacific Pathways; and (2) synchronized plans and incorporated ... costs . Such an analysis could both: • incorporate financial and non-financial costs and benefits of the initiative, to include readiness benefits for... logistics and sustainment units, any training efficiencies or cost avoidance resulting from Pacific Pathways, and non-financial costs , such as

  11. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

    Science.gov (United States)

    Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

    2010-04-01

    Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

  12. Perineural Invasion Predicts Increased Recurrence, Metastasis, and Death From Prostate Cancer Following Treatment With Dose-Escalated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Felix Y. [University of Michigan Medical Center, Ann Arbor, MI (United States); Ann Arbor Veteran Affairs Medical System, Ann Arbor, MI (United States); Qian Yushen; Stenmark, Matthew H.; Halverson, Schuyler; Blas, Kevin; Vance, Sean [University of Michigan Medical Center, Ann Arbor, MI (United States); Sandler, Howard M. [Cedars Sinai Medical System, Los Angeles, CA (United States); Hamstra, Daniel A., E-mail: dhamm@med.umich.edu [University of Michigan Medical Center, Ann Arbor, MI (United States)

    2011-11-15

    Purpose: To assess the prognostic value of perineural invasion (PNI) for patients treated with dose-escalated external-beam radiation therapy for prostate cancer. Methods and Materials: Outcomes were analyzed for 651 men treated for prostate cancer with EBRT to a minimum dose {>=}75 Gy. We assessed the impact of PNI as well as pretreatment and treatment-related factors on freedom from biochemical failure (FFBF), freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival. Results: PNI was present in 34% of specimens at biopsy and was significantly associated with higher Gleason score (GS), T stage, and prostate-specific antigen level. On univariate and multivariate analysis, the presence of PNI was associated with worse FFBF (hazard ratio = 1.7, p <0.006), FFM (hazard ratio = 1.8, p <0.03), and CSS (HR = 1.4, p <0.05) compared with absence of PNI; there was no difference in overall survival. Seven-year rates of FFBF, FFM, and CCS were 64% vs. 80%, 84% vs. 92%, and 91% vs. 95% for those patients with and without PNI, respectively. On recursive partitioning analysis, PNI predicted for worse FFM and CSS in patients with GS 8-10, with FFM of 67% vs. 89% (p <0.02), and CSS of 69% vs. 91%, (p <0.04) at 7 years for those with and without PNI, respectively. Conclusions: The presence of PNI in the prostate biopsy predicts worse clinical outcome for patients treated with dose-escalated external-beam radiation therapy. Particularly in patients with GS 8-10 disease, the presence of PNI suggests an increased risk of metastasis and prostate cancer death.

  13. Perineural Invasion Predicts Increased Recurrence, Metastasis, and Death From Prostate Cancer Following Treatment With Dose-Escalated Radiation Therapy

    International Nuclear Information System (INIS)

    Feng, Felix Y.; Qian Yushen; Stenmark, Matthew H.; Halverson, Schuyler; Blas, Kevin; Vance, Sean; Sandler, Howard M.; Hamstra, Daniel A.

    2011-01-01

    Purpose: To assess the prognostic value of perineural invasion (PNI) for patients treated with dose-escalated external-beam radiation therapy for prostate cancer. Methods and Materials: Outcomes were analyzed for 651 men treated for prostate cancer with EBRT to a minimum dose ≥75 Gy. We assessed the impact of PNI as well as pretreatment and treatment-related factors on freedom from biochemical failure (FFBF), freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival. Results: PNI was present in 34% of specimens at biopsy and was significantly associated with higher Gleason score (GS), T stage, and prostate-specific antigen level. On univariate and multivariate analysis, the presence of PNI was associated with worse FFBF (hazard ratio = 1.7, p <0.006), FFM (hazard ratio = 1.8, p <0.03), and CSS (HR = 1.4, p <0.05) compared with absence of PNI; there was no difference in overall survival. Seven-year rates of FFBF, FFM, and CCS were 64% vs. 80%, 84% vs. 92%, and 91% vs. 95% for those patients with and without PNI, respectively. On recursive partitioning analysis, PNI predicted for worse FFM and CSS in patients with GS 8–10, with FFM of 67% vs. 89% (p <0.02), and CSS of 69% vs. 91%, (p <0.04) at 7 years for those with and without PNI, respectively. Conclusions: The presence of PNI in the prostate biopsy predicts worse clinical outcome for patients treated with dose-escalated external-beam radiation therapy. Particularly in patients with GS 8–10 disease, the presence of PNI suggests an increased risk of metastasis and prostate cancer death.

  14. Activity-based costing evaluation of [18F]-fludeoxyglucose production.

    Science.gov (United States)

    Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Vander Borght, Thierry

    2008-01-01

    As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [(18)F]-fludeoxyglucose ((18)F-FDG) studies is mainly influenced by the price of the radiopharmaceutical, which may vary throughout Europe from 300 to 500 Euro per patient dose (370 MBq). The aim of the current study is to conduct an activity-based costing (ABC) estimation of (18)F-FDG production in Europe to better identify the different cost components and to analyse their relative contribution to the total cost. Financial data were collected on capital expense and global operating costs through interviews with industry experts, PET centre managers, evaluation of prior studies, and review of expenses incurred at the University Medical Centre in Groningen (The Netherlands). After mapping the activities, we divided the cost in five categories: wage, equipment, consumables, overhead and space costs. A sensitivity analysis was performed for key cost components, including the compliance with regulatory requirements. The critical factor for profitability was throughput. Including the European regulation procedure, the cost for 370 MBq (18)F-FDG patient dose, 3 h EOS without delivery cost, ranges between 155 and 177 Euro/dose for two production runs and between 210 and 237 Euro/dose for one production run. These costs are predominantly determined by personnel and equipment costs, although the cost for quality assurance increases steadily. The ABC analysis provides significant insight into the production cost components of (18)F-FDG through different operating configurations. Reductions in equipment prices, increased availability of radiopharmaceuticals, growth in demand, and improvements in reimbursement will all contribute to the financial viability of this imaging technique.

  15. Activity-based costing evaluation of [18F]-fludeoxyglucose production

    International Nuclear Information System (INIS)

    Krug, Bruno; Pirson, Anne-Sophie; Borght, Thierry vander; Zanten, Annie van; Crott, Ralph

    2008-01-01

    As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [ 18 F]-fludeoxyglucose ( 18 F-FDG) studies is mainly influenced by the price of the radiopharmaceutical, which may vary throughout Europe from 300 to 500 Euro per patient dose (370 MBq). The aim of the current study is to conduct an activity-based costing (ABC) estimation of 18 F-FDG production in Europe to better identify the different cost components and to analyse their relative contribution to the total cost. Financial data were collected on capital expense and global operating costs through interviews with industry experts, PET centre managers, evaluation of prior studies, and review of expenses incurred at the University Medical Centre in Groningen (The Netherlands). After mapping the activities, we divided the cost in five categories: wage, equipment, consumables, overhead and space costs. A sensitivity analysis was performed for key cost components, including the compliance with regulatory requirements. The critical factor for profitability was throughput. Including the European regulation procedure, the cost for 370 MBq 18 F-FDG patient dose, 3 h EOS without delivery cost, ranges between 155 and 177 Euro/dose for two production runs and between 210 and 237 Euro/dose for one production run. These costs are predominantly determined by personnel and equipment costs, although the cost for quality assurance increases steadily. The ABC analysis provides significant insight into the production cost components of 18 F-FDG through different operating configurations. Reductions in equipment prices, increased availability of radiopharmaceuticals, growth in demand, and improvements in reimbursement will all contribute to the financial viability of this imaging technique. (orig.)

  16. Two experiments focusing on de-escalation oriented coverage of post-war conflicts

    Directory of Open Access Journals (Sweden)

    Wilhelm Kempf

    2005-10-01

    Full Text Available War coverage has a strong bias towards the promotion of conflict escalation and - though less pronounced - this bias often survives in post-war coverage as well. Even after the end of war, only a minority of journalists frame conflict in a firmly de-escalation oriented way. Do they have a chance to reach the public? Will their reports be respected by the audience as more balanced and unbiased? Will they have an impact on the audience's mental models of the conflict? Or will the audience continue to cling to its prejudices and reject news articles which do not affirm the enemy images that emerged during wartime? The present paper investigates these questions by means of two experimental studies. In the first experiment, news articles on three events in former Yugoslavia after the fall of Milosevic were presented to a total of n = 128 subjects, representative of the readership of the German quality press: (1 violent conflicts in Southern Serbia (December 2000, (2 the extradition of Milosevic to The Hague (June, 2001 and (3 the treaty between Serbia and Montenegro (March 2003. For each of the events, four different types of articles were used: moderately escalation oriented articles from prestigious German newspapers (Die Welt, Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung and three variants of these articles, (a with increased escalation-oriented framing, (b with moderate de-escalation oriented framing and (c with more strongly de-escalation oriented framing of the events. Each subject was asked to read one article on each of the three events in chronological order and after each article (a to narrate the reported events in their own words and (b to fill out a questionnaire designed to measure the acceptance of the articles as unbiased, well-balanced, interesting, etc. The subjects' mental models of the reported events were inferred from their narratives by means of quantitative content analysis. The second experiment measured the

  17. Competitiveness of Colombian Cotton in Relation to the Main Producing Countries Through the Focus of Production Costs

    Directory of Open Access Journals (Sweden)

    Antonio M. Martínez Reina

    2015-07-01

    Full Text Available This paper studies the competitiveness of cotton production in Colombia through a comparative analysis of the patterns of production costs in the producing regions of Colombia in relation to the main producers of cotton fiber. The basic information for this study is based on statistics taken mostly from Conalgodón, producer organizations and the textile industry. Economic statistics and estimates measurement techniques by the method of ordinary least squares (OLS were used, especially for estimating the functions of supply and demand. For the analysis of competitiveness, the unit production cost of Colombia was compared against other countries producing cotton fiber. The results show, on the one hand, that the production of short fiber in Colombia is likely to increase and to dedicate more areas to such type of crops given the growing trend of demand from the industry, which exceeds right now the spinning rings or long-fiber; and on the other hand, the results show that under the current conditions the country is not producing cotton in a competitive way and therefore the component of imported cotton is growing over time.

  18. Midwives' experiences of performing maternal observations and escalating concerns: a focus group study.

    Science.gov (United States)

    Jeffery, Justine; Hewison, Alistair; Goodwin, Laura; Kenyon, Sara

    2017-09-02

    For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations. The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations. Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation). A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the

  19. The conceptual design and development of Novel low cost sensors for measuring the relative light emission in the pre-millisecond stages detonating explosive charges

    CSIR Research Space (South Africa)

    Olivier, M

    2012-12-01

    Full Text Available Thesis December 2012/ Stellenbosch University The conceptual design and development of Novel low cost sensors for measuring the relative light emission in the pre-millisecond stages detonating explosive charges Olivier M CSIR. Defence, Peace...

  20. Statistical model for forecasting uranium prices to estimate the nuclear fuel cycle cost

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Ki; Ko, Won Il; Nam, Hyoon [Nuclear Fuel Cycle Analysis, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Chul Min; Chung, Yang Hon; Bang, Sung Sig [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

    2017-08-15

    This paper presents a method for forecasting future uranium prices that is used as input data to calculate the uranium cost, which is a rational key cost driver of the nuclear fuel cycle cost. In other words, the statistical autoregressive integrated moving average (ARIMA) model and existing engineering cost estimation method, the so-called escalation rate model, were subjected to a comparative analysis. When the uranium price was forecasted in 2015, the margin of error of the ARIMA model forecasting was calculated and found to be 5.4%, whereas the escalation rate model was found to have a margin of error of 7.32%. Thus, it was verified that the ARIMA model is more suitable than the escalation rate model at decreasing uncertainty in nuclear fuel cycle cost calculation.

  1. Statistical model for forecasting uranium prices to estimate the nuclear fuel cycle cost

    International Nuclear Information System (INIS)

    Kim, Sung Ki; Ko, Won Il; Nam, Hyoon; Kim, Chul Min; Chung, Yang Hon; Bang, Sung Sig

    2017-01-01

    This paper presents a method for forecasting future uranium prices that is used as input data to calculate the uranium cost, which is a rational key cost driver of the nuclear fuel cycle cost. In other words, the statistical autoregressive integrated moving average (ARIMA) model and existing engineering cost estimation method, the so-called escalation rate model, were subjected to a comparative analysis. When the uranium price was forecasted in 2015, the margin of error of the ARIMA model forecasting was calculated and found to be 5.4%, whereas the escalation rate model was found to have a margin of error of 7.32%. Thus, it was verified that the ARIMA model is more suitable than the escalation rate model at decreasing uncertainty in nuclear fuel cycle cost calculation

  2. A MultiFactorial Risk Score to weigh toxicities and co-morbidities relative to costs of antiretrovirals in a cohort of HIV-infected patients

    OpenAIRE

    M Tontodonati; F Sozio; F Vadini; E Polilli; T Ursini; G Calella; P Di Stefano; E Mazzotta; A Costantini; C D'Amario; G Parruti

    2012-01-01

    Purpose of the study: Considering costs of antiretrovirals (ARVs) for HIV patients is increasingly needed. A simple and comprehensive tool weighing comorbidities and ARV-related toxicities could be useful to judge the appropriateness of use of more expensive drugs. We conceived a MultiFactorial Risk Score (MFRS) to evaluate the appropriateness of ARVs prescription relative to their costs. Methods: HIV patients were consecutively enrolled in 2010-2011. We considered socio-demographic character...

  3. Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS: literature review and case series report

    Directory of Open Access Journals (Sweden)

    Langan Julie

    2012-11-01

    Full Text Available Abstract Background “Neuroleptic malignant syndrome” (NMS is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined. Description We aimed to identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7 mg/day during days 1–15 to 346.9 mg/day during days 16–30 and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators. Conclusions Rapid dose escalation occurred in less than half of this case series (n = 5, 38.5%, although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS.

  4. Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia - a pilot evaluation.

    Science.gov (United States)

    Lenoir-Wijnkoop, Irene; van der Beek, Eline M; Garssen, Johan; Nuijten, Mark J C; Uauy, Ricardo D

    2015-01-01

    Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life. Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences. Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country

  5. Teacher Costs

    OpenAIRE

    DINIS MOTA DA COSTA PATRICIA; DE SOUSA LOBO BORGES DE ARAUJO LUISA

    2015-01-01

    The purpose of this technical brief is to assess current methodologies for the collection and calculation of teacher costs in European Union (EU) Member States in view of improving data series and indicators related to teacher salaries and teacher costs. To this end, CRELL compares the Eurydice collection on teacher salaries with the similar Organisation for Economic Co-operation and Development (OECD) data collection and calculates teacher costs based on the methodology established by Statis...

  6. Sport-related concussions in New Zealand: a review of 10 years of Accident Compensation Corporation moderate to severe claims and costs.

    Science.gov (United States)

    King, Doug; Gissane, Conor; Brughelli, Matt; Hume, Patria A; Harawira, Joseph

    2014-05-01

    This paper provides an overview of the epidemiology of sport-related concussion and associated costs in New Zealand requiring medical treatment from 2001 to 2011 in seven sports codes. A retrospective review of injury entitlement claims by seven sports from 2001 to 2011. Data were analyzed by sporting code, age, ethnicity, gender and year of competition for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs. A total of 20,902 claims costing $NZD 16,546,026 were recorded over the study period of which 1330 (6.4%) were MSC claims. The mean yearly number and costs of MSC claims were 133 ± 36 and $1,303,942 ± 378,949. Rugby union had the highest number of MSC claims per year (38; 95% CI 36-41 per 1000 MSC claims). New Zealand Māori recorded the highest total ($6,000,759) and mean cost ($21,120) per MSC claim. Although MSC injury claims were only 6.4% of total claims, they accounted for 79.1% of total costs indicating that although the majority of sport-related concussions may be minor in severity, the related economic costs associated with more serious sport-related concussion can be high. The finding that rugby union recorded the most MSC claims in the current study was not unexpected. Of concern is that rugby league recorded a low number of MSC claims but the highest mean cost per claim. Due to the high mean cost per concussion, and the high total and mean cost for New Zealand Māori, further investigation is warranted. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  7. Preventing and De-Escalating Ethical Conflict: A Communication-Training Mediation Model.

    Science.gov (United States)

    Levin, Tomer T; Parker, Patricia A

    2015-01-01

    While ethical conflicts in the provision of healthcare are common, the current third-party mediator model is limited by a lack of expert ethical mediators, who are often not on site when conflict escalates. In order to improve clinical outcomes in situations such as conflicts at the end of life, we suggest that clinicians-physicians, nurses and social workers-be trained to prevent and de-escalate emerging conflicts. This can be achieved using a mediation model framed by a communication-training approach. A case example is presented and the model is discussed. The implication of this preventative/early intervention model for improving clinical outcomes, in particular end-of life conflict, is considered. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  8. Going Up? Canada's metropolitan areas and their role as escalators or elevators

    Directory of Open Access Journals (Sweden)

    Bruce Newbold

    2015-10-01

    Full Text Available Canada’s major metropolitan areas offer multiple opportunities for economic and social advancement for in-migrants. As such, young adults may be attracted to these locations. In-migrants to Toronto have been observed to receive a substantial income benefit associated with migration into Toronto that is consistent with a productivity effect. This income effect is greater than the income benefit received by migrants elsewhere in the system or those who did not migrate. However, migration into Toronto did not lead to an acceleration in income gains consistent with the more rapid career progression expected to result from the migration into an escalator region.Consequently, this paper explores the income benefits for young adult migrants by considering the role of other major metropolitan areas within Canada, and whether they function similar to Toronto as escalators, or serve other roles that are unique to employment sector and type.

  9. The impact of relative energy prices on industrial energy consumption in China: a consideration of inflation costs.

    Science.gov (United States)

    He, Lingyun; Ding, Zhihua; Yin, Fang; Wu, Meng

    2016-01-01

    Significant effort has been exerted on the study of economic variables such as absolute energy prices to understand energy consumption and economic growth. However, this approach ignores general inflation effects, whereby the prices of baskets of goods may rise or fall at different rates from those of energy prices. Thus, it may be the relative energy price, not the absolute energy price, that has most important effects on energy consumption. To test this hypothesis, we introduce a new explanatory variable, the domestic relative energy price, which we define as "the ratio of domestic energy prices to the general price level of an economy," and we test the explanatory power of this new variable. Thus, this paper explores the relationship between relative energy prices and energy consumption in China from the perspective of inflation costs over the period from 1988 to 2012. The direct, regulatory and time-varying effects are captured using methods such as ridge regression and the state-space model. The direct impacts of relative energy prices on total energy consumption and intensity are -0.337 and -0.250, respectively; the effects of comprehensive regulation on energy consumption through the economic structure and the energy structure are -0.144 and -0.148, respectively; and the depressing and upward effects of rising and falling energy prices on energy consumption are 0.3520 and 0.3564, respectively. When economic growth and the energy price level were stable, inflation persisted; thus, rising energy prices benefitted both the economy and the environment. Our analysis is important for policy makers to establish effective energy-pricing policies that ensure both energy conservation and the stability of the pricing system.

  10. Does increasing community and liquor licensees' awareness, police activity, and feedback reduce alcohol-related violent crime? A benefit-cost analysis.

    Science.gov (United States)

    Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M; Petrie, Dennis J

    2013-10-28

    Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees' awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.

  11. Does Increasing Community and Liquor Licensees’ Awareness, Police Activity, and Feedback Reduce Alcohol-Related Violent Crime? A Benefit-Cost Analysis

    Science.gov (United States)

    Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M.; Petrie, Dennis J.

    2013-01-01

    Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions. PMID:24169411

  12. Does Increasing Community and Liquor Licensees’ Awareness, Police Activity, and Feedback Reduce Alcohol-Related Violent Crime? A Benefit-Cost Analysis

    Directory of Open Access Journals (Sweden)

    Dennis J. Petrie

    2013-10-01

    Full Text Available Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.

  13. The Effect of Image Compatibility and Escalation of Commitment on Decision Performance

    OpenAIRE

    Harris K. Turino; Budi W. Soetjipto

    2012-01-01

    This study aims at empirically examining the extent to which Image Theory, initially developed as a theoretical basis for selecting a strategy or a decision, can be a theoretical basis for predicting a decision performance in two opposite frames: positive and negative. Image compatibility are employed to operationalize such a theory and the decision under study is progress decision represented by escalation of commitment. Thus, this study also empirically examines the connection between imag...

  14. Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation. A planning study

    International Nuclear Information System (INIS)

    Botticella, A.; Defraene, G.; Nackaerts, K.; Deroose, C.; Coolen, J.; Nafteux, P.; Vanstraelen, B.; Joosten, S.; Michiels, L.A.W.; Peeters, S.; Ruysscher, D. de

    2017-01-01

    After lung-sparing radiotherapy for malignant pleural mesothelioma (MPM), local failure at sites of previous gross disease represents the dominant form of failure. Our aim is to investigate if selective irradiation of the gross pleural disease only can allow dose escalation. In all, 12 consecutive stage I-IV MPM patients (6 left-sided and 6 right-sided) were retrospectively identified and included. A magnetic resonance imaging-based pleural gross tumor volume (GTV) was contoured. Two sets of planning target volumes (PTV) were generated for each patient: (1) a ''selective'' PTV (S-PTV), originating from a 5-mm isotropic expansion from the GTV and (2) an ''elective'' PTV (E-PTV), originating from a 5-mm isotropic expansion from the whole ipsilateral pleural space. Two sets of volumetric modulated arc therapy (VMAT) treatment plans were generated: a ''selective'' pleural irradiation plan (SPI plan) and an ''elective'' pleural irradiation plan (EPI plan, planned with a simultaneous integrated boost technique [SIB]). In the SPI plans, the average median dose to the S-PTV was 53.6 Gy (range 41-63.6 Gy). In 4 of 12 patients, it was possible to escalate the dose to the S-PTV to >58 Gy. In the EPI plans, the average median doses to the E-PTV and to the S-PTV were 48.6 Gy (range 38.5-58.7) and 49 Gy (range 38.6-59.5 Gy), respectively. No significant dose escalation was achievable. The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM. (orig.) [de

  15. Rehabilitation costs

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Arthur S [BDM Corp., VA (United States); [Bikini Atoll Rehabilitation Committee, Berkeley, CA (United States)

    1986-07-01

    The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates.

  16. Rehabilitation costs

    International Nuclear Information System (INIS)

    Kubo, Arthur S.

    1986-01-01

    The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates

  17. First-in-Man Dose-Escalation Study of the Selective BRAF Inhibitor RG7256 in Patients with BRAF V600-Mutated Advanced Solid Tumors

    DEFF Research Database (Denmark)

    Dienstmann, Rodrigo; Lassen, Ulrik; Cebon, Jonathan

    2016-01-01

    V600-mutated advanced solid tumors. PATIENTS AND METHODS: Patients received RG7256 orally over 8 dose levels from 200 mg once a day (QD) to 2400 mg twice a day (BID) (50-, 100- and 150-mg tablets) using a classic 3 + 3 dose escalation design. RESULTS: In total, 45 patients were enrolled; most (87...... %) had advanced melanoma (94 % BRAF V600E). RG7256 was rapidly absorbed, with limited accumulation and dose-proportional increase in exposure up to 1950 mg BID. The maximal tolerated dose (MTD) was not reached. The most common drug-related adverse events (AEs) were dyspepsia (20 %), dry skin (18 %), rash...

  18. The iMTA Productivity Cost Questionnaire: A Standardized Instrument for Measuring and Valuing Health-Related Productivity Losses.

    Science.gov (United States)

    Bouwmans, Clazien; Krol, Marieke; Severens, Hans; Koopmanschap, Marc; Brouwer, Werner; Hakkaart-van Roijen, Leona

    2015-09-01

    Productivity losses often contribute significantly to the total costs in economic evaluations adopting a societal perspective. Currently, no consensus exists on the measurement and valuation of productivity losses. We aimed to develop a standardized instrument for measuring and valuing productivity losses. A group of researchers with extensive experience in measuring and valuing productivity losses designed an instrument suitable for self-completion, building on preknowledge and evidence on validity. The instrument was designed to cover all domains of productivity losses, thus allowing quantification and valuation of all productivity losses. A feasibility study was performed to check the questionnaire's consistency and intelligibility. The iMTA Productivity Cost Questionnaire (iPCQ) includes three modules measuring productivity losses of paid work due to 1) absenteeism and 2) presenteeism and productivity losses related to 3) unpaid work. Questions for measuring absenteeism and presenteeism were derived from existing validated questionnaires. Because validated measures of losses of unpaid work are scarce, the questions of this module were newly developed. To enhance the instrument's feasibility, simple language was used. The feasibility study included 195 respondents (response rate 80%) older than 18 years. Seven percent (n = 13) identified problems while filling in the iPCQ, including problems with the questionnaire's instructions and routing (n = 6) and wording (n = 2). Five respondents experienced difficulties in estimating the time that would be needed for other people to make up for lost unpaid work. Most modules of the iPCQ are based on validated questions derived from previously available instruments. The instrument is understandable for most of the general public. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. Strategy Escalation: An emerging paradigm for safe clinical development of T cell gene therapies

    Directory of Open Access Journals (Sweden)

    Junghans Richard

    2010-06-01

    Full Text Available Abstract Gene therapy techniques are being applied to modify T cells with chimeric antigen receptors (CARs for therapeutic ends. The versatility of this platform has spawned multiple options for their application with new permutations in strategies continually being invented, a testimony to the creative energies of many investigators. The field is rapidly expanding with immense potential for impact against diverse cancers. But this rapid expansion, like the Big Bang, comes with a somewhat chaotic evolution of its therapeutic universe that can also be dangerous, as seen by recently publicized deaths. Time-honored methods for new drug testing embodied in Dose Escalation that were suitable for traditional inert agents are now inadequate for these novel "living drugs". In the following, I propose an approach to escalating risk for patient exposures with these new immuno-gene therapy agents, termed Strategy Escalation, that accounts for the molecular and biological features of the modified cells and the methods of their administration. This proposal is offered not as a prescriptive but as a discussion framework that investigators may wish to consider in configuring their intended clinical applications.

  20. Ion Elevators and Escalators in Multilevel Structures for Lossless Ion Manipulations.

    Science.gov (United States)

    Ibrahim, Yehia M; Hamid, Ahmed M; Cox, Jonathan T; Garimella, Sandilya V B; Smith, Richard D

    2017-02-07

    We describe two approaches based upon ion "elevator" and "escalator" components that allow moving ions to different levels in structures for lossless ion manipulations (SLIM). Guided by ion motion simulations, we designed elevator and escalator components based upon ion current measurements providing essentially lossless transmission in multilevel designs. The ion elevator design allowed ions to efficiently bridge a 4 mm gap between levels. The component was integrated in a SLIM and coupled to a QTOF mass spectrometer using an ion funnel interface to evaluate the m/z range transmitted as compared to transmission within a level (e.g., in a linear section). The analysis of singly charged ions of m/z 600-2700 produced similar mass spectra for both elevator and straight (linear motion) components. In the ion escalator design, traveling waves (TW) were utilized to transport ions efficiently between two SLIM levels. Ion current measurements and ion mobility (IM) spectrometry analysis illustrated that ions can be transported between TW-SLIM levels with no significant loss of either ions or IM resolution. These developments provide a path for the development of multilevel designs providing, e.g., much longer IM path lengths, more compact designs, and the implementation of much more complex SLIM devices in which, e.g., different levels may operate at different temperatures or with different gases.

  1. Escalation to High Dose Defibrotide in Patients with Hepatic Veno-Occlusive Disease

    Science.gov (United States)

    Triplett, Brandon M.; Kuttab, Hani I.; Kang, Guolian; Leung, Wing

    2015-01-01

    Hepatic veno-occlusive disease (VOD) is a serious complication of high-dose chemotherapy regimens, such as those utilized in hematopoietic cell transplantation recipients. Defibrotide is considered a safe and effective treatment when dosed at 25 mg/kg/day. However, patients who develop VOD still have increased mortality despite the use of defibrotide. Data are limited on the use of doses above 60 mg/kg/day for persistent VOD. In this prospective clinical trial, 34 patients received escalating doses of defibrotide. For patients with persistent VOD despite doses of 60 mg/kg/day, doses were increased to a maximum of 110 mg/kg/day. There was no observed increase in toxicity until doses rose beyond 100 mg/kg/day. Patients receiving doses between 10–100 mg/kg/day experienced an average of 3 bleeding episodes per 100 days of treatment, while those receiving doses >100 mg/kg/day experienced 13.2 bleeding episodes per 100 days (p=0.008). Moreover, dose reductions due to toxicity were needed at doses of 110 mg/kg/day more often than at lower doses. Defibrotide may be safely escalated to doses well above the current standard without an increase in bleeding risk. However, the efficacy of this dose escalation strategy remains unclear, as outcomes were similar to published cohorts of patients receiving standard doses of defibrotide for VOD. PMID:26278046

  2. Escalation to High-Dose Defibrotide in Patients with Hepatic Veno-Occlusive Disease.

    Science.gov (United States)

    Triplett, Brandon M; Kuttab, Hani I; Kang, Guolian; Leung, Wing

    2015-12-01

    Hepatic veno-occlusive disease (VOD) is a serious complication of high-dose chemotherapy regimens, such as those used in hematopoietic cell transplantation recipients. Defibrotide is considered a safe and effective treatment when dosed at 25 mg/kg/day. However, patients who develop VOD still have increased mortality despite the use of defibrotide. Data are limited on the use of doses above 60 mg/kg/day for persistent VOD. In this prospective clinical trial 34 patients received escalating doses of defibrotide. For patients with persistent VOD despite doses of 60 mg/kg/day, doses were increased to a maximum of 110 mg/kg/day. Increased toxicity was not observed until doses rose beyond 100 mg/kg/day. Patients receiving doses between 10 and 100 mg/kg/day experienced an average of 3 bleeding episodes per 100 days of treatment, whereas those receiving doses >100 mg/kg/day experienced 13.2 bleeding episodes per 100 days (P = .008). Moreover, dose reductions due to toxicity were needed at doses of 110 mg/kg/day more often than at lower doses. Defibrotide may be safely escalated to doses well above the current standard without an increase in bleeding risk. However, the efficacy of this dose-escalation strategy remains unclear, because outcomes were similar to published cohorts of patients receiving standard doses of defibrotide for VOD. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  3. Limits of dose escalation in lung cancer: a dose-volume histogram analysis comparing coplanar and non-coplanar techniques

    Energy Technology Data Exchange (ETDEWEB)

    Derycke, S; Van Duyse, B; Schelfhout, J; De Neve, W

    1995-12-01

    To evaluate the feasibility of dose escalation in radiotherapy of inoperable lung cancer, a dose-volume histogram analysis was performed comparing standard coplanar (2D) with non-coplanar (3D) beam arrangements on a non-selected group of 20 patients planned by Sherouse`s GRATISTM 3D-planning system. Serial CT-scanning was performed and 2 Target Volumes (Tvs) were defined. Gross Tumor Volume (GTV) defined a high-dose Target Volume (TV-1). GTV plus location of node stations with > 10% probability of invasion (Minet et al.) defined an intermediate-dose Target Volume (TV-2). However, nodal regions which are incompatible with cure were excluded from TV-2. These are ATS-regions 1, 8, 9 and 14 all left and right as well as heterolateral regions. For 3D-planning, Beam`s Eye View selected (by an experienced planner) beam arrangements were optimised using Superdot, a method of target dose-gradient annihilation developed by Sherouse. A second 3D-planning was performed using 4 beam incidences with maximal angular separation. The linac`s isocenter for the optimal arrangement was located at the geometrical center of gravity of a tetraheder, the tetraheder`s comers being the consecutive positions of the virtual source. This ideal beam arrangement was approximated as close as possible, taking into account technical limitations (patient-couch-gantry collisions). Criteria for tolerance were met if no points inside the spinal cord exceeded 50 Gy and if at least 50% of the lung volume received less than 20Gy. If dose regions below 50 Gy were judged acceptable at TV-2, 2D- as well as 3D-plans allow safe escalation to 80 Gy at TV-1. When TV-2 needed to be encompassed by isodose surfaces exceeding 50Gy, 3D-plans were necessary to limit dose at the spinal cord below tolerance. For large TVs dose is limited by lung tolerance for 3D-plans. An analysis (including NTCP-TCP as cost functions) of rival 3D-plans is being performed.

  4. Medical care costs incurred by patients with smoking-related non-small cell lung cancer treated at the National Cancer Institute of Mexico.

    Science.gov (United States)

    Arrieta, Oscar; Quintana-Carrillo, Roger Humberto; Ahumada-Curiel, Gabriel; Corona-Cruz, Jose Francisco; Correa-Acevedo, Elma; Zinser-Sierra, Juan; de la Mata-Moya, Dolores; Mohar-Betancourt, Alejandro; Morales-Oyarvide, Vicente; Reynales-Shigematsu, Luz Myriam

    2014-01-01

    Smoking is a public health problem in Mexico and worldwide; its economic impact on developing countries has not been well documented. The aim of this study was to assess the direct medical costs attributable to smoking incurred by lung cancer patients treated at the National Cancer Institute of Mexico (INCan). The study was conducted at INCan in 2009. We carried out a cost of illness (COI) methodology, using data derived from an expert panel consensus and from medical chart review. A panel of experts developed a diagnostic-therapeutic guide that combined the hospital patient pathways and the infrastructure, human resources, technology, and services provided by the medical units at INCan. Cost estimates in Mexican pesos were adjusted by inflation and converted into US Dollars using the 2013 FIX exchange rate for foreign transactions (1 USD = 13.06 Mexican pesos). A 297 incident cases diagnosed with any type of lung cancer were analyzed. According to clinical stage, the costs per patient were 13,456; 35,648; 106,186; and 144,555 USD, for lung cancer stages I, II, III, and IV respectively. The weighted average annual cost/patient was and 139,801 USD and the average annual cost/patient that was attributable to smoking was 92,269 USD. This cost was independent of the clinical stage, with stage IV representing 96% of the annual cost. The total annual cost of smoking-related lung cancer at INCan was 19,969,781 USD. The medical care costs of lung cancer attributable to smoking represent a high cost both for INCan and the Mexican health sector. These costs could be reduced if all provisions established in the Framework Convention of Tobacco Control of the World Health Organization were implemented in Mexico.

  5. PPICA, Power Plant Investment Cost Analysis

    International Nuclear Information System (INIS)

    Lefevre, J.C.

    2002-01-01

    1 - Description of program or function: This software package contains two modules: - CAPITAL1 calculates investment costs from overnight costs, based on the capital structure of the utility (debt/equity ratio), return and interest rates according to the type of securities involved, and a standard-shaped curve of capital outlays during construction of a power plant. - FCRATE1 calculates the year-by-year revenue requirements to cover the capital-related charges incurred by the new investment and their economic equivalent: the levelled fixed-charge rate and capital contribution to the levelled unit power generation cost per kWh. They are proposed as an alternative to the corresponding modules CAPITAL and FCRATE, included in the LPGC (Levelled Power Generation Cost) suite of codes developed by ORNL and US-DOE. They perform the same type of analysis and provide the same results. 2 - Methods: Results output from CAPITAL1, in terms of the initial investment at startup and the fraction thereof that is allowable for tax depreciation, can be transferred automatically as data input to FCRATE1. Other user-defined data are: the project life, the time horizon of the economic analysis (which does not necessarily coincide with the project life), the plant load factor (lifetime average), the tax rate applicable to utility's income, the tax depreciation scheme and the tax charge accounting method (normalised or flow- through). The results of CAPITAL1 and FCRATE1 are expressed both in current money and in constant money of a reference year. Inflation rate and escalation rate of construction expenditures during construction period, and of fixed charges during service life are defined by the user. The discount rate is set automatically by the programme, equal to the weighted average tax-adjusted cost of money. 3 - Restrictions on the complexity of the problem: CAPITAL1 and FCRATE1 are 'alternatives', not 'substitutes', to the corresponding programs CAPITAL and FCRATE of the LPGC

  6. Estimation of the Levelised Electricity Generation Cost for a PWR-Power Plant and Preliminary Evaluation of National Participation

    International Nuclear Information System (INIS)

    Saba, G; Hainoun, A

    2008-01-01

    This work deals with the detailed economic evaluation of the Levelised discounted electricity generation costs (LDEGC) for a nuclear power plant with pressurized water reactor (PWR). The total generation costs are splited in base construction costs, supplementary costs, owner's costs, financial costs, fuel cycle costs and operation and maintenance costs. The evaluation covers also the sensitivity of the estimated energy unit cost to various factors (real annual discount rate, escalation rate, interest rate, load factor, ..) including the role of national participation, that depends upon the development of national infrastructure. For performing this study the IAEA's program package for economic bid evaluation (Bideval-3) has been employed. The program is designed to assist the user in the economic evaluation of bids for nuclear power plant (NPP). It follows the recommended method of determining the present worth value of all costs components for generated electricity unit. The performed study aims at developing national expertise in the field of bid evaluation for electric power plants with main emphasis on NPP. Additional goal is to convoying the technical and economic development of NPP technology that can help in supporting the decision maker with adequate information related to the future development of energy supply system and measures required for ensuring national energy supply security. (author)

  7. Effect of a health system's medical error disclosure program on gastroenterology-related claims rates and costs.

    Science.gov (United States)

    Adams, Megan A; Elmunzer, B Joseph; Scheiman, James M

    2014-04-01

    In 2001, the University of Michigan Health System (UMHS) implemented a novel medical error disclosure program. This study analyzes the effect of this program on gastroenterology (GI)-related claims and costs. This was a review of claims in the UMHS Risk Management Database (1990-2010), naming a gastroenterologist. Claims were classified according to pre-determined categories. Claims data, including incident date, date of resolution, and total liability dollars, were reviewed. Mean total liability incurred per claim in the pre- and post-implementation eras was compared. Patient encounter data from the Division of Gastroenterology was also reviewed in order to benchmark claims data with changes in clinical volume. There were 238,911 GI encounters in the pre-implementation era and 411,944 in the post-implementation era. A total of 66 encounters resulted in claims: 38 in the pre-implementation era and 28 in the post-implementation era. Of the total number of claims, 15.2% alleged delay in diagnosis/misdiagnosis, 42.4% related to a procedure, and 42.4% involved improper management, treatment, or monitoring. The reduction in the proportion of encounters resulting in claims was statistically significant (P=0.001), as was the reduction in time to claim resolution (1,000 vs. 460 days) (P<0.0001). There was also a reduction in the mean total liability per claim ($167,309 pre vs. $81,107 post, 95% confidence interval: 33682.5-300936.2 pre vs. 1687.8-160526.7 post). Implementation of a novel medical error disclosure program, promoting transparency and quality improvement, not only decreased the number of GI-related claims per patient encounter, but also dramatically shortened the time to claim resolution.

  8. A study of the effects of internal organ motion on dose escalation in conformal prostate treatments

    International Nuclear Information System (INIS)

    Happersett, Laura; Mageras, Gig S.; Zelefsky, Michael J.; Burman, Chandra M.; Leibel, Steven A.; Chui Chen; Fuks, Zvi; Bull, Sarah; Ling, C. Clifton; Kutcher, Gerald J.

    2003-01-01

    Background and purpose: To assess the effect of internal organ motion on the dose distributions and biological indices for the target and non-target organs for three different conformal prostate treatment techniques. Materials and methods: We examined three types of treatment plans in 20 patients: (1) a six field plan, with a prescribed dose of 75.6 Gy; (2) the same six field plan to 72 Gy followed by a boost to 81 Gy; and (3) a five field plan with intensity modulated beams delivering 81 Gy. Treatment plans were designed using an initial CT data set (planning) and applied to three subsequent CT scans (treatment). The treatment CT contours were used to represent patient specific organ displacement; in addition, the dose distribution was convolved with a Gaussian distribution to model random setup error. Dose-volume histograms were calculated using an organ deformation model in which the movement between scans of individual points interior to the organs was tracked and the dose accumulated. The tumor control probability (TCP) for the prostate and proximal half of seminal vesicles (clinical target volume, CTV), normal tissue complication probability (NTCP) for the rectum and the percent volume of bladder wall receiving at least 75 Gy were calculated. Results: The patient averaged increase in the planned TCP between plan types 2 and 1 and types 3 and 1 was 9.8% (range 4.9-12.5%) for both, whereas the corresponding increases in treatment TCP were 9.0% (1.3-16%) and 8.1% (-1.3-13.8%). In all patients, plans 2 and 3 (81 Gy) exhibited equal or higher treatment TCP than plan 1 (75.6 Gy). The maximum treatment NTCP for rectum never exceeded the planning constraint and percent volume of bladder wall receiving at least 75 Gy was similar in the planning and treatment scans for all three plans. Conclusion: For plans that deliver a uniform prescribed dose to the planning target volume (PTV) (plan 1), current margins are adequate. In plans that further escalate the dose to part

  9. Trojan Decommissioning Project Cost Performance

    International Nuclear Information System (INIS)

    Michael B. Lackey

    2000-01-01

    The Trojan nuclear plant (Trojan) was an 1160-MW(electric) four-loop pressurized water reactor located in Rainier, Oregon. The plant was permanently shut down in 1993 after ∼17 yr of commercial operation. The early plant closure was an economic decision. The key factors in the closure analysis were escalation of inspection and repair costs associated with steam generator tube cracking and the projected availability of inexpensive replacement power in the Pacific Northwest region of the United States. Since the plant closure, Portland General Electric (PGE) has been actively engaged in decommissioning. The Trojan Decommissioning Project currently has a forecast at completion of $429.7 million (all costs are in millions of 1997 dollars, unless otherwise noted). The cost performance of the Trojan Decommissioning Project to date is addressed, as well as the tools that are in place to provide cost control through completion of decommissioning

  10. The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

    Science.gov (United States)

    Mabry, C D

    2001-03-01

    Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement. Copyright 2001 by W.B. Saunders Company

  11. Nuclear power generation costs in the United States of America

    International Nuclear Information System (INIS)

    Willis, W.F.

    1983-01-01

    Increasing world energy prices and shortages of fuel resources make the utilization of nuclear power extremely important. The United States nuclear power industry represents the largest body of nuclear power experience in the world. Analysis of the recent United States experience of substantial increases in the cost of nuclear power generation provides good insight into the interdependence of technological, financial, and institutional influences and their combined impact on the economic viability of nuclear power generation. The various factors influencing ultimate generation costs, including construction cost, fuel cost, regulatory reviews, and siting considerations are discussed, and their relative impacts are explored, including discussion of design complexity and related regulatory response. A closer look into the recent relatively high escalation of nuclear plant construction costs shows how differing economic conditions can affect the relative cost effectiveness of various methods of power generation. The vulnerability of capital-intensive, long-lead-time projects to changes in economic conditions and uncertainty in future power demands is discussed. Likewise, the pitfalls of new designs and increased sophistication are contrasted to the advantages which result from proven designs, reliable engineering, and shorter lead times. The value of reliable architect-engineers experienced in the design and construction of the plant is discussed. A discussion is presented of additional regulatory requirements stemming from public safety aspects of nuclear power. These include recognition of requirements for the very large effort for quality assurance of materials and workmanship during plant construction and operation. Likewise, a discussion is included of the demanding nature of operations, maintenance, and modification of plants during the operational phase because of the need for highly qualified operations and maintenance personnel and strict quality assurance

  12. Resolution of methylphenidate osmotic release oral system-induced hair loss in two siblings after dose escalation.

    Science.gov (United States)

    Ardic, Ulku Akyol; Ercan, Eyup Sabri

    2017-11-01

    This report describes the cases of two siblings who experienced hair loss after treatment with methylphenidate (MPH) osmotic release oral system (OROS). Hair loss was resolved after discontinuation of the drug, but the children re-initiated treatment, after which hair loss again occurred, but they continued the treatment. After dose escalation, the hair loss resolved. This is the first report to describe resolution of OROS-MPH-induced hair loss after dose escalation. © 2017 Japan Pediatric Society.

  13. Assessment of costs related to the implementation of management solutions on the long term for high and medium level long life radioactive wastes. ANDRA's proposition

    International Nuclear Information System (INIS)

    2014-10-01

    This huge document contains several volumes which propose detailed costing of the various parts of the Cigeo project after sketch studies (this project deals with the deep geological storage of high and medium level long life radioactive wastes). It notably states the various hypotheses regarding the inventory of radioactive wastes, the waste supply prediction, and works closure. This cost assessment takes the different project stages into account and a cost update. Various aspects are thus assessed, some related to investments (design studies, preliminary works, construction of the various installations, renewal of equipment during exploitation, installation dismantling and works closure, insurance, commissioning authority and engineering subcontracting), to exploitation (production and maintenance, support, activities related to safety, radiation protection and control of the environment, operating costs, utilities, storage containers, insurance), and to other expenses (tax, research and development, technological tests, control after closure)

  14. Optimization of temperature differences in a utilizer in relation to the lowest sum of capital and operating cost

    International Nuclear Information System (INIS)

    Kustrin, I.; Tuma, M.

    1992-01-01

    Our environment and nature are currently overburdened with the emission of noxious substances. Steam boilers fired with coal are therefore not very popular. Wherever possible, they are being replaced by devices which are less harmful for the environment because they use different fuel. This paper discusses replacing a steam boiler with a gas turbine and an utilizer. A mathematical model for performing the optimization of capital and operating costs is presented. The model optimizes the degree of preheating of the flue gases i.e. the temperature of the entering flue gases. The smallest temperature difference (pinch point) was not estimated by the pinch technology because the presented example is relatively simple and the pinch point temperature difference was chosen according to the values reported in various literature sources. The optimization is supplemented with an analysis of the thermal and exergetical efficiencies of the utilizer under different conditions (average temperature difference between the hot gases and water or steam, exit temperature of the hot gases), which condition the choice of the type of utilizer

  15. Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kotecha, Rupesh [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Kotecha, Ritesh [MidMichigan Medical Center, Midland, Michigan (United States); Modugula, Sujith [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Murphy, Erin S. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Jones, Mark; Kotecha, Rajesh [MidMichigan Medical Center, Midland, Michigan (United States); Reddy, Chandana A. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Suh, John H. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Barnett, Gene H. [Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (United States); Neyman, Gennady [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Machado, Andre; Nagel, Sean [Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (United States); Chao, Samuel T., E-mail: chaos@ccf.org [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States)

    2016-09-01

    Purpose: To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). Methods and Materials: A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Results: Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Conclusions: Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness.

  16. Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes

    International Nuclear Information System (INIS)

    Kotecha, Rupesh; Kotecha, Ritesh; Modugula, Sujith; Murphy, Erin S.; Jones, Mark; Kotecha, Rajesh; Reddy, Chandana A.; Suh, John H.; Barnett, Gene H.; Neyman, Gennady; Machado, Andre; Nagel, Sean; Chao, Samuel T.

    2016-01-01

    Purpose: To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). Methods and Materials: A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Results: Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Conclusions: Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness.

  17. Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Brouwer, Elizabeth D; Watkins, David; Olson, Zachary; Goett, Jane; Nugent, Rachel; Levin, Carol

    2015-11-26

    The burden of cardiovascular disease (CVD) and CVD risk conditions is rapidly increasing in low- and middle-income countries, where health systems are generally ill-equipped to manage chronic disease. Policy makers need an understanding of the magnitude and drivers of the costs of cardiovascular disease related conditions to make decisions on how to allocate limited health resources. We undertook a systematic review of the published literature on provider-incurred costs of treatment for cardiovascular diseases and risk conditions in low- and middle-income countries. Total costs of treatment were inflated to 2012 US dollars for comparability across geographic settings and time periods. This systematic review identified 60 articles and 143 unit costs for the following conditions: ischemic heart disease, non-ischemic heart diseases, stroke, heart failure, hypertension, diabetes, and chronic kidney disease. Cost data were most readily available in middle-income countries, especially China, India, Brazil, and South Africa. The most common conditions with cost studies were acute ischemic heart disease, type 2 diabetes mellitus, stroke, and hypertension. Emerging economies are currently providing a base of cost evidence for NCD treatment that may prove useful to policy-makers in low-income countries. Initial steps to publicly finance disease interventions should take account of costs. The gaps and limitations in the current literature include a lack of standardized reporting as well as sparse evidence from low-income countries.

  18. DO FINANCIAL STATEMENTS PROVIDE ADEQUATE INFORMATION ABOUT THE CAPITALIZATION OF COSTS RELATED TO INTANGIBLE ASSETS?: AN EMPIRICAL RESEARCH ON ITALIAN LISTED COMPANIES

    Directory of Open Access Journals (Sweden)

    Stefania Vignini

    2015-11-01

    Full Text Available The aim of our research is to verify if Italian listed companies financial statements provide adequate information about the capitalization of costs related to intangible assets and if the information provided are reliable. Moreover, we investigated if they merely comply with law or provide additional information on cost capitalization and reveal if internal control systems (especially managerial accounting systems or other information systems are applied to support the measurement process and the cost control, thus guaranteeing the verifiability and representational faithfulness of the information disclosed. This paper is an empirical analysis and is concerned to investigate the financial statements of 250 Italian listed companies.

  19. SU-D-202-01: Functional Lung Avoidance and Response-Adaptive Escalation (FLARE) RT: Feasibility of a Precision Radiation Oncology Strategy

    International Nuclear Information System (INIS)

    Bowen, S; Lee, E; Miyaoka, R; Kinahan, P; Sandison, G; Vesselle, H; Rengan, R; Zeng, J; Saini, J; Wong, T

    2016-01-01

    Purpose: NSCLC patient RT is planned without consideration of spatial heterogeneity in lung function or tumor response, which may have contributed to failed uniform dose escalation in a randomized trial. The feasibility of functional lung avoidance and response-adaptive escalation (FLARE) RT to reduce dose to ["9"9"mTc]MAA-SPECT/CT perfused lung while redistributing 74Gy within ["1"8F]FDG-PET/CT biological target volumes was assessed. Methods: Eight Stage IIB–IIIB NSCLC patients underwent FDG-PET/CT and MAA-SPECT/CT treatment planning scans. Perfused lung objectives were derived from scatter/collimator/attenuation-corrected MAA-SPECT uptake relative to ITV-subtracted lung to maintain <20Gy mean lung dose (MLD). Prescriptions included 60Gy to PTV and concomitant boost of 74Gy mean to biological target volumes (BTV=GTV+PET margin) scaled to each BTV voxel by relative FDG-PET SUV. Dose-painting-by-numbers prescriptions were integrated into commercial TPS via previously reported ROI discretization. Dose constraints for lung, heart, cord, and esophagus were defined. FLARE RT plans were optimized with VMAT, proton pencil beam scanning (PBS) with 3%-3mm robust optimization, and combination PBS (avoidance) plus VMAT (escalation). Dosimetric differences were evaluated by Friedman non-parametric paired test with multiple sampling correction. Results: PTV and normal tissue objectives were not violated in 24 FLARE RT plans. Population median of mean BTV dose was 73.7Gy (68.5–75.5Gy), mean FDG-PET peak dose was 89.7Gy (73.5–103Gy), MLD was 12.3Gy (7.5–19.6Gy), and perfused MLD was 4.8Gy (0.9–12.1Gy). VMAT achieved higher dose to the FDG-PET peak subvolume (p=0.01), while PBS delivered lower dose to lung (p<0.001). Voxelwise linear correlation between BTV dose and FDG-PET uptake was higher for VMAT (R=0.93) and PBS+VMAT (R=0.94) compared to PBS alone (R=0.89). Conclusion: FLARE RT is feasible with VMAT and PBS. A combination of PBS for functional lung avoidance and

  20. SU-D-202-01: Functional Lung Avoidance and Response-Adaptive Escalation (FLARE) RT: Feasibility of a Precision Radiation Oncology Strategy

    Energy Technology Data Exchange (ETDEWEB)

    Bowen, S; Lee, E; Miyaoka, R; Kinahan, P; Sandison, G; Vesselle, H; Rengan, R; Zeng, J [University of Washington, School of Medicine, Seattle, WA (United States); Saini, J; Wong, T [SCCA Proton Therapy Center, Seattle, WA (United States)

    2016-06-15

    Purpose: NSCLC patient RT is planned without consideration of spatial heterogeneity in lung function or tumor response, which may have contributed to failed uniform dose escalation in a randomized trial. The feasibility of functional lung avoidance and response-adaptive escalation (FLARE) RT to reduce dose to [{sup 99m}Tc]MAA-SPECT/CT perfused lung while redistributing 74Gy within [{sup 18}F]FDG-PET/CT biological target volumes was assessed. Methods: Eight Stage IIB–IIIB NSCLC patients underwent FDG-PET/CT and MAA-SPECT/CT treatment planning scans. Perfused lung objectives were derived from scatter/collimator/attenuation-corrected MAA-SPECT uptake relative to ITV-subtracted lung to maintain <20Gy mean lung dose (MLD). Prescriptions included 60Gy to PTV and concomitant boost of 74Gy mean to biological target volumes (BTV=GTV+PET margin) scaled to each BTV voxel by relative FDG-PET SUV. Dose-painting-by-numbers prescriptions were integrated into commercial TPS via previously reported ROI discretization. Dose constraints for lung, heart, cord, and esophagus were defined. FLARE RT plans were optimized with VMAT, proton pencil beam scanning (PBS) with 3%-3mm robust optimization, and combination PBS (avoidance) plus VMAT (escalation). Dosimetric differences were evaluated by Friedman non-parametric paired test with multiple sampling correction. Results: PTV and normal tissue objectives were not violated in 24 FLARE RT plans. Population median of mean BTV dose was 73.7Gy (68.5–75.5Gy), mean FDG-PET peak dose was 89.7Gy (73.5–103Gy), MLD was 12.3Gy (7.5–19.6Gy), and perfused MLD was 4.8Gy (0.9–12.1Gy). VMAT achieved higher dose to the FDG-PET peak subvolume (p=0.01), while PBS delivered lower dose to lung (p<0.001). Voxelwise linear correlation between BTV dose and FDG-PET uptake was higher for VMAT (R=0.93) and PBS+VMAT (R=0.94) compared to PBS alone (R=0.89). Conclusion: FLARE RT is feasible with VMAT and PBS. A combination of PBS for functional lung avoidance

  1. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010.

    Science.gov (United States)

    Rehm, Colin D; Monsivais, Pablo; Drewnowski, Adam

    2015-04-01

    Food prices may be one reason for the growing socioeconomic disparities in diet quality. To evaluate the association between diet costs and the Healthy Eating Index-2010 (HEI-2010). Cross-sectional study based on 11,181 adults from the 2007-2010 National Health and Nutrition Examination Survey, analyzed in spring 2014. Diet cost was estimated by linking dietary data with a national food price database. The HEI-2010, a measure of adherence to the dietary guidelines, was the outcome. The population ratio method was used to estimate the average HEI-2010 scores by quintile of energy-adjusted diet cost. Additional analyses evaluated the association between cost and HEI-2010 components. There was a strong positive association between lower energy-adjusted diet costs and lower HEI-2010 scores. The association was stronger among women (p-interaction=0.003). Lower diet costs were associated with lower consumption of vegetables, fruits, whole grains, and seafood, and higher consumption of refined grains and solid fat, alcohol and added sugars. Lower energy-adjusted diet costs were associated with lower-quality diets. Future efforts to improve the nutritional status of the US public should take food prices and diet costs into account. Copyright © 2015. Published by Elsevier Inc.

  2. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010

    Science.gov (United States)

    Rehm, Colin D.; Monsivais, Pablo; Drewnowski, Adam

    2016-01-01

    Background Food prices may be one reason for the growing socioeconomic disparities in diet quality. Objective To evaluate the association between diet costs and the Healthy Eating Index-2010 (HEI-2010). Methods Cross-sectional study based on 11,181 adults from the 2007-2010 National Health and Nutrition Examination Survey, analyzed in spring 2014. Diet cost was estimated by linking dietary data with a national food price database. The HEI-2010, a measure of adherence to the Dietary Guidelines, was the outcome. The population ratio method was used to estimate the average HEI-2010 scores by quintile of energy-adjusted diet cost. Additional analyses evaluated the association between cost and HEI-2010 components. Results There was a strong positive association between lower energy-adjusted diet costs and lower HEI-2010 scores. The association was stronger among women (p-interaction=0.003). Lower diet costs were associated with lower consumption of vegetables, fruit, whole grains, and seafood, and higher consumption of refined grains and solid fat, alcohol and added sugars. Conclusions Lower energy-adjusted diet costs were associated with lower-quality diets. Future efforts to improve the nutritional status of the US public should take food prices and diet costs into account. PMID:25625693

  3. Moderation of the Relation of County-Level Cost of Living to Nutrition by the Supplemental Nutrition Assistance Program.

    Science.gov (United States)

    Basu, Sanjay; Wimer, Christopher; Seligman, Hilary

    2016-11-01

    To examine the association of county-level cost of living with nutrition among low-income Americans. We used the National Household Food Acquisition and Purchase Survey (2012-2013; n = 14 313; including 5414 persons in households participating in the Supplemental Nutrition Assistance Program [SNAP]) to examine associations between county-level cost-of-living metrics and both food acquisitions and the Healthy Eating Index, with control for individual-, household-, and county-level covariates and accounting for unmeasured confounders influencing both area of living and food acquisition. Living in a higher-cost county-particularly one with high rent costs-was associated with significantly lower volume of acquired vegetables, fruits, and whole grains; greater volume of acquired refined grains, fats and oils, and added sugars; and an 11% lower Healthy Eating Index score. Participation in SNAP was associated with nutritional improvements among persons living in higher-cost counties. Living in a higher-cost county (particularly with high rent costs) is associated with poorer nutrition among low-income Americans, and SNAP may mitigate the negative nutritional impact of high cost of living.

  4. Relative Cost-Effectiveness of Treatments for Adolescent Depression: 36-Week Results from the TADS Randomized Trial

    Science.gov (United States)

    Domino, Marisa Elena; Foster, E. Michael; Vitiello, Benedetto; Kratochvil, Christopher J.; Burns, Barbara J.; Silva, Susan G.; Reinecke, Mark A.; March, John S.

    2009-01-01

    Randomized controlled trials that involve 327 participants aged 12 to 18 who were diagnosed with major depression were given either fluoxetine alone, cognitive-behavioral therapy, or a combination of both. Cost-effectiveness acceptability curves suggest that combination treatment is highly likely to be the most cost-effective treatment than…

  5. Three-Dimensional Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy Combined With Transcatheter Arterial Chemoembolization for Locally Advanced Hepatocellular Carcinoma: An Irradiation Dose Escalation Study

    International Nuclear Information System (INIS)

    Ren Zhigang; Zhao Jiandong; Gu Ke; Chen Zhen; Lin Junhua; Xu Zhiyong; Hu Weigang; Zhou Zhenhua; Liu Luming; Jiang Guoliang

    2011-01-01

    Purpose: To determine the maximum tolerated dose (MTD) of three-dimensional conformal radiation therapy (3DCRT)/intensity-modulated radiation therapy (IMRT) combined with transcatheter arterial chemoembolization for locally advanced hepatocellular carcinoma. Methods and Materials: Patients were assigned to two subgroups based on tumor diameter: Group 1 had tumors <10 cm; Group II had tumors ≥10 cm. Escalation was achieved by increments of 4.0 Gy for each cohort in both groups. Dose-limiting toxicity (DLT) was defined as a grade of ≥3 acute liver or gastrointestinal toxicity or any grade 5 acute toxicity in other organs at risk or radiation-induced liver disease. The dose escalation would be terminated when ≥2 of 8 patients in a cohort experienced DLT. Results: From April 2005 to May 2008, 40 patients were enrolled. In Group I, 11 patients had grade ≤2 acute treatment-related toxicities, and no patient experienced DLT; and in Group II, 10 patients had grade ≤2 acute toxicity, and 1 patient in the group receiving 52 Gy developed radiation-induced liver disease. MTD was 62 Gy for Group I and 52 Gy for Group II. In-field progression-free and local progression-free rates were 100% and 69% at 1 year, and 93% and 44% at 2 years, respectively. Distant metastasis rates were 6% at 1 year and 15% at 2 years. Overall survival rates for 1-year and 2-years were 72% and 62%, respectively. Conclusions: The irradiation dose was safely escalated in hepatocellular carcinoma patients by using 3DCRT/IMRT with an active breathing coordinator. MTD was 62 Gy and 52 Gy for patients with tumor diameters of <10 cm and ≥10 cm, respectively.

  6. Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.

    Science.gov (United States)

    Childs, John D; Wu, Samuel S; Teyhen, Deydre S; Robinson, Michael E; George, Steven Z

    2014-04-01

    Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing

  7. Cost-effectiveness of anti-oxidant vitamins plus zinc treatment to prevent the progression of intermediate age-related macular degeneration. A Singapore perspective.

    Science.gov (United States)

    Saxena, Nakul; George, Pradeep Paul; Heng, Bee Hoon; Lim, Tock Han; Yong, Shao Onn

    2015-06-01

    To determine if providing high dose anti-oxidant vitamins and zinc treatment age-related eye disease study (AREDS formulation) to patients with intermediate age-related macular degeneration (AMD) aged 40-79 years from Singapore is cost-effective in preventing progression to wet AMD. A hypothetical cohort of category 3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly) for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen). Costs were estimated for the above scenarios from the providers' perspective, and cost-effectiveness was measured by cost per disability-adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs were discounted at an annual rate of 3%. Over 5400 patients could be prevented from progressing to wet AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was cost-effective compared to placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more cost-effective compared to AREDS formulation followed by bevacizumab. Prophylactic treatment with AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore.

  8. Report on ENGIE's regulated tariffs for gas sale - Audit supply costs and non-supply related costs. Deliberation of the Commission for energy regulation on the 25 May 2016 bearing approval of the audit report on supply costs and non-supply related costs as basis for the calculation of the evolution of ENGIE's regulated tariffs for natural gas sale

    International Nuclear Information System (INIS)

    Ladoucette, Philippe De; Edwige, Catherine; Gassin, Helene; Padova, Yann; Sotura, Jean-Pierre

    2016-05-01

    After a recall of the context and objectives of the analysis performed by the French Commission for Energy Regulation (CRE), and a synthetic presentation of the main conclusions, this report first proposes an assessment for 2015 by discussing the share of consumptions provided under the regulated tariff with respect to those provided on the retail market, the evolution of these tariffs, by noticing that ENGIE costs have been covered by income associated with sales at regulated tariffs. The second part addresses perspectives of evolution for supply costs by outlining the existence of market indexing, the lack of factors which would justify an evolution of gas price indexing level, and a possible reviewing of indices at the moment of revision of the indexing formula. The third part addresses the perspectives of evolution of non-supply related costs. It notices the impact of recent evolution of infrastructure costs, some lack of information regarding provisional trade costs, and a significant decrease of these costs for 2016

  9. Potentiation of amygdala AMPA receptor activity selectively promotes escalated alcohol self-administration in a CaMKII-dependent manner.

    Science.gov (United States)

    Cannady, Reginald; Fisher, Kristen R; Graham, Caitlin; Crayle, Jesse; Besheer, Joyce; Hodge, Clyde W

    2017-05-01

    Growing evidence indicates that drugs of abuse gain control over the individual by usurping glutamate-linked mechanisms of neuroplasticity in reward-related brain regions. Accordingly, we have shown that glutamate α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) activity in the amygdala is required for the positive reinforcing effects of alcohol, which underlie the initial stages of addiction. It is unknown, however, if enhanced AMPAR activity in the amygdala facilitates alcohol self-administration, which is a kernel premise of glutamate hypotheses of addiction. Here, we show that low-dose alcohol (0.6 g/kg/30 minutes) self-administration increases phosphorylation (activation) of AMPAR subtype GluA1 S831 (pGluA1 S831) in the central amygdala (CeA), basolateral amygdala and nucleus accumbens core (AcbC) of selectively bred alcohol-preferring P-rats as compared with behavior-matched (non-drug) sucrose controls. The functional role of enhanced AMPAR activity was assessed via site-specific infusion of the AMPAR positive modulator, aniracetam, in the CeA and AcbC prior to alcohol self-administration. Intra-CeA aniracetam increased alcohol-reinforced but not sucrose-reinforced responding and was ineffective following intra-AcbC infusion. Because GluA1 S831 is a Ca2+/calmodulin-dependent protein kinase II (CaMKII) substrate, we sought to determine if AMPAR regulation of enhanced alcohol self-administration is dependent on CaMKII activity. Intra-CeA infusion of the cell-permeable CaMKII peptide inhibitor myristolated autocamtide-2-related inhibitory peptide (m-AIP) dose-dependently reduced alcohol self-administration. A subthreshold dose of m-AIP also blocked the aniracetam-induced escalation of alcohol self-administration, demonstrating that AMPAR-mediated potentiation of alcohol reinforcement requires CaMKII activity in the amygdala. Enhanced activity of plasticity-linked AMPAR-CaMKII signaling in the amygdala may promote escalated alcohol use

  10. Money Related Decommissioning and Funding Decision Making

    International Nuclear Information System (INIS)

    Goodman, Lynne S.

    2008-01-01

    'Money makes the world go round', as the song says. It definitely influences decommissioning decision-making and financial assurance for future decommissioning. This paper will address two money-related decommissioning topics. The first is the evaluation of whether to continue or to halt decommissioning activities at Fermi 1. The second is maintaining adequacy of financial assurance for future decommissioning of operating plants. Decommissioning costs considerable money and costs are often higher than originally estimated. If costs increase significantly and decommissioning is not well funded, decommissioning activities may be deferred. Several decommissioning projects have been deferred when decision-makers determined future spending is preferable than current spending, or when costs have risen significantly. Decommissioning activity timing is being reevaluated for the Fermi 1 project. Assumptions for waste cost-escalation significantly impact the decision being made this year on the Fermi 1 decommissioning project. They also have a major impact on the estimated costs for decommissioning currently operating plants. Adequately funding full decommissioning during plant operation will ensure that the users who receive the benefit pay the full price of the nuclear-generated electricity. Funding throughout operation also will better ensure that money is available following shutdown to allow decommissioning to be conducted without need for additional funds

  11. Benign thyroid disorders, radioiodine therapy and diagnosis related groups (DRGs): aspects of cost/benefit; Benigne Schilddruesenerkrankungen, Radioiodtherapie und Diagnosis Related Groups (DRGs): Kosten-Nutzen-Aspekte

    Energy Technology Data Exchange (ETDEWEB)

    Dietlein, M.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. zu Koeln (Germany)

    2005-06-01

    The increasing prevalence of goiter and thyroid nodules in older patients is accompanied by an increasing frequency of treatment and cost. Cost-effectiveness is given for programs of prophylaxis (primary prevention, e.g. alimentary iodine supplementation), for programs of screening (secondary prevention. e.g. TSH-screening), and for therapeutic strategies to avoid complications of thyroid dysfunction (atrial fibrillation, myocardial infarction, death for cardiac reasons) and to minimize iatrogenic complications (tertiary prevention). Examples of tertiary prevention are radioiodine-therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), radioiodine therapy of ouvert or subclinical hyperthyroidism, and radioiodine therapy of large goiters in older patients or in patients suffering from a relevant co-morbidity. A cost-effectiveness-analysis for different therapeutic strategies of Graves' disease has been published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%. Cost-minimization-analysis, comparing resection of goiter and radioiodine, has shown lower cost of radioiodine therapy for toxic multinodular goiter up to 100 ml and for Graves' disease up to 60 ml goiter volume. Medical aspects (volume of goiter, uptake of nodules, regressive goiter, suspicion on malignancy, patients' age, co-morbidity, patients' decision) remain decisive for the choice of treatment. (orig.)

  12. Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.

    Science.gov (United States)

    Burger, Emily A; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S; Kim, Jane J

    2014-01-01

    Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding

  13. Accounting for Heterogeneity in Relative Treatment Effects for Use in Cost-Effectiveness Models and Value-of-Information Analyses.

    Science.gov (United States)

    Welton, Nicky J; Soares, Marta O; Palmer, Stephen; Ades, Anthony E; Harrison, David; Shankar-Hari, Manu; Rowan, Kathy M

    2015-07-01

    Cost-effectiveness analysis (CEA) models are routinely used to inform health care policy. Key model inputs include relative effectiveness of competing treatments, typically informed by meta-analysis. Heterogeneity is ubiquitous in meta-analysis, and random effects models are usually used when there is variability in effects across st