Reducing patient drug acquisition costs can lower diabetes health claims.

Science.gov (United States)

Mahoney, John J

2005-08-01

Concerned about rising prevalence and costs of diabetes among its employees, Pitney Bowes Inc recently revamped its drug benefit design to synergize with ongoing efforts in its disease management and patient education programs. Specifically, based on a predictive model showing that low medication adherence was linked to subsequent increases in healthcare costs in patients with diabetes, the company shifted all diabetes drugs and devices from tier 2 or 3 formulary status to tier 1. The rationale was that reducing patient out-of-pocket costs would eliminate financial barriers to preventive care, and thereby increase adherence, reduce costly complications, and slow the overall rate of rising healthcare costs. This single change in pharmaceutical benefit design immediately made critical brand-name drugs available to most Pitney Bowes employees and their covered dependents for 10% coinsurance, the same coinsurance level as for generic drugs, versus the previous cost share of 25% to 50%. After 2 to 3 years, preliminary results in plan participants with diabetes indicate that medication possession rates have increased significantly, use of fixed-combination drugs has increased (possibly related to easier adherence), average total pharmacy costs have decreased by 7%, and emergency department visits have decreased by 26%. Hospital admission rates, although increasing slightly, remain below the demographically adjusted Medstat benchmark. Overall direct healthcare costs per plan participant with diabetes decreased by 6%. In addition, the rate of increase in overall per-plan-participant health costs at Pitney Bowes has slowed markedly, with net per-plan-participant costs in 2003 at about 4000 dollars per year versus 6500 dollars for the industry benchmark. This recent moderation in overall corporate health costs may be related to these strategic changes in drug benefit design for diabetes, asthma, and hypertension and also to ongoing enhancements in the company's disease

Reducing the cost of administrative justice

International Nuclear Information System (INIS)

Tourtellotte, J.R.

1982-01-01

In virtually every sector of government regulation, the complaint has been lodged that the costs of administrative justice are too high. These costs in time, money, resources, and productivity can have a profound effect on the individual consumer. When applied to an energy technology such as nuclear power, costs of administrative justice can transcent time and money to have even more profound and pervasive soeietal effects. Societal costs can be expressed in terms of their impact on important national concerns, that is, the standard of living, technological superiority, and the national energy equation. Some views are presented on the interests involved in the regulation of nuclear power and what can be done to bring those interests into better balance so as to reduce the cost of administrative justice

The ITER reduced cost design

International Nuclear Information System (INIS)

Aymar, R.

2000-01-01

Six years of joint work under the international thermonuclear experimental reactor (ITER) EDA agreement yielded a mature design for ITER which met the objectives set for it (ITER final design report (FDR)), together with a corpus of scientific and technological data, large/full scale models or prototypes of key components/systems and progress in understanding which both validated the specific design and are generally applicable to a next step, reactor-oriented tokamak on the road to the development of fusion as an energy source. In response to requests from the parties to explore the scope for addressing ITER's programmatic objective at reduced cost, the study of options for cost reduction has been the main feature of ITER work since summer 1998, using the advances in physics and technology databases, understandings, and tools arising out of the ITER collaboration to date. A joint concept improvement task force drawn from the joint central team and home teams has overseen and co-ordinated studies of the key issues in physics and technology which control the possibility of reducing the overall investment and simultaneously achieving the required objectives. The aim of this task force is to achieve common understandings of these issues and their consequences so as to inform and to influence the best cost-benefit choice, which will attract consensus between the ITER partners. A report to be submitted to the parties by the end of 1999 will present key elements of a specific design of minimum capital investment, with a target cost saving of about 50% the cost of the ITER FDR design, and a restricted number of design variants. Outline conclusions from the work of the task force are presented in terms of physics, operations, and design of the main tokamak systems. Possible implications for the way forward are discussed

The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.

Directory of Open Access Journals (Sweden)

Delphine Hu

Full Text Available BACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS: We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE: Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency

Metaldyne: Plant-Wide Assessment at Royal Oak Finds Opportunities to Improve Manufacturing Efficiency, Reduce Energy Use, and Achieve Significant Cost Savings

Energy Technology Data Exchange (ETDEWEB)

2005-05-01

This case study prepared for the U.S. Department of Energy's Industrial Technologies Program describes a plant-wide energy assessment conducted at the Metaldyne, Inc., forging plant in Royal Oak, Michigan. The assessment focused on reducing the plant's operating costs, inventory, and energy use. If the company were to implement all the recommendations that came out of the assessment, its total annual energy savings for electricity would be about 11.5 million kWh and annual cost savings would be $12.6 million.

Device interactions in reducing the cost of tidal stream energy

International Nuclear Information System (INIS)

Vazquez, A.; Iglesias, G.

2015-01-01

Highlights: • Numerical modelling is used to estimate the levelised cost of tidal stream energy. • As a case study, a model of Lynmouth (UK) is implemented and successfully validated. • The resolution of the model allows the demarcation of individual devices on the model grid. • Device interactions reduce the available tidal resource and the cost increases significantly. - Abstract: The levelised cost of energy takes into account the lifetime generated energy and the costs associated with a project. The objective of this work is to investigate the effects of device interactions on the energy output and, therefore, on the levelised cost of energy of a tidal stream project, by means of numerical modelling. For this purpose, a case study is considered: Lynmouth (North Devon, UK), an area in the Bristol Channel in which the first tidal stream turbine was installed − a testimony of its potential as a tidal energy site. A state-of-the-art hydrodynamics model is implemented on a high-resolution computational grid, which allows the demarcation of the individual devices. The modification to the energy output resulting from interaction between turbines within the tidal farm is thus resolved for each individual turbine. The results indicate that significant changes in the levelised cost of energy values, of up to £0.221 kW h −1 , occur due to the aforementioned modifications, which should not be disregarded if the cost of tidal stream energy is to be minimised

Improving performance and reducing costs of cooling towers

International Nuclear Information System (INIS)

Bartz, J.A.

1992-01-01

Cooling towers represent a significant capital investment at a steam electric power station. In addition, deficiencies in thermal performance can result in major operating penalties of fuel cost, replacement energy, and capacity addition. This paper summarizes two recent EPRI research projects aimed at reducing thermal performance deficiencies and decreasing installed costs of evaporative cooling towers. First, EPRI Research Project 2113, Cooling Tower Performance Prediction and Improvement, is summarized. This project has resulted in published data sets on the measured thermal performance characteristics of a variety of cooling tower packings, computer codes to predict tower performance, and computer code validation through large-scale tower performance measurements. Principal results are contained in an EPRIGEMS software module, Cooling Tower Advisor. This PC- based software contains a tutorial plus codes to predict tower thermal performance, arranged in a user-friendly format. The second EPRI effort, Research Project 2819-10/11, Fabric Structures for Power Plant Applications, has resulted in designs and costs of large structures with shells constructed of recently-developed fabrics. Primary power plant applications for such structures are the shells of natural draft cooling towers and coal-pile covers. Fabric structures offer low initial cost, acceptable life, and seismic superiority, among other advantages. Detailed conceptual designs and installed cost data are reviewed. 8 refs., 9 figs., 3 tabs

The role of information technology (IT) in reducing offshore operating costs

International Nuclear Information System (INIS)

Stern, M.J.

1993-01-01

The rapid changes in information technology (IT) and its application have helped to improve efficiency and reduce operating costs offshore. Developments in IT itself, in terms of technology, organization and standards together with cultural change have created new opportunities. In the application of IT, the most significant impact on operations costs and effectiveness has come from the use of information throughout the life cycle, and improved telecommunications. This paper describes recent developments in IT and its application, and cites examples where oil companies have derived major benefits

Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

Science.gov (United States)

Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

2015-08-01

To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

Manual for Reducing Educational Unit Costs in Latin American Countries.

Science.gov (United States)

Centro Multinacional de Investigacion Educativa, San Jose (Costa Rica).

Designed for educational administrators, this manual provides suggestions for reducing educational unit costs in Latin America without reducing the quality of the education. Chapter one defines unit cost concepts and compares the costs of the Latin American countries. Chapter two deals with the different policies which could affect the principal…

Using preventive home monitoring to reduce hospital admission rates and reduce costs

DEFF Research Database (Denmark)

Dinesen, Birthe Irene; Haesum, Lisa K E; Soerensen, Natascha

2012-01-01

We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health centre, general practitioner (GP) or the pulmonary hospital ward....... They were randomized to usual care or tele-rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to follow...... of admissions was €3461 per patient in the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls, but the difference was not significant. Future work requires...

Reducing maintenance costs

International Nuclear Information System (INIS)

Zaiss, W.; Reuschle, K.; Baier, B.

2002-01-01

The increasingly more expensive maintenance measures, cuts in the cost budget, and the loss of know-how on the part of vendors all require a change of policy with respect to maintenance concepts of the part of operators. This also applies to the existing valve concepts, the drives included. Under these aspects, the current drive, which is self-actuated and actuated by outside media, for a parallel-plate valve of a nomial width of 700 was reconsidered. The effort served to reduce maintenance costs and, at the same time, simplify the drive concept as well as cut back on the number of in-service inspections. Moreover, the number of active components were to be minimized and installation conditions in the plant were to be improved. When the boundary conditions to be observed with respect to process technology had been laid down, the competent technical department developed a concept of modification of the drive. A major constituent part was the demonstration of the functioning capability of the new drive under accident conditions. It was achieved mainly by an analytical approach. In the resultant drive concept, the same control valves are employed to actuate a driving cylinder by means of self-actuation or by an outside medium as a function of pressure. (orig.) [de

Reducing Interaction Costs for Self-interested Agents

Science.gov (United States)

Zhang, Yunqi; Larson, Kate

In many multiagent systems, agents are not able to freely interact with each other or with a centralized mechanism. They may be limited in their interactions by cost or by the inherent structure of the system. Using a combinatorial auction application as motivation, we study the impact of interaction costs and structure on the strategic behaviour of self-interested agents. We present a particular model of costly agent-interaction, and argue that self-interested agents may wish to coordinate their actions with their neighbours so as to reduce their individual costs. We highlight the issues that arise in such a setting, propose a cost-sharing mechanism that agents can use, and discuss group coordination procedures. Experimental work validates our model.

Reducing the length of postnatal hospital stay: implications for cost and quality of care.

Science.gov (United States)

Bowers, John; Cheyne, Helen

2016-01-15

UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing the length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. Although average length of stay on the postnatal ward has fallen substantially over the years there is pressure to make still further reductions. This paper explores and discusses the possible cost savings of further reductions in length of stay, the consequences for postnatal services in the community, and the impact on quality of care. We draw on a range of pre-existing data sources including, national level routinely collected data, workforce planning data and data from national surveys of women's experience. Simulation and a financial model were used to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay. These data are discussed in relation to findings of national surveys to draw inferences about potential impacts on cost and quality of care. Reducing the length of time women spend in hospital after birth implies that staff and bed numbers can be reduced. However, the cost savings may be reduced if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Furthermore, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. This might still be a significant saving over a high volume service however, earlier discharge results in more women and babies with significant care needs at home. Quality

Autonomous Droop Scheme With Reduced Generation Cost

DEFF Research Database (Denmark)

Nutkani, Inam Ullah; Loh, Poh Chiang; Wang, Peng

2014-01-01

) of the microgrid. To reduce this TGC without relying on fast communication links, an autonomous droop scheme is proposed here, whose resulting power sharing is decided by the individual DG generation costs. Comparing it with the traditional scheme, the proposed scheme retains its simplicity and it is hence more....... This objective might, however, not suit microgrids well since DGs are usually of different types, unlike synchronous generators. Other factors like cost, efficiency, and emission penalty of each DG at different loading must be considered since they contribute directly to the total generation cost (TGC...

A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience.

Science.gov (United States)

Cavarocchi, N C; Wallace, S; Hong, E Y; Tropea, A; Byrne, J; Pitcher, H T; Hirose, H

2015-03-01

The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes. A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared. During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events. We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes. © The Author(s) 2014.

Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs.

Science.gov (United States)

Yarbrough, Peter M; Kukhareva, Polina V; Horton, Devin; Edholm, Karli; Kawamoto, Kensaku

2016-05-01

Inappropriate laboratory testing is a contributor to waste in healthcare. To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. A retrospective, controlled, interrupted time series (ITS) study. University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Costs of reducing nutrient losses in Denmark

DEFF Research Database (Denmark)

Jacobsen, Brian H.; Abildtrup, Jens; Jensen, Jørgen Dejgård

to the eastern part of Denmark. The final plan for the Aquatic Environment III from 2004 included a 13% reduction of N-leaching until 2015 based on cost effective administrative measures like wetlands and catch crops. Also a tax on mineral phosphorus in feedstuffs was included in order to half the phosphorus......The economic calculations carried out prior to the Plan for the Aquatic Environment III included a comparison of regulation systems aimed at reducing nitrogen leaching, analyses of measures for reducing phosphorus losses and estimation of administrative costs. The conclusions were that taxation...... surplus. The measures in the Plan will have to be supplemented by more measures to meet the targets in the EU's Water Framework Directive....

Optimizing power plant cycling operations while reducing generating plant damage and costs

Energy Technology Data Exchange (ETDEWEB)

Lefton, S A; Besuner, P H; Grimsrud, P [Aptech Engineering Services, Inc., Sunnyvale, CA (United States); Bissel, A [Electric Supply Board, Dublin (Ireland)

1999-12-31

This presentation describes a method for analyzing, quantifying, and minimizing the total cost of fossil, combined cycle, and pumped hydro power plant cycling operation. The method has been developed, refined, and applied during engineering studies at some 160 units in the United States and 8 units at the Irish Electric Supply Board (ESB) generating system. The basic premise of these studies was that utilities are underestimating the cost of cycling operation. The studies showed that the cost of cycling conventional boiler/turbine fossil power plants can range from between $2,500 and $500,000 per start-stop cycle. It was found that utilities typically estimate these costs by factors of 3 to 30 below actual costs and, thus, often significantly underestimate their true cycling costs. Knowledge of the actual, or total, cost of cycling will reduce power production costs by enabling utilities to more accurately dispatch their units to manage unit life expectancies, maintenance strategies and reliability. Utility management responses to these costs are presented and utility cost savings have been demonstrated. (orig.) 7 refs.

Optimizing power plant cycling operations while reducing generating plant damage and costs

Energy Technology Data Exchange (ETDEWEB)

Lefton, S.A.; Besuner, P.H.; Grimsrud, P. [Aptech Engineering Services, Inc., Sunnyvale, CA (United States); Bissel, A. [Electric Supply Board, Dublin (Ireland)

1998-12-31

This presentation describes a method for analyzing, quantifying, and minimizing the total cost of fossil, combined cycle, and pumped hydro power plant cycling operation. The method has been developed, refined, and applied during engineering studies at some 160 units in the United States and 8 units at the Irish Electric Supply Board (ESB) generating system. The basic premise of these studies was that utilities are underestimating the cost of cycling operation. The studies showed that the cost of cycling conventional boiler/turbine fossil power plants can range from between $2,500 and $500,000 per start-stop cycle. It was found that utilities typically estimate these costs by factors of 3 to 30 below actual costs and, thus, often significantly underestimate their true cycling costs. Knowledge of the actual, or total, cost of cycling will reduce power production costs by enabling utilities to more accurately dispatch their units to manage unit life expectancies, maintenance strategies and reliability. Utility management responses to these costs are presented and utility cost savings have been demonstrated. (orig.) 7 refs.

Costs of emission-reducing manure application

NARCIS (Netherlands)

Huijsmans, J.F.M.; Verwijs, B.; Rodhe, L.; Smith, K.

2004-01-01

Favourable economics of handling and application of manure are of fundamental importance to encourage the implementation of emission-reducing application techniques. The economics of manure application depend on the costs of the equipment and the time to carry out the field operation. In this study

Reducing capital and operating costs in gas processing, liquefaction, and storage

Energy Technology Data Exchange (ETDEWEB)

Krusen, III, L C [Phillips Petroleum Co., Bartlesville, OK (United States). Research Div.

1997-06-01

The LNG industry is unanimous that capital costs must be reduced throughout the chain, and especially at the liquefaction facility including associated gas processing and LNG storage. The Ken ai LNG plant provides an example of how both reduced capital and operating costs were attained. This paper will cover cost production strategies that can be applied to liquefaction processes in general, and will than focus on their realization in the Phillips Optimized Cascade LNG process. The paper concludes that reduced LNG plant costs are attainable. (Author).

Reducing capital and operating costs in gas processing, liquefaction, and storage

International Nuclear Information System (INIS)

Krusen, L.C. III

1997-01-01

The LNG industry is unanimous that capital costs must be reduced throughout the chain, and especially at the liquefaction facility including associated gas processing and LNG storage. The Ken ai LNG plant provides an example of how both reduced capital and operating costs were attained. This paper will cover cost production strategies that can be applied to liquefaction processes in general, and will than focus on their realization in the Phillips Optimized Cascade LNG process. The paper concludes that reduced LNG plant costs are attainable. (Author)

Reducing Design Cycle Time and Cost Through Process Resequencing

Science.gov (United States)

Rogers, James L.

2004-01-01

In today's competitive environment, companies are under enormous pressure to reduce the time and cost of their design cycle. One method for reducing both time and cost is to develop an understanding of the flow of the design processes and the effects of the iterative subcycles that are found in complex design projects. Once these aspects are understood, the design manager can make decisions that take advantage of decomposition, concurrent engineering, and parallel processing techniques to reduce the total time and the total cost of the design cycle. One software tool that can aid in this decision-making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). The DeMAID software minimizes the feedback couplings that create iterative subcycles, groups processes into iterative subcycles, and decomposes the subcycles into a hierarchical structure. The real benefits of producing the best design in the least time and at a minimum cost are obtained from sequencing the processes in the subcycles.

Making renewable energy competitive in India: Reducing financing costs via a government-sponsored hedging facility

International Nuclear Information System (INIS)

Farooquee, Arsalan Ali; Shrimali, Gireesh

2016-01-01

In India, a significant barrier to market-competitiveness of renewable energy is a shortage of attractive debt. Domestic debt has high cost, short tenors, and variable interest rates, adding 30% to the cost of renewable energy compared to renewable energy projects elsewhere. Foreign debt is as expensive as domestic debt because it requires costly market-based currency hedging solutions. We investigate a government-sponsored foreign exchange facility as an alternative to reducing hedging costs. Using the geometric Brownian motion (GBM) as a representative stochastic model of the INR–USD foreign exchange rate, we find that the expected cost of providing a currency hedge via this facility is 3.5 percentage points, 50% lower than market. This leads to an up to 9% reduction in the per unit cost of renewable energy. However, this requires the government to manage the risks related to unexpected currency movements appropriately. One option to manage these risks is via a capital buffer; for the facility to obtain India's sovereign rating, the capital buffer would need to be almost 30% of the underlying loan. Our findings have significant policy implications given that the Indian government can use this facility to make renewable energy more competitive and, therefore, hasten its deployment. - Highlights: • We analyze a government-sponsored foreign exchange facility in India. •We use geometric Brownian motion to represent the INR–USD exchange rate. •This facility can reduce the currency hedging costs by 50%. •This facility can reduce the levelized cost of renewable energy by 9%. •The capital buffer to reach India's sovereign rating is 30% of the original loan.

Cost-effectiveness of pharmacotherapy to reduce obesity.

Directory of Open Access Journals (Sweden)

J Lennert Veerman

Full Text Available AIMS: Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. METHODS: We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs below A$50 000 per Disability Adjusted Life Year (DALY averted are considered good value for money. RESULTS: The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000 for sibutramine and A$230 000/DALY (170 000-340 000 for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. CONCLUSIONS: Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking

Science.gov (United States)

Malcolm, Philippe; Derave, Wim; Galle, Samuel; De Clercq, Dirk

2013-01-01

Background Even though walking can be sustained for great distances, considerable energy is required for plantarflexion around the instant of opposite leg heel contact. Different groups attempted to reduce metabolic cost with exoskeletons but none could achieve a reduction beyond the level of walking without exoskeleton, possibly because there is no consensus on the optimal actuation timing. The main research question of our study was whether it is possible to obtain a higher reduction in metabolic cost by tuning the actuation timing. Methodology/Principal Findings We measured metabolic cost by means of respiratory gas analysis. Test subjects walked with a simple pneumatic exoskeleton that assists plantarflexion with different actuation timings. We found that the exoskeleton can reduce metabolic cost by 0.18±0.06 W kg−1 or 6±2% (standard error of the mean) (p = 0.019) below the cost of walking without exoskeleton if actuation starts just before opposite leg heel contact. Conclusions/Significance The optimum timing that we found concurs with the prediction from a mathematical model of walking. While the present exoskeleton was not ambulant, measurements of joint kinetics reveal that the required power could be recycled from knee extension deceleration work that occurs naturally during walking. This demonstrates that it is theoretically possible to build future ambulant exoskeletons that reduce metabolic cost, without power supply restrictions. PMID:23418524

Reducing health care costs - potential and limitations of local ...

African Journals Online (AJOL)

Reducing health care costs - potential and limitations of local authority health services. ... both the quality and the cost-effectiveness of health care would be improved. ... LAs offer an appropriate structure for effective community control over the ...

Cost reducing investments and spatial competition

OpenAIRE

Domenico Scalera; Alberto Zazzaro

2005-01-01

In this paper we analyze the relationship between competition and cost reducing investments in the context of a location model. In particular, we derive the symmetric subgame-perfect equilibrium of a three-stage circular city model with closed-loop strategies, and study the effects of changes in competition fundamentals under both a given number of firms and free entry

The Dynamics of Bertrand Price Competition with Cost-Reducing Investments

DEFF Research Database (Denmark)

Iskhakov, Fedor; Rust, John; Schjerning, Bertel

We present a dynamic extension of the classic static model of Bertrand price competition that allows competing duopolists to undertake cost-reducing investments in an attempt to “leapfrog” their rival to attain low-cost leadership – at least temporarily. We show that leapfrogging occurs in equili......We present a dynamic extension of the classic static model of Bertrand price competition that allows competing duopolists to undertake cost-reducing investments in an attempt to “leapfrog” their rival to attain low-cost leadership – at least temporarily. We show that leapfrogging occurs...... in equilibrium, resolving the Bertrand investment paradox., i.e. leapfrogging explains why firms have an ex ante incentive to undertake cost-reducing investments even though they realize that simultaneous investments to acquire the state of the art production technology would result in Bertrand price competition...... leader. We show that the equilibrium involves investment preemption only when the firms invest in a deterministically alternating fashion and technological progress is deterministic. We prove that when technological progress is deterministic and firms move in an alternating fashion, the game has a unique...

Using performance indicators to reduce cost uncertainty of China's CO2 mitigation goals

International Nuclear Information System (INIS)

Xu, Yuan

2013-01-01

Goals on absolute emissions and intensity play key roles in CO 2 mitigation. However, like cap-and-trade policies with price uncertainty, they suffer from significant uncertainty in abatement costs. This article examines whether an indicator could be established to complement CO 2 mitigation goals and help reduce cost uncertainty with a particular focus on China. Performance indicators on CO 2 emissions per unit of energy consumption could satisfy three criteria: compared with the mitigation goals, (i) they are more closely associated with active mitigation efforts and (ii) their baselines have more stable projections from historical trajectories. (iii) Their abatement costs are generally higher than other mitigation methods, particularly energy efficiency and conservation. Performance indicators could be used in the following way: if a CO 2 goal on absolute emissions or intensity is attained, the performance indicator should still reach a lower threshold as a cost floor. If the goal cannot be attained, an upper performance threshold should be achieved as a cost ceiling. The narrower cost uncertainty may encourage wider and greater mitigation efforts. - Highlights: ► CO 2 emissions per unit of energy consumption could act as performance indicators. ► Performance indicators are more closely related to active mitigation activities. ► Performance indicators have more stable historical trajectories. ► Abatement costs are higher for performance indicators than for other activities. ► Performance thresholds could reduce the cost uncertainty of CO 2 mitigation goals.

Optimum value engineering and integrated design methods for reducing the cost of R-2000 houses

Energy Technology Data Exchange (ETDEWEB)

Proskiw, G. [Proskiw Engineering Ltd., Winnipeg, MB (Canada); Parekh, A. [Natural Resources Canada, Ottawa, ON (Canada)

2009-07-01

Opportunities exist to reduce the incremental cost of R-2000 construction by using optimum value engineering (OVE) and integrated design (ID) techniques. OVE is a construction philosophy in which components and systems are designed to meet their intended purposes without excessive or unnecessary use of resources. This paper summarized a study that was designed to identify opportunities for reducing the costs of R-2000 houses while improving their performance. These included detailed energy and cost analysis of various OVE/ID options which were then applied to a sample of 18 representative new home designs from British Columbia, Manitoba, and New Brunswick. The paper described the OVE/ID measures studied, cost analysis, measure utilization and energy analysis. It also included a detailed discussion of individual OVE/ID measures. Examples of some of these measures were the elimination of floor system cross-bridging; support of non-load bearing partition walls; engineered wood beams; drywall clips at corners; and non-load bearing partition walls. It was concluded that significant opportunities exist to reduce the incremental cost of R-2000 houses through careful application of OVE and ID practices. 5 refs., 4 tabs., 1 fig.

Reducing the Cost of Grid Extension for Rural Electrification

OpenAIRE

NRECA International, Ltd.

2000-01-01

This study first reviews the cost of grid extension in a number of countries. It then identifies ways to reduce costs by examining how they are affected by a variety of factors. An electricity supply system may be divided into two discrete components: the grid extension and the low-voltage distribution system. This study will focus on the first of these two components, the cost of grid ext...

DEMAND ILLUSION AS A WAY TO REDUCE COSTS

Directory of Open Access Journals (Sweden)

Kirill N. Sosnovskij

2014-01-01

Full Text Available Article devoted to a technique that reduces costs to retailers, as well as increase the speed of discounted products. This article deals with the laws of visual merchandising that have a significant impact on the implementation of the company’s products. The analysis of the first law, with the subsequent introduction into it of a new additional method. Consider the effect of «Illusion of deficit» arising from the application of the proposed method. The article also defines the basic hypothesis of the existence of methods and effect, and the conditions for their effective implementation. To confirm the effectiveness of the developed method, quantitative surveys are conducted for different age groups creating situational model, which allows respondents to feel as a consumer.

Reducing Development and Operations Costs using NASA's "GMSEC" Systems Architecture

Science.gov (United States)

Smith, Dan; Bristow, John; Crouse, Patrick

2007-01-01

This viewgraph presentation reviews the role of Goddard Mission Services Evolution Center (GMSEC) in reducing development and operation costs in handling the massive data from NASA missions. The goals of GMSEC systems architecture development are to (1) Simplify integration and development, (2)Facilitate technology infusion over time, (3) Support evolving operational concepts, and (4) All for mix of heritage, COTS and new components. First 3 missions (i.e., Tropical Rainforest Measuring Mission (TRMM), Small Explorer (SMEX) missions - SWAS, TRACE, SAMPEX, and ST5 3-Satellite Constellation System) each selected a different telemetry and command system. These results show that GMSEC's message-bus component-based framework architecture is well proven and provides significant benefits over traditional flight and ground data system designs. The missions benefit through increased set of product options, enhanced automation, lower cost and new mission-enabling operations concept options .

Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team.

Science.gov (United States)

Arana, Melissa; Harper, Licia; Qin, Huanying; Mabrey, Jay

The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.

Green roofs: roof system reducing heating and cooling costs

Directory of Open Access Journals (Sweden)

Konasova, Sarka

2016-06-01

Full Text Available Green roofs are among the passive building systems that contribute to the thermal stability of the rooms under the roof in both summer and winter. Green roofs can provide a significant contribution to the thermal balance of the protected space. Over the past ten years, many studies have been carried out to investigate the energy benefits of green roofs in terms of the energy performance of buildings. These studies show that the installation of vegetated cover can achieve energy savings for both winter heating and summer cooling. The green roof, as a thermal insulation, reduces the amount of building operating energy costs and reduces heat losses. This article summarizes current literature and points to situations in which green roofs can play an important role in saving energy for heating and cooling due to improved thermal insulating function of the roof, in case of extensive vegetation coverage without significant overloading of the roof structure and associated over-dimensioning. It is important to note that these energy savings always depend on the particular climate, the type of building and the availability and the type of roof structure.

Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?

Science.gov (United States)

Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca

2016-04-01

Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (Pcosts were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

Sucralfate significantly reduces ciprofloxacin concentrations in serum.

OpenAIRE

Garrelts, J C; Godley, P J; Peterie, J D; Gerlach, E H; Yakshe, C C

1990-01-01

The effect of sucralfate on the bioavailability of ciprofloxacin was evaluated in eight healthy subjects utilizing a randomized, crossover design. The area under the concentration-time curve from 0 to 12 h was reduced from 8.8 to 1.1 micrograms.h/ml by sucralfate (P less than 0.005). Similarly, the maximum concentration of ciprofloxacin in serum was reduced from 2.0 to 0.2 micrograms/ml (P less than 0.005). We conclude that concurrent ingestion of sucralfate significantly reduces the concentr...

Strategies Used by Adults to Reduce Their Prescription Drug Costs

Science.gov (United States)

... data from the 2011 National Health Interview Survey (NHIS). Keywords: National Health Interview Survey, alternative therapies, medication ... to cost ( 9 ) that are not measured in NHIS. Definitions Strategies for reducing prescription drug costs : Based ...

Do Statins Reduce the Health and Health Care Costs of Obesity?

Science.gov (United States)

Gaudette, Étienne; Goldman, Dana P; Messali, Andrew; Sood, Neeraj

2015-07-01

Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae. Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins. Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %. Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

Estimating the marginal cost of reducing global fossil fuel CO2 emissions

International Nuclear Information System (INIS)

Edmonds, J.; Barns, D.W.; McDonald, S.

1992-01-01

This paper estimates the marginal, total, and average cost and effectiveness of carbon taxes applied either by the Organization for Economic Cooperation and Development (OECD) members alone, or as part of a global cooperative strategy, to reduce potential future emissions and their direct implications for employment in the US coal industry. Two sets of cases are examined, one set in which OECD members acts alone, and another set in which the world acts in concert. In each case set taxes are examined which achieve four alternative levels of emissions reduction: halve the rate of emissions growth, no emissions growth, 20% reduction from 1988 levels, and 50% reduction from 1988 levels. For the global cooperation case, carbon tax rates of $32, $113, $161, and $517 per metric ton of carbon (mtC) were needed in the year 2025 to achieve the objectives. Total costs were respectively $40, $178, $253, and $848 billions of 1990 US dollars per year in the year 2025. Average costs were $32, $55, $59, and $135 per mtC. Costs were significantly higher in the cases in which the OECD members states acted alone. OECD member states, acting alone, could not reduce global emissions by 50% or 20% relative to 1988, given reference case assumptions regarding developing and recently planned nations economic growth

Are the Costs of Reducing Greenhouse Gases from Passenger Vehicles Negative?

OpenAIRE

Parry, Ian W.H.

2006-01-01

Energy models suggest that the cost of reducing carbon emissions from the transportation sector is high relative to other sectors, such as electricity generation. However, this paper shows that taxes to reduce passenger vehicle emissions produce large net benefits, rather than costs, when account is taken of (a) their impact on reducing non-carbon externalities from passenger vehicle use, and (b) interactions with the broader fiscal system. Both of these considerations also strengthen the cas...

Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes.

Science.gov (United States)

Richardson, Michael T; Backhus, Leah M; Berry, Mark F; Vail, Daniel G; Ayers, Kelsey C; Benson, Jalen A; Bhandari, Prasha; Teymourtash, Mehran; Shrager, Joseph B

2018-03-01

To determine whether surgeon selection of instrumentation and other supplies during video-assisted thoracoscopic lobectomy (VATSL) can safely reduce intraoperative costs. In this retrospective, cost-focused review of all video-assisted thoracoscopic surgery anatomic lung resections performed by 2 surgeons at a single institution between 2010 and 2014, we compared VATSL hospital costs and perioperative outcomes between the surgeons, as well as costs of VATSL compared with thoracotomy lobectomy (THORL). A total of 100 VATSLs were performed by surgeon A, and 70 were performed by surgeon B. The preoperative risk factors did not differ significantly between the 2 groups of surgeries. Mean VATSL total hospital costs per case were 24% percent greater for surgeon A compared with surgeon B (P = .0026). Intraoperative supply costs accounted for most of this cost difference and were 85% greater for surgeon A compared with surgeon B (P costs, accounting for 55% of the difference in intraoperative supply costs between the surgeons. Operative time was 25% longer for surgeon A compared with surgeon B (P accounted for only 11% of the difference in total cost. Surgeon A's overall VATSL costs per case were similar to those of THORLs (n = 100) performed over the same time period, whereas surgeon B's VATSL costs per case were 24% less than those of THORLs. On adjusted analysis, there was no difference in VATSL perioperative outcomes between the 2 surgeons. The costs of VATSL differ substantially among surgeons and are heavily influenced by the use of disposable equipment/devices. Surgeons can substantially reduce the costs of VATSL to far lower than those of THORL without compromising surgical outcomes through prudent use of costly instruments and technologies. Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.

New transmission interconnection reduces consumer costs

Energy Technology Data Exchange (ETDEWEB)

Anon.

2008-09-15

The Central American electric interconnection system (SIEPAC) project will involve the construction of a 1830 km 230 kV transmission system that will link Guatemala, El Salvador, Honduras, Costa Rica, Nicaragua, and Panama. The system is expected to alleviate the region's power shortages and reduce electricity costs for consumers. Costs for the SIEPAC project have been estimated at $370 million. The system will serve approximately 37 million customers, and will include 15 substations. The contract for building the electrical equipment has been awarded to Schweitzer Engineering Laboratories (SEL) who plan to manufacture components at a plant in Mexico. The equipment will include high speed line protection, automation, and control systems. Line current differential systems and satellite-synchronized clocks will also be used. The new transmission system is expected to be fully operational by 2009. 1 fig.

Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males.

Directory of Open Access Journals (Sweden)

Stephanie L Sansom

Full Text Available BACKGROUND: HIV incidence was substantially lower among circumcised versus uncircumcised heterosexual African men in three clinical trials. Based on those findings, we modeled the potential effect of newborn male circumcision on a U.S. male's lifetime risk of HIV, including associated costs and quality-adjusted life-years saved. METHODOLOGY/PRINCIPAL FINDINGS: Given published estimates of U.S. males' lifetime HIV risk, we calculated the fraction of lifetime risk attributable to heterosexual behavior from 2005-2006 HIV surveillance data. We assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime, and varied efficacy in sensitivity analyses. We calculated differences in lifetime HIV risk, expected HIV treatment costs and quality-adjusted life years (QALYs among circumcised versus uncircumcised males. The main outcome measure was cost per HIV-related QALY saved. Circumcision reduced the lifetime HIV risk among all males by 15.7% in the base case analysis, ranging from 7.9% for white males to 20.9% for black males. Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males. The net cost of newborn circumcision per QALY saved was $87,792 for white males. Results were most sensitive to the discount rate, and circumcision efficacy and cost. CONCLUSIONS/SIGNIFICANCE: Newborn circumcision resulted in lower expected HIV-related treatment costs and a slight increase in QALYs. It reduced the 1.87% lifetime risk of HIV among all males by about 16%. The effect varied substantially by race and ethnicity. Racial and ethnic groups who could benefit the most from circumcision may have least access to it due to insurance coverage and state Medicaid policies, and these financial barriers should be addressed. More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful.

Fitness costs of animal medication: antiparasitic plant chemicals reduce fitness of monarch butterfly hosts.

Science.gov (United States)

Tao, Leiling; Hoang, Kevin M; Hunter, Mark D; de Roode, Jacobus C

2016-09-01

The emerging field of ecological immunology demonstrates that allocation by hosts to immune defence against parasites is constrained by the costs of those defences. However, the costs of non-immunological defences, which are important alternatives to canonical immune systems, are less well characterized. Estimating such costs is essential for our understanding of the ecology and evolution of alternative host defence strategies. Many animals have evolved medication behaviours, whereby they use antiparasitic compounds from their environment to protect themselves or their kin from parasitism. Documenting the costs of medication behaviours is complicated by natural variation in the medicinal components of diets and their covariance with other dietary components, such as macronutrients. In the current study, we explore the costs of the usage of antiparasitic compounds in monarch butterflies (Danaus plexippus), using natural variation in concentrations of antiparasitic compounds among plants. Upon infection by their specialist protozoan parasite Ophryocystis elektroscirrha, monarch butterflies can selectively oviposit on milkweed with high foliar concentrations of cardenolides, secondary chemicals that reduce parasite growth. Here, we show that these antiparasitic cardenolides can also impose significant costs on both uninfected and infected butterflies. Among eight milkweed species that vary substantially in their foliar cardenolide concentration and composition, we observed the opposing effects of cardenolides on monarch fitness traits. While high foliar cardenolide concentrations increased the tolerance of monarch butterflies to infection, they reduced the survival rate of caterpillars to adulthood. Additionally, although non-polar cardenolide compounds decreased the spore load of infected butterflies, they also reduced the life span of uninfected butterflies, resulting in a hump-shaped curve between cardenolide non-polarity and the life span of infected butterflies

Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work.

Science.gov (United States)

Bregman, D J J; Harlaar, J; Meskers, C G M; de Groot, V

2012-01-01

In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the AFO in late stance will support ankle push-off, and reduce the energy cost of walking. In 10 patients with multiple sclerosis and stroke the energy cost of walking, 3D kinematics, joint power, and joint work were measured during gait, with and without the AFO. The mechanical characteristics of the AFO were measured separately, and used to calculate the contribution of the AFO to the ankle kinetics. We found a significant decrease of 9.8% in energy cost of walking when walking with the AFO. With the AFO, the range of motion of the ankle was reduced by 12.3°, and the net work around the ankle was reduced by 29%. The total net work in the affected leg remained unchanged. The AFO accounted for 60% of the positive ankle work, which reduced the total amount of work performed by the leg by 11.1% when walking with the AFO. The decrease in energy cost when walking with a spring-like energy-storing AFO in central neurological patients is not induced by an augmented net ankle push-off, but by the AFO partially taking over ankle work. Copyright © 2011 Elsevier B.V. All rights reserved.

Effect of reducing cost sharing for outpatient care on children's inpatient services in Japan.

Science.gov (United States)

Kato, Hirotaka; Goto, Rei

2017-08-15

Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children's healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

Reducing Reforestation Costs in Lebanon: Adaptive Field Trials

Directory of Open Access Journals (Sweden)

Garabet (Garo Haroutunian

2017-05-01

Full Text Available Lebanon’s Ministry of Environment initiated a project in 2009 to determine low-cost reforestation techniques for stone pine (Pinus pinea and Lebanon cedar (Cedrus libani for large-scale land rehabilitation activities in the arid Middle East. Irrigation (several techniques vs. no water, planting (8- to 18-month-old seedlings, seeding, and soil preparation methods were evaluated in three sets of adaptive management field trials. The aim was to reduce reforestation costs while still achieving sufficient regeneration. A key result for management was that non-irrigated seed planting of stone pine and possibly of Lebanon cedar showed promise for cost-effective reforestation and could be competitive with seedlings, given correct seed source and planting conditions. Stone pine seeds collected from nearby mother trees and planted without irrigation on sandy soil showed 35% survival for <600 USD/ha; seedlings planted without irrigation cost about 2500 USD/ha and achieved 50–70% survival (costs based on 800 seedlings/ha. Water supplements increased establishment costs over 2 years without concomitant improvements to survival. Future studies should evaluate how soil texture and soil preparation interact with other factors to affect seed germination and survival for each species.

Investing in CenteringPregnancy™ Group Prenatal Care Reduces Newborn Hospitalization Costs.

Science.gov (United States)

Crockett, Amy; Heberlein, Emily C; Glasscock, Leah; Covington-Kolb, Sarah; Shea, Karen; Khan, Imtiaz A

CenteringPregnancy™ group prenatal care is an innovative model with promising evidence of reducing preterm birth. The outpatient costs of offering CenteringPregnancy pose barriers to model adoption. Enhanced provider reimbursement for group prenatal care may improve birth outcomes and generate newborn hospitalization cost savings for insurers. To investigate potential cost savings for investment in CenteringPregnancy, we evaluated the impact on newborn hospital admission costs of a pilot incentive project, where BlueChoice Health Plan South Carolina Medicaid managed care organization paid an obstetric practice offering CenteringPregnancy $175 for each patient who participated in at least five group prenatal care sessions. Using a one to many case-control matching without replacement, each CenteringPregnancy participant was matched retrospectively on propensity score, age, race, and clinical risk factors with five individual care participants. We estimated the odds of newborn hospital admission type (neonatal intensive care unit [NICU] or well-baby admission) for matched CenteringPregnancy and individual care cohorts with four or more visits using multivariate logistic regression. Cost savings were calculated using mean costs per admission type at the delivery hospital. Of the CenteringPregnancy newborns, 3.5% had a NICU admission compared with 12.0% of individual care newborns (p Investing in CenteringPregnancy for 85 patients ($14,875) led to an estimated net savings for the managed care organization of $67,293 in NICU costs. CenteringPregnancy may reduce costs through fewer NICU admissions. Enhanced reimbursement from payers to obstetric practices supporting CenteringPregnancy sustainability may improve birth outcomes and reduce associated NICU costs. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Spatial analyses of cost efficient measures to reduce N-leaching

DEFF Research Database (Denmark)

Jacobsen, Brian H.; Abildtrup, Jens; Ørum, Jens Erik

(WFD). The analysis shows that the geographical position of the measures are very important in order to achieve the expected nutrient reduction. The current income varies a lot in the River basin and this might influence the choice of cost effective measures to reduce nutrient load. Furthermore a close......The Nitrate Directive has only been implemented satisfactorily in a few EU countries. The Commission have accepted the Danish implementation of the directive based on the Plan for the Aquatic Environment II. The costs of this plan has been calculated to 70 million € or 2,0 € per kg N in reduced...... leaching. The farmers have paid 60% of the costs. The paper then describes an example of a regional analysis covering the River Basin of Ringkøbing Fjord in Denmark, which indicates the type of calculations needed to find the measures and costs in order to comply with parts of the Water Framework Directive...

Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis.

Science.gov (United States)

John-Baptiste, A; Sowerby, L J; Chin, C J; Martin, J; Rotenberg, B W

2016-01-01

When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.

CANDU 9 - reducing capital costs through advanced construction

International Nuclear Information System (INIS)

Hedges, K.; Yu, S.; Hopwood, J.

1996-01-01

Reducing costs is a clear priority in nuclear markets where capital reaches billions and financing is hard-won. To address that priority, AECL introduced the use of advanced construction techniques. This has been one of the key thrusts behind its development of CANDU 9. (author)

Concepts of increasing productivity and reducing the processing cost of machine parts

Directory of Open Access Journals (Sweden)

О. С. Кленов

2017-06-01

Full Text Available The basic conditions to reduce the cost of processing technology and improve productivity through the use of modern cutting tools produced by leading foreign firms producing tools have been appraised from theory in the work. Theoretically, it has been found that an increase in the cost of processing varies according to extremum dependence, passing the minimum point. It is possible to reduce the minimum processing cost due to the increase of productivity using cutting edge tools, characterized by a high capacity for work in high cutting temperatures. The criterion showing the technological price cost minimum is the ratio of the expenditures on workers’ wages to the expenditures on the cutting tools, it being quite specific for various processing conditions. To analyze the possibilities of practical use of the proposed criterion, a complex of experimental researches of the technological prime cost and productivity of the processing with hard alloy cutting tools with wear-resistant coatings produced by the company «Iscar» has been carried out. It has been established that their use makes it possible by more than one half to reduce the labour consumption and overall costs as compared to the hard alloy cutting tools traditionally used in home industry. It has been shown that this effect is achieved by increasing the cutting speed and feed due to increased wear resistance and heat resistance of the «Iscar» company tools. It was established that it is much more possible to achieve low processing cost at milling than at turning. It was stated with regard to all major expenditures including the workers' wages, the cost of the cutting tools, equipment and other costs, allowing more correctly estimate the cost-effectiveness of mechanical processing. Experiments confirmed that the main condition for reducing the processing cost to its minimum value is to increase the processing performance through the use of a heat-resistant and wear-resistant cutting

A minimal cost micropropagation protocol for Dianthus caryophyllus L.-- a commercially significant venture.

Science.gov (United States)

Pant, Manu

2016-03-01

In tissue culture, high production cost of the products restricts their reach. Though tissue culture is a major strength in floriculture it is marred by pricing issues. Hence, we developed a complete regeneration low cost micropropagation protocol for an economically important floriculture crop, carnation (Dianthus caryophyllus L.). Successful regeneration of carnation from nodal explants on cost-efficient medium indicates that psyllium husk, sugar and RO water can effectively replace the conventional medium comprising agar, sucrose and distilled water. The protocol can contribute to increased carnation production at comparatively reduced cost, and there by encourage wide scale adoption by the common growers.

Reducing the cost of back-contact module technology

Energy Technology Data Exchange (ETDEWEB)

Bennett, I.J.; Eerenstein, W.; Rosca, V. [ECN Solar Energy, P.O. Box 1, 1755 ZG Petten (Netherlands)

2013-07-01

Back-contact modules made using a conductive back-sheet foil have a number of advantages over standard H-pattern modules including a higher power output, compatibility with very thin cells and high throughput, high yield manufacturing. For a conductive back-sheet based module the most cost critical components are the conductive back-sheet and the conductive adhesives used to make the contact between the cells and the conductive back-sheet. In this paper a number of methods for reducing the module materials cost will be presented. Climate chamber testing of low cost foils without isolation coating and without silver contacts demonstrated that this type of foil is reliable in damp-heat, reaching 2000 hours at 85%RH and 85{sup o}C with a loss in fill-factor of less than 2%.

Use of commercial grade item dedication to reduce procurement costs

International Nuclear Information System (INIS)

Rosch, F.

1995-01-01

In the mid-1980s, the Nuclear Regulatory Industry (NRC) began inspecting utility practices of procuring and dedicating commercial grade items intended for plant safety-related applications. As a result of the industry efforts to address NRC concerns, nuclear utilities have enhanced existing programs and procedures for dedication of commercial grade items. Though these programs were originally enhanced to meet NRC concerns, utilities have discovered that the dedication of commercial grade items can also reduce overall procurement costs. This paper will discuss the enhancement of utility dedication programs and demonstrates how utilities have utilized them to reduce procurement costs

Offshore windfarm proposal to reduce costs of foundations and installations.

Energy Technology Data Exchange (ETDEWEB)

NONE

2007-09-04

The principle aim of this project is to develop innovative pile insertion, installation vessel pile handling and pile transfer systems that reduce the installed cost per kW of offshore wind turbine foundation installation. The project was to accomplish this by first developing a novel method of handling foundation piles without the use of craneage thereby allowing long piles of 5-6m diameter to be lifted safely in shallow water. This would extend the operating envelope by allowing work to continue without the weather constraints associated with lifting heavy loads by crane. The method would eventually reduce the size of the pile installation barge resulting in reduced installation costs. This part of the project has been satisfactorily completed, resulting in an innovative pile handling technique. Secondly a nonpercussive pile insertion method would be developed suitable for large diameter piles. The targeted aims of this method are as follows: To reduce or negate the need to handle and dispose of large amounts of spoil. To eliminate the need for piling hammers large enough to drive 6m diameter piles. These would be too heavy for the present generation of offshore cranes to lift, and the rental costs exorbitant. The advantages of these aims are: A reduction in the noise pollution produced by all percussive methods of pile driving and in particular large hammers. These noise levels are unacceptable to present and future environmental constraints. Because of the reduced drill spoil being handled compared to an industry standard full face drill, the energy consumption and therefore cost, is also reduced. Owing to the high cost and risk associated with mobilising and operating the equipment necessary for field trials in a marine environment (the cost for mobilising and operating a construction jack-up barge, all backup marine support craft, pile driving hammers and test piles can be several times the available grant funding), it was decided and agreed at an early stage

New roller cone bits with unique nozzle designs reduce drilling costs

International Nuclear Information System (INIS)

Moffitt, S.R.; Pearce, D.E.; Ivie, C.R.

1992-01-01

This paper reports that selection of the optimum rock bit design to achieve the lowest drilling cost in a given application is often difficult due to a large number of rock bit performance considerations. However, in a majority of applications increased penetration rate is the key consideration in reducing drilling costs. Discovery of a new bit design concept has led to the development of roller cone bits that achieve significant penetration rate increases using superior hydraulic nozzle designs. Prototype designs have achieved 20 to 40% increases in penetration rate with comparable footage drilled when tested in 6 1/2, 8 1/2, 8-3/4, 9-7/8 and 12 1/4 IADC 437, 517 and 537 type bits in the U.S., North Sea, Italy, and Oman. Second-generation designs tested in a full-scale drilling laboratory have delivered 70% increases in penetration rates

The System 80+ standard plant design reduces operations and maintenance costs

International Nuclear Information System (INIS)

Chari, D.R.; Robertson, J.E.

1998-01-01

To be cost-competitive, nuclear power plants must maximize plant availability and minimize operations and maintenance (O and M) costs. A plant whose design supports these goals will generate more power at less cost and thereby have a lower unit generating cost. The ABB Combustion Engineering Nuclear Systems (ABB-CE) System 80+ Standard Nuclear Power Plant, rated at 1400 megawatts electric (MWe), is designed for high availability at reduced cost. To demonstrate that the duration of refueling outages, the major contributor to plant unavailability, can be shortened, ABB-CE developed a detailed plan that shows a System 80+ plant can safely perform a refueling and maintenance outage in 18 days. This is a significant reduction from the average current U.S. plant outages of 45 days, and is possible due to a two-part outage strategy: use System 80+ advanced system design features and relaxed technical specification (TS) time limits to shift some maintenance from outages to operating periods: and, use System 80+ structural, system, and component features, such as the larger operating floor, permanent pool seal, integral reactor head area cable tray system and missile shield, and longer life reactor coolant pump seals, to reduce the scope and duration of outage maintenance activities. Plant staffing level is the major variable, or controllable contributor to operations costs. ABB-CE worked with the Institute of Nuclear Power Operations (INPO) to perform detailed staffing analyses that show a System 80+ plant can be operated reliably with 30 percent less staff than currently operating nuclear plants of similar size. Safety was not sacrificed when ABB-CE developed the System 80+ refueling outage plan and staffing level. The outage plan was developed utilizing a defense-in-depth concept for shutdown safety. The defense in-depth concept is implemented via systematic control of outage risk evaluation (SCORE) cards. The SCORE cards identify primary and alternate means of

Corruption Significantly Increases the Capital Cost of Power Plants in Developing Contexts

Directory of Open Access Journals (Sweden)

Kumar Biswajit Debnath

2018-03-01

Full Text Available Emerging economies with rapidly growing population and energy demand, own some of the most expensive power plants in the world. We hypothesized that corruption has a relationship with the capital cost of power plants in developing countries such as Bangladesh. For this study, we analyzed the capital cost of 61 operational and planned power plants in Bangladesh. Initial comparison study revealed that the mean capital cost of a power plant in Bangladesh is twice than that of the global average. Then, the statistical analysis revealed a significant correlation between corruption and the cost of power plants, indicating that higher corruption leads to greater capital cost. The high up-front cost can be a significant burden on the economy, at present and in the future, as most are financed through international loans with extended repayment terms. There is, therefore, an urgent need for the review of the procurement and due diligence process of establishing power plants, and for the implementation of a more transparent system to mitigate adverse effects of corruption on megaprojects.

SIR (Safe Integral Reactor) - reducing size can reduce cost

International Nuclear Information System (INIS)

Hayns, M.R.

1991-01-01

Traditional engineering economics have favoured the advantages of larger size as a means of reducing specific capital costs and hence unit generating costs. For large and small plants utilising the same concept, e.g. a small four-loop PWR vs a large four-loop PWR with the same number of components, economies of scale are well established. If, however, a smaller plant is sized to take advantage of features which are only feasible at smaller outputs, is of simpler design, with the advantage taken of the simplified design to produce the most cost-effective layout, and incorporates fewer, more easily replaceable components with minimal assembly on site, it is possible to produce a plant which is competitive with larger plant of more traditional design. When 'system' effects, such as better matching of installed capacity to the growth in demand and the fact that a smaller total capacity will be needed to meet a given demand with a specified level of confidence, are taken into account, it can be shown that a utility's overall cash-flow position can be improved with lower associated absolute financial risks. The UK/US Safe Integral Reactor (SIR) is an integral pressurized water reactor in the 300-400 MW(e) range which utilises conventional water reactor technology in a way not feasible at the very large, sizes of recent years. The SIR concept is briefly explained and its technical and economic advantages in terms of simplicity, construction, maintenance, availability, decommissioning, safety and siting described. The results of system analyses which demonstrate the overall financial advantages to a utility are presented. (author)

Subsea industry implements NORSOK: Happy marriages reduce costs

International Nuclear Information System (INIS)

Heggelund, N.

1995-01-01

Cost reduction by implementing NORSOK standards and cooperation between subsea suppliers to the Norwegian continental shelf, are discussed in this article. The aim of NORSOK, which is based on US standards, is to achieve standardization of technical requirements for drilling and production facilities, to identify and develop common requirements for equipment and installations, based on functional specifications, interfaces and limited variety for equipment and design, and to take into consideration existing industry standards and use these where possible. The offspring of cooperation is notable cost reductions. Subsea costs at Saga's Vigdis field have been reduced by 50% in two years. More subsea projects could come up soon. Norsk Hydro has short-listed a semi PDQ (Processing, Drilling and living Quarters), a ship or Gullfaks tie-in as runner-up concepts for the Viksund project. 1 fig

Cost implications of reduced work hours and workloads for resident physicians.

Science.gov (United States)

Nuckols, Teryl K; Bhattacharya, Jay; Wolman, Dianne Miller; Ulmer, Cheryl; Escarce, José J

2009-05-21

Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other changes, improved adherence to the 2003 ACGME limits, naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads. We used published data to estimate labor costs associated with transferring excess work from residents to substitute providers, and we examined the effects of our assumptions in sensitivity analyses. Next, using a probability model to represent labor costs as well as mortality and costs associated with preventable adverse events, we determined the net costs to major teaching hospitals and cost-effectiveness across a range of hypothetical changes in the rate of preventable adverse events. Annual labor costs from implementing the IOM recommendations were estimated to be $1.6 billion (in 2006 U.S. dollars) across all ACGME-accredited programs ($1.1 billion to $2.5 billion in sensitivity analyses). From a 10% decrease to a 10% increase in preventable adverse events, net costs per admission ranged from $99 to $183 for major teaching hospitals and from $17 to $266 for society. With 2.5% to 11.3% decreases in preventable adverse events, costs to society per averted death ranged from $3.4 million to $0. Implementing the four IOM recommendations would be costly, and their effectiveness is unknown. If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high. 2009 Massachusetts Medical Society

Cost effectiveness of reducing radon exposure in Spanish dwellings

International Nuclear Information System (INIS)

Colgan, P.A.; Gutierrez, J.

1996-01-01

Published information on the distribution of radon levels in Spanish single family dwellings is used to evaluate the cost-effectiveness of three different intervention scenarios: remediation of existing dwellings, radon proofing of all future dwellings and the targetting of areas with higher than average indoor radon concentrations. Analysis is carried out on the basis of a Reference Level of 400 Bq m -3 for the existing housing stock and 200 Bq m -3 for new dwellings. Certain assumptions are made about the effectiveness and durability of the measures applied and annualised costs are used to calculate the costs per lung cancer death averted. The results reveal that targetting future housing is a more cost-effective option than remediation of existing dwellings with radon concentrations above the Reference Level -the costs per lung cancer death averted are typically $145000. In high-risk areas, these costs can be considerably less, depending on the percentage of dwellings expected to exceed the Reference Level and the average savings in exposure as a result of the intervention. The costs of intervention to reduce lung cancer deaths following exposure to radon compare favourably with those of other health programmes in other countries. (Author)

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison.

Science.gov (United States)

Zhang, S X; Shoptaw, S; Reback, C J; Yadav, K; Nyamathi, A M

2018-01-01

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM). Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners. A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures. The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher. Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Can E-Filing Reduce Tax Compliance Costs in Developing Countries?

OpenAIRE

Yilmaz, Fatih; Coolidge, Jacqueline

2013-01-01

The purpose of this study is to investigate the association between electronic filing (e-filing) and the total tax compliance costs incurred by small and medium size businesses in developing countries, based on survey data from South Africa, Ukraine, and Nepal. A priori, most observers expect that use of e-filing should reduce tax compliance costs, but this analysis suggests that the assum...

Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse.

Science.gov (United States)

Shepard, Donald S; Lwin, Aung K; Barnett, Nancy P; Mastroleo, Nadine; Colby, Suzanne M; Gwaltney, Chad; Monti, Peter M

2016-05-01

To estimate the incremental cost, cost-effectiveness and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. The underlying trial took place at a major urban hospital in the United States. The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited. We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 US$, incorporated quality and mortality effects from a closely related trial and derived the cost per quality-adjusted life-year (QALY) gained. From a health system perspective, the incremental cost per patient of adding an SO was $341.09 [95% confidence interval (CI) = $244.44-437.74]. The incremental cost per year per hazardous drinker averted was $3623 (CI = $1777-22,709), the cost per QALY gained $32,200 (CI = $15,800-201,700), and the benefit-cost ratio was 4.73 (95% CI = 0.7-9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in a trauma unit, it would become even more cost-beneficial. Using criteria established by the World Health Organization (cost-effectiveness below the country's gross domestic product per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost-effective. © 2015 Society for the Study of Addiction.

Reducing Wildlife Damage with Cost-Effective Management Programmes.

Directory of Open Access Journals (Sweden)

Cheryl R Krull

Full Text Available Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control, with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation

Predictive models reduce talent development costs in female gymnastics.

Science.gov (United States)

Pion, Johan; Hohmann, Andreas; Liu, Tianbiao; Lenoir, Matthieu; Segers, Veerle

2017-04-01

This retrospective study focuses on the comparison of different predictive models based on the results of a talent identification test battery for female gymnasts. We studied to what extent these models have the potential to optimise selection procedures, and at the same time reduce talent development costs in female artistic gymnastics. The dropout rate of 243 female elite gymnasts was investigated, 5 years past talent selection, using linear (discriminant analysis) and non-linear predictive models (Kohonen feature maps and multilayer perceptron). The coaches classified 51.9% of the participants correct. Discriminant analysis improved the correct classification to 71.6% while the non-linear technique of Kohonen feature maps reached 73.7% correctness. Application of the multilayer perceptron even classified 79.8% of the gymnasts correctly. The combination of different predictive models for talent selection can avoid deselection of high-potential female gymnasts. The selection procedure based upon the different statistical analyses results in decrease of 33.3% of cost because the pool of selected athletes can be reduced to 92 instead of 138 gymnasts (as selected by the coaches). Reduction of the costs allows the limited resources to be fully invested in the high-potential athletes.

Cost benchmarking of railway projects in Europe – can it help to reduce costs?

DEFF Research Database (Denmark)

Trabo, Inara; Landex, Alex; Nielsen, Otto Anker

a certain overview of the range of costs in various budget disciplines. The Copenhagen-Ringsted project is shown to be right in the middle of the range in terms of total costs per kilometre, and its values in the discipline comparisons do not significantly differ from the values of the less expensive...... projects. Deeper analysis of project unit costs is still continuing, but the preliminary results show that the cost values for projects located in the same geographical zone are similar. For example, this can be explained by their use of the same construction companies. However, unit prices in southern...

Cost-effectiveness of reducing emissions from tropical deforestation, 2016-2050

Science.gov (United States)

Busch, Jonah; Engelmann, Jens

2017-12-01

Reducing tropical deforestation is potentially a large-scale and low-cost strategy for mitigating climate change. Yet previous efforts to project the cost-effectiveness of policies to reduce greenhouse gas emissions from future deforestation across the tropics were hampered by crude available data on historical forest loss. Here we use recently available satellite-based maps of annual forest loss between 2001-2012, along with information on topography, accessibility, protected status, potential agricultural revenue, and an observed inverted-U-shaped relationship between forest cover loss and forest cover, to project tropical deforestation from 2016-2050 under alternative policy scenarios and to construct new marginal abatement cost curves for reducing emissions from tropical deforestation. We project that without new forest conservation policies 289 million hectares of tropical forest will be cleared from 2016-2050, releasing 169 GtCO2. A carbon price of US20/tCO2 (50/tCO2) across tropical countries would avoid 41 GtCO2 (77 GtCO2) from 2016-2050. By comparison, we estimate that Brazil’s restrictive policies in the Amazon between 2004-2012 successfully decoupled potential agricultural revenue from deforestation and reduced deforestation by 47% below what would have otherwise occurred, preventing the emission of 5.2 GtCO2. All tropical countries enacting restrictive anti-deforestation policies as effective as those in the Brazilian Amazon between 2004-2012 would avoid 58 GtCO2 from 2016-2050.

Small Habitat Commonality Reduces Cost for Human Mars Missions

Science.gov (United States)

Griffin, Brand N.; Lepsch, Roger; Martin, John; Howard, Robert; Rucker, Michelle; Zapata, Edgar; McCleskey, Carey; Howe, Scott; Mary, Natalie; Nerren, Philip (Inventor)

2015-01-01

Most view the Apollo Program as expensive. It was. But, a human mission to Mars will be orders of magnitude more difficult and costly. Recently, NASA's Evolvable Mars Campaign (EMC) mapped out a step-wise approach for exploring Mars and the Mars-moon system. It is early in the planning process but because approximately 80% of the total life cycle cost is committed during preliminary design, there is an effort to emphasize cost reduction methods up front. Amongst the options, commonality across small habitat elements shows promise for consolidating the high bow-wave costs of Design, Development, Test and Evaluation (DDT&E) while still accommodating each end-item's functionality. In addition to DDT&E, there are other cost and operations benefits to commonality such as reduced logistics, simplified infrastructure integration and with inter-operability, improved safety and simplified training. These benefits are not without a cost. Some habitats are sub-optimized giving up unique attributes for the benefit of the overall architecture and because the first item sets the course for those to follow, rapidly developing technology may be excluded. The small habitats within the EMC include the pressurized crew cabins for the ascent vehicle,

DOES ECO-EFFICENCY REDUCE THE COST OF EQUITY CAPITAL? EMPIRICAL EVIDENCE FROM INDONESIA

OpenAIRE

Lisa Alviani; Mahfud Sholihin

2015-01-01

The objective of this study is to examine the effect of eco-efficiency on the cost of equity capital. The study hypothesizes that the implementation of eco-efficiency reduces the cost of equity capital. Using manufacturing companies listed on the Indonesian Stock Exchange for the period 2010-2012 as data, and controlling for beta, company size, Book to Market ratio, and leverage; the study finds that the implementation of eco-efficiency may reduce the cost of equity capital. The findings sugg...

Reducing electrocoagulation harvesting costs for practical microalgal biodiesel production.

Science.gov (United States)

Dassey, Adam J; Theegala, Chandra S

2014-01-01

Electrocoagulation has shown potential to be a primary microalgae harvesting technique for biodiesel production. However, methods to reduce energy and electrode costs are still necessary for practical application. Electrocoagulation tests were conducted on Nannochloris sp. and Dunaliella sp. using perforated aluminium and iron electrodes under various charge densities. Aluminium electrodes were shown to be more efficient than iron electrodes when harvesting both algal species. Despite the lower harvesting efficiency, however, the iron electrodes were more energy and cost efficient. Operational costs of less than $0.03/L oil were achieved when harvesting Nannochloris sp. with iron electrodes at 35% harvest efficiency, whereas aluminium electrodes cost $0.75/L oil with 42% harvesting efficiency. Increasing the harvesting efficiencies for both aluminium and iron electrodes also increased the overall cost per litre of oil, therefore lower harvesting efficiencies with lower energy inputs was recommended. Also, increasing the culturing salinity to 2 ppt sodium chloride for freshwater Nannochloris sp. was determined practical to improve the electrocoagulation energy efficiency despite a 25% reduction in cell growth.

An assessment of monitoring requirements and costs of 'Reduced Emissions from Deforestation and Degradation'

Directory of Open Access Journals (Sweden)

McCallum Ian

2009-08-01

Full Text Available Abstract Background Negotiations on a future climate policy framework addressing Reduced Emissions from Deforestation and Degradation (REDD are ongoing. Regardless of how such a framework will be designed, many technical solutions of estimating forest cover and forest carbon stock change exist to support policy in monitoring and accounting. These technologies typically combine remotely sensed data with ground-based inventories. In this article we assess the costs of monitoring REDD based on available technologies and requirements associated with key elements of REDD policy. Results We find that the design of a REDD policy framework (and specifically its rules can have a significant impact on monitoring costs. Costs may vary from 0.5 to 550 US$ per square kilometre depending on the required precision of carbon stock and area change detection. Moreover, they follow economies of scale, i.e. single country or project solutions will face relatively higher monitoring costs. Conclusion Although monitoring costs are relatively small compared to other cost items within a REDD system, they should be shared not only among countries but also among sectors, because an integrated monitoring system would have multiple benefits for non-REDD management. Overcoming initialization costs and unequal access to monitoring technologies is crucial for implementation of an integrated monitoring system, and demands for international cooperation.

Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

Science.gov (United States)

Martini, Gilbert R., Jr.

1991-01-01

A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity.

Science.gov (United States)

Forster, M; Veerman, J L; Barendregt, J J; Vos, T

2011-08-01

To analyze whether two dietary weight loss interventions--the dietary approaches to stop hypertension (DASH) program and a low-fat diet program--would be cost-effective in Australia, and to assess their potential to reduce the disease burden related to excess body weight. We constructed a multi-state life-table-based Markov model in which the distribution of body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. The target population was the overweight and obese adult population in Australia in 2003. We used a lifetime horizon for health effects and costs, and a health sector perspective for costs. We populated the model with data identified from Medline and Cochrane searches, Australian Bureau of Statistics published catalogues, Australian Institute of Health and Welfare, and Department of Health and Ageing. Disability adjusted life years (DALYs) averted, incremental cost-effectiveness ratios (ICERs) and proportions of disease burden avoided. ICERs under AUS$50,000 per DALY are considered cost-effective. The DASH and low-fat diet programs have ICERs of AUS$12,000 per DALY (95% uncertainty range: Cost-saving- 68,000) and AUS$13,000 per DALY (Cost-saving--130,000), respectively. Neither intervention reduced the body weight-related disease burden at population level by more than 0.1%. The sensitivity analysis showed that when participants' costs for time and travel are included, the ICERs increase to AUS$75,000 per DALY for DASH and AUS$49,000 per DALY for the low-fat diet. Modest weight loss during the interventions, post-intervention weight regain and low participation limit the health benefits. Diet and exercise interventions to reduce obesity are potentially cost-effective but have a negligible impact on the total body weight-related disease burden.

Does Eco-efficency Reduce the Cost of Equity Capital? Empirical Evidence From Indonesia

OpenAIRE

Alviani, Lisa; Sholihin, Mahfud

2015-01-01

The objective of this study is to examine the effect of eco-efficiency on the cost of equity capital. The study hypothesizes that the implementation of eco-efficiency reduces the cost of equity capital. Using manufacturing companies listed on the Indonesian Stock Exchange for the period 2010-2012 as data, and controlling for beta, company size, Book to Market ratio, and leverage; the study finds that the implementation of eco-efficiency may reduce the cost of equity capital. The findings sugg...

DOES ECO-EFFICENCY REDUCE THE COST OF EQUITY CAPITAL? EMPIRICAL EVIDENCE FROM INDONESIA

Directory of Open Access Journals (Sweden)

Lisa Alviani

2015-05-01

Full Text Available The objective of this study is to examine the effect of eco-efficiency on the cost of equity capital. The study hypothesizes that the implementation of eco-efficiency reduces the cost of equity capital. Using manufacturing companies listed on the Indonesian Stock Exchange for the period 2010-2012 as data, and controlling for beta, company size, Book to Market ratio, and leverage; the study finds that the implementation of eco-efficiency may reduce the cost of equity capital. The findings suggest that companies should implement eco-efficency.

Does a renewable fuel standard for biofuels reduce climate costs?

Energy Technology Data Exchange (ETDEWEB)

Greaker, Mads; Hoel, Michael; Rosendahl, Knut Einar

2012-07-01

Recent contributions have questioned whether biofuels policies actually lead to emissions reductions, and thus lower climate costs. In this paper we make two contributions to the literature. First, we study the market effects of a renewable fuel standard. Opposed to most previous studies we model the supply of fossil fuels taking into account that fossil fuels is a non-renewable resource. Second, we model emissions from land use change explicitly when we evaluate the climate effects of the renewable fuel standard. We find that extraction of fossil fuels most likely will decline initially as a consequence of the standard. Thus, if emissions from biofuels are sufficiently low, the standard will have beneficial climate effects. Furthermore, we find that the standard tends to reduce total fuel (i.e., oil plus biofuels) consumption initially. Hence, even if emissions from biofuels are substantial, climate costs may be reduced. Finally, if only a subset of countries introduce a renewable fuel standard, there will be carbon leakage to the rest of the world. However, climate costs may decline as global extraction of fossil fuels is postponed.(Author)

Valuing patents on cost-reducing technology: A case study

NARCIS (Netherlands)

van Triest, S.P.; van de Vis, Wim

2007-01-01

We present an approach for valuing patents on production process improvements. Specifically, we focus on valuing a patent on cost-reducing process improvements from the viewpoint of the patent holding firm. We do this by considering the relevant cash flows that result from owning the patent. The

Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

Science.gov (United States)

Iles, Ross Anthony; Wyatt, M; Pransky, G

2012-12-01

This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

One Improvement Method of Reducing Duration Directly to Solve Time-Cost Tradeoff Problem

Science.gov (United States)

Jian-xun, Qi; Dedong, Sun

Time and cost are two of the most important factors for project plan and schedule management, and specially, time-cost tradeoff problem is one classical problem in project scheduling, which is also a difficult problem. Methods of solving the problem mainly contain method of network flow and method of mending the minimal cost. Thereinto, for the method of mending the minimal cost is intuitionistic, convenient and lesser computation, these advantages make the method being used widely in practice. But disadvantage of the method is that the result of each step is optimal but the terminal result maybe not optimal. In this paper, firstly, method of confirming the maximal effective quantity of reducing duration is designed; secondly, on the basis of above method and the method of mending the minimal cost, the main method of reducing duration directly is designed to solve time-cost tradeoff problem, and by analyzing validity of the method, the method could obtain more optimal result for the problem.

43 CFR 429.26 - When may Reclamation reduce or waive costs or fees?

Science.gov (United States)

2010-10-01

... Reductions or Waivers of Application Fees, Administrative Costs, and Use Fees § 429.26 When may Reclamation reduce or waive costs or fees? (a) As determined appropriate and approved and documented by the applicable Regional Director, the application fees may be waived, and charges for administrative costs or use...

The Significance of Storage in the “Cost of Risk” of Digital Preservation

Directory of Open Access Journals (Sweden)

Richard Wright

2009-12-01

Full Text Available Normal 0 false false false MicrosoftInternetExplorer4 As storage costs drop, storage is becoming the lowest cost in a digital repository – and the biggest risk. We examine current modelling of costs and risks in digital preservation, concentrating on the Total Cost of Risk when using digital storage systems for preserving audiovisual material. We review the vital role of storage and show how planning for long-term preservation of data should consider the risks involved in using digital storage technology. Gaps in information necessary for accurate modelling – and planning – are presented. We call for new functionality to support recovery of files with errors, to eliminate the all-or-nothing approach of current IT systems, which in turn reduces the impact of failures of digital storage technology and mitigates against loss of digital data.

Proven Innovations and New Initiatives in Ground System Development: Reducing Costs in the Ground System

Science.gov (United States)

Gunn, Jody M.

2006-01-01

The state-of-the-practice for engineering and development of Ground Systems has evolved significantly over the past half decade. Missions that challenge ground system developers with significantly reduced budgets in spite of requirements for greater and previously unimagined functionality are now the norm. Making the right trades early in the mission lifecycle is one of the key factors to minimizing ground system costs. The Mission Operations Strategic Leadership Team at the Jet Propulsion Laboratory has spent the last year collecting and working through successes and failures in ground systems for application to future missions.

Low polymer hydraulic fracturing applications in Reconcavo basin wells can reduce cost and improve conductivity

International Nuclear Information System (INIS)

Suzart, Joao Walter Pereira; Araujo, Paulo Fernando de

2000-01-01

Gels used for hydraulic-fracturing treatments generally contain high concentrations of polymer. The polymer helps the fracturing fluid achieve the level of viscosity necessary for transporting proppant through the rock matrix. However, high-polymer gels leave greater amounts of residue in the formation and can therefore cause formation damage. This paper describes how low polymer (L P) gels can be used for hydraulic-fracturing operations to reduce job costs and increase conductivity by reducing formation damage while maintaining the characteristics of a high-polymer gel. The L P fluid system has a low p H and contains an appropriate breaker concentration. Operators have achieved positive results with this system, which allows them to measure robust gel breaks and reduces the necessity for well cleaning. Consequently, formation damage can be significantly reduced. (author)

Consolidating staff augmentation contracts improves teamwork and reduces costs

International Nuclear Information System (INIS)

Townsend, J.; Sibilla, L.; Gregovich, J.W.

1991-01-01

Nuclear power plants have traditionally used multiple contracting firms to provide temporary staff augmentation personnel primarily because of two perceptions: (1) managers believe they have greater access to a higher quality, readily available pool of applicants. (2) using multiple contractors inherently keeps costs down as a result of several competitors submitting resumes for the same position. This paper provides information, based on the experiences of a leading nuclear power plant, that disproves these perceptions. It explains why consolidating several contracts for professional and technical classifications (excluding craft labor and refueling personnel) and competitively bidding and awarding the contract to a single contracting firm promotes teamwork and reduces costs

Increase plant safety and reduce cost by implementing risk-informed in-service inspection programs

International Nuclear Information System (INIS)

Billington, A.; Monette, P.

2001-01-01

The idea behind the program is that it is possible to 'inspect less, but inspect better'. In other words, the risk-informed In-Service Inspection (ISI) process is used to improve the effectiveness of examination of piping components, i.e. concentrate inspection resources and enhance inspection strategies on high safety significant locations, and reduce inspection requirements on others. The Westinghouse Owners Group (WOG) risk-informed ISI process has already been applied for full scope (Millstone 3, Surry 1) and limited scope (Beznau, Ringhals 4, Asco, Turkey Point 3). By examining the high safety significant piping segments for the different fluid piping systems, the total piping core damage frequency is reduced. In addition, more than 80% of the risk associated with potential pressure boundary failures is addressed with the WOG risk-informed ISI process, while typically less that 50% of this same risk is addressed by the current inspection programs. The risk-informed ISI processes are used to improve the effectiveness of inspecting safety-significant piping components, to reduce inspection requirements on other piping components, to evaluate improvements to plant availability and enhanced safety measures, including reduction of personnel radiation exposure, and to reduce overall Operation and Maintenance (O and M) costs while maintaining regulatory compliance. A description of the process as well as benefits from past projects is presented, since the methodology is applicable for WWER plant design. (author)

Increase plant safety and reduce cost by implementing risk-informed In-Service Inspection programs

International Nuclear Information System (INIS)

Billington, A.; Monette, P.; Doumont, C.

2000-01-01

The idea behind the program is that it is possible to 'inspect less, but inspect better'. In other words, the risk-informed In-Service Inspection (ISI) process is used to improve the effectiveness of examination of piping components, i.e. concentrate inspection resources and enhance inspection strategies on high safety significant locations, and reduce inspection requirements on others. The Westinghouse Owners Group (WOG) risk-informed ISI process has already been applied for full scope (Millstone 3, Surry 1) and limited scope (Beznau, Ringhals 4, Asco, Turkey Point 3). By examining the high safety significant piping segments for the different fluid piping systems, the total piping core damage frequency is reduced. In addition, more than 80% of the risk associated with potential pressure boundary failures is addressed with the WOG risk-informed ISI process, while typically less than 50% of this same risk is addressed by the current inspection programs. The risk-informed ISI processes are used: to improve the effectiveness of inspecting safety-significant piping components; to reduce inspection requirements on other piping components; to evaluate improvements to plant availability and enhanced safety measures, including reduction of personnel radiation exposure; and to reduce overall Operation and Maintenance (O and M) costs while maintaining regulatory compliance. A description of the process as well as benefits of past projects is presented, since the methodology is applicable for VVER plant design. (author)

Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).

Science.gov (United States)

Sabin, Lora L; Knapp, Anna B; MacLeod, William B; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H; Gill, Christopher J

2012-01-01

The Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

Operating Costs Reducing in MDF Manufacturing Industries

Directory of Open Access Journals (Sweden)

José Augusto Coeve Florino

2014-05-01

Full Text Available The sustained efforts by electric motors when subjected to cutting, trimming or finishing are directly related to the material being machined and the angle of attack of the tool. Choosing the right tool for this operation depends on an expected result. So the engines behave differently to each operation. The optimization between strength, speed, power, material and type of operation, can be found to reduce operational costs of production, besides determining the exact time to make the set-up of worn tool. The reduction in operating costs is an item of sustainability that outlines the strategic positioning on companies to become competitive in the global marketplace. With the great technological development present today, this issue goes away with the very latest products on the market for professionals who productivity will be dealt with in these modern maintenance equipment such as power quality analyzer, Imager, profile projector and microscope for research. The result of this work is the optimization of the cutting operation and energy consumption thereby demonstrating an optimum point of operation in a case study presented in this work.

Patient education after stoma creation may reduce health-care costs.

Science.gov (United States)

Danielsen, Anne Kjærgaard; Rosenberg, Jacob

2014-04-01

Researchers are urged to include health-economic assessments when exploring the benefits and drawbacks of a new treatment. The aim of the study was to assess the costs associated with the establishment of a new patient education programme for patients with a stoma. Following a previous case-control study that explored the effect of patient education for stoma patients, we set out to examine the costs related to such a patient education programme. The primary outcome was disease-specific health-related quality of life measured with the Ostomy Adjustment Scale six months after surgery. The secondary outcome was generic health-related quality of life measured with Short Form (SF)-36. In this secondary analysis, we calculated direct health-care costs for the first six months post-operatively from the perspective of the health-care system, including costs related to the hospital as well as primary health care. The overall cost related to establishing a patient education programme showed no significant increase in the overall average costs. However, we found a significant reduction in costs related to unplanned readmissions (p = 0.01) as well as a reduction in visits to the general practitioner (p = 0.05). Establishing a patient education programme - which increased quality of life - will probably not increase the overall costs associated with the patient course. The study received financial support from Søster Inge Marie Dahlgaards Fond, Diakonissestiftelsen, Denmark, and from Aase and Ejnar Danielsens Foundation, Denmark. NCT01154725.

Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP.

Directory of Open Access Journals (Sweden)

Lora L Sabin

Full Text Available The Lufwanyama Neonatal Survival Project ("LUNESP" was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness.We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020. In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation.Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

Autonomous exoskeleton reduces metabolic cost of human walking during load carriage

Science.gov (United States)

2014-01-01

Background Many soldiers are expected to carry heavy loads over extended distances, often resulting in physical and mental fatigue. In this study, the design and testing of an autonomous leg exoskeleton is presented. The aim of the device is to reduce the energetic cost of loaded walking. In addition, we present the Augmentation Factor, a general framework of exoskeletal performance that unifies our results with the varying abilities of previously developed exoskeletons. Methods We developed an autonomous battery powered exoskeleton that is capable of providing substantial levels of positive mechanical power to the ankle during the push-off region of stance phase. We measured the metabolic energy consumption of seven subjects walking on a level treadmill at 1.5 m/s, while wearing a 23 kg vest. Results During the push-off portion of the stance phase, the exoskeleton applied positive mechanical power with an average across the gait cycle equal to 23 ± 2 W (11.5 W per ankle). Use of the autonomous leg exoskeleton significantly reduced the metabolic cost of walking by 36 ± 12 W, which was an improvement of 8 ± 3% (p = 0.025) relative to the control condition of not wearing the exoskeleton. Conclusions In the design of leg exoskeletons, the results of this study highlight the importance of minimizing exoskeletal power dissipation and added limb mass, while providing substantial positive power during the walking gait cycle. PMID:24885527

Can automation in radiotherapy reduce costs?

Science.gov (United States)

Massaccesi, Mariangela; Corti, Michele; Azario, Luigi; Balducci, Mario; Ferro, Milena; Mantini, Giovanna; Mattiucci, Gian Carlo; Valentini, Vincenzo

2015-01-01

Computerized automation is likely to play an increasingly important role in radiotherapy. The objective of this study was to report the results of the first part of a program to implement a model for economical evaluation based on micro-costing method. To test the efficacy of the model, the financial impact of the introduction of an automation tool was estimated. A single- and multi-center validation of the model by a prospective collection of data is planned as the second step of the program. The model was implemented by using an interactive spreadsheet (Microsoft Excel, 2010). The variables to be included were identified across three components: productivity, staff, and equipment. To calculate staff requirements, the workflow of Gemelli ART center was mapped out and relevant workload measures were defined. Profit and loss, productivity and staffing were identified as significant outcomes. Results were presented in terms of earnings before interest and taxes (EBIT). Three different scenarios were hypothesized: baseline situation at Gemelli ART (scenario 1); reduction by 2 minutes of the average duration of treatment fractions (scenario 2); and increased incidence of advanced treatment modalities (scenario 3). By using the model, predicted EBIT values for each scenario were calculated across a period of eight years (from 2015 to 2022). For both scenarios 2 and 3 costs are expected to slightly increase as compared to baseline situation that is particularly due to a little increase in clinical personnel costs. However, in both cases EBIT values are more favorable than baseline situation (EBIT values: scenario 1, 27%, scenario 2, 30%, scenario 3, 28% of revenues). A model based on a micro-costing method was able to estimate the financial consequences of the introduction of an automation tool in our radiotherapy department. A prospective collection of data at Gemelli ART and in a consortium of centers is currently under way to prospectively validate the model.

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

Energy Technology Data Exchange (ETDEWEB)

Scott, Michael T. [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (United States); Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States)

2016-10-01

therapy, where N equals the number of children aged 3 to 12 years treated in 1 year. This formula assumes that the payer subsidizes the cost for the employment of a CCLS, although our institution absorbed this expense for this data cohort. The predicted annualized health care system cost savings from reducing the frequency of anesthesia with radiation therapy when treating 100 children aged 3 to 12 years per year could exceed $775,000. Conclusions: These data suggest that a CCLS significantly reduces the frequency of daily anesthesia for children treated with radiation therapy. Health care system payers may achieve significant cost savings by financially supporting the employment of a CCLS in high-volume pediatric radiation therapy centers.

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.

Science.gov (United States)

Scott, Michael T; Todd, Kimberly E; Oakley, Heather; Bradley, Julie A; Rotondo, Ronny L; Morris, Christopher G; Klein, Stuart; Mendenhall, Nancy P; Indelicato, Daniel J

2016-10-01

�years treated in 1 year. This formula assumes that the payer subsidizes the cost for the employment of a CCLS, although our institution absorbed this expense for this data cohort. The predicted annualized health care system cost savings from reducing the frequency of anesthesia with radiation therapy when treating 100 children aged 3 to 12 years per year could exceed $775,000. These data suggest that a CCLS significantly reduces the frequency of daily anesthesia for children treated with radiation therapy. Health care system payers may achieve significant cost savings by financially supporting the employment of a CCLS in high-volume pediatric radiation therapy centers. Copyright © 2016 Elsevier Inc. All rights reserved.

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

International Nuclear Information System (INIS)

Scott, Michael T.; Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P.; Indelicato, Daniel J.

2016-01-01

equals the number of children aged 3 to 12 years treated in 1 year. This formula assumes that the payer subsidizes the cost for the employment of a CCLS, although our institution absorbed this expense for this data cohort. The predicted annualized health care system cost savings from reducing the frequency of anesthesia with radiation therapy when treating 100 children aged 3 to 12 years per year could exceed $775,000. Conclusions: These data suggest that a CCLS significantly reduces the frequency of daily anesthesia for children treated with radiation therapy. Health care system payers may achieve significant cost savings by financially supporting the employment of a CCLS in high-volume pediatric radiation therapy centers.

Advanced transfer chute reduces dust at lower cost

Energy Technology Data Exchange (ETDEWEB)

Blazek, C. [Benetech Inc. (United States)

2005-10-01

Dominion Resources' Kincaid Generating Station in Illinois is recognized as a leader in handling and burning PRB coal. Since being named the Powder Plant of the Year in 2001 and 2004 by the PRB Coal Users' Group, Kincaid has improved its coal handling by installing an InteliFlo controlled-flow transfer chute from Benetech. The InteliFlo design eliminates the need for skirt boards, conveyor discharge hoods, and complex load bed designs, and reduces O & M costs. 4 figs.

Societal value of generic medicines beyond cost-saving through reduced prices.

Science.gov (United States)

Dylst, Pieter; Vulto, Arnold; Simoens, Steven

2015-01-01

This paper aims to provide an overview of the added societal value of generic medicines beyond their cost-saving potential through reduced prices. In addition, an observational case study will document the impact of generic entry on access to pharmacotherapy in The Netherlands and an illustrative exercise was carried out to highlight the budget impact of generic entry. A narrative literature review was carried out to explore the impact of generic medicines on access to pharmacotherapy, innovation and medication adherence. Data from the Medicines and Medical Devices Information Project database in The Netherlands were used for the case study in which the impact of generic medicine entrance on the budget and the number of users was calculated as an illustrative exercise. Generic medicines have an additional societal value beyond their cost-saving potential through reduced prices. Generic medicines increase access to pharmacotherapy, provide a stimulus for innovation by both originator companies and generic companies and, under the right circumstances, have a positive impact on medication adherence. Generic medicines offer more to society than just their cost-saving potential through reduced prices. As such, governments must not focus only on the prices of generic medicines as this will threaten their long-term sustainability. Governments must therefore act appropriately and implement a coherent set of policies to increase the use of generic medicines.

Costs reduced by innovative plastic distribution pipe use

International Nuclear Information System (INIS)

Maxwell, F.W.

1995-01-01

As part of a strategic corporate cost-reduction initiative, Pacific Gas and Electric Company's Gas Distribution Group has achieved some quick but significant cash savings. System design, construction, and the purchasing function were areas that produced some fast paybacks while maintaining reliability and safety. The primary savings were made by optimizing pipe specifications to match system operating parameters. This allowed the use of smaller diameter pipes and/or thinner wall pipes which conserved the materials cost of the pipeline. Other realized savings in the form of coiled pipe, purchasing changes, and backfilling specifications are also described

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

Science.gov (United States)

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

Cost of reproduction in a long-lived bird: incubation effort reduces immune function and future reproduction.

Science.gov (United States)

Hanssen, Sveinn Are; Hasselquist, Dennis; Folstad, Ivar; Erikstad, Kjell Einar

2005-05-22

Life-history theory predicts that increased current reproductive effort should lead to a fitness cost. This cost of reproduction may be observed as reduced survival or future reproduction, and may be caused by temporal suppression of immune function in stressed or hard-working individuals. In birds, consideration of the costs of incubating eggs has largely been neglected in favour of the costs of brood rearing. We manipulated incubation demand in two breeding seasons (2000 and 2001) in female common eiders (Somateria mollissima) by creating clutches of three and six eggs (natural range 3-6 eggs). The common eider is a long-lived sea-duck where females do not eat during the incubation period. Mass loss increased and immune function (lymphocyte levels and specific antibody response to the non-pathogenic antigens diphtheria and tetanus toxoid) was reduced in females incubating large clutches. The increased incubation effort among females assigned to large incubation demand did not lead to adverse effects on current reproduction or return rate in the next breeding season. However, large incubation demand resulted in long-term fitness costs through reduced fecundity the year after manipulation. Our data show that in eiders, a long-lived species, the cost of high incubation demand is paid in the currency of reduced future fecundity, possibly mediated by reduced immune function.

Reducing healthcare costs facilitated by surgical auditing: a systematic review.

Science.gov (United States)

Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria

2015-07-01

Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs.

Science.gov (United States)

Nordin, Andrew B; Sales, Stephen; Nielsen, Jason W; Adler, Brent; Bates, David Gregory; Kenney, Brian

2018-01-01

Ultrasound is preferred over computed tomography (CT) for diagnosing appendicitis in children to avoid undue radiation exposure. We previously reported our experience in instituting a standardized appendicitis ultrasound template, which decreased CT rates by 67.3%. In this analysis, we demonstrate the ongoing cost savings associated with using this template. Retrospective chart review for the time period preceding template implementation (June 2012-September 2012) was combined with prospective review through December 2015 for all patients in the emergency department receiving diagnostic imaging for appendicitis. The type of imaging was recorded, and imaging rates and ultrasound test statistics were calculated. Estimated annual imaging costs based on pretemplate ultrasound and CT utilization rates were compared with post-template annual costs to calculate annual and cumulative savings. In the pretemplate period, ultrasound and CT rates were 80.2% and 44.3%, respectively, resulting in a combined annual cost of $300,527.70. Similar calculations were performed for each succeeding year, accounting for changes in patient volume. Using pretemplate rates, our projected 2015 imaging cost was $371,402.86; however, our ultrasound rate had increased to 98.3%, whereas the CT rate declined to 9.6%, yielding an annual estimated cost of $224,853.00 and a savings of $146,549.86. Since implementation, annual savings have steadily increased for a cumulative cost savings of $336,683.83. Standardizing ultrasound reports for appendicitis not only reduces the use of CT scans and the associated radiation exposure but also decreases annual imaging costs despite increased numbers of imaging studies. Continued cost reduction may be possible by using diagnostic algorithms. Copyright © 2017 Elsevier Inc. All rights reserved.

An Active Learning Classifier for Further Reducing Diabetic Retinopathy Screening System Cost

Directory of Open Access Journals (Sweden)

Yinan Zhang

2016-01-01

Full Text Available Diabetic retinopathy (DR screening system raises a financial problem. For further reducing DR screening cost, an active learning classifier is proposed in this paper. Our approach identifies retinal images based on features extracted by anatomical part recognition and lesion detection algorithms. Kernel extreme learning machine (KELM is a rapid classifier for solving classification problems in high dimensional space. Both active learning and ensemble technique elevate performance of KELM when using small training dataset. The committee only proposes necessary manual work to doctor for saving cost. On the publicly available Messidor database, our classifier is trained with 20%–35% of labeled retinal images and comparative classifiers are trained with 80% of labeled retinal images. Results show that our classifier can achieve better classification accuracy than Classification and Regression Tree, radial basis function SVM, Multilayer Perceptron SVM, Linear SVM, and K Nearest Neighbor. Empirical experiments suggest that our active learning classifier is efficient for further reducing DR screening cost.

A reduced-cost iterated local search heuristic for the fixed-charge transportation problem

NARCIS (Netherlands)

Buson, Erika; Roberti, Roberto; Toth, Paolo

2014-01-01

The fixed-charge transportation problem (FCTP) is a generalization of the transportation problem where an additional fixed cost is paid for sending a flow from an origin to a destination. We propose an iterated local search heuristic based on the utilization of reduced costs for guiding the restart

Healthcare technology: physician collaboration in reducing the surgical cost.

Science.gov (United States)

Olson, Steven A; Obremskey, William T; Bozic, Kevin J

2013-06-01

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

Fixed-point image orthorectification algorithms for reduced computational cost

Science.gov (United States)

French, Joseph Clinton

Imaging systems have been applied to many new applications in recent years. With the advent of low-cost, low-power focal planes and more powerful, lower cost computers, remote sensing applications have become more wide spread. Many of these applications require some form of geolocation, especially when relative distances are desired. However, when greater global positional accuracy is needed, orthorectification becomes necessary. Orthorectification is the process of projecting an image onto a Digital Elevation Map (DEM), which removes terrain distortions and corrects the perspective distortion by changing the viewing angle to be perpendicular to the projection plane. Orthorectification is used in disaster tracking, landscape management, wildlife monitoring and many other applications. However, orthorectification is a computationally expensive process due to floating point operations and divisions in the algorithm. To reduce the computational cost of on-board processing, two novel algorithm modifications are proposed. One modification is projection utilizing fixed-point arithmetic. Fixed point arithmetic removes the floating point operations and reduces the processing time by operating only on integers. The second modification is replacement of the division inherent in projection with a multiplication of the inverse. The inverse must operate iteratively. Therefore, the inverse is replaced with a linear approximation. As a result of these modifications, the processing time of projection is reduced by a factor of 1.3x with an average pixel position error of 0.2% of a pixel size for 128-bit integer processing and over 4x with an average pixel position error of less than 13% of a pixel size for a 64-bit integer processing. A secondary inverse function approximation is also developed that replaces the linear approximation with a quadratic. The quadratic approximation produces a more accurate approximation of the inverse, allowing for an integer multiplication calculation

Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF.

Science.gov (United States)

Yates, A P; Rustamov, O; Roberts, S A; Lim, H Y N; Pemberton, P W; Smith, A; Nardo, L G

2011-09-01

Anti-Müllerian hormone (AMH) is increasingly used to quantify ovarian reserve, but it has not yet realized its full clinical potential in assisted reproduction technology. We investigated the possible benefits of using novel, stratified ovarian hyperstimulation protocols, tailored to individual AMH levels, compared with conventional stimulation. Retrospective data were collected from 769 women (first cycle of IVF, using fresh embryos), in a UK tertiary care unit: 346 women using conventional stimulation protocols; 423 women treated under new AMH-tailored protocols. Embryo transfer rates increased significantly (79-87%: P= 0.002) after the introduction of AMH-tailored stimulation protocols. Pregnancy rate per cycle started and live birth rate also increased significantly compared with conventionally treated women (17.9-27.7%, P= 0.002 and 15.9-23.9%, P = 0.007, respectively). Moreover, in the AMH group, the incidence of the ovarian hyperstimulation syndrome (OHSS) fell significantly (6.9-2.3%, P = 0.002) and failed fertilization fell from 7.8 to 4.5%. The cost of fertility drug treatment fell by 29% per patient and the overall cost of clinical management of OHSS fell by 43% in the AMH group. GnRH antagonist protocols, introduced as part of AMH-tailored treatment, may have contributed to the observed improvements: however, within the AMH-tailored group, the live birth rate was not significantly different between agonist and antagonist-treated groups. Although large, prospective, multicentre studies are indicated, we have clearly demonstrated that individualized, AMH-guided, controlled ovarian hyperstimulation protocols significantly improved positive clinical outcomes, reduced the incidence of complications and reduced the financial burden associated with assisted reproduction.

Rightsizing HVAC Systems to Reduce Capital Costs and Save Energy

Science.gov (United States)

Sebesta, James

2010-01-01

Nearly every institution is faced with the situation of having to reduce the cost of a construction project from time to time through a process generally referred to as "value engineering." Just the mention of those words, however, gives rise to all types of connotations, thoughts, and memories (usually negative) for those in the…

Reducing Operating Costs and Energy Consumption at Water Utilities

Science.gov (United States)

Due to their unique combination of high energy usage and potential for significant savings, utilities are turning to energy-efficient technologies to help save money. Learn about cost and energy saving technologies from this brochure.

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.

Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction.

Science.gov (United States)

Sandhu, Alexander T; Ollendorf, Daniel A; Chapman, Richard H; Pearson, Steven D; Heidenreich, Paul A

2016-11-15

Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction. To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure. Markov decision model. Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables. Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less. Lifetime. Societal. Treatment with sacubitril-valsartan or lisinopril. Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios. The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure. Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained. The benefit of sacubitril-valsartan is based on a single clinical trial. Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure. U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.

Environmental tipping points significantly affect the cost-benefit assessment of climate policies.

Science.gov (United States)

Cai, Yongyang; Judd, Kenneth L; Lenton, Timothy M; Lontzek, Thomas S; Narita, Daiju

2015-04-14

Most current cost-benefit analyses of climate change policies suggest an optimal global climate policy that is significantly less stringent than the level required to meet the internationally agreed 2 °C target. This is partly because the sum of estimated economic damage of climate change across various sectors, such as energy use and changes in agricultural production, results in only a small economic loss or even a small economic gain in the gross world product under predicted levels of climate change. However, those cost-benefit analyses rarely take account of environmental tipping points leading to abrupt and irreversible impacts on market and nonmarket goods and services, including those provided by the climate and by ecosystems. Here we show that including environmental tipping point impacts in a stochastic dynamic integrated assessment model profoundly alters cost-benefit assessment of global climate policy. The risk of a tipping point, even if it only has nonmarket impacts, could substantially increase the present optimal carbon tax. For example, a risk of only 5% loss in nonmarket goods that occurs with a 5% annual probability at 4 °C increase of the global surface temperature causes an immediate two-thirds increase in optimal carbon tax. If the tipping point also has a 5% impact on market goods, the optimal carbon tax increases by more than a factor of 3. Hence existing cost-benefit assessments of global climate policy may be significantly underestimating the needs for controlling climate change.

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

Directory of Open Access Journals (Sweden)

Helen Mason

Full Text Available BACKGROUND: Coronary Heart Disease (CHD is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy. All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30% resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

The cost-effectiveness of methanol for reducing motor vehicle emissions and urban ozone

International Nuclear Information System (INIS)

Krupnick, A.J.; Walls, M.A.

1992-01-01

This article analyzes the costs and emissions characteristics of methanol vehicles. The cost-effectiveness of methanol - the cost per ton of reactive hydrocarbon emissions reduced - is calculated and compared to the cost-effectiveness of other hydrocarbon reduction strategies. Methanol is found to cost from $33,000 to nearly $60,000 per ton, while several other options are available for under $10,000 per ton. The cost per part-per-million reduction in peak ambient ozone levels is also computed for two cities, Houston and Philadelphia. Despite the greater improvement in ozone in Philadelphia than Houston, methanol is found to be more cost-effective in Houston. This result occurs because Houston's distribution and marketing costs are lower than Philadelphia's. The costs in both cities, however, are far higher than estimates of the benefits from acute health improvements. Finally, the reduction in ozone exposure in Los Angeles is estimated and the costs of the reduction compared with an estimate of acute health benefits. Again, the benefits fall far short of the costs. 51 refs., 5 tabs

Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial.

Science.gov (United States)

Pizzi, Laura T; Seligman, Neil S; Baxter, Jason K; Jutkowitz, Eric; Berghella, Vincenzo

2014-05-01

Preterm birth (PTB) is a costly public health problem in the USA. The PREGNANT trial tested the efficacy of vaginal progesterone (VP) 8 % gel in reducing the likelihood of PTB among women with a short cervix. We calculated the costs and cost effectiveness of VP gel versus placebo using decision analytic models informed by PREGNANT patient-level data. PREGNANT enrolled 459 pregnant women with a cervical length of 10-20 mm and randomized them to either VP 8 % gel or placebo. We used a cost model to estimate the total cost of treatment per mother and a cost-effectiveness model to estimate the cost per PTB averted with VP gel versus placebo. Patient-level trial data informed model inputs and included PTB rates in low- and high-risk women in each study group at <28 weeks gestation, 28-31, 32-36, and ≥37 weeks. Cost assumptions were based on 2010 US healthcare services reimbursements. The cost model was validated against patient-level data. Sensitivity analyses were used to test the robustness of the cost-effectiveness model. The estimated cost per mother was $US23,079 for VP gel and $US36,436 for placebo. The cost-effectiveness model showed savings of $US24,071 per PTB averted with VP gel. VP gel realized cost savings and cost effectiveness in 79 % of simulations. Based on findings from PREGNANT, VP gel was associated with cost savings and cost effectiveness compared with placebo. Future trials designed to include cost metrics are needed to better understand the value of VP.

Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

Science.gov (United States)

McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

2015-10-01

Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency. Copyright © 2015 Elsevier Inc. All rights reserved.

Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

Science.gov (United States)

2014-01-01

Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

Effects of worksite health interventions involving reduced work hours and physical exercise on sickness absence costs.

Science.gov (United States)

von Thiele Schwarz, Ulrica; Hasson, Henna

2012-05-01

To investigate the effects of physical exercise during work hours (PE) and reduced work hours (RWH) on direct and indirect costs associated with sickness absence (SA). Sickness absence and related costs at six workplaces, matched and randomized to three conditions (PE, RWH, and referents), were retrieved from company records and/or estimated using salary conversion methods or value-added equations on the basis of interview data. Although SA days decreased in all conditions (PE, 11.4%; RWH, 4.9%; referents, 15.9%), costs were reduced in the PE (22.2%) and RWH (4.9%) conditions but not among referents (10.2% increase). Worksite health interventions may generate savings in SA costs. Costs may not be linear to changes in SA days. Combing the friction method with indirect cost estimates on the basis of value-added productivity may help illuminate both direct and indirect SA costs.

Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (sCr) for acute kidney injury (AKI) diagnosis.

Science.gov (United States)

Parikh, Amay; Rizzo, John A; Canetta, Pietro; Forster, Catherine; Sise, Meghan; Maarouf, Omar; Singer, Eugenia; Elger, Antje; Elitok, Saban; Schmidt-Ott, Kai; Barasch, Jonathon; Nickolas, Thomas L

2017-01-01

Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a sensitive and specific diagnostic test for acute kidney injury (AKI) in the Emergency Department (ED), but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr) would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone. A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr). A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007-8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated. For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp) in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts) at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients). Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs. Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.

Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL & serum creatinine (sCr for acute kidney injury (AKI diagnosis.

Directory of Open Access Journals (Sweden)

Amay Parikh

Full Text Available Urine neutrophil gelatinase-associated lipocalin (uNGAL is a sensitive and specific diagnostic test for acute kidney injury (AKI in the Emergency Department (ED, but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone.A cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr. A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007-8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated.For a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients. Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs.Using uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.

Preliminary analysis about reducing production costs in uranium mining and metallurgy at Fuzhou uranium mine

International Nuclear Information System (INIS)

Wu Sanmao

1999-01-01

The production costs in uranium ming and metallurgy have been analyzed quantitatively term by term according to present production situation for The Uranium Mining and Metallurgy Corp, which is part of Fuzhou Uranium Mine. The principal factors influencing on the production costs and the main means reducing the production costs have been found

Economic feasibility of invesment alternatives for reducing torula yeast' production cost

International Nuclear Information System (INIS)

Torres Fernández, Alfredo; Díaz de los Ríos, Manuel; Saura Laria, Gustavo

2016-01-01

The prices of ammonium salts which are used in the torula yeast production technology are very high nowadays. In the other hand, this technology has very high energy costs which are consumed by blowers in fermentation, separators machines and in the concentration and drying of yeast. In this paper, different technical alternatives are analyzed for reducing the production cost of torula yeast, through changes in production inputs, electric motors and the replacement of a portion of the fuel used for drying by biogas. Then, the economic feasibility in both currencies is evaluated for practical application. (author)

ECONOMIC FEASIBILITY OF INVESMENT ALTERNATIVES FOR REDUCING TORULA YEAST' PRODUCTION COST

Directory of Open Access Journals (Sweden)

Alfredo Torres Fernández

2016-01-01

Full Text Available The prices of ammonium salts which are used in the torula yeast production technology are very high nowadays. In the other hand, this technology has very high energy costs which are consumed by blowers in fermentation, separators machines and in the concentration and drying of yeast. In this paper, different technical alternatives are analyzed for reducing the production cost of torula yeast, through changes in production inputs, electric motors and the replacement of a portion of the fuel used for drying by biogas. Then, the economic feasibility in both currencies is evaluated for practical application.

Main means for reducing the production costs in process of leaching uranium

International Nuclear Information System (INIS)

Jiang Lang

2000-01-01

The production costs in process of leaching uranium have been reduced by controlling mixture ratio of crudes, milling particle size, liquid/solid mass ratio of leaching pulp, potential and residue acidity, and improving power equipment

Incorrect predictions reduce switch costs.

Science.gov (United States)

Kleinsorge, Thomas; Scheil, Juliane

2015-07-01

In three experiments, we combined two sources of conflict within a modified task-switching procedure. The first source of conflict was the one inherent in any task switching situation, namely the conflict between a task set activated by the recent performance of another task and the task set needed to perform the actually relevant task. The second source of conflict was induced by requiring participants to guess aspects of the upcoming task (Exps. 1 & 2: task identity; Exp. 3: position of task precue). In case of an incorrect guess, a conflict accrues between the representation of the guessed task and the actually relevant task. In Experiments 1 and 2, incorrect guesses led to an overall increase of reaction times and error rates, but they reduced task switch costs compared to conditions in which participants predicted the correct task. In Experiment 3, incorrect guesses resulted in faster performance overall and to a selective decrease of reaction times in task switch trials when the cue-target interval was long. We interpret these findings in terms of an enhanced level of controlled processing induced by a combination of two sources of conflict converging upon the same target of cognitive control. Copyright © 2015 Elsevier B.V. All rights reserved.

Reduced Cost Composite Hot Structures with Oxidation Protection, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — Innovative, low cost high performance technologies are critical to the affordability of future space missions. Carbon/carbon (C/C) composites have significant...

Reducing Nitrogen Pollution while Decreasing Farmers' Costs and Increasing Fertilizer Industry Profits.

Science.gov (United States)

Kanter, David R; Zhang, Xin; Mauzerall, Denise L

2015-03-01

Nitrogen (N) pollution is emerging as one of the most important environmental issues of the 21st Century, contributing to air and water pollution, climate change, and stratospheric ozone depletion. With agriculture being the dominant source, we tested whether it is possible to reduce agricultural N pollution in a way that benefits the environment, reduces farmers' costs, and increases fertilizer industry profitability, thereby creating a "sweet spot" for decision-makers that could significantly increase the viability of improved N management initiatives. Although studies of the economic impacts of improved N management have begun to take into account farmers and the environment, this is the first study to consider the fertilizer industry. Our "sweet spot" hypothesis is evaluated via a cost-benefit analysis of moderate and ambitious N use efficiency targets in U.S. and China corn sectors over the period 2015-2035. We use a blend of publicly available crop and energy price projections, original time-series modeling, and expert elicitation. The results present a mixed picture: although the potential for a "sweet spot" exists in both countries, it is more likely that one occurs in China due to the currently extensive overapplication of fertilizer, which creates a greater potential for farmers and the fertilizer industry to gain economically from improved N management. Nevertheless, the environmental benefits of improving N management consistently dwarf the economic impacts on farmers and the fertilizer industry in both countries, suggesting that viable policy options could include incentives to farmers and the fertilizer industry to increase their support for N management policies. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Income Tax Returns: Reducing Compliance Costs for Personal Income Taxpayers in Slovenia

Directory of Open Access Journals (Sweden)

Maja Klun

2009-06-01

Full Text Available Simplifying procedures and improving legislation generally lead to a reduction in the compliance costs. The introduction of pre-filled tax returns clearly simplifies the tax compliance procedure. Before the introduction of pre-filled tax returns for personal income taxpayers in Slovenia, tax legislation was also modified. This paper presents the results of research into the compliance costs for personal income taxpayers before and after the simplification of the compliance procedure in Slovenia, irrespective of tax legislation itself not being simplified. The results indicate that pre-filled tax returns reduce compliance costs for personal income taxpayers by around 73%. Nevertheless, this is only a tentative estimate, since several assumptions are taken into account.

G-CSF in solid tumor chemotherapy: a tailored regimen reduces febrile neutropenia, treatment delays and direct costs.

Science.gov (United States)

Tsavaris, Nicolas; Kosmas, Christos; Gouveris, Panagiotis; Vadiak, Maria; Dimitrakopoulos, Antonis; Karadima, Dimitra; Pagouni, Efterpi; Panagiotakopoulos, George; Tzima, Evanthia; Ispoglou, Sevasti; Sakelariou, Dimitris; Koufos, Christos

2004-02-01

Current guidelines do not recommend G-CSF for patients with risk factors for neutropenia. One-hundred patients undergoing chemotherapy were randomized to treatment with G-CSF at 5 Kg/kg for established febrile neutropenia (ANC <1000/microl) (Group A) or G-CSF at 263 Kg/day if ANC was 1500/microl or less on the day of the expected nadir, with the duration of treatment determined by the severity of neutropenia (Group B). The number of doses of G-CSF was similar in the two groups. There were 34 cases of febrile neutropenia in Group A, but none in Group B (p=0.0001). Hospital admission for febrile neutropenia, antibiotic use and delays in chemotherapy were all significantly more common in Group A. Total direct costs were estimated to be 66, 646 for Group A and 47, 119 for Group B. Tailoring treatment does not increase G-CSF use, but significantly reduces febrile neutropenia and treatment delays and lowers direct costs.

Reducing rotor weight

Energy Technology Data Exchange (ETDEWEB)

Cheney, M.C. [PS Enterprises, Inc., Glastonbury, CT (United States)

1997-12-31

The cost of energy for renewables has gained greater significance in recent years due to the drop in price in some competing energy sources, particularly natural gas. In pursuit of lower manufacturing costs for wind turbine systems, work was conducted to explore an innovative rotor designed to reduce weight and cost over conventional rotor systems. Trade-off studies were conducted to measure the influence of number of blades, stiffness, and manufacturing method on COE. The study showed that increasing number of blades at constant solidity significantly reduced rotor weight and that manufacturing the blades using pultrusion technology produced the lowest cost per pound. Under contracts with the National Renewable Energy Laboratory and the California Energy Commission, a 400 kW (33m diameter) turbine was designed employing this technology. The project included tests of an 80 kW (15.5m diameter) dynamically scaled rotor which demonstrated the viability of the design.

Reducing BWR O and M costs through on-line performance monitoring

International Nuclear Information System (INIS)

Jonas, T.; Gross, R.; Logback, F.; Josyula, R.

1995-01-01

Competition in the electric power industry has placed significant emphasis on reducing operating and maintenance (O and M) costs at nuclear facilities. Therefore, on-line performance monitoring to locate power losses for boiling water reactor (BWR) plants is creating tremendous interest. In addition, the ability to automate activities such as data collection, analysis, and reporting increases the efficiency of plant engineers and gives them more time to concentrate on solving plant efficiency problems. This capability is now available with a unique software product called GEBOPS. GE Nuclear Energy, in conjunction with Joint Venture partner Black and Veatch, has undertaken development of the General Electric/Black and Veatch On-line Performance System (GEBOPS), an on-line performance monitoring system for BWR plants. The experience and expertise of GE Nuclear Energy with BWR plants, coupled with the proven on-line monitoring software development experience and capability of Black and Veatch, provide the foundation for a unique product which addresses the needs of today's BWR plants

The application of an integrated approach to design, procurement and construction in reducing overall nuclear power plant costs. Annex 19

International Nuclear Information System (INIS)

Didsbury, R.; Shalaby, B.A.; Torgerson, D.F.

2002-01-01

As part of its on-going efforts to reduce the cost of CANDU nuclear power plants, AECL has embarked on an integrated approach to design, procurement and construction activities associated with new CANDU 6 and CANDU 9 projects. The approach is predicated on the fact there is a vast quantity of information that needs to be managed and controlled over the life of a nuclear power plant project. Therefore, ensuring the completeness and correctness of all the information needed by all project participants, facilitating sharing of this information amongst the project's participants, and automating the various deliverable production processes offers significant potential not only for overall project cost (and schedule) savings but also for reducing operations and maintenance costs once the plant enters service. Facilitating and indeed of key importance to this approach is the use of a suite of integrated information technology-based engineering, procurement and project control tools used throughout the design, engineering, procurement and construction phases of the project. A unique and important feature of these tools is their high degree of integration both from a work process and a data perspective. Use of these tools is well underway on AECL's Qinshan Project which is realizing significant benefits in cost and schedule. This paper will describe the approach AECL is taking, along with the tools it has both put in place, and those additional items planned for the future along with the cost, schedule and quality benefits that arise from their use. Progress to date on the Qinshan project also will be discussed as well as the expected application to the plant once it has gone into service will also be discussed. (author)

Navy Ordnance Analysis of Business Area Efforts to Streamline Operations and Reduce Costs

National Research Council Canada - National Science Library

1997-01-01

.... The Navy reorganized this business area in 1993 in order to reduce costs and address various deficiencies in ordnance logistics management that were identified during Desert Shield/Desert Storm...

Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective.

Science.gov (United States)

Mortimer, Joshua W; McLachlan, Craig S; Hansen, Carmen J; Assareh, Hassan; Last, Andrew; McKay, Michael J; Shakespeare, Thomas P

2016-02-01

The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration. Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences. Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy. Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. © 2015 The Royal Australian and New Zealand College of Radiologists.

Autonomous exoskeleton reduces metabolic cost of human walking.

Science.gov (United States)

Mooney, Luke M; Rouse, Elliott J; Herr, Hugh M

2014-11-03

Passive exoskeletons that assist with human locomotion are often lightweight and compact, but are unable to provide net mechanical power to the exoskeletal wearer. In contrast, powered exoskeletons often provide biologically appropriate levels of mechanical power, but the size and mass of their actuator/power source designs often lead to heavy and unwieldy devices. In this study, we extend the design and evaluation of a lightweight and powerful autonomous exoskeleton evaluated for loaded walking in (J Neuroeng Rehab 11:80, 2014) to the case of unloaded walking conditions. The metabolic energy consumption of seven study participants (85 ± 12 kg body mass) was measured while walking on a level treadmill at 1.4 m/s. Testing conditions included not wearing the exoskeleton and wearing the exoskeleton, in both powered and unpowered modes. When averaged across the gait cycle, the autonomous exoskeleton applied a mean positive mechanical power of 26 ± 1 W (13 W per ankle) with 2.12 kg of added exoskeletal foot-shank mass (1.06 kg per leg). Use of the leg exoskeleton significantly reduced the metabolic cost of walking by 35 ± 13 W, which was an improvement of 10 ± 3% (p = 0.023) relative to the control condition of not wearing the exoskeleton. The results of this study highlight the advantages of developing lightweight and powerful exoskeletons that can comfortably assist the body during walking.

Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

Energy Technology Data Exchange (ETDEWEB)

Busch, Jonah [Center for Applied Biodiversity Science, Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Strassburg, Bernardo [Center for Social and Economic Research on the Global Environment, University of East Anglia, Norwich NR4 7TJ (United Kingdom); Cattaneo, Andrea [Woods Hole Research Center, 149 Woods Hole Road, Falmouth, MA 02540-1644 (United States); Lubowski, Ruben [Environmental Defense Fund, 1875 Connecticut Avenue NW, Washington, DC (United States); Bruner, Aaron; Rice, Richard; Boltz, Frederick [Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Creed, Anna; Ashton, Ralph, E-mail: jbusch@conservation.or [Terrestrial Carbon Group, 900 17th Street NW, Suite 700, Washington, DC (United States)

2009-10-15

The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

International Nuclear Information System (INIS)

Busch, Jonah; Strassburg, Bernardo; Cattaneo, Andrea; Lubowski, Ruben; Bruner, Aaron; Rice, Richard; Boltz, Frederick; Creed, Anna; Ashton, Ralph

2009-01-01

The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

A structured blood conservation programme reduces transfusions and costs in cardiac surgery.

Science.gov (United States)

Ternström, Lisa; Hyllner, Monica; Backlund, Erika; Schersten, Henrik; Jeppsson, Anders

2014-11-01

Transfusions of blood products can be lifesaving, but they are also associated with considerable risks and adverse effects, including immune response and infections. In cardiac surgery, transfusions have also been associated with increased mortality. We prospectively studied the effects of a structured programme to reduce transfusions and transfusion-associated costs in cardiac surgery. The programme included: (i) education of all staff about the risks and benefits of blood transfusions; (ii) revised guidelines for transfusions; and (iii) a transfusion log where indication for transfusion, status of the patient and prescribing physician were registered. Transfusion prevalence, complications and costs for blood products were registered for all acute and elective cardiac operations during a 12-month period before (n = 1128) and after (n = 1034) the programme was started. The two time periods were compared. In addition, the prevalence of transfusions was registered for 2 more years after the programme was initiated. The first year after the programme was initiated the proportion of patients transfused with red blood cell concentrate decreased by 21.8% (from 58.2 to 45.5%, P platelets by 21.0% (from 20.5 to 16.2%, P = 0.010). Reoperations for bleeding (5.8 vs 5.0%), early complication rate and 30-day mortality (2.5 vs 2.6%) were not significantly different before and after the start date. Based on the 2009 institutional prices for red blood cell concentrate (102 €/unit), plasma (35 €/unit) and platelets (290 €/unit), the savings on blood products were €161,623 during the first 12 months after the programme was launched. The proportion of patients transfused with any blood product was 60.9% before the programme was started and 48.3, 54.0 and 50.7% 1-3 years after its start (all P conservation programme reduces transfusions and costs for blood products in cardiac surgery, without any signs of compromised medical safety. The effects of introducing such a programme

Clinical practice guidelines (CPGs) reduce costs in the management of isolated splenic injuries at pediatric trauma centers.

Science.gov (United States)

Gutierrez, Ivan M; Zurakowski, David; Chen, Qiaoli; Mooney, David P

2013-02-01

The American Pediatric Surgical Association Trauma Committee proposed the use of a clinical practice guideline (CPG) for the non-operative management of isolated splenic injuries in 1998. An analysis was conducted to determine the financial impact of CPGs on the management of these injuries. The Pediatric Health Information System database, which contains data from 44 children's hospitals, was used to identify children who sustained a graded isolated splenic injury between June 2005 and June 2010. Demographics, length of stay (LOS), readmission rates, and laboratory, imaging, procedural, and total cost data were determined for all hospitals verified as a pediatric trauma center by the American College of Surgeons and/or designated by their local authority. Comparisons were made between facilities self-identifying as having a splenic injury management CPG and those without a CPG. Children (1,154) with isolated splenic injuries (grades 1-4) were cared for in 26 pediatric trauma centers: 20 with a CPG and 6 without (non-CPG). Median costs were significantly lower at CPG than non-CPG centers for imaging (US $163 vs. US $641, P splenic injuries at a pediatric trauma center results in significantly reduced imaging, laboratory, and total hospital costs independent of patient age, gender, grade, and LOS.

Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service.

Science.gov (United States)

Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R

2014-06-01

The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.

Lowering the UK domestic radon action level to reduce radiation-induced lung cancer in general population: when and where is it cost effective?

International Nuclear Information System (INIS)

Denman, A.R.; Phillips, P.S.

2008-01-01

Case studies have shown that radon gas can be present within domestic properties at sufficiently high levels that it can significantly increase the risk of lung cancer in occupants. Recently, Darby et al. (2006) have shown that this risk exists at radon concentrations as low as 100 Bq·m -3 , which is below the UK domestic Action Level of 200 Bq·m -3 . As a result, there have been suggestions that national domestic Action Levels should be reduced. This paper considers the benefits and costs of the domestic radon remediation programmes in the UK, when a range of Action Levels from 125 Bq·m -3 to 600 Bq·m -3 are applied. The variations of total cost, cost-effectiveness, dose reduction and lung cancers saved for each proposed action level, and the proportion of houses over the proposed action level, were estimated. The study shows that, for an Action Level above 200 Bq·m -3 , a completed domestic radon remediation programme in Northamptonshire, where 6.3% of existing houses have initial radon levels over 200 Bq·m -3 , will cost less and will target those most at risk, but will be less cost effective. In addition, a higher Action Level leaves a higher residual dose and greater risk of cancer in the population living in unremediated homes. Reducing the Action Level below 200 Bq·m -3 will prevent more cancers, but at significantly higher cost. It will be less cost-effective, because a significant number of houses with moderate radon levels will be remediated with modest health benefit to occupants. The study suggests that a completed radon remediation programme is most cost-effective with an action level of around 250 to 300 Bq·m -3 . The finding appears to be independent of the percentage of houses over the Action Level. This has clear implications for future health policy. (author)

Competitive investments in cost reducing process improvement : The role of managerial incentives and spillover learning

NARCIS (Netherlands)

Veldman, Jasper; Gaalman, Gerard J.c.

2015-01-01

We study the rivalry between two firms and consider the effect of spillovers when the firms' operations and technology managers are given bonuses for cost reduction. We model a game in which the firm owners independently offer their manager a bonus to stimulate cost reducing process improvement

Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa--the case of Zimbabwean women.

Directory of Open Access Journals (Sweden)

Martial L Ndeffo Mbah

Full Text Available Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection.We developed a mathematical model of female genital schistosomiasis (FGS and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa.We showed that for a variation of efficacy between 30-70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16-101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30-70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36-92 million over a ten-year period.In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass praziquantel administration should be prioritized

Improving the delivery of care and reducing healthcare costs with the digitization of information.

Science.gov (United States)

Noffsinger, R; Chin, S

2000-01-01

In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

Basking hamsters reduce resting metabolism, body temperature and energy costs during rewarming from torpor.

Science.gov (United States)

Geiser, Fritz; Gasch, Kristina; Bieber, Claudia; Stalder, Gabrielle L; Gerritsmann, Hanno; Ruf, Thomas

2016-07-15

Basking can substantially reduce thermoregulatory energy expenditure of mammals. We tested the hypothesis that the largely white winter fur of hamsters (Phodopus sungorus), originating from Asian steppes, may be related to camouflage to permit sun basking on or near snow. Winter-acclimated hamsters in our study were largely white and had a high proclivity to bask when resting and torpid. Resting hamsters reduced metabolic rate (MR) significantly (>30%) when basking at ambient temperatures (Ta) of ∼15 and 0°C. Interestingly, body temperature (Tb) also was significantly reduced from 34.7±0.6°C (Ta 15°C, not basking) to 30.4±2.0°C (Ta 0°C, basking), which resulted in an extremely low (thermal conductance. Induced torpor (food withheld) during respirometry at Ta 15°C occurred on 83.3±36.0% of days and the minimum torpor MR was 36% of basal MR at an average Tb of 22.0±2.6°C; movement to the basking lamp occurred at Tb50%) during radiant heat-assisted rewarming; however, radiant heat per se without an endogenous contribution by animals did not strongly affect metabolism and Tb during torpor. Our data show that basking substantially modifies thermal energetics in hamsters, with a drop of resting Tb and MR not previously observed and a reduction of rewarming costs. The energy savings afforded by basking in hamsters suggest that this behaviour is of energetic significance not only for mammals living in deserts, where basking is common, but also for P. sungorus and probably other cold-climate mammals. © 2016. Published by The Company of Biologists Ltd.

78 FR 41857 - Simplified Cost Accounting and Other Actions To Reduce Paperwork in the Summer Food Service...

Science.gov (United States)

2013-07-12

... CFR Parts 210 and 225 RIN 0584-AD84 Simplified Cost Accounting and Other Actions To Reduce Paperwork... Consolidated Appropriations Act, 2008. The changes extend simplified cost accounting and reporting procedures... nondiscretionary simplified cost accounting and reporting procedures established in the Consolidated Appropriations...

What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.

Science.gov (United States)

Hunter, Wynn G; Zhang, Cecilia Z; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

2016-10-01

More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression). Focus on 3 conditions with potentially high out-of-pocket costs. Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes. © The Author(s) 2016.

Does SDDS Subscription Reduce Borrowing Costs for Emerging Market Economies?

OpenAIRE

John Cady

2005-01-01

Does macroeconomic data transparency-as signaled by subscription to the IMF's Special Data Dissemination Standard (SDDS)-help reduce borrowing costs in international capital markets? This question is examined using data on new issues of sovereign foreign-currency-denominated (U.S. dollar, yen, and euro) bonds for several emerging market economies. Panel econometric estimates indicate that spreads on new bond issues declined on average by close to 20 percent, or by an average of about 55 basis...

A way for reducing drug supply chain cost for a hospital district: A case study

Energy Technology Data Exchange (ETDEWEB)

Postacchini, L.; Ciarapica, F.E.; Bevilacqua, M.; Mazzuto, G.; Paciarotti, C.

2016-07-01

This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization); re-order and inventory management policies (Economic Order Quantity or Economic Order Interval); required service levels (90% or 95%); the number of available vans (one or two). For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments) analysis has been executed. The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. This paper fulfils an identified need to study which combination of transshipment policies, re-order/inventory management policies and required service levels, can be the

A way for reducing drug supply chain cost for a hospital district: A case study

Directory of Open Access Journals (Sweden)

Leonardo Postacchini

2016-03-01

Full Text Available Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization; re-order and inventory management policies (Economic Order Quantity or Economic Order Interval; required service levels (90% or 95%; the number of available vans (one or two. For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments analysis has been executed. Findings: The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. Practical implications: This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. Originality/value: This paper fulfils an identified need to study which combination of

Analysis and modeling of rail maintenance costs

Directory of Open Access Journals (Sweden)

Amir Ali Bakhshi

2012-01-01

Full Text Available Railroad maintenance engineering plays an important role on availability of roads and reducing the cost of railroad incidents. Rail is of the most important parts of railroad industry, which needs regular maintenance since it covers a significant part of total maintenance cost. Any attempt on optimizing total cost of maintenance could substantially reduce the cost of railroad system and it can reduce total cost of the industry. The paper presents a new method to estimate the cost of rail failure using different cost components such as cost of inspection and cost of risk associated with possible accidents. The proposed model of this paper is used for a real-world case study of railroad transportation of Tehran region and the results have been analyzed.

Early appendectomy reduces costs in children with perforated appendicitis.

Science.gov (United States)

Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

2017-12-01

Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier

Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome

Directory of Open Access Journals (Sweden)

A Iyengar

2013-01-01

Full Text Available Cyclosporine A (CyA is an effective agent for the treatment of glucocorticoid-dependent idiopathic nephrotic syndrome (GCDNS, but costs are prohibitive in resource-poor societies. The objectives of this study were to evaluate the efficacy and safety of reducing the dose of CyA by co-administering ketoconazole. A prospective study targeting children 2-18 years of age with GCDNS in remission with CyA monotherapy was conducted. CyA dose was reduced by 50% and ketoconazole was added at 25% of the recommended therapeutic dose, and the drug levels and therapeutic and adverse effects (AE were monitored. Continued combined therapy after completion of the 4-week trial period was offered. Ten patients (median age 9.5 years, range 3.0-16.0 years were enrolled in the study. At week 4, the CyA dose was 2.2 ± 0.7 mg/kg/day compared with 5.6 ± 0.9 mg/kg/day at enrolment ( P 50% without increased adverse events or drug monitoring needs. This intervention demonstrates how access of patients with limited resources to needed drugs can be improved by interference with physiological drug elimination.

Installation, Operation, and Maintenance Strategies to Reduce the Cost of Offshore Wind Energy

Energy Technology Data Exchange (ETDEWEB)

Maples, B. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Saur, G. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hand, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); van de Pietermen, R. [Energy Research Center of the Netherlands (Netherlands); Obdam, T. [Energy Research Center of the Netherlands (Netherlands)

2013-07-01

Currently, installation, operation, and maintenance (IO&M) costs contribute approximately 30% to the LCOE of offshore wind plants. To reduce LCOE while ensuring safety, this paper identifies principal cost drivers associated with IO&M and quantifies their impacts on LCOE. The paper identifies technology improvement opportunities and provides a basis for evaluating innovative engineering and scientific concepts developed subsequently to the study. Through the completion of a case study, an optimum IO&M strategy for a hypothetical offshore wind project is identified.

Synergistic Role of Balanced Scorecard/Activity Based Costing and Goal Programming Combined Model on Strategic Cost Management

OpenAIRE

Taleghani, Mohammad

2017-01-01

During the past few years, we have seen a significant shift in cost accounting and management. In the new business environment, cost management has become a critical skill, but it is not sufficient for simply reducing costs; instead, costs must be managed strategically. Application of a successful Strategic Cost Management (StraCM) system plays the significant role in success of organization performance. In this study, we want to illustrate how the goal programming model in combination with t...

Cost Analysis of Physician Assistant Home Visit Program to Reduce Readmissions After Cardiac Surgery.

Science.gov (United States)

Nabagiez, John P; Shariff, Masood A; Molloy, William J; Demissie, Seleshi; McGinn, Joseph T

2016-09-01

A physician assistant home care (PAHC) program providing house calls was initiated to reduce hospital readmissions after adult cardiac surgery. The purpose of our study was to compare 30-day PAHC and pre-PAHC readmission rate, length of stay, and cost. Patients who underwent adult cardiac surgery in the 48 months from September 2008 through August 2012 were retrospectively reviewed using pre-PAHC patients as the control group. Readmission rate, length of stay, and health care cost, as measured by hospital billing, were compared between groups matched with propensity score. Of the 1,185 patients who were discharged directly home, 155 (13%) were readmitted. Total readmissions for the control group (n = 648) was 101 patients (16%) compared with the PAHC group (n = 537) total readmissions of 54 (10%), a 38% reduction in the rate of readmission (p = 0.0049). Propensity score matched groups showed a rate reduction of 41% with 17% (62 of 363) for the control compared with 10% (37 of 363) for the PAHC group (p = 0.0061). The average hospital bill per readmission was $39,100 for the control group and $56,600 for the PAHC group (p = 0.0547). The cost of providing home visits was $25,300 for 363 propensity score matched patients. The PAHC program reduced the 30-day readmission rate by 41% for propensity score matched patients. Analysis demonstrated a savings of $977,500 at a cost of $25,300 over 2 years, or $39 in health care saved, in terms of hospital billing, for every $1 spent. Therefore, a home visit by a cardiac surgical physician assistant is a cost-effective strategy to reduce readmissions after cardiac surgery. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Methods Reduce Cost, Enhance Quality of Nanotubes

Science.gov (United States)

2009-01-01

For all the challenges posed by the microgravity conditions of space, weight is actually one of the more significant problems NASA faces in the development of the next generation of U.S. space vehicles. For the Agency s Constellation Program, engineers at NASA centers are designing and testing new vessels as safe, practical, and cost-effective means of space travel following the eventual retirement of the space shuttle. Program components like the Orion Crew Exploration Vehicle, intended to carry astronauts to the International Space Station and the Moon, must be designed to specific weight requirements to manage fuel consumption and match launch rocket capabilities; Orion s gross liftoff weight target is about 63,789 pounds. Future space vehicles will require even greater attention to lightweight construction to help conserve fuel for long-range missions to Mars and beyond. In order to reduce spacecraft weight without sacrificing structural integrity, NASA is pursuing the development of materials that promise to revolutionize not only spacecraft construction, but also a host of potential applications on Earth. Single-walled carbon nanotubes are one material of particular interest. These tubular, single-layer carbon molecules - 100,000 of them braided together would be no thicker than a human hair - display a range of remarkable characteristics. Possessing greater tensile strength than steel at a fraction of the weight, the nanotubes are efficient heat conductors with metallic or semiconductor electrical properties depending on their diameter and chirality (the pattern of each nanotube s hexagonal lattice structure). All of these properties make the nanotubes an appealing material for spacecraft construction, with the potential for nanotube composites to reduce spacecraft weight by 50 percent or more. The nanotubes may also feature in a number of other space exploration applications, including life support, energy storage, and sensor technologies. NASA s various

Cost of reproduction in a long-lived bird: incubation effort reduces immune function and future reproduction

OpenAIRE

Hanssen, S A; Hasselquist, Dennis; Folstad, I; Erikstad, K E

2005-01-01

Life-history theory predicts that increased current reproductive effort should lead to a fitness cost. This cost of reproduction may be observed as reduced survival or future reproduction, and may be caused by temporal suppression of immune function in stressed or hard-working individuals. In birds, consideration of the costs of incubating eggs has largely been neglected in favour of the costs of brood rearing. We manipulated incubation demand in two breeding seasons (2000 and 2001) in female...

Strategies for reducing implant costs in the revision total knee arthroplasty episode of care.

Science.gov (United States)

Elbuluk, Ameer M; Old, Andrew B; Bosco, Joseph A; Schwarzkopf, Ran; Iorio, Richard

2017-12-01

Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models. Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014. Average cost of components for each case was calculated and compared to the total hospital cost for that admission. Costs for an all-component revision were then compared to a proposed "direct to hospital" (DTH) standardized pricing model and a fixed price revision option. Potential savings were calculated from these figures. On average, 28% of the total hospital cost was spent on implants for rTKA. The average cost for revision of all components was $13,640 and ranged from $3000 to $28,000. On average, this represented 32.7% of the total hospital cost. Direct to hospital implant pricing could potentially save approximately $7000 per rTKA, and the fixed pricing model could provide a further $1000 reduction per rTKA-potentially saving $8000 per case on implants alone. Alternative implant pricing models could help lower the total cost of rTKA, which would allow hospitals to achieve significant cost containment.

Cost-effectiveness of universal rotavirus vaccination in reducing rotavirus gastroenteritis in Ireland.

LENUS (Irish Health Repository)

Tilson, L

2011-10-06

We evaluated the cost-effectiveness of universal infant rotavirus (RV) vaccination compared to current standard of care of "no vaccination". Two RV vaccines are currently licensed in Ireland: Rotarix and RotaTeq. A cohort model used in several European countries was adapted using Irish epidemiological, resource utilisation and cost data. The base case model considers the impact of Rotarix vaccination on health-related quality of life of children under five years old from a healthcare payer perspective. Other scenarios explored the use of RotaTeq, impact on one caregiver, on societal costs and on cases that do not seek medical attention. Cost was varied between the vaccine list price (€100\\/course) in the base case and an assumed tender price (€70\\/course). One-way and probabilistic sensitivity analyses were conducted. Implementing universal RV vaccination may prevent around 1970 GP visits, 3280 A&E attendances and 2490 hospitalisations. A vaccination programme was estimated to cost approximately €6.54 million per year but €4.65 million of this would be offset by reducing healthcare resource use. The baseline ICER was €112,048\\/QALY and €72,736\\/QALY from the healthcare payer and societal perspective, respectively, falling to €68,896 and €43,916\\/QALY, respectively, if the impact on one caregiver was considered. If the price fell to €70 per course, universal RV vaccination would be cost saving under all scenarios. Results were sensitive to vaccination costs, incidence of RV infection and direct medical costs. Universal RV vaccination would not be cost-effective under base case assumptions. However, it could be cost-effective at a lower vaccine price or from a wider societal perspective.

Building Commissioning: A Golden Opportunity for Reducing Energy Costs and Greenhouse-gas Emissions

Energy Technology Data Exchange (ETDEWEB)

Mills, Evan

2009-07-16

data are available revealed over 10,000 energy-related problems, resulting in 16% median whole-building energy savings in existing buildings and 13% in new construction, with payback time of 1.1 years and 4.2 years, respectively. In terms of other cost-benefit indicators, median benefit-cost ratios of 4.5 and 1.1, and cash-on-cash returns of 91% and 23% were attained for existing and new buildings, respectively. High-tech buildings were particularly cost-effective, and saved higher amounts of energy due to their energy-intensiveness. Projects with a comprehensive approach to commissioning attained nearly twice the overall median level of savings and five-times the savings of the least-thorough projects. It is noteworthy that virtually all existing building projects were cost-effective by each metric (0.4 years for the upper quartile and 2.4 years for the lower quartile), as were the majority of new-construction projects (1.5 years and 10.8 years, respectively). We also found high cost-effectiveness for each specific measure for which we have data. Contrary to a common perception, cost-effectiveness is often achieved even in smaller buildings. Thanks to energy savings valued more than the cost of the commissioning process, associated reductions in greenhouse gas emissions come at 'negative' cost. In fact, the median cost of conserved carbon is negative - -$110 per tonne for existing buildings and -$25/tonne for new construction - as compared with market prices for carbon trading and offsets in the +$10 to +$30/tonne range. Further enhancing the value of commissioning, its non-energy benefits surpass those of most other energy-management practices. Significant first-cost savings (e.g., through right-sizing of heating and cooling equipment) routinely offset at least a portion of commissioning costs - fully in some cases. When accounting for these benefits, the net median commissioning project cost was reduced by 49% on average, while in many cases they exceeded

The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.

Science.gov (United States)

Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo

2018-02-23

To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.

Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance.

Science.gov (United States)

Heller, Michael; Zanocco, Kyle; Zydowicz, Sara; Elaraj, Dina; Nayar, Ritu; Sturgeon, Cord

2012-09-01

The 2007 National Cancer Institute (NCI) conference on Thyroid Fine-Needle Aspiration (FNA) introduced the category atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS). Repeat FNA in 3 to 6 months was recommended for low-risk patients. Compliance with these recommendations has been suboptimal. We hypothesized that repeat FNA would be more effective than diagnostic lobectomy, with decreased costs and improved rates of cancer detection. Cost-effectiveness analysis was performed in which we compared diagnostic lobectomy with repeat FNA. A Markov model was developed. Outcomes and probabilities were identified from literature review. Third-party payer costs were estimated in 2010 US dollars. Outcomes were weighted by use of the quality-of-life utility factors, yielding quality-adjusted life years (QALYs). Monte Carlo simulation and sensitivity analysis were used to examine the uncertainty of probability, cost, and utility estimates. The diagnostic lobectomy strategy cost $8,057 and produced 23.99 QALYs. Repeat FNA cost $2,462 and produced 24.05 QALYs. Repeat FNA was dominant until the cost of FNA increased to $6,091. Dominance of the repeat FNA strategy was not sensitive to the cost of operation or the complication rate. The NCI recommendations for repeat FNA regarding follow-up of AUS/FLUS results are cost-effective. Improving compliance with these guidelines should lead to less overall costs, greater quality of life, and fewer unnecessary operations. Copyright © 2012 Mosby, Inc. All rights reserved.

Evaluation of a New Strategy for Attending Takeoffs and Landings to Reduce Aircraft Operating Costs and Passenger Delays at the Mexico City International Airport

Directory of Open Access Journals (Sweden)

Herrera-García Alfonso

2014-01-01

Full Text Available The objective of this research was to evaluate a strategy for attending the takeoffs and landings at a congested airport, in order to reduce aircraft operating costs and passenger delay times. The continuous growth of air transport activity has created congestion at major airports worldwide, this situation produces increases in the aircraft operating costs and passenger discomfort. In the strategy evaluated the traditional rule for attending to aircraft, on a first-come-first-served basis, was substituted with a sequence that reduces operating costs and passenger delays. In order to perform this evaluation a discrete-event simulation model was developed for the Mexico City International Airport. Results showed that it is possible to obtain significant benefits if the proposed strategy is applied, an annual benefit of around 28.6 million pesos could be achieved.

Costs of reducing water use of concentrating solar power to sustainable levels: Scenarios for North Africa

International Nuclear Information System (INIS)

Damerau, Kerstin; Williges, Keith; Patt, Anthony G.; Gauche, Paul

2011-01-01

Concentrating solar power (CSP) has the potential to become a leading sustainable energy technology for the European electricity system. In order to reach a substantial share in the energy mix, European investment in CSP appears most profitable in North Africa, where solar potential is significantly higher than in southern Europe. As well as sufficient solar irradiance, however, the majority of today's CSP plants also require a considerable amount of water, primarily for cooling purposes. In this paper we examine water usage associated with CSP in North Africa, and the cost penalties associated with technologies that could reduce those needs. We inspect four representative sites to compare the ecological and economical drawbacks from conventional and alternative cooling systems, depending on the local environment, and including an outlook with climate change to the mid-century. Scaling our results up to a regional level indicates that the use of wet cooling technologies would likely be unsustainable. Dry cooling systems, as well as sourcing of alternative water supplies, would allow for sustainable operation. Their cost penalty would be minor compared to the variance in CSP costs due to different average solar irradiance values. - Highlights: → Scaling up CSP with wet cooling from ground water will be unsustainable in North Africa. → Desalination and alternative cooling systems can assure a sustainable water supply. → On large-scale, the cost penalties of alternative cooling technologies appear minor.

A conceptual framework for the evaluation of cost-effectiveness of projects to reduce GHG emissions and sequester carbon

International Nuclear Information System (INIS)

Sathaye, J.; Norgaard, R.; Makundi, W.

1993-07-01

This paper proposes a conceptual framework for evaluating the cost of projects to reduce atmospheric greenhouse gases (GHGs). The evaluation of cost-effectiveness should account for both the timing of carbon emissions and the damage caused by the atmospheric stock of carbon. We develop a conceptual basis to estimate the cost-effectiveness of projects in terms of the cost of reducing atmospheric carbon (CRAC) and other GHGs. CRAC accounts for the economic discount rate, alternative functional forms of the shadow price, the residence period of carbon in the atmosphere, and the multiple monetary benefits of projects. The last item is of particular importance to the developing countries

Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction.

Science.gov (United States)

Gaziano, Thomas A; Fonarow, Gregg C; Claggett, Brian; Chan, Wing W; Deschaseaux-Voinet, Celine; Turner, Stuart J; Rouleau, Jean L; Zile, Michael R; McMurray, John J V; Solomon, Scott D

2016-09-01

The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the United States. Data from US adults (mean [SD] age, 63.8 [11.5] years) with HF with reduced ejection fraction and characteristics similar to those in the PARADIGM-HF trial were used as inputs for a 2-state Markov model simulated HF. Risks of all-cause mortality and hospitalization from HF or other reasons were estimated with a 30-year time horizon. Quality of life was based on trial EQ-5D scores. Hospital costs combined Medicare and private insurance reimbursement rates; medication costs included the wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was used. Sensitivity analyses were performed on key inputs including: hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality-of-life estimates. Hospitalizations, quality-adjusted life-years (QALYs), costs, and incremental costs per QALY gained. The 2-state Markov model of US adult patients (mean age, 63.8 years) calculated that there would be 220 fewer hospital admissions per 1000 patients with HF treated with sacubitril/valsartan vs enalapril over 30 years. The incremental costs and QALYs gained with sacubitril/valsartan treatment were estimated at $35 512 and 0.78, respectively, compared with enalapril, equating to an incremental cost-effectiveness ratio (ICER) of $45 017 per QALY for the base-case. Sensitivity analyses demonstrated ICERs ranging from $35 357 to $75 301 per QALY. For eligible patients with HF with reduced ejection fraction, the Markov

Methodology for reducing energy and resource costs in construction of trenchless crossover of pipelines

Science.gov (United States)

Toropov, V. S.

2018-05-01

The paper suggests a set of measures to select the equipment and its components in order to reduce energy costs in the process of pulling the pipeline into the well in the constructing the trenchless pipeline crossings of various materials using horizontal directional drilling technology. A methodology for reducing energy costs has been developed by regulating the operation modes of equipment during the process of pulling the working pipeline into a drilled and pre-expanded well. Since the power of the drilling rig is the most important criterion in the selection of equipment for the construction of a trenchless crossover, an algorithm is proposed for calculating the required capacity of the rig when operating in different modes in the process of pulling the pipeline into the well.

Facility Management as a Way of Reducing Costs in Transport Companies

Science.gov (United States)

Matusova, Dominika; Gogolova, Martina

2017-10-01

For facility management exists a several interpretations. These interpretations emerged progressively. At the time of the notion of facility management was designed to manage an administrative building, in the United States (US). They can ensure their operation and maintenance. From the US, this trend is further moved to Europe and now it start becoming a current and actual topic also in Slovakia. Facility management is contractually agreed scheme of services, semantically recalls traditional building management. There by finally pushed for activities related to real estates. For facility management is fundamental - certification and certification systems. Therefore, is essential to know, the cost structure of certification. The most commonly occurring austerity measures include: heat pumps, use of renewable energy, solar panels and water savings. These measures can reduce the cost.

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.

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

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.

ePrescribing: Reducing Costs through In-Class Therapeutic Interchange.

Science.gov (United States)

Stenner, Shane P; Chakravarthy, Rohini; Johnson, Kevin B; Miller, William L; Olson, Julie; Wickizer, Marleen; Johnson, Nate N; Ohmer, Rick; Uskavitch, David R; Bernard, Gordon R; Neal, Erin B; Lehmann, Christoph U

2016-12-14

Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative. Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members. For all medication classes, significant improvements were demonstrated - the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member. A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan - $17.77 per member per year. Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

Science.gov (United States)

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Radically Reducing the Costs of Panel Critical Reviews According to ISO 14040

DEFF Research Database (Denmark)

Weidema, Bo Pedersen; Christiansen, Kim; Wernet, Gregor

2013-01-01

We suggest a procedure that radically reduces the critical review costs without compromising their thoroughness and overall quality. This procedure has 3 elements: A fixed panel for all reviews, an already critically reviewed background database, and a software-supported review procedure. The pre....... The presentation discusses these elements in the light of the upcoming ISO 14071 on critical review....

Managing concrete bridges: Methods for reducing costs and user inconveniences

DEFF Research Database (Denmark)

Goltermann, Per

2005-01-01

The paper presents experiences from modern bridge maintenance management, which has been forced to develop new and cost-efficient approaches in order to cope with the increase in overall deterioration of the aging bridge stock, the growing requirements to accessibility and the decreasing budgets...... situations often postpone or reduce the repair and rehabilitation activities required in critical parts of the structure. The paper will present some cases, where these approaches have been used on existing concrete bridges and explain how these experiences can be applied on other types of structures...

Alternative strategies to reduce cost and waste volume in HEPA filtration using metallic filter media - 59348

International Nuclear Information System (INIS)

Chadwick, Chris

2012-01-01

Document available in abstract form only. Full text of publication follows: The disposal costs of contaminated HEPA and THE filter elements have been proved to be disproportionately high compared with the cost of the elements themselves. Work published elsewhere (Moore, et el 1992; Bergman et al 1997) suggests that the cost of use of traditional, panel type, glass fibre HEPA filtration trains to the DOE was, during that period, $29.5 million, based on a five year life cycle, and including installation, testing, removal and disposal life cycle costs being based on estimates dating from 1987-1990. Within that cost estimate, $300 was the value given to the filter and $4, 450 was given to the peripheral activity. Clearly, if the $4, 450 component could be reduced, tremendous saving could ensue, in addition to the reduction of the legacy burden of waste volume. This issue exists for operators in both the US and in Europe. If HEPA filters could be cleaned to a condition where they could either be re-used or decontaminated to the extent that they could be stored as a lower cost wasteform or if HEPA/THE filter elements were available without any organic content likely to give rise to flammable or explosive decomposition gases during long term storage this would also reduce the costs and monitoring necessary in storage. (author)

How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

NARCIS (Netherlands)

Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.

2012-01-01

Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic

Transforming Wartime Contracting: Controlling Costs, Reducing Risks

Science.gov (United States)

2011-08-01

conceptual ambiguity lies nestled in the meaning ascribed to “inherent.” The language of the Instruction also serves as an illustration that...other factors to the composite rate to present a fuller accounting of the cost of military personnel. It adds costs for recruitment and advertising ...Defense Adds to above: Costs for recruitment and advertising , training, subsidized groceries (commissaries), education assistance, child-development

Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial.

Science.gov (United States)

Polinder, Suzanne; Boyé, Nicole D A; Mattace-Raso, Francesco U S; Van der Velde, Nathalie; Hartholt, Klaas A; De Vries, Oscar J; Lips, Paul; Van der Cammen, Tischa J M; Patka, Peter; Van Beeck, Ed F; Van Lieshout, Esther M M

2016-11-04

The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers. In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with 'care as usual' in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance. We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups. Withdrawal of FRID's in older persons who visited an emergency department due to a fall, did not lead to

Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL trial

Directory of Open Access Journals (Sweden)

Suzanne Polinder

2016-11-01

Full Text Available Abstract Background The use of Fall-Risk-Increasing-Drugs (FRIDs has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus ‘care as usual’ on health-related quality of life (HRQoL, costs, and cost-utility in community-dwelling older fallers. Methods In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with ‘care as usual’ in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural and indirect costs (travel costs were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance. Results We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs did not differ significantly between the intervention group and the control group (€2204 versus €2285. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02. The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups. Conclusions Withdrawal of FRID’s in older

The role of technology in reducing health care costs. Phase II and phase III.

Energy Technology Data Exchange (ETDEWEB)

Cilke, John F.; Parks, Raymond C.; Funkhouser, Donald Ray; Tebo, Michael A.; Murphy, Martin D.; Hightower, Marion Michael; Gallagher, Linda K.; Craft, Richard Layne, II; Garcia, Rudy John

2004-04-01

In Phase I of this project, reported in SAND97-1922, Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. The effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements and an economic analysis model for development of care pathway costs for two conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Phases II and III of this project, which are presented in this report, were directed at detailing the parameters of telemedicine that influence care delivery costs and quality. These results were used to identify and field test the communication, interoperability, and security capabilities needed for cost-effective, secure, and reliable health care via telemedicine.

Highly reusable space transportation: Approaches for reducing ETO launch costs to $100 - $200 per pound of payload

Science.gov (United States)

Olds, John R.

1995-01-01

The Commercial Space Transportation Study (CSTS) suggests that considerable market expansion in earth-to-orbit transportation would take place if current launch prices could be reduced to around $400 per pound of payload. If these low prices can be achieved, annual payload delivered to low earth orbit (LEO) is predicted to reach 6.7 million pounds. The primary market growth will occur in communications, government missions, and civil transportation. By establishing a cost target of $100-$200 per pound of payload for a new launch system, the Highly Reusable Space Transportation (HRST) program has clearly set its sights on removing the current restriction on market growth imposed by today's high launch costs. In particular, achieving the goal of $100-$200 per pound of payload will require significant coordinated efforts in (1) marketing strategy development, (2) business planning, (3) system operational strategy, (4) vehicle technical design, and (5) vehicle maintenance strategy.

Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction.

Science.gov (United States)

Liang, Lin; Bin-Chia Wu, David; Aziz, Mohamed Ismail Abdul; Wong, Raymond; Sim, David; Leong, Kui Toh Gerard; Wei, Yong Quek; Tan, Doreen; Ng, Kwong

2018-02-01

Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care. To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective. A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I-IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively. At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study

A New Remote Communications Link to Reduce Residential PV Solar Costs

Energy Technology Data Exchange (ETDEWEB)

King, Randy [Operant Solar Corporation,CA (United States); Sugiyama, Rod [Operant Solar Corporation,CA (United States)

2017-12-11

Monitoring of PV/DER site production is expensive to install and unreliable. Among third party systems providers, lost communications links are a growing concern. Nearly 20% of links are failing, provisioning is complex, recovery is expensive, production data is lost, and access is fragmented. FleetLink is a new concept in DER system communications, purpose built for lowering the cost of maintaining active contact with residential end user sites and ensuring that production data is reliably available to third party systems providers. Systems providers require accurate, secure system monitoring and reporting of production data and system faults while driving down overall costs to compete effectively. This plug and play, independently operating communications solution lowers the cost of fleet contact from typically .08 dollars-$.12/W down to .02 dollars -.03/W including installation and maintenance expenses. FleetLink establishes a breakthrough in simplicity that facilitates rapid expansion of residential solar by reducing initial capital outlay and lowering installation labor time and skill levels. The solution also facilitates higher DER installation growth rates by driving down maintenance costs and eliminating communications trouble calls. This is accomplished by the FleetLink’s unique network technology that enables dynamic network configuration for fast changes, and active, self-healing DER site contact for uptime assurance. Using an open source network framework with proprietary, application specific enhancements, FleetLink independently manages connectivity, security, recovery, grid control communications, and fleet expansion while presenting a compliant SunSpec interface to the third party operations centers. The net system cost savings of at least .05 dollars/W supports the SunShot cost goals and the flexibility and scalability of the solution accelerates the velocity and ubiquitous adoption of solar.

Costs of Reducing Greenhouse Gas Emissions: A Case Study of India’s Power Generation Sector

OpenAIRE

Manish Gupta

2006-01-01

If India were to participate in any international effort towards mitigating CO2 emissions, the power sector which is one of the largest emitters of CO2 in the country would be required to play a major role. In this context the study estimates the marginal abatement costs, which correspond to the costs incurred by the power plants to reduce one unit of CO2 from the current level. The study uses an output distance function approach and its duality with the revenue function to derive these costs...

REDUCING ENVIRONMENTAL IMPACT AND COST OF PRODUCTION FOR DRYING FRUITS

Directory of Open Access Journals (Sweden)

Murad Erol

2013-12-01

Full Text Available To reduce the production costs for heat used in drying fruit plants was studied using of local biomass from tree branch pruning. The average annual get 3 t / ha biomass whit energy potential of 37 GJ/ha at a cost of up to 60 €/t. biomass at 10 - 50 mm chopped and dried below 20% can be gasefied with TLUD process characterized by high energy conversion efficiency, stability and safety in operation, emissions of CO and PM very low. TLUD process produces on average and 15% biochar that can be used as fuel or as agricultural amendment to increase fertility and for atmospheric carbon sequestration. There have been experiments simulated by model of USCMER 30/60MGB dryer equipped with two thermal modules TLUD FORTE-40 for apple slices drying heat of the apple prinings. Biomass used and biochar resulting chemical and energy were defined as micro-gasification process TLUD. That can dry 205 kg of apple slices in 6 hours with 74 kg of dry biomass to 10% of that remains and 12.2 kg biochar, biochar with or without 52 kg biomass, which costs € 8.55 or € 5.97, ie 4.3 or 6.1 times cheaper than diesel. On dry ton of sliced apple it can produce 59.6 kg biochar with soil seize -174.8 kg. CO2.

Human Responding on Random-Interval Schedules of Response-Cost Punishment: The Role of Reduced Reinforcement Density

Science.gov (United States)

Pietras, Cynthia J.; Brandt, Andrew E.; Searcy, Gabriel D.

2010-01-01

An experiment with adult humans investigated the effects of response-contingent money loss (response-cost punishment) on monetary-reinforced responding. A yoked-control procedure was used to separate the effects on responding of the response-cost contingency from the effects of reduced reinforcement density. Eight adults pressed buttons for money…

Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs

Science.gov (United States)

Pettit, R. G.; Wang, J. J.; Toh, C.

2000-01-01

The continual need to reduce airframe cost and the emergence of high speed machining and other manufacturing technologies has brought about a renewed interest in large-scale integral structures for aircraft applications. Applications have been inhibited, however, because of the need to demonstrate damage tolerance, and by cost and manufacturing risks associated with the size and complexity of the parts. The Integral Airframe Structures (IAS) Program identified a feasible integrally stiffened fuselage concept and evaluated performance and manufacturing cost compared to conventional designs. An integral skin/stiffener concept was produced both by plate hog-out and near-net extrusion. Alloys evaluated included 7050-T7451 plate, 7050-T74511 extrusion, 6013-T6511 extrusion, and 7475-T7351 plate. Mechanical properties, structural details, and joint performance were evaluated as well as repair, static compression, and two-bay crack residual strength panels. Crack turning behavior was characterized through panel tests and improved methods for predicting crack turning were developed. Manufacturing cost was evaluated using COSTRAN. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current technology baseline.

The significance of reduced respiratory chain enzyme activities: clinical, biochemical and radiological associations.

Science.gov (United States)

Mordekar, S R; Guthrie, P; Bonham, J R; Olpin, S E; Hargreaves, I; Baxter, P S

2006-03-01

Mitochondrial diseases are an important group of neurometabolic disorders in children with varied clinical presentations and diagnosis that can be difficult to confirm. To report the significance of reduced respiratory chain enzyme (RCE) activity in muscle biopsy samples from children. Retrospective odds ratio was used to compare clinical and biochemical features, DNA studies, neuroimaging, and muscle biopsies in 18 children with and 48 without reduced RCE activity. Children with reduced RCE activity were significantly more likely to have consanguineous parents, to present with acute encephalopathy and lactic acidaemia and/or within the first year of life; to have an axonal neuropathy, CSF lactate >4 mmol/l; and/or to have signal change in the basal ganglia. There were positive associations with a maternal family history of possible mitochondrial cytopathy; a presentation with failure to thrive and lactic acidaemia, ragged red fibres, reduced fibroblast fatty acid oxidation and with an abnormal allopurinol loading test. There was no association with ophthalmic abnormalities, deafness, epilepsy or myopathy. The association of these clinical, biochemical and radiological features with reduced RCE activity suggests a possible causative link.

Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.

Science.gov (United States)

Anderson, Peter; Chisholm, Dan; Fuhr, Daniela C

2009-06-27

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.

Department of Defenses 2015 Retirement Plan Cost Analysis

Science.gov (United States)

2016-06-01

PLAN COST ANALYSIS ABSTRACT The new military retirement system is advertised to significantly reduce the Department of Defense’s (DOD...200 words) The new military retirement system is advertised to significantly reduce the Department of Defense’s (DOD) monetary outlays over the...determine how changing the value of the following planning assumptions in the MCRMC report will impact the estimated cost savings of this new plan through

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji.

Science.gov (United States)

Webster, Jacqui; Pillay, Arti; Suku, Arleen; Gohil, Paayal; Santos, Joseph Alvin; Schultz, Jimaima; Wate, Jillian; Trieu, Kathy; Hope, Silvia; Snowdon, Wendy; Moodie, Marj; Jan, Stephen; Bell, Colin

2018-01-30

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

Dramatically improve the Safety Performance of Li ion Battery Separators and Reduce the Manufacturing Cost Using Ultraviolet Curing and High Precision Coating Technologies

Energy Technology Data Exchange (ETDEWEB)

Voelker, Gary [Miltec UV International, LLC, Stevensville, MD (United States); Arnold, John [Miltec UV International, LLC, Stevensville, MD (United States)

2017-06-30

The objective of this project was to improve the safety of operation of Lithium ion batteries (LIB)and at the same time significantly reduce the manufacturing cost of LIB separators. The project was very successful in demonstrating the improved performance and reduced cost attributed to using UV curable binder and high speed printing technology to place a very thin and precisely controlled ceramic layer on the surface of base separators made of polyolefins such as Polyethylene, Polypropylene and combinations of the two as well as cellulosic base separators. The underlying need for this new technology is the recently identified potential of fire in large format Lithium ion batteries used in hybrid, plug-in hybrid and electric vehicles. The primary potential cause of battery fire is thermal runaway caused by several different electrical or mechanical mechanisms; such as, overcharge, puncture, overheating, compaction, and internal short circuit. During thermal runaway, the ideal separator prevents ion flow and continues to physically separate the anode from the cathode. If the temperature of the battery gets higher, the separator may melt and partially clog the pores and help prevent ion flows but it also can shrink which can result in physical contact of the electrodes and accelerate thermal run-away even further. Ceramic coated separators eliminate many of the problems related to the usage of traditional separators. The ceramic coating provides an electrically insulating layer that retains its physical integrity at high temperature, allows for more efficient thermal heat transfer, helps reduce thermal shrinkage, and inhibits dendrite growth that could create a potential short circuit. The use of Ultraviolet (UV) chemistry to bind fine ceramic particles on separators is a unique and innovative approach primarily because of the instant curing of the UV curable binder upon exposure to UV light. This significant reduction in drying/curing time significantly reduces the

ENHANCING VOLUNTARY COMPLIANCE BY REDUCING COMPLIANCE COSTS: A TAXPAYER SERVICE APPROACH

OpenAIRE

Glenn Jenkins; EDWIN FORLEMU

1993-01-01

In this paper an overview is made of the determinants of voluntary tax compliance. Unlike previous treatments of this subject, the cost of taxpayer compliance is considered as an important determinant of overall level of voluntary compliance in a country. A number of ways that tax authorities reduce compliance are discussed, and the most common uses of information technology in providing taxpayer service is described. Finally, the paper considers some of the ways that such activities might be...

Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.

Science.gov (United States)

Kolls, Brad J; Mace, Brian E; Dombrowski, Keith E

2017-10-24

Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced

Optimal distributed energy resources and the cost of reduced greenhouse gas emissions in a large retail shopping centre

International Nuclear Information System (INIS)

Braslavsky, Julio H.; Wall, Josh R.; Reedman, Luke J.

2015-01-01

Highlights: • Optimal options for distributed energy resources are analysed for a shopping centre. • A multiobjective optimisation model is formulated and solved using DER-CAM. • Cost and emission trade-offs are compared in four key optimal investment scenarios. • Moderate investment in DER technologies lowers emissions by 29.6% and costs by 8.5%. • Larger investment in DER technologies lowers emissions by 72% at 47% higher costs. - Abstract: This paper presents a case study on optimal options for distributed energy resource (DER) technologies to reduce greenhouse gas emissions in a large retail shopping centre located in Sydney, Australia. Large retail shopping centres take the largest share of energy consumed by all commercial buildings, and present a strong case for adoption of DER technologies to reduce energy costs and emissions. However, the complexity of optimally designing and operating DER systems has hindered their widespread adoption in practice. This paper examines and demonstrates the value of DER in reducing the carbon footprint of the shopping centre by formulating and solving a multiobjective optimisation problem using the Distributed Energy Resources Customer Adoption Model (DER-CAM) tool. An economic model of the shopping centre is developed in DER-CAM using on-site-specific demand, tariffs, and performance data for each DER technology option available. Four key optimal DER technology investment scenarios are then analysed by comparing: (1) solution trade-offs of costs and emissions, (2) the cost of reduced emissions attained in each investment scenario, and (3) investment benefits with respect to the business-as-usual scenario. The analysis shows that a moderate investment in combined cooling, heat and power (CCHP) technology alone can reduce annual energy costs by 8.5% and carbon dioxide-equivalent emissions by 29.6%. A larger investment in CCHP technology, in conjunction with on-site solar photovoltaic (PV) generation, can deliver

Cost Analysis by Applying Time-Driven Activity Based Costing Method in Container Terminals

OpenAIRE

Yaşar, R. Şebnem

2017-01-01

Container transportation, which can also be called as “industrialization of maritime transportation”, gained significant ground in the world trade by offering numerous technical and economic advantages, and accordingly the container terminals have grown up in importance. Increased competition between container terminals puts pressure on the ports to reduce costs and increase operational productivity. To have the right cost information constitutes a prerequisite for cost reduction. Time-Driven...

Solution of resource allocation problem for identification of cost-effective measures to reduce nuclear proliferation risks

International Nuclear Information System (INIS)

Andrianov, A.; Kuptsov, I.

2013-01-01

This report presents a methodology of selection of cost-effective measures to reduce nuclear proliferation risks. The methodology relies on a graded security model used in practice in different applications. The method is based on the controlled finite Markov chain approach set in combination with discrete dynamic programming and MCDM (Multi Criteria Decision Making) techniques that enables the expert to select the cost-effective measures to reduce nuclear proliferation risks depending on availability of resources. The analysis performed with different number of possible measures confirms the conclusions that the implementation of extra-large costs may not produce the required effect, and the increase in resources above a certain level does not appear sensitive. Diversification in improving the effectiveness of other measures seems more rational and efficient for the whole system than the unlimited improvement of the effectiveness of only one measure

Solution of resource allocation problem for identification of cost-effective measures to reduce nuclear proliferation risks

Energy Technology Data Exchange (ETDEWEB)

Andrianov, A.; Kuptsov, I. [Obninsk Institute for Nuclear Power Engineering, Studgorodok 1, Obninsk, Kaluga region 249030 (Russian Federation)

2013-07-01

This report presents a methodology of selection of cost-effective measures to reduce nuclear proliferation risks. The methodology relies on a graded security model used in practice in different applications. The method is based on the controlled finite Markov chain approach set in combination with discrete dynamic programming and MCDM (Multi Criteria Decision Making) techniques that enables the expert to select the cost-effective measures to reduce nuclear proliferation risks depending on availability of resources. The analysis performed with different number of possible measures confirms the conclusions that the implementation of extra-large costs may not produce the required effect, and the increase in resources above a certain level does not appear sensitive. Diversification in improving the effectiveness of other measures seems more rational and efficient for the whole system than the unlimited improvement of the effectiveness of only one measure.

Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.

Science.gov (United States)

Beck, Owen N; Taboga, Paolo; Grabowski, Alena M

2017-04-01

Inspired by the springlike action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. However, manufacturer's recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed 15 trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of 3 different prosthetic models (Freedom Innovations Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with 5 combinations of stiffness categories (manufacturer's recommended and ± 1) and heights (International Paralympic Committee's maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness [fixed effect (β) = 0.036; P = 0.008] but not height ( P ≥ 0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (in kilonewtons per meter), using the Flex-Run (β = -0.139; P = 0.044) and 1E90 Sprinter prostheses (β = -0.176; P = 0.009) reduced net metabolic costs by 4.3-4.9% compared with using the Catapult prostheses. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β = 2.786; P = 0.001), stride frequencies (β = 0.911; P < 0.001), and leg stiffness values (β = 0.053; P = 0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness but not height. NEW & NOTEWORTHY We measured the

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

Science.gov (United States)

Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

Older adults learn less, but still reduce metabolic cost, during motor adaptation

Science.gov (United States)

Huang, Helen J.

2013-01-01

The ability to learn new movements and dynamics is important for maintaining independence with advancing age. Age-related sensorimotor changes and increased muscle coactivation likely alter the trial-and-error-based process of adapting to new movement demands (motor adaptation). Here, we asked, to what extent is motor adaptation to novel dynamics maintained in older adults (≥65 yr)? We hypothesized that older adults would adapt to the novel dynamics less well than young adults. Because older adults often use muscle coactivation, we expected older adults to use greater muscle coactivation during motor adaptation than young adults. Nevertheless, we predicted that older adults would reduce muscle activity and metabolic cost with motor adaptation, similar to young adults. Seated older (n = 11, 73.8 ± 5.6 yr) and young (n = 15, 23.8 ± 4.7 yr) adults made targeted reaching movements while grasping a robotic arm. We measured their metabolic rate continuously via expired gas analysis. A force field was used to add novel dynamics. Older adults had greater movement deviations and compensated for just 65% of the novel dynamics compared with 84% in young adults. As expected, older adults used greater muscle coactivation than young adults. Last, older adults reduced muscle activity with motor adaptation and had consistent reductions in metabolic cost later during motor adaptation, similar to young adults. These results suggest that despite increased muscle coactivation, older adults can adapt to the novel dynamics, albeit less accurately. These results also suggest that reductions in metabolic cost may be a fundamental feature of motor adaptation. PMID:24133222

Four-phonon scattering significantly reduces intrinsic thermal conductivity of solids

Science.gov (United States)

Feng, Tianli; Lindsay, Lucas; Ruan, Xiulin

2017-10-01

For decades, the three-phonon scattering process has been considered to govern thermal transport in solids, while the role of higher-order four-phonon scattering has been persistently unclear and so ignored. However, recent quantitative calculations of three-phonon scattering have often shown a significant overestimation of thermal conductivity as compared to experimental values. In this Rapid Communication we show that four-phonon scattering is generally important in solids and can remedy such discrepancies. For silicon and diamond, the predicted thermal conductivity is reduced by 30% at 1000 K after including four-phonon scattering, bringing predictions in excellent agreement with measurements. For the projected ultrahigh-thermal conductivity material, zinc-blende BAs, a competitor of diamond as a heat sink material, four-phonon scattering is found to be strikingly strong as three-phonon processes have an extremely limited phase space for scattering. The four-phonon scattering reduces the predicted thermal conductivity from 2200 to 1400 W/m K at room temperature. The reduction at 1000 K is 60%. We also find that optical phonon scattering rates are largely affected, being important in applications such as phonon bottlenecks in equilibrating electronic excitations. Recognizing that four-phonon scattering is expensive to calculate, in the end we provide some guidelines on how to quickly assess the significance of four-phonon scattering, based on energy surface anharmonicity and the scattering phase space. Our work clears the decades-long fundamental question of the significance of higher-order scattering, and points out ways to improve thermoelectrics, thermal barrier coatings, nuclear materials, and radiative heat transfer.

Cost-effectiveness of feeding strategies to reduce greenhouse gas emissions from dairy farming.

Science.gov (United States)

Van Middelaar, C E; Dijkstra, J; Berentsen, P B M; De Boer, I J M

2014-01-01

The objective of this paper was to evaluate the cost-effectiveness of 3 feeding strategies to reduce enteric CH4 production in dairy cows by calculating the effect on labor income at the farm level and on greenhouse gas (GHG) emissions at the chain level (i.e., from production of farm inputs to the farm gate). Strategies included were (1) dietary supplementation of an extruded linseed product (56% linseed; 1kg/cow per day in summer and 2kg/cow per day in winter), (2) dietary supplementation of a nitrate source (75% nitrate; 1% of dry matter intake), and (3) reducing the maturity stage of grass and grass silage (grazing at 1,400 instead of 1,700kg of dry matter/ha and harvesting at 3,000 instead of 3,500kg of dry matter/ha). A dairy farm linear programing model was used to define an average Dutch dairy farm on sandy soil without a predefined feeding strategy (reference situation). Subsequently, 1 of the 3 feeding strategies was implemented and the model was optimized again to determine the new economically optimal farm situation. Enteric CH4 production in the reference situation and after implementing the strategies was calculated based on a mechanistic model for enteric CH4 and empirical formulas explaining the effect of fat and nitrate supplementation on enteric CH4 production. Other GHG emissions along the chain were calculated using life cycle assessment. Total GHG emissions in the reference situation added up to 840kg of CO2 equivalents (CO2e) per t of fat- and protein-corrected milk (FPCM) and yearly labor income of €42,605. Supplementation of the extruded linseed product reduced emissions by 9kg of CO2e/t of FPCM and labor income by €16,041; supplementation of the dietary nitrate source reduced emissions by 32kg of CO2e/t of FPCM and labor income by €5,463; reducing the maturity stage of grass and grass silage reduced emissions by 11kg of CO2e/t of FPCM and labor income by €463. Of the 3 strategies, reducing grass maturity was the most cost

Advanced technology heavy water monitors offering reduced implementation costs

International Nuclear Information System (INIS)

Kalechstein, W.; Hippola, K.B.

1984-10-01

The development of second generation heavy water monitors for use at CANDU power stations and heavy water plants has been completed and the instruments brought to the stage of commercial availability. Applications of advanced technology and reduced utilization of custom manufactured components have together resulted in instruments that are less expensive to produce than the original monitors and do not require costly station services. The design has been tested on two prototypes and fully documented, including the inspection and test procedures required for manufacture to the CSA Z299.3 quality verfication program standard. Production of the new monitors by a commercial vendor (Barringer Research Ltd.) has begun and the first instrument is scheduled for delivery to CRNL's NRU reactor in late 1984

Reusable single-port access device shortens operative time and reduces operative costs.

Science.gov (United States)

Shussman, Noam; Kedar, Asaf; Elazary, Ram; Abu Gazala, Mahmoud; Rivkind, Avraham I; Mintz, Yoav

2014-06-01

In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy. We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis. SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy. Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.

Using collaborative work groups to reduce O ampersand M costs

International Nuclear Information System (INIS)

Francoeur, R.; Jones, J.N.

1995-01-01

Commonwealth Edison Company (ComEd) entered the nineties burdened with external distractions from its core business of power generation. Its unresolved 1987 rate case continued to face intervention in the courts. Some of its largest industrial and municipal customers were exploring more economical alternatives. The new convention facility in Chicago actually engaged an independent energy supplier. Retail wheeling was the hot topic, and internal problems were present. Operations and Maintenance (O ampersand M) costs were steadily increasing. Two of their six nuclear stations were on the Nuclear Regulatory Commission's Watch List. Immediate changes had to occur if ComEd was to ensure its future competitiveness. At ComEd Braidwood Nuclear Power Station some untraditional work methodologies were embarked upon to help the parent company reduce its O ampersand M costs. Various types of collaborative work groups were formed, and have succeeded in lowering O ampersand M costs through shorter refueling outages and the use of fewer contracted personnel. These collaborative work groups are listed below and are described in detail in the remainder of this paper: (1) A core group of Maintenance Modification Contractor (MMC) supervision integrated into the Owner's Maintenance Staff, (2) A Corporate Outage Support Group of supervisory personnel which supplements the site's Maintenance Staff, (3) The Integrated Outage and Turbine Overhaul Contractor using a mixture of its own and Maintenance Staff supervisory personnel during outages with the Owner supplementing craft support using a third-party, (4) Six nuclear stations sharing key MMC personnel to insure experienced individuals are used effectively, and (5) Composite teams of maintenance personnel working across defined disciplines Braidwood Station has capitalized on the strategy of positive collaboration to become one of the lowest cost producers of nuclear power. Its use has enabled the Station to successfully complete the

SunShot solar power reduces costs and uncertainty in future low-carbon electricity systems.

Science.gov (United States)

Mileva, Ana; Nelson, James H; Johnston, Josiah; Kammen, Daniel M

2013-08-20

The United States Department of Energy's SunShot Initiative has set cost-reduction targets of $1/watt for central-station solar technologies. We use SWITCH, a high-resolution electricity system planning model, to study the implications of achieving these targets for technology deployment and electricity costs in western North America, focusing on scenarios limiting carbon emissions to 80% below 1990 levels by 2050. We find that achieving the SunShot target for solar photovoltaics would allow this technology to provide more than a third of electric power in the region, displacing natural gas in the medium term and reducing the need for nuclear and carbon capture and sequestration (CCS) technologies, which face technological and cost uncertainties, by 2050. We demonstrate that a diverse portfolio of technological options can help integrate high levels of solar generation successfully and cost-effectively. The deployment of GW-scale storage plays a central role in facilitating solar deployment and the availability of flexible loads could increase the solar penetration level further. In the scenarios investigated, achieving the SunShot target can substantially mitigate the cost of implementing a carbon cap, decreasing power costs by up to 14% and saving up to $20 billion ($2010) annually by 2050 relative to scenarios with Reference solar costs.

Reducing operating costs: A collaborative approach between industry and electric utilities

International Nuclear Information System (INIS)

Tyers, B.; Sibbald, L.

1993-01-01

The unit cost of electricity to industrial consumers is expected to increase at a rate of 5% annually in the 1990s. The partnership that has been created between Amoco Canada Petroleum Company and TransAlta Utilities to control the cost of electricity is described. To allow the company to receive lower rates for interruptible power, a number of measures have been taken. The Amoco Whitecourt plant has standby generators in reserve that can be used when utility power is not available. A Pembina compressor can be turned off for up to 12 hours, at 30 minutes notice, without affecting field pressure. At the East Crossfield plant sales gas can be compressed using electricity or a gas-driven engine. Spot market energy is used in a number of plants allowing electric drive alternatives to plant operators and offering short term energy markets. TransAlta invests in electrical equipment such as switchgear as well as transmission lines and transformers. New rate alternatives offered by TransAlta Utilities include review of the need for a demand ratchet, additional time of use rates, unbundling of rates allowing power purchase from alternative sources, rates that follow product costs, reduced rates for conversion of gas to electric drives certain circumstances, energy audits, and power factor credits. 5 figs

Cost-effectiveness of feeding strategies to reduce greenhouse gas emissions from dairy farming

NARCIS (Netherlands)

Middelaar, van C.E.; Dijkstra, J.; Berentsen, P.B.M.; Boer, de I.J.M.

2014-01-01

The objective of this paper was to evaluate the cost-effectiveness of 3 feeding strategies to reduce enteric CH4 production in dairy cows by calculating the effect on labor income at the farm level and on greenhouse gas (GHG) emissions at the chain level (i.e., from production of farm inputs to the

What Are the Most Significant Cost and Value Drivers for Pancreatic Resection in an Integrated Healthcare System?

Science.gov (United States)

Vuong, Brooke; Dehal, Ahmed; Uppal, Abhineet; Stern, Stacey L; Mejia, Juan; Weerasinghe, Roshanthi; Kapoor, Vandana; Ong, Evan; Hansen, Paul D; Bilchik, Anton J

2018-03-23

An initiative was established to improve value-based care for pancreatic surgery in a large nonprofit health system. Cost data were presented bimonthly to a hepatobiliary clinical performance group via videoconference. The direct costs were calculated for all patients undergoing distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) between January 2014 and July 2017. Median length of stay, 30-day and 90-day mortality rates, readmission rate, and costs were stratified by surgeon volume using 2 published criteria: "volume pledge" criteria (≥5 PDs/year) and Leapfrog criteria (≥11 PDs/year). There were 270 DPs and 526 PDs performed in 14 hospitals spanning 4 states. Median PD costs were lower for high-volume surgeons (≥5 PDs/year), $21,026 vs $24,706 (p = 0.005). High-volume surgeons had a shorter length of stay (9 days vs 11 days; p definition of high volume. The sharing of detailed financial data with HPB surgeons on a regular basis provides an opportunity to evaluate practice patterns and thereby reduce direct costs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

Directory of Open Access Journals (Sweden)

Maxwell Ayindenaba Dalaba

2014-05-01

Full Text Available Introduction: The Government of Ghana introduced the National Health Insurance Scheme (NHIS in 2003 to replace out-of-pocket (OOP payment for health services with the inherent aim of reducing the direct cost of treating illness to households. Objective: To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana. Methods: We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective. Results: Of the 4,226 households visited, a total of 1,324 (31% household members reported fever and 51% (675 reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424, with the remainder either self-medicating with drugs from chemical shops 32% (217 or with leftover drugs or herbs 5% (34. Most of those who sought care from formal health facilities were insured 79% (334. The average direct medical cost of treating malaria was GH¢3.2 (US$2.1 per case with the insured spending less (GH¢2.6/US$1.7 per case than the uninsured (GH¢3.2/US$2.1. The overall average cost (direct and indirect incurred by households per malaria treatment was GH¢20.9 (US$13.9. Though the insured accounted for a larger proportion of admissions at health facilities 76% (31 than the uninsured 24% (10, the average amount households spent on the insured was less (GH¢4/US$2.7 than their uninsured counterparts (GH¢6.4/US$4.3. The difference was not statistically significant (p=0.2330. Conclusion: Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect

Options for cost-effectively reducing atmospheric methane concentrations from anthropogenic biomass sources

International Nuclear Information System (INIS)

Roos, K.F.; Jacobs, C.; Orlic, M.

1993-01-01

Methane is a major greenhouse gas, second only to carbon dioxide in its contribution to future global warming. Methane concentrations have more than doubled over the last two centuries and continue to rise annually. These increases are largely correlated with increasing human populations. Methane emissions from human related activities currently account for about 70 percent of annual emissions. Of these human related emissions, biomass sources account for about 75 percent and non-biomass sources about 25 percent. Because methane has a shorter lifetime than other major greenhouse gases, efforts to reduce methane emissions may fairly quickly be translated into lower atmospheric concentrations of methane and lower levels of radiative forcing. This fairly quick response would have the benefit of slowing the rate of climate change and hence allow natural ecosystems more time to adapt. Importantly, methane may be cost-effectively reduced from a number of biomass and non-biomass sources in the United States and worldwide. Methane is a valuable fuel, not just a waste by-product, and often systems may be reconfigured to reap the fuel value of the methane and more than justify the necessary expenditures. Such options for reducing methane emission from biomass sources exist for landfills, livestock manures, and ruminant livestock, and have been implemented to varying degrees in countries around the world. However, there are a number of barriers that hinder the more widespread use of technologies, including institutional, financial, regulatory, informational, and other barriers. This paper describes an array of available options that may be cost-effectively implemented to reduce methane emissions from biomass sources. This paper also discusses a number of programs that have been developed in the United States and internationally to promote the implementation of these methane reduction options and overcome existing barriers

Reducing costs of wind power with a gearless permanent-magnet generator

International Nuclear Information System (INIS)

Vihriaelae, H.; Peraelae, R.; Soederlund, L.; Eriksson, J.T.

1995-01-01

This article examines a disc-type axial-field permanent magnet generator (PMG) utilizing the latest generation of permanent magnet material, namely Nd 15 B 8 Fe 77 . A frequency converter (FC) is needed to keep the system synchronized with the grid. It also offers a possibility to use variable speed. The main advantages of this novel system compared to the conventional one are a higher overall efficiency, better reliability, reduced weight and diminished need for maintenance, all contributing to the cost-reduction of wind power. (author)

The production of reduced graphene oxide by a low-cost vacuum system for supercapacitors applications

International Nuclear Information System (INIS)

Cardoso, Q.A.; Sakata, S.K.; Faria, R.N.; Silva, F.M.; Vieira, L.S.; Casini, J.C.S.

2016-01-01

Graphene (G) has attracted great interest for its excellent electrical properties. However, the large-scale production of graphene is still currently under investigations. Graphene oxide (GO) can be partially reduced to graphene-like sheets by removing the oxygen-containing groups with the recovery of a conjugated structure. It can be produced using inexpensive graphite as raw material by cost-effective chemical methods. High vacuum and temperature (10 -7 mbar/1100 deg C) is well established as an effective route for reduced powder preparation on a laboratory scale. However, a high vacuum reduction system, which can be routinely operated at 10 -7 mbar, has a considerable capital, operational and maintenance cost to be used in a large scale. In the present work, a low-cost route aiming large scale reduction of graphene oxide has been investigated. A stainless steel vessel has been evacuated to backing-pump pressure (10 -2 mbar) to process graphene oxide at low and high temperatures. Attempts of reducing GO powder using low vacuum pressures have been carried out and investigated by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The experimental results of processing graphene oxide powder at various temperatures (200-1000°C) at relatively low pressures have been reported. The microstructures of the processed material have been investigated using scanning electron microscopy (SEM) and chemical microanalyses employing energy dispersive X-ray analysis (EDX). (author)

Great hammerhead sharks swim on their side to reduce transport costs.

Science.gov (United States)

Payne, Nicholas L; Iosilevskii, Gil; Barnett, Adam; Fischer, Chris; Graham, Rachel T; Gleiss, Adrian C; Watanabe, Yuuki Y

2016-07-26

Animals exhibit various physiological and behavioural strategies for minimizing travel costs. Fins of aquatic animals play key roles in efficient travel and, for sharks, the functions of dorsal and pectoral fins are considered well divided: the former assists propulsion and generates lateral hydrodynamic forces during turns and the latter generates vertical forces that offset sharks' negative buoyancy. Here we show that great hammerhead sharks drastically reconfigure the function of these structures, using an exaggerated dorsal fin to generate lift by swimming rolled on their side. Tagged wild sharks spend up to 90% of time swimming at roll angles between 50° and 75°, and hydrodynamic modelling shows that doing so reduces drag-and in turn, the cost of transport-by around 10% compared with traditional upright swimming. Employment of such a strongly selected feature for such a unique purpose raises interesting questions about evolutionary pathways to hydrodynamic adaptations, and our perception of form and function.

Use of configuration management to reduce development costs in metal parts

International Nuclear Information System (INIS)

Kalsoom, T.; Ahmad, S.

2005-01-01

In development and manufacturing phases of metal parts, design efforts are converted in set of engineering data pack under the given guidelines of Configuration Management (CM). These engineering documents define Configuration Management of metal parts production in a local industry. The development phase is normally less structured and open to Engineering Change Proposals. In our local engineering organizations most of the work done is normally not well documented for future revisions and modernization. This leads to delays in development and increase in production costs of metal parts. This becomes more pronounced if any member of the design team disassociates and leaves the organization. The Configuration Management helps to reduce development costs by providing infrastructure for product identification, documentation, change control, interface control and technical reviews and product audits. Automated or Computer-Assisted CM activities can also be used to shorten response time and increase accuracy and reliability of the produced metal components. (author)

Reducing the costs of landscape restoration by using invasive alien plant biomass for bioenergy

CSIR Research Space (South Africa)

Stafford, William HL

2018-02-01

Full Text Available reviews the extent of IAPs as well as efforts to eradicate them, and identifies value-adding opportunities to use the cleared IAP biomass for reducing the costs of landscape restoration. Since bioenergy is suited to a large portion of the biomass...

The benefits and costs of reducing emissions from the electricity sector.

Science.gov (United States)

Palmer, Karen; Burtraw, Dallas; Shih, Jhih-Shyang

2007-04-01

Recent federal policy proposals to reduce emissions of sulfur dioxide (SO(2)), nitrogen oxides (NO(x)), and mercury from the US electricity sector promise important improvements in air quality and reductions in acid deposition. The cost of achieving these reductions depends on the form and stringency of the regulation. In this research, we analyze the economic benefits and costs of the US Environmental Protection Agency's (EPA's) Clean Air Interstate Rule (CAIR) as characterized in the supplemental rule proposed in June 2004, and the Clean Air Mercury Rule (CAMR) as proposed in February 2004. The assessment integrates a model of the electricity sector, two models of atmospheric transport of air pollutants, and a model of environmental and public health endpoints affected by pollution. We model explicitly the emissions of SO(2), NO(x), mercury and carbon dioxide (CO(2)) and the effects of changes in emissions of SO(2) and NO(x) on environmental and public health. The manner in which mercury emissions are regulated will have important implications not only for the cost of the regulation, but also for emission levels for SO(2) and NO(x) and where those emissions are located. We find the economic benefits of CAIR and CAMR are far greater than the costs. Recent estimates of benefits of reductions in mercury and acidification indicate that our model captures the lion's share of quantifiable benefits. We also find that the EPA would have been justified on economic grounds in pursuing additional SO(2) emissions reductions beyond the requirements of CAIR.

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

Directory of Open Access Journals (Sweden)

Jacqui Webster

2018-01-01

Full Text Available This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

Lean Six Sigma for reduced cycle costs and improved readiness

OpenAIRE

Apte, Uday; Kang, Keebom

2006-01-01

Sponsored Report (for Acquisition Research Program) In general, during the lifecycle of a weapon system a significantly larger amount of money gets spent in operating and maintaining the system than acquiring it. Hence, efficient logistics systems, including transportation, inventory management, modifications and maintenance activities, are critically important for containing the lifecycle costs of weapon systems and for maintaining the highest level of military readiness given the extant ...

Effects of slim holes on hydrothermal exploration costs

International Nuclear Information System (INIS)

Entingh, D.; Petty, S.

1992-01-01

This paper estimates hydrothermal exploration costs and the effects that using slim holes could have on those costs using a computer code developed for the US-DOE. The primary goal of exploration is to generate decision driving information about particular geothermal reservoirs. Compared to today's exploration strategies, the main effect of using slim holes would be to reduce the cost of exploration by about 40 percent. Slim hole exploration does not reduce the overall cost of electricity by much; however, the cost burden is shifted later in the project when outside financing is more likely. The reduced costs of slim holes may also encourage developers to drill more holes that better characterize the reservoir, thus reducing long term reservoir risk. The cost of power could then be cut as much as six percent and project financial risks related to reservoir uncertainties could be reduced by up to one quarter. In order to realize these improvements, the amount of reservoir information recovered from small diameter bore holes needs to be significantly increased

Development of Production PVD-AIN Buffer Layer System and Processes to Reduce Epitaxy Costs and Increase LED Efficiency

Energy Technology Data Exchange (ETDEWEB)

Cerio, Frank

2013-09-14

The DOE has set aggressive goals for solid state lighting (SSL) adoption, which require manufacturing and quality improvements for virtually all process steps leading to an LED luminaire product. The goals pertinent to this proposed project are to reduce the cost and improve the quality of the epitaxial growth processes used to build LED structures. The objectives outlined in this proposal focus on achieving cost reduction and performance improvements over state-of-the-art, using technologies that are low in cost and amenable to high efficiency manufacturing. The objectives of the outlined proposal focus on cost reductions in epitaxial growth by reducing epitaxy layer thickness and hetero-epitaxial strain, and by enabling the use of larger, less expensive silicon substrates and would be accomplished through the introduction of a high productivity reactive sputtering system and an effective sputtered aluminum-nitride (AlN) buffer/nucleation layer process. Success of the proposed project could enable efficient adoption of GaN on-silicon (GaN/Si) epitaxial technology on 150mm silicon substrates. The reduction in epitaxy cost per cm{sup 2} using 150mm GaN-on-Si technology derives from (1) a reduction in cost of ownership and increase in throughput for the buffer deposition process via the elimination of MOCVD buffer layers and other throughput and CoO enhancements, (2) improvement in brightness through reductions in defect density, (3) reduction in substrate cost through the replacement of sapphire with silicon, and (4) reduction in non-ESD yield loss through reductions in wafer bow and temperature variation. The adoption of 150mm GaN/Si processing will also facilitate significant cost reductions in subsequent wafer fabrication manufacturing costs. There were three phases to this project. These three phases overlap in order to aggressively facilitate a commercially available production GaN/Si capability. In Phase I of the project, the repeatability of the performance

Defense Inventory Management: Expanding Use of Best Practices for Hardware Items Can Reduce Logistics Costs

National Research Council Canada - National Science Library

1998-01-01

...) logistics practices with those of the private sector. We are continuously examining DOD'S inventory management practices to identify areas where costs can be reduced and problems can be avoided by using leading private sector practices...

Cost effectiveness of a screen-and-treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity.

Science.gov (United States)

Kiss, H; Pichler, Eva; Petricevic, L; Husslein, P

2006-08-01

The purpose of this investigation was to determine the cost-saving potential of a simple screen-and-treat program for vaginal infection, which has previously been shown to lead to a reduction of 50% in the rate of preterm births. To determine the potential cost savings, we compared the direct costs of preterm delivery of infants with a birth weight below 1900g with the costs of the screen-and-treat program. We used a cut-off birth weight of 1900g because, in our population, all infants with a birth weight below 1900g were transferred to the neonatal intensive care unit. The direct costs associated with preterm delivery were defined to include the costs of the initial hospitalization of both mother and infant and the costs of outpatient follow-up throughout the first 6 years of life of the former preterm infant. The costs of the screen-and-treat program were defined to include the costs of the screening examination and the resulting costs of antimicrobial treatment and follow-up. All calculations were based on health-economic data obtained in the metropolitan area of Vienna, Austria. The number of preterm infants with a birth weight below 1900g was 12 (0.5%) in the intervention group (N=2058) and 29 (1.3%) in the control group (N=2097). The direct costs per preterm birth were found to amount to EUR (euro) 60262. Overall, the expected total savings in direct costs achieved by the screen-and-treat program and the ensuing 50% reduction in the number preterm births with a birth weight below 1900g amounted to more than euro 11 million. The costs of screening and treatment were found to amount to merely 7% of the direct costs saved as a result of the screen-and-treat program. A simple preterm prevention program, consisting of screening and antimicrobial treatment and follow-up of women with asymptomatic vaginal infection, leads not only to a significant reduction in the rate of preterm births but also to substantial savings in the direct costs associated with prematurity.

Reducing costs of wind power with a gearless permanent-magnet generator

Energy Technology Data Exchange (ETDEWEB)

Vihriaelae, H; Peraelae, R; Soederlund, L; Eriksson, J T [Tampere Univ. of Technology (Finland). Lab. of Electricity and Magnetism

1996-12-31

This article examines a disc-type axial-field permanent magnet generator (PMG) utilizing the latest generation of permanent magnet material, namely Nd{sub 15}B{sub 8}Fe{sub 77}. A frequency converter (FC) is needed to keep the system synchronized with the grid. It also offers a possibility to use variable speed. The main advantages of this novel system compared to the conventional one are a higher overall efficiency, better reliability, reduced weight and diminished need for maintenance, all contributing to the cost-reduction of wind power. (author)

Reducing costs of wind power with a gearless permanent-magnet generator

Energy Technology Data Exchange (ETDEWEB)

Vihriaelae, H.; Peraelae, R.; Soederlund, L.; Eriksson, J.T. [Tampere Univ. of Technology (Finland). Lab. of Electricity and Magnetism

1995-12-31

This article examines a disc-type axial-field permanent magnet generator (PMG) utilizing the latest generation of permanent magnet material, namely Nd{sub 15}B{sub 8}Fe{sub 77}. A frequency converter (FC) is needed to keep the system synchronized with the grid. It also offers a possibility to use variable speed. The main advantages of this novel system compared to the conventional one are a higher overall efficiency, better reliability, reduced weight and diminished need for maintenance, all contributing to the cost-reduction of wind power. (author)

Ventilation cost impact of reduced radon-daughter working levels

International Nuclear Information System (INIS)

Bates, R.C.

1981-01-01

Published information on costs of radon-daughter control in uranium mines was analyzed to develop estimates of the cost per ton for any level of radiation exposure control. All data were converted to 1967 cost of living index to provide a common analysis base. Results of the analysis show that the cost per ton increases exponentially as the radiation level is lowered. A linear relationship with the cost of living index is assumed, and equations and graphs are provided to estimate control cost per ton for any exposure control level and cost of living index

Transgenic Anopheles gambiae expressing an antimalarial peptide suffer no significant fitness cost.

Directory of Open Access Journals (Sweden)

Clare C McArthur

Full Text Available Mosquito-borne diseases present some of the greatest health challenges faced by the world today. In many cases, existing control measures are compromised by insecticide resistance, pathogen tolerance to drugs and the lack of effective vaccines. In light of these difficulties, new genetic tools for disease control programmes, based on the deployment of genetically modified mosquitoes, are seen as having great promise. Transgenic strains may be used to control disease transmission either by suppressing vector populations or by replacing susceptible with refractory genotypes. In practice, the fitness of the transgenic strain relative to natural mosquitoes will be a critical determinant of success. We previously described a transgenic strain of Anopheles gambiae expressing the Vida3 peptide into the female midgut following a blood-meal, which exhibited significant protection against malaria parasites. Here, we investigated the fitness of this strain relative to non-transgenic controls through comparisons of various life history traits. Experiments were designed, as far as possible, to equalize genetic backgrounds and heterogeneity such that fitness comparisons focussed on the presence and expression of the transgene cassette. We also employed reciprocal crosses to identify any fitness disturbance associated with inheritance of the transgene from either the male or female parent. We found no evidence that the presence or expression of the effector transgene or associated fluorescence markers caused any significant fitness cost in relation to larval mortality, pupal sex ratio, fecundity, hatch rate or longevity of blood-fed females. In fact, fecundity was increased in transgenic strains. We did, however, observe some fitness disturbances associated with the route of inheritance of the transgene. Maternal inheritance delayed male pupation whilst paternal inheritance increased adult longevity for both males and unfed females. Overall, in comparison to

Potential and cost-effectiveness of CO{sub 2}-reducing measures in the pulp and paper industry

Energy Technology Data Exchange (ETDEWEB)

Moellersten, K.; Westermark, M.; Yan, J. [Royal Institute of Technology (KTH), Stockholm (Sweden). Dept. of Chemical Engineering and Technology/Energy Processes

2001-07-01

Using the two criteria of potential CO{sub 2} reduction and cost of CO{sub 2} reduction several technical options in the pulp and paper industry are investigated. Principal CO{sub 2} reducing measures include: decreasing fuel consumption through improved heat exchanging or new processes with lower heat demand, decreasing electricity consumption, substituting fossil fuels with biofuels, exporting refined biofuels for external use, increasing CO{sub 2} neutral electricity generation, improving waste heat utilization and decreasing specific raw material consumption. The results show that electricity conservation and improvement of existing steam power cycles are the most cost-effective options that have a large potential to reduce CO{sub 2} emissions. Outsourcing of industrial energy operations to utilities may enable CO{sub 2} reducing measures that would not be carried out by industry due to differences in demands for profit on spent capita. 21 refs., 1 fig., 2 tabs.

Timely Referral to Outpatient Nephrology Care Slows Progression and Reduces Treatment Costs of Chronic Kidney Diseases

Directory of Open Access Journals (Sweden)

Gerhard Lonnemann

2017-03-01

Discussion: Timely referral to outpatient nephrology care is associated with slowed disease progression, less hospital admissions, reduced total treatment costs, and improved survival in patients with CKD.

Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections.

Science.gov (United States)

Hover, Alexander R; Sistrunk, William W; Cavagnol, Robert M; Scarrow, Alan; Finley, Phillip J; Kroencke, Audrey D; Walker, Judith L

2014-01-01

Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective. © 2013 by the American College of Medical Quality.

Paying our way: thinking strategically to offset the cost of reducing fire hazard in western forests.

Science.gov (United States)

Rhonda Mazza

2008-01-01

The fire hazard in many western forests is unacceptably high, posing risks to human health and property, wildlife habitat, and air and water quality. Cost is an inhibiting factor for reducing hazardous fuel, given the amount of acreage needing treatment. Thinning overly dense forests is one way to reduce fuel loads. Much of the product removed during these treatments...

The production of reduced graphene oxide by a low-cost vacuum system for supercapacitors applications

Energy Technology Data Exchange (ETDEWEB)

Cardoso, Q.A.; Sakata, S.K.; Faria, R.N. [Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEN-SP), São Paulo, SP (Brazil); Silva, F.M.; Vieira, L.S.; Casini, J.C.S., E-mail: julio.casini@ifro.edu.br [Instituto Federal de Ciencia e Tecnologia de Rondonia (IFRO), RO (Brazil)

2016-07-01

Graphene (G) has attracted great interest for its excellent electrical properties. However, the large-scale production of graphene is still currently under investigations. Graphene oxide (GO) can be partially reduced to graphene-like sheets by removing the oxygen-containing groups with the recovery of a conjugated structure. It can be produced using inexpensive graphite as raw material by cost-effective chemical methods. High vacuum and temperature (10{sup -7}mbar/1100 deg C) is well established as an effective route for reduced powder preparation on a laboratory scale. However, a high vacuum reduction system, which can be routinely operated at 10{sup -7} mbar, has a considerable capital, operational and maintenance cost to be used in a large scale. In the present work, a low-cost route aiming large scale reduction of graphene oxide has been investigated. A stainless steel vessel has been evacuated to backing-pump pressure (10{sup -2} mbar) to process graphene oxide at low and high temperatures. Attempts of reducing GO powder using low vacuum pressures have been carried out and investigated by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The experimental results of processing graphene oxide powder at various temperatures (200-1000°C) at relatively low pressures have been reported. The microstructures of the processed material have been investigated using scanning electron microscopy (SEM) and chemical microanalyses employing energy dispersive X-ray analysis (EDX). (author)

Systems/cost summary

International Nuclear Information System (INIS)

Grand, P.; Danby, G.; Keane, J.; Spiro, J.; Sutter, D.; Cole, F.; Hoyer, E.; Freytag, K.; Burke, R.

1977-01-01

The purpose of the meeting was to discuss and develop cost-estimating methods for heavy-ion fusion accelerator systems. The group did not consider that its purpose was to make technical judgements on proposed systems, but to develop methods for making reasonable cost estimates of these systems. Such estimates will, it is hoped, provide material for systems studies, will help in guiding research and development efforts by identifying ''high-leverage'' subsystems (areas that account for a significant part of total system cost and that might be reduced in cost by further technical development) and to begin to provide data to aid in an eventual decision on the optimum type of accelerator for heavy-ion fusion

Opportunities for Low Cost Titanium in Reduced Fuel Consumption, Improved Emissions, and Enhanced Durability Heavy Duty Vehicles

Energy Technology Data Exchange (ETDEWEB)

Kraft, E.H.

2002-07-22

The purpose of this study was to determine which components of heavy-duty highway vehicles are candidates for the substitution of titanium materials for current materials if the cost of those Ti components is very significantly reduced from current levels. The processes which could be used to produce those low cost components were also investigated. Heavy-duty highway vehicles are defined as all trucks and busses included in Classes 2C through 8. These include heavy pickups and vans above 8,500 lbs. GVWR, through highway tractor trailers. Class 8 is characterized as being a very cyclic market, with ''normal'' year volume, such as in 2000, of approximately 240,000 new vehicles. Classes 3-7 are less cyclic, with ''normal'' i.e., year 2000, volume totaling approximately 325,000 new vehicles. Classes 3-8 are powered about 88.5% by diesel engines, and Class 2C at very roughly 83% diesel. The engine portion of the study therefore focused on diesels. Vehicle production volumes were used in estimates of the market size for candidate components.

How uncertainty analysis of streamflow data can reduce costs and promote robust decisions in water management applications

Science.gov (United States)

McMillan, Hilary; Seibert, Jan; Petersen-Overleir, Asgeir; Lang, Michel; White, Paul; Snelder, Ton; Rutherford, Kit; Krueger, Tobias; Mason, Robert; Kiang, Julie

2017-07-01

Streamflow data are used for important environmental and economic decisions, such as specifying and regulating minimum flows, managing water supplies, and planning for flood hazards. Despite significant uncertainty in most flow data, the flow series for these applications are often communicated and used without uncertainty information. In this commentary, we argue that proper analysis of uncertainty in river flow data can reduce costs and promote robust conclusions in water management applications. We substantiate our argument by providing case studies from Norway and New Zealand where streamflow uncertainty analysis has uncovered economic costs in the hydropower industry, improved public acceptance of a controversial water management policy, and tested the accuracy of water quality trends. We discuss the need for practical uncertainty assessment tools that generate multiple flow series realizations rather than simple error bounds. Although examples of such tools are in development, considerable barriers for uncertainty analysis and communication still exist for practitioners, and future research must aim to provide easier access and usability of uncertainty estimates. We conclude that flow uncertainty analysis is critical for good water management decisions.

Misinterpretation of the strategic significance of cost driver analysis: evidence from management accounting theory and practice

Directory of Open Access Journals (Sweden)

Henry T Palowski

2011-06-01

Full Text Available This paper traces the development of cost driver theory in the Strategy literature and reflects on misinterpretations of the strategic significance of the theory in related academic disciplines, notably Management Accounting. Management Accounting has largely been responsible for informing costing practice in a wide range of organizational settings. The paper considers one such application- i.e. the case of the Higher Education Funding Council’s (HEFC costing and pricing initiative for UK universities. The project was completed just under five years ago, although details of implementation are still ongoing, to a degree. The systems in place incorporate most of the theoretical flaws outlined in this paper. Rather than providing cost driver analysis to aid the strategic management process in universities, the system appears to represent little more than a compliance and reporting framework between university central administrations and the funding provider, HEFC.

Cost-effectiveness of sacubitril/valsartan in chronic heart-failure patients with reduced ejection fraction.

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Ademi, Zanfina; Pfeil, Alena M; Hancock, Elizabeth; Trueman, David; Haroun, Rola Haroun; Deschaseaux, Celine; Schwenkglenks, Matthias

2017-11-29

We aimed to assess the cost effectiveness of sacubitril/valsartan compared to angiotensin-converting enzyme inhibitors (ACEIs) for the treatment of individuals with chronic heart failure and reduced-ejection fraction (HFrEF) from the perspective of the Swiss health care system. The cost-effectiveness analysis was implemented as a lifelong regression-based cohort model. We compared sacubitril/valsartan with enalapril in chronic heart failure patients with HFrEF and New York-Heart Association Functional Classification II-IV symptoms. Regression models based on the randomised clinical phase III PARADIGM-HF trials were used to predict events (all-cause mortality, hospitalisations, adverse events and quality of life) for each treatment strategy modelled over the lifetime horizon, with adjustments for patient characteristics. Unit costs were obtained from Swiss public sources for the year 2014, and costs and effects were discounted by 3%. The main outcome of interest was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life years (QALYs) gained. Deterministic sensitivity analysis (DSA) and scenario and probabilistic sensitivity analysis (PSA) were performed. In the base-case analysis, the sacubitril/valsartan strategy showed a decrease in the number of hospitalisations (6.0% per year absolute reduction) and lifetime hospital costs by 8.0% (discounted) when compared with enalapril. Sacubitril/valsartan was predicted to improve overall and quality-adjusted survival by 0.50 years and 0.42 QALYs, respectively. Additional net-total costs were CHF 10 926. This led to an ICER of CHF 25 684. In PSA, the probability of sacubitril/valsartan being cost-effective at thresholds of CHF 50 000 was 99.0%. The treatment of HFrEF patients with sacubitril/valsartan versus enalapril is cost effective, if a willingness-to-pay threshold of CHF 50 000 per QALY gained ratio is assumed.

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

Science.gov (United States)

Wilcox, Meredith L; Mason, Helen; Fouad, Fouad M; Rastam, Samer; al Ali, Radwan; Page, Timothy F; Capewell, Simon; O'Flaherty, Martin; Maziak, Wasim

2015-01-01

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

Simulation at the point of care: reduced-cost, in situ training via a mobile cart.

Science.gov (United States)

Weinstock, Peter H; Kappus, Liana J; Garden, Alexander; Burns, Jeffrey P

2009-03-01

The rapid growth of simulation in health care has challenged traditional paradigms of hospital-based education and training. Simulation addresses patient safety through deliberative practice of high-risk low-frequency events within a safe, structured environment. Despite its inherent appeal, widespread adoption of simulation is prohibited by high cost, limited space, interruptions to clinical duties, and the inability to replicate important nuances of clinical environments. We therefore sought to develop a reduced-cost low-space mobile cart to provide realistic simulation experiences to a range of providers within the clinical environment and to serve as a model for transportable, cost-effective, widespread simulation-based training of bona-fide workplace teams. Descriptive study. A tertiary care pediatric teaching hospital. A self-contained mobile simulation cart was constructed at a cost of $8054 (mannequin not included). The cart is compatible with any mannequin and contains all equipment needed to produce a high quality simulation experience equivalent to that of our on-site center--including didactics and debriefing with videotaped recordings complete with vital sign overlay. Over a 3-year period the cart delivered 57 courses to 425 participants from five pediatric departments. All individuals were trained among their native teams and within their own clinical environment. By bringing all pedagogical elements to the actual clinical environment, a mobile cart can provide simulation to hospital teams that might not otherwise benefit from the educational tool. By reducing the setup cost and the need for dedicated space, the mobile approach provides a mechanism to increase the number of institutions capable of harnessing the power of simulation-based education internationally.

The role of technology in reducing health care costs. Final project report

Energy Technology Data Exchange (ETDEWEB)

Sill, A.E.; Warren, S.; Dillinger, J.D.; Cloer, B.K.

1997-08-01

Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. This study was conducted by implementing both top-down and bottom-up strategies. The top-down approach used prosperity gaming methodology to identify future health care delivery needs. This effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements. The bottom-up approach identified and ranked interventional therapies employed in existing care delivery systems for a host of health-related conditions. Economic analysis formed the basis for development of care pathway interaction models for two of the most pervasive, chronic disease/disability conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Societal cost-benefit relationships based on these analyses were used to evaluate the effect of emerging technology in these treatment areas. 17 figs., 48 tabs.

Expanding ART for Treatment and Prevention of HIV in South Africa: Estimated Cost and Cost-Effectiveness 2011-2050

Science.gov (United States)

Granich, Reuben; Kahn, James G.; Bennett, Rod; Holmes, Charles B.; Garg, Navneet; Serenata, Celicia; Sabin, Miriam Lewis; Makhlouf-Obermeyer, Carla; De Filippo Mack, Christina; Williams, Phoebe; Jones, Louisa; Smyth, Caoimhe; Kutch, Kerry A.; Ying-Ru, Lo; Vitoria, Marco; Souteyrand, Yves; Crowley, Siobhan; Korenromp, Eline L.; Williams, Brian G.

2012-01-01

Background Antiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa. Methods We model a best case scenario of 90% annual HIV testing coverage in adults 15–49 years old and four ART eligibility scenarios: CD4 count ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses. Results Expanding ART to CD4 count ART and monitoring costs, all CD4 levels saves $0.6 billion versus current; other ART scenarios cost $9–194 per DALY averted. If ART reduces transmission by 99%, savings from all CD4 levels reach $17.5 billion. Sensitivity analyses suggest that poor retention and predominant acute phase transmission reduce DALYs averted by 26% and savings by 7%. Conclusion Increasing the provision of ART to ART uptake, retention, and adherence should be evaluated. PMID:22348000

Cost reduction at NSP using IPE results

International Nuclear Information System (INIS)

Asmus, T.J.

1995-01-01

Operating nuclear power generating facilities are under increasing pressure to reduce costs to be able to compete successfully in the competitive electric sales market of today. With the completion of the individual plant evaluations (IPEs), numerous opportunities exist for application of probabilistic risk assessment methodology to reduce production costs. This paper presents two nontraditional methods in which IPE results can be used to help reduce nuclear insurance coverage limits and local property taxes. Significant savings can be realized through use of either of these two methods

Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

Energy Technology Data Exchange (ETDEWEB)

Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)

2015-05-01

To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)

The cost-effectiveness of household photovoltaic systems in reducing greenhouse gas emissions in Australia: Linking subsidies with emission reductions

International Nuclear Information System (INIS)

Burtt, D.; Dargusch, P.

2015-01-01

Highlights: • Payback period for Australian household PV fell to four years in 2011 and 2012. • PV became attractive due to high feed-in tariffs and declining PV costs. • Cost was AU$200/t CO 2 e in 2010, expected to be AU$65 to AU$100/t CO 2 e by 2020. • PV resulted in greenhouse gas emissions reducing by 3.7 million t CO 2 e in 2013. • PV expected to reduce greenhouse gas emissions by 8 million t CO 2 e in 2020. - Abstract: This paper examines the cost-effectiveness of subsidies (feed-in tariffs and renewable energy credits) paid for by electricity consumers to support the uptake of roof top photovoltaic (PV) systems by households in Australia. We estimate annual payback periods, and then regress these against the actual uptake of household PV and associated emission reductions, creating a relationship not apparent in other research. Sensitivity analysis reveals that the declining cost of PV panels had most impact on PV uptake followed by feed-in tariffs, renewable energy credits and the increasing cost of household electricity tariffs. Our modelling shows that feed-in tariffs were higher than necessary to achieve the resultant levels of PV uptake and that the low cost of PV panels and comparatively high electricity tariffs are likely to result in a continuing strong uptake of household PV in Australia. Our modelling shows that subsidies peaked in 2011 and 2012, with payback periods of three to four years, having since increased to five to six years. Emission reduction costs are expected to reduce from over AU$200 per t CO 2 e in 2013 to between AU$65 and AU$100 per t CO 2 e in 2020. Household PV reduced Australia’s emissions by 3.7 million t CO 2 e in 2013 (1.7% of Australia’s total emissions) and is expected to reach eight million tonnes (3.7% of Australia’s total emissions) by 2020

Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

Science.gov (United States)

Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

Cost Minimization Analysis of Different Strategies of Management of Clinically Significant Scorpion Envenomation Among Pediatric Patients.

Science.gov (United States)

Sinha, Madhumita; Quan, Dan; McDonald, Fred W; Valdez, André

2016-12-01

Scorpion antivenom was recently approved for use in patients with clinically significant scorpion envenomation in the United States; no formal economic analysis on its impact on cost of management has been performed. Three different strategies of management of scorpion envenomation with systemic neurotoxic symptoms in children were compared for cost minimization from a societal perspective. In strategy I, patients were managed with supportive care only without antivenom. In strategy II, an aggressive strategy of full-dose antivenom (initial dose of 3 vials with the use of additional vials administered 1 vial at a time) was considered. In strategy III, a single-vial serial antivenom dosing strategy titrated to clinical response was considered. Clinical probabilities for the different strategies were obtained from retrospective review of medical records of patients with scorpion envenomation over a 10-year period at our institution. Baseline cost values were obtained from patient reimbursement data from our institution. In baseline analysis, strategy I of supportive care only with no antivenom was least costly at US $3466.50/patient. Strategy III of single-vial serial dosing was intermediate but less expensive than strategy II of full-dose antivenom, with an incremental cost of US $3171.08 per patient. In a 1-way sensitivity analysis, at a threshold antivenom cost of US $1577.87, strategy III of single-vial serial dosing became the least costly strategy. For children with scorpion envenomation, use of a management strategy based on serial dosing of antivenom titrated to clinical response is less costly than a strategy of initial use of full-dose antivenom.

Profiling stainless steel welding processes to reduce fume emissions, hexavalent chromium emissions and operating costs in the workplace.

Science.gov (United States)

Keane, Michael; Siert, Arlen; Stone, Samuel; Chen, Bean T

2016-01-01

Nine gas metal arc welding (GMAW) processes for stainless steel were assessed for fume generation rates, fume generation rates per g of electrode consumed, and emission rates for hexavalent chromium (Cr(6+)). Elemental manganese, nickel, chromium, iron emissions per unit length of weld, and labor plus consumables costs were similarly measured. Flux-cored arc welding and shielded metal arc (SMAW) processes were also studied. The objective was to identify the best welding processes for reducing workplace exposures, and estimate costs for all processes. Using a conical chamber, fumes were collected, weighed, recovered, and analyzed by inductively coupled atomic emission spectroscopy for metals, and by ion chromatography for Cr(6+). GMAW processes used were Surface Tension Transfer, Regulated Metal Deposition, Cold Metal Transfer, short-circuit, axial spray, and pulsed spray modes. Flux-cored welding used gas shielding; SMAW used E308 rods. Costs were estimated as dollars per m length of a ¼ in (6.3 mm) thick horizontal butt weld; equipment costs were estimated as ratios of new equipment costs to a 250 ampere capacity SMAW welding machine. Results indicate a broad range of fume emission factors for the processes studied. Fume emission rates per g of electrode were lowest for GMAW processes such as pulsed-spray mode (0.2 mg/g), and highest for SMAW (8 mg fume/g electrode). Emission rates of Cr(6+) ranged from 50-7800 µg/min, and Cr(6+) generation rates per g electrode ranged from 1-270 µg/g. Elemental Cr generation rates spanned 13-330 µg/g. Manganese emission rates ranged from 50-300 µg/g. Nickel emission rates ranged from 4-140 µg/g. Labor and consumables costs ranged from $3.15 (GMAW pulsed spray) to $7.40 (SMAW) per meter of finished weld, and were measured or estimated for all 11 processes tested. Equipment costs for some processes may be as much as five times the cost of a typical SMAW welding machine. The results show that all of the GMAW processes in this

Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

Science.gov (United States)

Goldie, Sue J.; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

2010-01-01

Background Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Methods and Findings Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold (∼23%–35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately

Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

Directory of Open Access Journals (Sweden)

Sue J Goldie

2010-04-01

Full Text Available BACKGROUND: Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. METHODS AND FINDINGS: Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants. Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35% without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC. An integrated and stepwise approach was

Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

Science.gov (United States)

Goldie, Sue J; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

2010-04-20

Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended) and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants). Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately prevent four of five

Trade in the US and Mexico helps reduce environmental costs of agriculture

Science.gov (United States)

Martinez-Melendez, Luz A.; Bennett, Elena M.

2016-05-01

Increasing international crop trade has enlarged global shares of cropland, water and fertilizers used to grow crops for export. Crop trade can reduce the environmental burden on importing countries, which benefit from embedded environmental resources in imported crops, and from avoided environmental impacts of production in their territory. International trade can also reduce the universal environmental impact of food production if crops are grown where they are produced in the most environmentally efficient way. We compared production efficiencies for the same crops in the US and Mexico to determine whether current crop trade between these two countries provides an overall benefit to the environment. Our economic and environmental accounting for the key traded crops from 2010 to 2014 shows that exports to Mexico are just 3% (∼16 thousand Gg) of the total production of these crops in the US, and exports to US represent roughly 0.13% (∼46 Gg) of Mexican total production of the same crops. Yields were higher in US than Mexico for all crops except wheat. Use of nitrogen fertilizer was higher in US than in Mexico for all crops except corn. Current trade reduces some, but not all, environmental costs of agriculture. A counterfactual trade scenario showed that an overall annual reduction in cultivated land (∼371 thousand ha), water use (∼923 million m3), fertilizer use (∼122 Gg; ∼68 Gg nitrogen) and pollution (∼681 tonnes of N2O emissions to the atmosphere and ∼511 tonnes of leached nitrogen) can be achieved by changing the composition of food products traded. In this case, corn, soybeans and rice should be grown in the US, while wheat, sorghum and barley should be grown in Mexico. Assigning greater economic weight to the environmental costs of agriculture might improve the balance of trade to be more universally beneficial, environmentally.

Mechanism and capacities of reducing ecological cost through rice-duck cultivation.

Science.gov (United States)

Long, Pan; Huang, Huang; Liao, Xiaolan; Fu, Zhiqiang; Zheng, Huabin; Chen, Aiwu; Chen, Can

2013-09-01

Rice-duck cultivation is the essence of Chinese traditional agriculture. A scientific assessment of the mechanism and its capacity is of theoretical significance and practical value in improving modern agricultural technology. The duck's secretions, excreta and their treading, pecking and predation decrease the occurrence of plant diseases, pests and weeds, enrich species diversity and improve the field environment. The rice-duck intergrowth system effectively prevents rice planthoppers and rice leafhoppers. The control effects can be up to 98.47% and 100% respectively; it also has effects on the control of Chilo suppressalis, Tryporyza incertulas and the rice leafrollers. Notable control results are found on sheath blight, while the effects on other diseases are about 50%. Harm from weeds is placed under primary control; prevention of weeds is sequenced by broadleaf weeds > sedge weeds > Gramineae weeds. Contents of soil organic matter, N, P and K are improved by the system; nutrient utilization is accelerated, resulting in decreased fertilizer application. Greenhouse gas emissions are reduced by 1-2% and duck fodder is saved in this system. There is also an obvious economic benefit. Compared to conventional rice cultivation, rice-duck cultivation shows great benefits to ecologic cost and economic income. © 2013 The Authors. Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Can the household sector reduce global warming mitigation costs? sensitivity to key parameters in a TIMES techno-economic energy model

International Nuclear Information System (INIS)

Astudillo, Miguel F.; Vaillancourt, Kathleen; Pineau, Pierre-Olivier; Amor, Ben

2017-01-01

Highlights: •An energy system model of Quebec is combined with building simulation software. •Greenhouse gas emission reductions efforts increase annual electricity peak demand. •Alternative heating tech. And building envelopes can effectively reduce peak demand. •Denser urban developments massively reduced costs of global warming mitigation. •CO 2 emissions from hydropower reservoirs are relevant in global warming mitigation. -- Abstract: The transition to low carbon societies may increase peak electricity demand, which can be costly to supply with renewable energy, whose availability is uncertain. Buildings are often the main cause of peak demand, and they are believed to hold a large unrealised energy-efficiency potential. If realised, this potential could considerably mitigate the transition costs to low carbon societies, reducing average and peak electricity demands. We explore this potential in several cost-optimal global warming (GW) mitigation scenarios using a multi-sector TIMES energy system model of the province of Quebec for the period 2011–2050. Heating and conservation measures in the residential sector are modelled using building simulations and parameters’ values from the literature. The intra-annual availability of renewable energy and electricity imports is derived from time-series analysis. Additionally, the influence of key parameters such as the projections of primary energy demand and emissions from reservoir impoundment is evaluated. Finally, we discuss some of the barriers that could hamper the energy transition and how they can be overcome. Results indicate that peak demand would rise by 30% due to GW mitigation efforts, but it can be effectively reduced by interventions in the residential sector. Heat pumps are the most cost effective heating technology, despite their lower efficiencies in cold climates. Better-insulated building envelopes have an important role in new houses, reducing by 14% the GW mitigation costs and

Cost consequences due to reduced ulcer healing times - analyses based on the Swedish Registry of Ulcer Treatment.

Science.gov (United States)

Öien, Rut F; Forssell, Henrik; Ragnarson Tennvall, Gunnel

2016-10-01

Resource use and costs for topical treatment of hard-to-heal ulcers based on data from the Swedish Registry of Ulcer Treatment (RUT) were analysed in patients recorded in RUT as having healed between 2009 and 2012, in order to estimate potential cost savings from reductions in frequency of dressing changes and healing times. RUT is used to capture areas of improvement in ulcer care and to enable structured wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Patients included in the registry are treated in primary care, community care, private care, and inpatient hospital care. Cost calculations were based on resource use data on healing time and frequency of dressing changes in Swedish patients with hard-to-heal ulcers who healed between 2009 and 2012. Per-patient treatment costs decreased from SEK38 223 in 2009 to SEK20 496 in 2012, mainly because of shorter healing times. Frequency of dressing changes was essentially the same during these years, varying from 1·4 to 1·6 per week. The total healing time was reduced by 38%. Treatment costs for the management of hard-to-heal ulcers can be reduced with well-developed treatment strategies resulting in shortened healing times as shown in RUT. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

The effects of rising energy costs and transportation mode mix on forest fuel procurement costs

International Nuclear Information System (INIS)

Rauch, Peter; Gronalt, Manfred

2011-01-01

Since fossil fuels have been broadly recognized as a non-renewable energy source that threatens the climate, sustainable and CO 2 neutral energy sources - such as forest fuels - are being promoted in Europe, instead. With the expeditiously growing forest fuel demand, the strategic problem of how to design a cost-efficient distribution network has evolved. This paper presents an MILP model, comprising decisions on modes of transportation and spatial arrangement of terminals, in order to design a forest fuel supply network for Austria. The MILP model is used to evaluate the impacts of rising energy costs on procurement sources, transport mix and procurement costs on a national scale, based on the example of Austria. A 20% increase of energy costs results in a procurement cost increase of 7%, and another 20% increase of energy costs would have similar results. While domestic waterways become more important as a result of the first energy cost increase, rail only does so after the second. One way to decrease procurement costs would be to reduce the share of empty trips with truck and trailer. Reducing this share by 10% decreases the average procurement costs by up to 20%. Routing influences the modal split considerably, and the truck transport share increases from 86% to 97%, accordingly. Increasing forest fuel imports by large CHPs lowers domestic competition and also enables smaller plants to cut their procurement costs. Rising forest fuel imports via ship will not significantly decrease domestic market shares, but they will reduce procurement costs considerably. (author)

Reducing costs while maintaining quality in endovascular neurosurgical procedures.

Science.gov (United States)

Kashlan, Osama N; Wilson, Thomas J; Chaudhary, Neeraj; Gemmete, Joseph J; Stetler, William R; Dunnick, N Reed; Thompson, B Gregory; Pandey, Aditya S

2014-11-01

As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan. The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period. The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period. This yielded total estimated savings of $76,732.56 during the most recent 6-month period. The feedback system for unused items decreased the cost of wasted products by approximately $44.36 per procedure in the 6 months directly after the policy change and by $48.20 per procedure in the most recent 6-month period, leading to total estimated savings of $22,123.80 during the most recent 6-month period. According to

Reducing surface water pollution through the assessment of the cost-effectiveness of BMPs at different spatial scales.

Science.gov (United States)

Panagopoulos, Y; Makropoulos, C; Mimikou, M

2011-10-01

Two kinds of agricultural Best Management Practices (BMPs) were examined with respect to cost-effectiveness (CE) in reducing sediment, nitrates-nitrogen (NO(3)-N) and total phosphorus (TP) losses to surface waters of the Arachtos catchment in Western Greece. The establishment of filter strips at the edge of fields and a non-structural measure, namely fertilization reduction in alfalfa, combined with contour farming and zero-tillage in corn and reduction of animal numbers in pastureland, were evaluated. The Soil and Water Assessment Tool (SWAT) model was used as the non-point-source (NPS) estimator, while a simple economic component was developed estimating BMP implementation cost as the mean annual expenses needed to undertake and operate the practice for a 5-year period. After each BMP implementation, the ratio of their CE in reducing pollution was calculated for each Hydrologic Response Unit (HRU) separately, for each agricultural land use type entirely and for the whole catchment. The results at the HRU scale are presented comprehensively on a map, demonstrating the spatial differentiation of CE ratios across the catchment that enhances the identification of locations where each BMP is most advisable for implementation. Based on the analysis, a catchment management solution of affordable total cost would include the expensive measure of filter strips in corn and only in a small number of pastureland fields, in combination with the profitable measure of reducing fertilization to alfalfa fields. When examined for its impact on river loads at the outlet, the latter measure led to a 20 tn or 8% annual decrease of TP from the baseline with savings of 15€/kg of pollutant reduction. Filter strips in corn fields reduced annual sediments by 66 Ktn or 5%, NO(3)-N by 71 tn or 9.5% and TP by 27 tn or 10%, with an additional cost of 3.1 €/tn, 3.3 €/kg and 8.1 €/kg of each pollutant respectively. The study concludes that considerable reductions of several

Quality improvement in hospitals: how much does it reduce healthcare costs?

Science.gov (United States)

Jones, S B

1995-01-01

The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

Reduced-cost second-order algebraic-diagrammatic construction method for excitation energies and transition moments

Science.gov (United States)

Mester, Dávid; Nagy, Péter R.; Kállay, Mihály

2018-03-01

A reduced-cost implementation of the second-order algebraic-diagrammatic construction [ADC(2)] method is presented. We introduce approximations by restricting virtual natural orbitals and natural auxiliary functions, which results, on average, in more than an order of magnitude speedup compared to conventional, density-fitting ADC(2) algorithms. The present scheme is the successor of our previous approach [D. Mester, P. R. Nagy, and M. Kállay, J. Chem. Phys. 146, 194102 (2017)], which has been successfully applied to obtain singlet excitation energies with the linear-response second-order coupled-cluster singles and doubles model. Here we report further methodological improvements and the extension of the method to compute singlet and triplet ADC(2) excitation energies and transition moments. The various approximations are carefully benchmarked, and conservative truncation thresholds are selected which guarantee errors much smaller than the intrinsic error of the ADC(2) method. Using the canonical values as reference, we find that the mean absolute error for both singlet and triplet ADC(2) excitation energies is 0.02 eV, while that for oscillator strengths is 0.001 a.u. The rigorous cutoff parameters together with the significantly reduced operation count and storage requirements allow us to obtain accurate ADC(2) excitation energies and transition properties using triple-ζ basis sets for systems of up to one hundred atoms.

Waste Management Strategy for Dismantling Waste to Reduce Costs for Power Plant Decommissioning - 13543

Energy Technology Data Exchange (ETDEWEB)

Larsson, Arne; Lidar, Per [Studsvik Nuclear AB, SE-611 82 Nykoeping (Sweden); Bergh, Niklas; Hedin, Gunnar [Westinghouse Electric Sweden AB, Fredholmsgatan 2, SE-721 63, Vaesteraas (Sweden)

2013-07-01

interruptions. Bottle-necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)

Waste Management Strategy for Dismantling Waste to Reduce Costs for Power Plant Decommissioning - 13543

International Nuclear Information System (INIS)

Larsson, Arne; Lidar, Per; Bergh, Niklas; Hedin, Gunnar

2013-01-01

-necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)

Reduce operational cost and extend the life of pipeline infrastructure by automating remote cathodic protection systems

Energy Technology Data Exchange (ETDEWEB)

Rosado, Elroy [Freewave Technologies, Inc., Boulder, CO (United States). Latin America

2009-07-01

Energy and Pipeline Companies wrestle to control operating costs largely affected by new government regulations, ageing buried metal assets, rising steel prices, expanding pipeline operations, new interference points, HCA encroachment, restrictive land use policies, heightened network security, and an ageing soon-to-retire work force. With operating costs on the rise, seemingly out of control, many CP and Operations Professionals look to past best practices in cost containment through automation. Many companies achieve solid business results through deployment of telemetry and SCADA automation of remote assets and now hope to expand this success to further optimize operations by automating remote cathodic protection systems. This presentation will provide examples of how new remote cathodic protection systems are helping energy and pipeline companies address the growing issue of the aging pipeline infrastructure and reduce their costs while optimizing their operations. (author)

Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria.

Science.gov (United States)

Liu, Cindy M; Hungate, Bruce A; Tobian, Aaron A R; Serwadda, David; Ravel, Jacques; Lester, Richard; Kigozi, Godfrey; Aziz, Maliha; Galiwango, Ronald M; Nalugoda, Fred; Contente-Cuomo, Tania L; Wawer, Maria J; Keim, Paul; Gray, Ronald H; Price, Lance B

2013-04-16

Male circumcision reduces female-to-male HIV transmission. Hypothesized mechanisms for this protective effect include decreased HIV target cell recruitment and activation due to changes in the penis microbiome. We compared the coronal sulcus microbiota of men from a group of uncircumcised controls (n = 77) and from a circumcised intervention group (n = 79) at enrollment and year 1 follow-up in a randomized circumcision trial in Rakai, Uganda. We characterized microbiota using16S rRNA gene-based quantitative PCR (qPCR) and pyrosequencing, log response ratio (LRR), Bayesian classification, nonmetric multidimensional scaling (nMDS), and permutational multivariate analysis of variance (PerMANOVA). At baseline, men in both study arms had comparable coronal sulcus microbiota; however, by year 1, circumcision decreased the total bacterial load and reduced microbiota biodiversity. Specifically, the prevalence and absolute abundance of 12 anaerobic bacterial taxa decreased significantly in the circumcised men. While aerobic bacterial taxa also increased postcircumcision, these gains were minor. The reduction in anaerobes may partly account for the effects of circumcision on reduced HIV acquisition. The bacterial changes identified in this study may play an important role in the HIV risk reduction conferred by male circumcision. Decreasing the load of specific anaerobes could reduce HIV target cell recruitment to the foreskin. Understanding the mechanisms that underlie the benefits of male circumcision could help to identify new intervention strategies for decreasing HIV transmission, applicable to populations with high HIV prevalence where male circumcision is culturally less acceptable.

The effective cost of tritium for tokamak fusion power reactors with reduced tritium production systems

International Nuclear Information System (INIS)

Gilligan, J.G.; Evans, K.

1983-01-01

If sufficient tritium cannot be produced and processed in tokamak blankets then at least two alternatives are possible. Tritium can be purchased; or reactors with reduced tritium (RT) content in the plasma can be designed. The latter choice may require development of magnet technology etc., but the authors show that the impact on the cost-of-electricity may be mild. Cost tradeoffs are compared to the market value of tritium. Adequate tritium production in fusion blankets is preferred, but the authors show there is some flexibility in the deployment of fusion if this is not possible

Securitization of residential solar photovoltaic assets: Costs, risks and uncertainty

International Nuclear Information System (INIS)

Alafita, T.; Pearce, J.M.

2014-01-01

Limited access to low-cost financing is an impediment to high-velocity technological diffusion and high grid penetration of solar photovoltaic (PV) technology. Securitization of solar assets provides a potential solution to this problem. This paper assesses the viability of solar asset-backed securities (ABS) as a lower cost financing mechanism and identifies policies that could facilitate implementation of securitization. First, traditional solar financing is examined to provide a baseline for cost comparisons. Next, the securitization process is modeled. The model enables identification of several junctures at which risk and uncertainty influence costs. Next, parameter values are assigned and used to generate cost estimates. Results show that, under reasonable assumptions, securitization of solar power purchase agreements (PPA) can significantly reduce project financing costs, suggesting that securitization is a viable mechanism for improving the financing of PV projects. The clear impediment to the successful launch of a solar ABS is measuring and understanding the riskiness of underlying assets. This study identifies three classes of policy intervention that lower the cost of ABS by reducing risk or by improving the measurement of risk: (i) standardization of contracts and the contracting process, (ii) improved access to contract and equipment performance data, and (iii) geographic diversification. - Highlights: • Limited access to low-cost financing is hampering penetration of solar PV. • Solar asset-backed securities (ABS) provide a low cost financing mechanism. • Results for securitization of solar leases and power purchase agreements (PPA). • Securitization can significantly reduce project financing costs. • Identifies policy intervention that lower cost of ABS by reducing risk

Innovation in product design as a factor for reducing logistic and production costs

Directory of Open Access Journals (Sweden)

Luciana Fighera Marzall

2016-03-01

Full Text Available Innovation has been considered of fundamental importance for organizations competing in dynamic environments, which along with cost management has been shown as an organizational strategy that allows the company to measure its results and implement measures that impact on the organization's performance as a whole. This paper, carried out in a metal mechanical industry of a telecommunications engineering branch, aims to analyse cost reduction in logistics raw materials areas through innovation in the product design, which are antennas and towers for telephone networks. In terms of methodology, this study presents itself as a qualitative and quantitative research-action, which from the link between theory and practice allows for intervention in the middle of the researchers studied. As a result, an innovative project was developed, which allowed for the reduction costs of production by 68% and logistics by 32%. Despite the significant decrease in costs, the quality of manufactured products not declined and customer needs were met, thus making the company more competitive against competitors. Not widespread in the literature, this analysis of the impact on logistics and production costs due to improvements in the project is the main contribution theoretical of this paper.

Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

Science.gov (United States)

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

Reducing the risk of injury from table saw use: the potential benefits and costs of automatic protection.

Science.gov (United States)

Graham, John D; Chang, Joice

2015-02-01

The use of table saws in the United States is associated with approximately 28,000 emergency department (ED) visits and 2,000 cases of finger amputation per year. This article provides a quantitative estimate of the economic benefits of automatic protection systems that could be designed into new table saw products. Benefits are defined as reduced health-care costs, enhanced production at work, and diminished pain and suffering. The present value of the benefits of automatic protection over the life of the table saw are interpreted as the switch-point cost value, the maximum investment in automatic protection that can be justified by benefit-cost comparison. Using two alternative methods for monetizing pain and suffering, the study finds switch-point cost values of $753 and $561 per saw. These point estimates are sensitive to the values of inputs, especially the average cost of injury. The various switch-point cost values are substantially higher than rough estimates of the incremental cost of automatic protection systems. Uncertainties and future research needs are discussed. © 2014 Society for Risk Analysis.

Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers.

Science.gov (United States)

Bittman, Barry; Bruhn, Karl T; Stevens, Christine; Westengard, James; Umbach, Paul O

2003-01-01

This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.

Reducing the Cost and Time to Perform a Human Factors Engineering Evaluation

International Nuclear Information System (INIS)

Geary, L.C. Dr.

2003-01-01

The Westinghouse Savannah River Company, a contractor to the Department of Energy, has developed a new software tool for automating the Human Factors Engineering design review, analysis, and evaluation processes. The set of design guidelines, used in the tool, was obtained from the United States Nuclear Regulatory Commission Nuclear Regulatory Guide, NUREG- 0700 - Human System Interface Design Review Guideline. This tool has been described at a previous IEEE Conference on Human Factors and Power Plants. The original software tool in NUREG- 0700 was used to evaluate a facility and a separate independent evaluation was performed using the new tool for the same facility. A comparison was made between the two different tools; both in results obtained and cost and time to complete the evaluation. The results demonstrate a five to ten fold reduction in time and cost to complete the evaluation using the newly developed tool while maintaining consistent evaluation results. The time to per form the review was measured in weeks using the new software tool rather than months using the existing NUREG-0700 tool. The new tool has been so successful that it was applied to two additional facilities with the same reduced time and cost savings. Plans have been made to use the new tool at other facilities in order to provide the same savings

Quilting after mastectomy significantly reduces seroma formation

African Journals Online (AJOL)

reduce or prevent seroma formation among mastectomy patients ... of this prospective study is to evaluate the effect of surgical quilting ... Seroma was more common in smokers (p=0.003) and was not decreased by the .... explain its aetiology.

[Reduce Energy Costs While Maintaining Healthy IAQ.] "Indoor Air Quality Tools for Schools" Update #17

Science.gov (United States)

US Environmental Protection Agency, 2009

2009-01-01

This issue of "Indoor Air Quality Tools for Schools" Update ("IAQ TfS" Update) contains the following items: (1) News and Events; (2) Feature Article: Reduce Energy Costs while Maintaining Healthy IAQ; (3) Insight into Excellence: North East Independent School District ; (4) School Building Week 2009; and (5) Have Your Questions Answered!

Reducing the metabolic cost of walking with an ankle exoskeleton: interaction between actuation timing and power.

Science.gov (United States)

Galle, Samuel; Malcolm, Philippe; Collins, Steven Hartley; De Clercq, Dirk

2017-04-27

Powered ankle-foot exoskeletons can reduce the metabolic cost of human walking to below normal levels, but optimal assistance properties remain unclear. The purpose of this study was to test the effects of different assistance timing and power characteristics in an experiment with a tethered ankle-foot exoskeleton. Ten healthy female subjects walked on a treadmill with bilateral ankle-foot exoskeletons in 10 different assistance conditions. Artificial pneumatic muscles assisted plantarflexion during ankle push-off using one of four actuation onset timings (36, 42, 48 and 54% of the stride) and three power levels (average positive exoskeleton power over a stride, summed for both legs, of 0.2, 0.4 and 0.5 W∙kg -1 ). We compared metabolic rate, kinematics and electromyography (EMG) between conditions. Optimal assistance was achieved with an onset of 42% stride and average power of 0.4 W∙kg -1 , leading to 21% reduction in metabolic cost compared to walking with the exoskeleton deactivated and 12% reduction compared to normal walking without the exoskeleton. With suboptimal timing or power, the exoskeleton still reduced metabolic cost, but substantially less so. The relationship between timing, power and metabolic rate was well-characterized by a two-dimensional quadratic function. The assistive mechanisms leading to these improvements included reducing muscular activity in the ankle plantarflexors and assisting leg swing initiation. These results emphasize the importance of optimizing exoskeleton actuation properties when assisting or augmenting human locomotion. Our optimal assistance onset timing and average power levels could be used for other exoskeletons to improve assistance and resulting benefits.

Navvus FFR to reduce CONTRAst, Cost and radiaTion (CONTRACT); insights from a single-centre clinical and economical evaluation with the RXi Rapid-Exchange FFR device.

Science.gov (United States)

Masdjedi, Kaneshka; Van Mieghem, Nicolas M; Diletti, Roberto; van Geuns, Robert-Jan; de Jaegere, Peter; Regar, Evelyn; Zijlstra, Felix; van Domburg, Ron T; Daemen, Joost

2017-04-15

To assess whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention. FFR is the mainstay of functional hemodynamic assessment of coronary artery lesions. The RXi Navvus system (ACIST Medical Systems, Eden Prairie, MN) is a monorail microcatheter with FFR-measurement capability through optical pressure sensor technology. This is an investigator-initiated, prospective, single-center, observational cohort study. A total of 238 patients were enrolled, 97 patients with Navvus and 141 with conventional pressure-wire based FFR (PW-FFR). Final analyses were performed on the cohort in which only 1 device was used (82 Navvus procedures vs. 136 PW-FFR procedures). No significant differences were found in the total amount of contrast used (150±77 vs 147±79ml; p=0.81), radiation use (6200±4601 vs. 5076±4655 centiG∗cm 2 ; p=0.09) or costs (€1994,- vs. €1930,-; p=0.32) in the Navvus vs. PW-FFR groups respectively. No significant differences were found in the amount of contrast used, total procedural costs or radiation when the Navvus system was used as compared to conventional FFR wires. CONTRACT is an investigator-initiated, prospective, single-center, observational cohort study that evaluated whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention. Use of the RXi Navvus system was associated with comparable procedural costs, amount of radiation and contrast used as compared to PW-FFR systems. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Effective information channels for reducing costs of environmentally- friendly technologies: evidence from residential PV markets

International Nuclear Information System (INIS)

Rai, Varun; Robinson, Scott A

2013-01-01

Realizing the environmental benefits of solar photovoltaics (PV) will require reducing costs associated with perception, informational gaps and technological uncertainties. To identify opportunities to decrease costs associated with residential PV adoption, in this letter we use multivariate regression models to analyze a unique, household-level dataset of PV adopters in Texas (USA) to systematically quantify the effect of different information channels on aspiring PV adopters’ decision-making. We find that the length of the decision period depends on the business model, such as whether the system was bought or leased, and on special opportunities to learn, such as the influence of other PV owners in the neighborhood. This influence accrues passively through merely witnessing PV systems in the neighborhood, increasing confidence and motivation, as well as actively through peer-to-peer communications. Using these insights we propose a new framework to provide public information on PV that could drastically reduce barriers to PV adoption, thereby accelerating its market penetration and environmental benefits. This framework could also serve as a model for other distributed generation technologies. (letter)

Effective information channels for reducing costs of environmentally- friendly technologies: evidence from residential PV markets

Science.gov (United States)

Rai, Varun; Robinson, Scott A.

2013-03-01

Realizing the environmental benefits of solar photovoltaics (PV) will require reducing costs associated with perception, informational gaps and technological uncertainties. To identify opportunities to decrease costs associated with residential PV adoption, in this letter we use multivariate regression models to analyze a unique, household-level dataset of PV adopters in Texas (USA) to systematically quantify the effect of different information channels on aspiring PV adopters’ decision-making. We find that the length of the decision period depends on the business model, such as whether the system was bought or leased, and on special opportunities to learn, such as the influence of other PV owners in the neighborhood. This influence accrues passively through merely witnessing PV systems in the neighborhood, increasing confidence and motivation, as well as actively through peer-to-peer communications. Using these insights we propose a new framework to provide public information on PV that could drastically reduce barriers to PV adoption, thereby accelerating its market penetration and environmental benefits. This framework could also serve as a model for other distributed generation technologies.

Reducing Operating Costs by Optimizing Space in Facilities

Science.gov (United States)

2012-03-01

Design: Mapping the High Performance Workscape. Jossey-Bass. San Francisco. Berkman, Elliot. (2012). A Conceptual Guide to Statistics using SPSS. Sage ...Cleaning: Includes labor costs for in-house and contract service, payroll , taxes and fringe benefits, plus salaried supervisors and managers, as well as...Labor costs include payroll , taxes and fringe benefits for employees and contracted workers. Personnel include operating engineers, general

The electric vehicles as a mean to reduce CO2 emissions and energy costs in isolated regions. The São Miguel (Azores) case study

International Nuclear Information System (INIS)

Camus, Cristina; Farias, Tiago

2012-01-01

Most of small islands around the world today, are dependent on imported fossil fuels for the majority of their energy needs especially for transport activities and electricity production. The use of locally renewable energy resources and the implementation of energy efficiency measures could make a significant contribution to their economic development by reducing fossil fuel imports. An electrification of vehicles has been suggested as a way to both reduce pollutant emissions and increase security of supply of the transportation sector by reducing the dependence on oil products imports and facilitate the accommodation of renewable electricity generation, such as wind and, in the case of volcanic islands like São Miguel (Azores) of the geothermal energy whose penetration has been limited by the valley electricity consumption level. In this research, three scenarios of EV penetration were studied and it was verified that, for a 15% LD fleet replacement by EVs with 90% of all energy needs occurring during the night, the accommodation of 10 MW of new geothermal capacity becomes viable. Under this scenario, reductions of 8% in electricity costs, 14% in energy, 23% in fossil fuels use and CO 2 emissions for the transportation and electricity production sectors could be expected. - Highlights: ► EVs impacts on the electric system in energy and power profiles, costs and emissions. ► At least an EV penetration of 15% is needed to allow new geothermal power production. ► Reductions in energy, fossil fuels use and CO 2 emissions of 9%, 16% and 17% respectively. ► Electricity production with more % of renewable technologies reduces unit costs.

Cost-efficient scheduling of FAST observations

Science.gov (United States)

Luo, Qi; Zhao, Laiping; Yu, Ce; Xiao, Jian; Sun, Jizhou; Zhu, Ming; Zhong, Yi

2018-03-01

A cost-efficient schedule for the Five-hundred-meter Aperture Spherical radio Telescope (FAST) requires to maximize the number of observable proposals and the overall scientific priority, and minimize the overall slew-cost generated by telescope shifting, while taking into account the constraints including the astronomical objects visibility, user-defined observable times, avoiding Radio Frequency Interference (RFI). In this contribution, first we solve the problem of maximizing the number of observable proposals and scientific priority by modeling it as a Minimum Cost Maximum Flow (MCMF) problem. The optimal schedule can be found by any MCMF solution algorithm. Then, for minimizing the slew-cost of the generated schedule, we devise a maximally-matchable edges detection-based method to reduce the problem size, and propose a backtracking algorithm to find the perfect matching with minimum slew-cost. Experiments on a real dataset from NASA/IPAC Extragalactic Database (NED) show that, the proposed scheduler can increase the usage of available times with high scientific priority and reduce the slew-cost significantly in a very short time.

Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

LENUS (Irish Health Repository)

Costello, R W

2012-02-01

BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 +\\/- 0.41 to 0.8 +\\/- 0.37 and the mean number of bed days occupied was reduced from 16.6 +\\/- 2.94 to 5.3 +\\/- 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 +\\/- 0.27 to 1.2 +\\/- 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

The costs of reducing loss to follow-up in South African cervical cancer screening

Directory of Open Access Journals (Sweden)

Kuhn Louise

2005-11-01

Full Text Available Abstract Background This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. Methods Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s, and those who never returned despite attempted contact(s were determined. The number of CHW visits per woman was also estimated. Results 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5% occurred without CHW contact, 918 (24.8% occurred after contact(s, and 472 (12.7% did not occur despite contact(s. Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. Conclusion CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.

Cost-benefit analysis of the Swiss national policy on reducing micropollutants in treated wastewater.

Science.gov (United States)

Logar, Ivana; Brouwer, Roy; Maurer, Max; Ort, Christoph

2014-11-04

Contamination of freshwater with micropollutants (MPs) is a growing concern worldwide. Even at very low concentrations, MPs can have adverse effects on aquatic ecosystems and possibly also on human health. Switzerland is one of the first countries to start implementing a national policy to reduce MPs in the effluents of municipal sewage treatment plants (STPs). This paper estimates the benefits of upgrading STPs based on public's stated preferences. To assess public demand for the reduction of the environmental and health risks of MPs, we conducted a choice experiment in a national online survey. The results indicate that the average willingness to pay per household is CHF 100 (US$ 73) annually for reducing the potential environmental risk of MPs to a low level. These benefits, aggregated over households in the catchment of the STPs to be upgraded, generate a total annual economic value of CHF 155 million (US$ 113 million). This compares with estimated annual costs for upgrading 123 STPs of CHF 133 million (US$ 97 million) or CHF 86 (US$ 63) per household connected to these STPs. Hence, a cost-benefit analysis justifies the investment decision from an economic point of view and supports the implementation of the national policy in the ongoing political discussion.

Reduced cost design of liquid lithium target for international fusion material irradiation facility (IFMIF)

International Nuclear Information System (INIS)

Nakamura, Hiroo; Ida, Mizuho; Sugimoto, Masayoshi; Takeuchi, Hiroshi; Yutani, Toshiaki

2001-01-01

The International Fusion Materials Irradiation Facility (IFMIF) is being jointly planned to provide an accelerator-based D-Li neutron source to produce intense high energy neutrons (2 MW/m 2 ) up to 200 dpa and a sufficient irradiation volume (500 cm 3 ) for testing the candidate materials and components up to about a full lifetime of their anticipated use in ITER and DEMO. To realize such a condition, 40 MeV deuteron beam with a current of 250 mA is injected into high speed liquid lithium flow with a speed of 20 m/s. Following Conceptual Design Activity (1995-1998), a design study with focus on cost reduction without changing its original mission has been done in 1999. The following major changes to the CAD target design have been considered in the study and included in the new design: i) number of the Li target has been changed from 2 to 1, ii) spare of impurity traps of the Li loop was removed although the spare will be stored in a laboratory for quick exchange, iii) building volume was reduced via design changes in lithium loop length. This paper describes the reduced cost design of the lithium target system and recent status of Key Element Technology activities. (author)

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.

Development of Advanced Technologies to Reduce Design, Fabrication and Construction Costs for Future Nuclear Power Plants

Energy Technology Data Exchange (ETDEWEB)

DiNunzio, Camillo A. [Framatome ANP DE& S, Marlborough, MA (United States); Gupta, Abhinav [Univ. of North Carolina, Raleigh, NC (United States); Golay, Michael [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States); Luk, Vincent [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Turk, Rich [Westinghouse Electric Company Nuclear Systems, Windsor, CT (United States); Morrow, Charles [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jin, Geum-Taek [Korea Power Engineering Company Inc., Yongin-si, Gyeonggi-do (Korea, Republic of)

2002-11-30

This report presents a summation of the third and final year of a three-year investigation into methods and technologies for substantially reducing the capital costs and total schedule for future nuclear plants. In addition, this is the final technical report for the three-year period of studies.

Can community-based, low-cost antenatal care in the third trimester of pregnancy reduce the incidence of low birth weight newborns?

Science.gov (United States)

Chaudhary, A K; Chaudhary, Asha; Tiwari, S C; Dwivedi, R

2012-06-01

To determine if community-based, low-cost interventions during third trimester of pregnancy can reduce the incidence of low birth weight babies. In a case control study, 290 pregnant women from a slum area were registered in the beginning of third trimester of pregnancy and provided full antenatal care comprising fortnightly check up, one IFA tablet daily, counseling for minimum one-and-a-half hour post-lunch rest in left lateral position, additional diet to ensure minimum 2,200 kcal per day, and management of clinical conditions, if any. An equal number of pregnant women belonging to the same slum area were registered as control who received routine antenatal services from the existing health care facilities. The birth weight of the babies in the two groups were recorded and compared. Test of significance and correlation coefficient were applied to the data. Mean birth weight of the babies of the Subjects was 2.76 kg (SD 0.39) compared to mean birth weight of 2.57 kg (SD 0.36) of the babies in the Control group. Incidence of low birth weight babies among subjects who consumed minimum 2,400 kcal per day, had one-and-a-half hour post-lunch rest in left lateral position and who consumed one tablet of IFA (100 mg iron and 5 mg folic acid) per day during the last trimester of pregnancy was lower (17.6 %) as compared with women in the Control group (36.2 %). The difference in the mean birth weight of newborns of the two groups was statistically significant (t = 2.52, p < 0.01). Incidence of low birth weight babies can be significantly reduced by providing simple, low-cost care to pregnant women during the last trimester of pregnancy in the community setting.

Do workplace wellness programs reduce medical costs? Evidence from a Fortune 500 company.

Science.gov (United States)

Liu, Hangsheng; Mattke, Soeren; Harris, Katherine M; Weinberger, Sarah; Serxner, Seth; Caloyeras, John P; Exum, Ellen

2013-05-01

The recent passage of the Affordable Care Act has heightened the importance of workplace wellness programs. This paper used administrative data from 2002 to 2007 for PepsiCo's self-insured plan members to evaluate the effect of its wellness program on medical costs and utilization. We used propensity score matching to identify a comparison group who were eligible for the program but did not participate. No significant changes were observed in inpatient admissions, emergency room visits, or per-member per-month (PMPM) costs. The discrepancy between our findings and those of prior studies may be due to the difference in intervention intensity or program implementation.

Reduced metabolic cost of locomotion in Svalbard rock ptarmigan (Lagopus muta hyperborea during winter.

Directory of Open Access Journals (Sweden)

John Lees

2010-11-01

Full Text Available The Svalbard rock ptarmigan, Lagopus muta hyperborea experiences extreme photoperiodic and climatic conditions on the Arctic archipelago of Svalbard. This species, however, is highly adapted to live in this harsh environment. One of the most striking adaptations found in these birds is the deposition, prior to onset of winter, of fat stores which may comprise up to 32% of body mass and are located primarily around the sternum and abdominal region. This fat, while crucial to the birds' survival, also presents a challenge in that the bird must maintain normal physiological function with this additional mass. In particular these stores are likely to constrain the respiratory system, as the sternum and pelvic region must be moved during ventilation and carrying this extra load may also impact upon the energetic cost of locomotion. Here we demonstrate that winter birds have a reduced cost of locomotion when compared to summer birds. A remarkable finding given that during winter these birds have almost twice the body mass of those in summer. These results suggest that Svalbard ptarmigan are able to carry the additional winter fat without incurring any energetic cost. As energy conservation is paramount to these birds, minimising the costs of moving around when resources are limited would appear to be a key adaptation crucial for their survival in the barren Arctic environment.

Bottom-Up Cost Analysis of a High Concentration PV Module; NREL (National Renewable Energy Laboratory)

Energy Technology Data Exchange (ETDEWEB)

Horowitz, K.; Woodhouse, M.; Lee, H.; Smestad, G.

2015-04-13

We present a bottom-up model of III-V multi-junction cells, as well as a high concentration PV (HCPV) module. We calculate $0.65/Wp(DC) manufacturing costs for our model HCPV module design with today’s capabilities, and find that reducing cell costs and increasing module efficiency offer the promising pathways for future cost reductions. Cell costs could be significantly reduced via an increase in manufacturing scale, substrate reuse, and improved manufacturing yields. We also identify several other significant drivers of HCPV module costs, including the Fresnel lens primary optic, module housing, thermal management, and the receiver board. These costs could potentially be lowered by employing innovative module designs.

Defibrillator charging before rhythm analysis significantly reduces hands-off time during resuscitation

DEFF Research Database (Denmark)

Hansen, L. K.; Folkestad, L.; Brabrand, M.

2013-01-01

BACKGROUND: Our objective was to reduce hands-off time during cardiopulmonary resuscitation as increased hands-off time leads to higher mortality. METHODS: The European Resuscitation Council (ERC) 2005 and ERC 2010 guidelines were compared with an alternative sequence (ALT). Pulseless ventricular...... physicians were included. All had prior experience in advanced life support. Chest compressions were shorter interrupted using ALT (mean, 6.7 vs 13.0 seconds). Analyzing data for ventricular tachycardia scenarios only, hands-off time was shorter using ALT (mean, 7.1 vs 18.2 seconds). In ERC 2010 vs ALT, 12...... physicians were included. Two physicians had not prior experience in advanced life support. Hands-off time was reduced using ALT (mean, 3.9 vs 5.6 seconds). Looking solely at ventricular tachycardia scenarios, hands-off time was shortened using ALT (mean, 4.5 vs 7.6 seconds). No significant reduction...

Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

Directory of Open Access Journals (Sweden)

A. D. Chukalla

2017-07-01

by reducing water consumption at negligible yield reduction while reducing the cost for irrigation water and the associated costs for energy and labour. Next, moving from no to organic mulching has a high cost-effectiveness, reducing the WF significantly at low cost. Finally, changing from sprinkler or furrow to drip or subsurface drip irrigation reduces the WF, but at a significant cost.

Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

Science.gov (United States)

Chukalla, Abebe D.; Krol, Maarten S.; Hoekstra, Arjen Y.

2017-07-01

consumption at negligible yield reduction while reducing the cost for irrigation water and the associated costs for energy and labour. Next, moving from no to organic mulching has a high cost-effectiveness, reducing the WF significantly at low cost. Finally, changing from sprinkler or furrow to drip or subsurface drip irrigation reduces the WF, but at a significant cost.

Enrichment: CRISLA [chemical reaction by isotope selective activation] aims to reduce costs

International Nuclear Information System (INIS)

Eerkens, J.W.

1989-01-01

Every year, more than $3 billion is spent on enriching uranium. CRISLA (Chemical Reaction by Isotope Selective Activation) uses a laser-catalyzed chemical reaction which, its proponents claim, could substantially reduce these costs. In CRISLA, an infrared CO laser illuminates the intracavity reaction cell (IC) at a frequency tuned to excite primarily UF 6 . When UF 6 and co-reactant RX are passed through the IC, the tuned laser photons preferentially enhance the reaction of UF 6 with RX ten-thousand-fold over the thermal reaction rate. Thus the laser serves as an activator and the chemical energy for separation is largely chemical. (author)

Cost-Effectiveness Analysis of a Navigation Program for Colorectal Cancer Screening to Reduce Social Health Inequalities: A French Cluster Randomized Controlled Trial.

Science.gov (United States)

De Mil, Rémy; Guillaume, Elodie; Guittet, Lydia; Dejardin, Olivier; Bouvier, Véronique; Pornet, Carole; Christophe, Véronique; Notari, Annick; Delattre-Massy, Hélène; De Seze, Chantal; Peng, Jérôme; Launoy, Guy; Berchi, Célia

2018-06-01

Patient navigation programs to increase colorectal cancer (CRC) screening adherence have become widespread in recent years, especially among deprived populations. To evaluate the cost-effectiveness of the first patient navigation program in France. A total of 16,250 participants were randomized to either the usual screening group (n = 8145) or the navigation group (n = 8105). Navigation consisted of personalized support provided by social workers. A cost-effectiveness analysis of navigation versus usual screening was conducted from the payer perspective in the Picardy region of northern France. We considered nonmedical direct costs in the analysis. Navigation was associated with a significant increase of 3.3% (24.4% vs. 21.1%; P = 0.003) in participation. The increase in participation was higher among affluent participants (+4.1%; P = 0.01) than among deprived ones (+2.6%; P = 0.07). The cost per additional individual screened by navigation compared with usual screening (incremental cost-effectiveness ratio) was €1212 globally and €1527 among deprived participants. Results were sensitive to navigator wages and to the intervention effectiveness whose variations had the greatest impact on the incremental cost-effectiveness ratio. Patient navigation aiming at increasing CRC screening participation is more efficient among affluent individuals. Nevertheless, when the intervention is implemented for the entire population, social inequalities in CRC screening adherence increase. To reduce social inequalities, patient navigation should therefore be restricted to deprived populations, despite not being the most cost-effective strategy, and accepted to bear a higher extra cost per additional individual screened. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Dynamic Cost-Contingency Management: A Method for Reducing Project Costs While Increasing the Probability of Success

National Research Council Canada - National Science Library

Kujawski, Edouard

2007-01-01

In the real world, "Money Allocated is Money Spent" (MAIMS). As a consequence, cost underruns are rarely available to protect against cost overruns, while task overruns are passed on to the total project cost...

Development of Advanced Technologies to Reduce Design, Fabrication and Construction Costs for Future Nuclear Power Plants

International Nuclear Information System (INIS)

DiNunzio, Camillo A.; Gupta, Abhinav; Golay, Michael; Luk, Vincent; Turk, Rich; Morrow, Charles; Geum-Taek Jin

2002-01-01

OAK-B135 This report presents a summation of the third and final year of a three-year investigation into methods and technologies for substantially reducing the capital costs and total schedule for future nuclear plants. In addition, this is the final technical report for the three-year period of studies

Cost reducing code implementation strategies

International Nuclear Information System (INIS)

Kurtz, Randall L.; Griswold, Michael E.; Jones, Gary C.; Daley, Thomas J.

1995-01-01

Sargent and Lundy's Code consulting experience reveals a wide variety of approaches toward implementing the requirements of various nuclear Codes Standards. This paper will describe various Code implementation strategies which assure that Code requirements are fully met in a practical and cost-effective manner. Applications to be discussed includes the following: new construction; repair, replacement and modifications; assessments and life extensions. Lessons learned and illustrative examples will be included. Preferred strategies and specific recommendations will also be addressed. Sargent and Lundy appreciates the opportunity provided by the Korea Atomic Industrial Forum and Korean Nuclear Society to share our ideas and enhance global cooperation through the exchange of information and views on relevant topics

Capital Cost Optimization for Prefabrication: A Factor Analysis Evaluation Model

Directory of Open Access Journals (Sweden)

Hong Xue

2018-01-01

Full Text Available High capital cost is a significant hindrance to the promotion of prefabrication. In order to optimize cost management and reduce capital cost, this study aims to explore the latent factors and factor analysis evaluation model. Semi-structured interviews were conducted to explore potential variables and then questionnaire survey was employed to collect professionals’ views on their effects. After data collection, exploratory factor analysis was adopted to explore the latent factors. Seven latent factors were identified, including “Management Index”, “Construction Dissipation Index”, “Productivity Index”, “Design Efficiency Index”, “Transport Dissipation Index”, “Material increment Index” and “Depreciation amortization Index”. With these latent factors, a factor analysis evaluation model (FAEM, divided into factor analysis model (FAM and comprehensive evaluation model (CEM, was established. The FAM was used to explore the effect of observed variables on the high capital cost of prefabrication, while the CEM was used to evaluate comprehensive cost management level on prefabrication projects. Case studies were conducted to verify the models. The results revealed that collaborative management had a positive effect on capital cost of prefabrication. Material increment costs and labor costs had significant impacts on production cost. This study demonstrated the potential of on-site management and standardization design to reduce capital cost. Hence, collaborative management is necessary for cost management of prefabrication. Innovation and detailed design were needed to improve cost performance. The new form of precast component factories can be explored to reduce transportation cost. Meanwhile, targeted strategies can be adopted for different prefabrication projects. The findings optimized the capital cost and improved the cost performance through providing an evaluation and optimization model, which helps managers to

Systems/cost: summary

International Nuclear Information System (INIS)

Grand, P.; Danby, G.; Keane, J.; Spiro, J.; Sutter, D.; Cole, F.; Hoyer, E.; Freytag, K.; Burke, R.

1978-01-01

The purpose of the meeting was to discuss and develop cost-estimating methods for heavy-ion fusion accelerator systems. The group did not consider that its purpose was to make technical judgments on proposed systems, but to develop methods for making reasonable cost estimates of these systems. Such estimates will, it is hoped, provide material for systems studies, will help in guiding research and development efforts by identifying high-leverage subsystems (areas that account for a significant part of total system cost and that might be reduced in cost by further technical development) and to begin to provide data to aid in an eventual decision on the optimum type of accelerator for heavy-ion fusion. The systems considered as examples are: (1) injection system; (2) Wideroe linac; (3) Alvarez linac; (4) induction linac; (5) superconducting accumulator ring; (6) synchrotron; (7) final rf bunching; and (8) final beam transport to target

THE ROLE OF TIPPING IN REDUCING LABOUR COSTS: CASE OF SECTOR RETAIL PETROLEUM PRODUCTS

Directory of Open Access Journals (Sweden)

Andrej Raspor

2014-05-01

Full Text Available The purpose of this paper was to determine whether tipping could reduce labour costs in the petroleum products retail sector. The research we present was designed on the basis of survey results gathered from Slovenian petrol stations in 2009 and 2010. We have identified the following factors in the tipping process: job satisfaction, flexibility, service quality, satisfaction, motivation and the factor of receiving tips. The analysis showed correlation between methods used to increase the value of tips and better service quality, increased financial and numerical flexibility, motivation, satisfaction upon receipt of tips and the method used to increase the value of tips. In order to decrease labour costs we propose that the management take control of tipping and integrates tips into the reward system. Also, the employees should be made aware about how tipping improves service and increases their income.

Autonomous droop scheme with reduced generation cost

DEFF Research Database (Denmark)

Nutkani, Inam Ullah; Loh, Poh Chiang; Blaabjerg, Frede

2013-01-01

Droop scheme has been widely applied to the control of Distributed Generators (DGs) in microgrids for proportional power sharing based on their ratings. For standalone microgrid, where centralized management system is not viable, the proportional power sharing based droop might not suit well since...... DGs are usually of different types unlike synchronous generators. This paper presents an autonomous droop scheme that takes into consideration the operating cost, efficiency and emission penalty of each DG since all these factors directly or indirectly contributes to the Total Generation Cost (TGC......) of the overall microgrid. Comparing it with the traditional scheme, the proposed scheme has retained its simplicity, which certainly is a feature preferred by the industry. The overall performance of the proposed scheme has been verified through simulation and experiment....

Back to Back: A Focus on Reducing the Logistics Costs and Tax

Directory of Open Access Journals (Sweden)

Rogério João Lunkes

2012-06-01

Full Text Available The objective is to identify the main aspects related to the operation of Back to Back set out in international trade, which enables reduction of logistics costs and taxes. The operation of Back to Back is an excellent opportunity to increase foreign exchange gain and offer greater flexibility to commercial operations that the business requires. The methodology used in preparing this study was qualitative research according to the characteristics and nature of the problem. From the use of descriptive research study aims to demonstrate the main theoretical aspects underlying the subject in reference. This study aimed to identify the main aspects related to the operation of Back to Back set out in international trade and tax effects in an organization and logistics of industrial electronics segment of the State of Santa Catarina. The study demonstrated that the benefits of the operation of Back to Back is of paramount importance for companies having a positive impact in financial terms by reducing the need for tax payments and logistics costs which affect the processes of import and export. The results presented showed that the company studied the operation of Back to Back is essential for international negotiations.

Role of lignin in reducing life-cycle carbon emissions, water use, and cost for United States cellulosic biofuels.

Science.gov (United States)

Scown, Corinne D; Gokhale, Amit A; Willems, Paul A; Horvath, Arpad; McKone, Thomas E

2014-01-01

Cellulosic ethanol can achieve estimated greenhouse gas (GHG) emission reductions greater than 80% relative to gasoline, largely as a result of the combustion of lignin for process heat and electricity in biorefineries. Most studies assume lignin is combusted onsite, but exporting lignin to be cofired at coal power plants has the potential to substantially reduce biorefinery capital costs. We assess the life-cycle GHG emissions, water use, and capital costs associated with four representative biorefinery test cases. Each case is evaluated in the context of a U.S. national scenario in which corn stover, wheat straw, and Miscanthus are converted to 1.4 EJ (60 billion liters) of ethanol annually. Life-cycle GHG emissions range from 4.7 to 61 g CO2e/MJ of ethanol (compared with ∼ 95 g CO2e/MJ of gasoline), depending on biorefinery configurations and marginal electricity sources. Exporting lignin can achieve GHG emission reductions comparable to onsite combustion in some cases, reduce life-cycle water consumption by up to 40%, and reduce combined heat and power-related capital costs by up to 63%. However, nearly 50% of current U.S. coal-fired power generating capacity is expected to be retired by 2050, which will limit the capacity for lignin cofiring and may double transportation distances between biorefineries and coal power plants.

Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users.

Science.gov (United States)

Hardin, Lauran; Kilian, Adam; Muller, Leslie; Callison, Kevin; Olgren, Michael

2017-02-01

High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary's, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. ED mean visits decreased 43% (pcost of care.

Near-linear cost increase to reduce climate-change risk

Energy Technology Data Exchange (ETDEWEB)

Schaeffer, M. [Environmental Systems Analysis Group, Wageningen University and Research Centre, P.O. Box 47, 6700 AA Wageningen (Netherlands); Kram, T.; Van Vuuren, D.P. [Climate and Global Sustainability Group, Netherlands Environmental Assessment Agency, P.O. Box 303, 3720 AH Bilthoven (Netherlands); Meinshausen, M.; Hare, W.L. [Potsdam Institute for Climate Impact Research, P.O. Box 60 12 03, 14412 Potsdam (Germany); Schneider, S.H. (ed.) [Stanford University, Stanford, CA (United States)

2008-12-30

One approach in climate-change policy is to set normative long-term targets first and then infer the implied emissions pathways. An important example of a normative target is to limit the global-mean temperature change to a certain maximum. In general, reported cost estimates for limiting global warming often rise rapidly, even exponentially, as the scale of emission reductions from a reference level increases. This rapid rise may suggest that more ambitious policies may be prohibitively expensive. Here, we propose a probabilistic perspective, focused on the relationship between mitigation costs and the likelihood of achieving a climate target. We investigate the qualitative, functional relationship between the likelihood of achieving a normative target and the costs of climate-change mitigation. In contrast to the example of exponentially rising costs for lowering concentration levels, we show that the mitigation costs rise proportionally to the likelihood of meeting a temperature target, across a range of concentration levels. In economic terms investing in climate mitigation to increase the probability of achieving climate targets yields 'constant returns to scale', because of a counterbalancing rapid rise in the probabilities of meeting a temperature target as concentration is lowered.

COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

Directory of Open Access Journals (Sweden)

Moisello Anna Maria

2012-07-01

Full Text Available Firms are coping with a competitive scenario characterized by quick changes produced by internationalization, concentration, restructuring, technological innovation processes and financial market crisis. On the one hand market enlargement have increased the number and the segmentation of customers and have raised the number of competitors, on the other hand technological innovation has reduced product life cycle. So firms have to adjust their management models to this scenario, pursuing customer satisfaction and respecting cost constraints. In a context where price is a variable fixed by the market, firms have to switch from the cost measurement logic to the cost management one, adopting target costing methodology. The target costing process is a price driven, customer oriented profit planning and cost management system. It works, in a cross functional way, from the design stage throughout all the product life cycle and it involves the entire value chain. The process implementation needs a costing methodology consistent with the cost management logic. The aim of the paper is to focus on Activity Based Costing (ABC application to target costing process. So: -it analyzes target costing logic and phases, basing on a literary review, in order to highlight the costing needs related to this process; -it shows, through a numerical example, how to structure a flexible ABC model – characterized by the separation between variable, fixed in the short and fixed costs - that effectively supports target costing process in the cost measurement phase (drifting cost determination and in the target cost alignment; -it points out the effectiveness of the Activity Based Costing as a model of cost measurement applicable to the supplier choice and as a support for supply cost management which have an important role in target costing process. The activity based information allows a firm to optimize the supplier choice by following the method of minimizing the

A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

Science.gov (United States)

Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine

2017-08-01

Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.

Increasing coal-fired power generation efficiency to reduce electric cost and environmental emissions

International Nuclear Information System (INIS)

Torrens, I.M.; Stenzel, W.C.

1997-01-01

New generating capacity required globally between 1993 and 2010 is estimated to be around 1500 GW, of which some two-thirds will be outside the OECD, and some 40 % in the Asian non-OECD countries. Coal is likely to account for a substantial fraction of this new generation. Today's state-of-the-art supercritical coal-fired power plant has a conversion efficiency of some 42-45 %. The capital cost increase associated with the supercritical or ultra-supercritical pulverized coal power plant compared to a conventional subcritical plant is small to negligible. The increased efficiency associated with the supercritical plant leads to an actual reduction in the total cost of electricity generated in cents/kWh, relative to a conventional plant. Despite this, the power sector continues to build subcritical plants and has no near term plans to increase the efficiency of power plants in the projects it is developing. Advanced clean coal technologies such as integrated gasification combined cycle and pressurized fluidized bed combustion will be selected for independent power projects only in very specific circumstances. Advanced clean coal plants can be operated reliably and with superior performance, and specifically that their present estimated capital costs can be reduced substantially to a point where they are competitive with state-of-the-art pulverized coal technologies. (R.P.)

Ground-Based Telescope Parametric Cost Model

Science.gov (United States)

Stahl, H. Philip; Rowell, Ginger Holmes

2004-01-01

A parametric cost model for ground-based telescopes is developed using multi-variable statistical analysis, The model includes both engineering and performance parameters. While diameter continues to be the dominant cost driver, other significant factors include primary mirror radius of curvature and diffraction limited wavelength. The model includes an explicit factor for primary mirror segmentation and/or duplication (i.e.. multi-telescope phased-array systems). Additionally, single variable models based on aperture diameter are derived. This analysis indicates that recent mirror technology advances have indeed reduced the historical telescope cost curve.

Specifying the ovarian cancer risk threshold of 'premenopausal risk-reducing salpingo-oophorectomy' for ovarian cancer prevention: a cost-effectiveness analysis.

Science.gov (United States)

Manchanda, Ranjit; Legood, Rosa; Antoniou, Antonis C; Gordeev, Vladimir S; Menon, Usha

2016-09-01

Risk-reducing salpingo-oophorectomy (RRSO) is the most effective intervention to prevent ovarian cancer (OC). It is only available to high-risk women with >10% lifetime OC risk. This threshold has not been formally tested for cost-effectiveness. To specify the OC risk thresholds for RRSO being cost-effective for preventing OC in premenopausal women. The costs as well as effects of surgical prevention ('RRSO') were compared over a lifetime with 'no RRSO' using a decision analysis model. RRSO was undertaken in premenopausal women >40 years. The model was evaluated at lifetime OC risk levels: 2%, 4%, 5%, 6%, 8% and 10%. Costs and outcomes are discounted at 3.5%. Uncertainty in the model was assessed using both deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA). Outcomes included in the analyses were OC, breast cancer (BC) and additional deaths from coronary heart disease. Total costs and effects were estimated in terms of quality-adjusted life-years (QALYs); incidence of OC and BC; as well as incremental cost-effectiveness ratio (ICER). Published literature, Nurses Health Study, British National Formulary, Cancer Research UK, National Institute for Health and Care Excellence guidelines and National Health Service reference costs. The time horizon is lifetime and perspective: payer. Premenopausal RRSO is cost-effective at 4% OC risk (life expectancy gained=42.7 days, ICER=£19 536/QALY) with benefits largely driven by reduction in BC risk. RRSO remains cost-effective at >8.2% OC risk without hormone replacement therapy (ICER=£29 071/QALY, life expectancy gained=21.8 days) or 6%if BC risk reduction=0 (ICER=£27 212/QALY, life expectancy gained=35.3 days). Sensitivity analysis indicated results are not impacted much by costs of surgical prevention or treatment of OC/ BC or cardiovascular disease. However, results were sensitive to RRSO utility scores. Additionally, 37%, 61%, 74%, 84%, 96% and 99.5% simulations on PSA are cost

Cheap-GSHPs, an European project aiming cost-reducing innovations for shallow geothermal installations. - Geological data reinterpretation

Science.gov (United States)

Bertermann, David; Müller, Johannes; Galgaro, Antonio; Cultrera, Matteo; Bernardi, Adriana; Di Sipio, Eloisa

2016-04-01

The success and widespread diffusion of new sustainable technologies are always strictly related to their affordability. Nowadays the energy price fluctuations and the economic crisis are jeopardizing the development and diffusion of renewable technologies and sources. With the aim of both reduce the overall costs of shallow geothermal systems and improve their installation safety, an European project has took place recently, under the Horizon 2020 EU Framework Programme for Research and Innovation. The acronym of this project is Cheap-GSHPs, meaning "cheap and efficient application of reliable ground source heat exchangers and pumps"; the CHEAP-GSHPs project involves 17 partners among 9 European countries such Belgium, France, Germany, Greece, Ireland, Italy, Romania, Spain, Switzerland. In order to achieve the planned targets, an holistic approach is adopted, where all involved elements that take part of shallow geothermal activities are here integrated. In order to reduce the drilling specific costs and for a solid planning basis the INSPIRE-conformal ESDAC data set PAR-MAT-DOM ("parent material dominant") was analysed and reinterpreted regarding the opportunities for cost reductions. Different ESDAC classification codes were analysed lithologically and sedimentologically in order to receive the most suitable drilling technique within different formations. Together with drilling companies this geological data set was translated into a geotechnical map which allows drilling companies the usage of the most efficient drilling within a certain type of underground. The scale of the created map is 1: 100,000 for all over Europe. This leads to cost reductions for the final consumers. Further there will be the definition of different heat conductivity classes based on the reinterpreted PAR-MAT-DOM data set which will provide underground information. These values will be reached by sampling data all over Europe and literature data. The samples will be measured by several

The role of capital costs in decarbonizing the electricity sector

Science.gov (United States)

Hirth, Lion; Steckel, Jan Christoph

2016-11-01

Low-carbon electricity generation, i.e. renewable energy, nuclear power and carbon capture and storage, is more capital intensive than electricity generation through carbon emitting fossil fuel power stations. High capital costs, expressed as high weighted average cost of capital (WACC), thus tend to encourage the use of fossil fuels. To achieve the same degree of decarbonization, countries with high capital costs therefore need to impose a higher price on carbon emissions than countries with low capital costs. This is particularly relevant for developing and emerging economies, where capital costs tend to be higher than in rich countries. In this paper we quantitatively evaluate how high capital costs impact the transformation of the energy system under climate policy, applying a numerical techno-economic model of the power system. We find that high capital costs can significantly reduce the effectiveness of carbon prices: if carbon emissions are priced at USD 50 per ton and the WACC is 3%, the cost-optimal electricity mix comprises 40% renewable energy. At the same carbon price and a WACC of 15%, the cost-optimal mix comprises almost no renewable energy. At 15% WACC, there is no significant emission mitigation with carbon pricing up to USD 50 per ton, but at 3% WACC and the same carbon price, emissions are reduced by almost half. These results have implications for climate policy; carbon pricing might need to be combined with policies to reduce capital costs of low-carbon options in order to decarbonize power systems.

Sodium-Reduced Meat and Poultry Products Contain a Significant Amount of Potassium from Food Additives.

Science.gov (United States)

Parpia, Arti Sharma; Goldstein, Marc B; Arcand, JoAnne; Cho, France; L'Abbé, Mary R; Darling, Pauline B

2018-05-01

counterparts (mean difference [95% CI]: 486 [334-638]; Padditives appearing on the product label ingredient list, did not significantly differ between the two groups. Potassium additives are frequently added to sodium-reduced MPPs in amounts that significantly contribute to the potassium load for patients with impaired renal handling of potassium caused by chronic kidney disease and certain medications. Patients requiring potassium restriction should be counseled to be cautious regarding the potassium content of sodium-reduced MPPs and encouraged to make food choices accordingly. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Contracting and project strategy to reduce the costs

International Nuclear Information System (INIS)

Moum, I.O.; Mosbergvik, O.A.

1995-01-01

The Norwegian oil industry has developed and grown to a significant size from the 1970's through the 80's, and numerous large fields were developed under a business environment with high oil prices. The technological challenges were significant, but the expectation of high volumes of produced oil and increasing oil prices, secured the funding for development of these large fields. Today this situation is dramatically changed, and the low oil price alone would make it uneconomic to develop the new fields. In addition to low oil prices, people are now also facing smaller reservoirs, deeper water and more sever environmental conditions. The general competitiveness of the Norwegian Continental Shelf is challenged. Many initiatives have been launched in Norway to support the necessary improvements in business performance. The Norwegian oil and gas industry together with the authorities have through 1994 worked together in the NORSOK initiative to identify means to save 40--50% in cost and time for development of new fields. The industry has developed new technology. The authorities have been addressing the fiscal conditions and general framework for the oil companies, and several areas of improvement have been identified and to some degree implemented by the operators. The most important improvements are probably those that are directly implemented in actual development projects, and Statoil/Kvaerner have together some joint experiences that can illustrate how such ideas successfully can be implemented

Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury.

Science.gov (United States)

Morrison, Sarah A; Lorenz, Douglas; Eskay, Carol P; Forrest, Gail F; Basso, D Michele

2018-03-01

To determine the impact of long-term, body weight-supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers. Prospective observational cohort with longitudinal follow-up. Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN). Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions. Manually assisted locomotor training (LT) in a body weight-supported treadmill environment, overground standing and stepping activities, and community integration tasks. International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy. Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment. Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs. Copyright © 2018 American Congress of Rehabilitation Medicine

Intervention and societal costs of residential community reintegration for patients with acquired brain injury: a cost-analysis of the Brain Integration Programme.

Science.gov (United States)

van Heugten, Caroline M; Geurtsen, Gert J; Derksen, R Elze; Martina, Juan D; Geurts, Alexander C H; Evers, Silvia M A A

2011-06-01

The objective of this study was to examine the intervention costs of a residential community reintegration programme for patients with acquired brain injury and to compare the societal costs before and after treatment. A cost-analysis was performed identifying costs of healthcare, informal care, and productivity losses. The costs in the year before the Brain Integration Programme (BIP) were compared with the costs in the year after the BIP using the following cost categories: care consumption, caregiver support, productivity losses. Dutch guidelines were used for cost valuation. Thirty-three cases participated (72% response). Mean age was 29.8 years, 59% traumatic brain injury. The BIP costs were €68,400. The informal care and productivity losses reduced significantly after BIP (p costs per patient were €48,449. After BIP these costs were €39,773; a significant reduction (p costs after the BIP advocates the allocation of resources and, from an economic perspective, favours reimbursement of the BIP costs by healthcare insurance companies. However, this cost-analysis is limited as it does not relate costs to clinical effectiveness. :

International comparison of electricity generating costs

International Nuclear Information System (INIS)

Jones, P.M.S.; Stevens, G.H.; Wigley, K.

1989-01-01

The paper reviews the principal findings of successive studies of projected comparative generation costs for base-load electricity production conducted by Nuclear Energy Agency working groups, including a current study jointly sponsored by the International Energy Agency. It concludes that over the six years 1983-1989 nuclear generation costs have remained steady or slightly declined in the majority of OECD countries. This represents an excellent result in view of the difficulties that have arisen in many countries during the period. Nuclear power is projected to maintain a significant advantage in most OECD countries on an assessment basis reflecting utility experience and discount rates employed by the majority of participants. However, nuclear's projected advantage has declined due to a significant fall in projected coal prices which have decreased by 50% since 1983. This decline is only slightly offset by increased capital and operating costs for coal-fired plant. If rates of return sought by utilities were higher or if coal prices prove lower than utilities project then the economic balance between nuclear and coal-fired power would be further reduced and could in some instances be reversed. To improve on its competitiveness nuclear power will have to continue to control capital costs through replication and reduced construction schedules and to improve plant availability to maximise output

Early HIV Diagnosis Leads to Significantly Decreased Costs in the First 2 Years of HIV Care in an Urban Charity Hospital in New Orleans.

Science.gov (United States)

Halperin, Jason; Katz, Morgan; Pathmanathan, Ishani; Myers, Leann; Van Sickels, Nicholas; Seal, Paula Sereebutra; Richey, Lauren E

We undertook a retrospective cohort study of patients with a positive HIV test in the emergency department who were then linked to care. Inpatient, outpatient, and emergency costs were collected for the first 2 years after HIV diagnosis. Fifty-six patients met the inclusion criteria; they were predominantly uninsured (73%) and African American (89%). The median total cost for a newly diagnosed patient over the first 2 years was US$36 808, driven predominantly by outpatient costs of US$17 512. Median inpatient and total costs were significantly different between the lowest (499 cells/mm 3 ) CD4 count categories (US$21 878 vs US$6607, P <.05; US$61 378 vs US$18 837, P <.05, respectively). Total costs were significantly different between viral load categories <100 000 HIV-RNA copies/mL and ≥100 000 HIV-RNA copies/mL (US$28 219 vs US$49 482, P <.05). Costs were significantly lower among patients diagnosed earlier in their disease. Decreased cost is another factor supporting early diagnosis and linkage to care for patients with HIV.

Nuclear hazardous waste cost control management

International Nuclear Information System (INIS)

Selg, R.A.

1991-01-01

The effects of the waste content of glass waste forms on Savannah River high-level waste disposal costs are currently under study to adjust the glass frit content to optimize the glass waste loadings and therefore significantly reduce the overall waste disposal cost. Changes in waste content affect onsite Defense Waste Changes in waste contents affect onsite Defense Waste Processing Facility (DWPF) costs as well as offsite shipping and repository emplacement charges. A nominal 1% increase over the 28 wt% waste loading of DWPF glass would reduce disposal costs by about $50 million for Savannah River wastes generated to the year 2000. Optimization of the glass waste forms to be produced in the SWPF is being supported by economic evaluations of the impact of the forms on waste disposal costs. Glass compositions are specified for acceptable melt processing and durability characteristics, with economic effects tracked by the number of waste canisters produced. This paper presents an evaluation of the effects of variations in waste content of the glass waste forms on the overall cost of the disposal, including offsite shipment and repository emplacement, of the Savannah River high-level wastes

The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.

Science.gov (United States)

Padalino, Massimo A; Tessari, Chiara; Guariento, Alvise; Frigo, Anna C; Vida, Vladimiro L; Marcolongo, Andrea; Zanella, Fabio; Harvey, Michael J; Thiagarajan, Ravi R; Stellin, Giovanni

2017-04-01

Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system. We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Outcomes included postimplant complications and survival at weaning and at discharge. We used activity based costing to compare the costs of current basic ECMO with those of a 'full optional' dedicated ECMO team (hypothesis 1); ECMO with a bedside nurse and perfusionist (hypothesis 2), and ECMO with a bedside perfusionist (hypothesis 3). Basic cardiac ECMO was required for 121 patients (median age 75 days, median weight 4.4 kg). A total of 107 patients (88%) had congenital heart disease; 37 had univentricular physiology. The median duration of ECMO was 7 days (interquartile range [IQR], 4-15 days). Overall survival at weaning and at 30 days in the neonatal and paediatric age groups was 58.6% and 30.6%, respectively; these results were not significantly different from Extracorporeal Life Support Organization data. Cost analysis revealed a saving of €30 366, €22 144 and €13 837 for each patient on basic ECMO for hypotheses 1, 2 and 3, respectively. Despite reduced human, technical and economical resources, a basic ECMO model without a bedside specialist was associated with satisfactory survival and lower costs. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Pooled HIV-1 viral load testing using dried blood spots to reduce the cost of monitoring antiretroviral treatment in a resource-limited setting.

Science.gov (United States)

Pannus, Pieter; Fajardo, Emmanuel; Metcalf, Carol; Coulborn, Rebecca M; Durán, Laura T; Bygrave, Helen; Ellman, Tom; Garone, Daniela; Murowa, Michael; Mwenda, Reuben; Reid, Tony; Preiser, Wolfgang

2013-10-01

Rollout of routine HIV-1 viral load monitoring is hampered by high costs and logistical difficulties associated with sample collection and transport. New strategies are needed to overcome these constraints. Dried blood spots from finger pricks have been shown to be more practical than the use of plasma specimens, and pooling strategies using plasma specimens have been demonstrated to be an efficient method to reduce costs. This study found that combination of finger-prick dried blood spots and a pooling strategy is a feasible and efficient option to reduce costs, while maintaining accuracy in the context of a district hospital in Malawi.

Reducing Idle Power Consumption in Office Spaces Saves U.S. Navy in Energy Costs (Fact Sheet)

Energy Technology Data Exchange (ETDEWEB)

None, None

2014-04-01

As part of a two-year project to demonstrate energy efficiency measures, renewable energy generation, and energy systems integration, the National Renewable Energy Laboratory (NREL) has identified advanced plug load controls as a promising technology for reducing energy use and related costs in the U.S. Navy's Naval Facilities Engineering Command (NAVFAC) office spaces.

Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden

Directory of Open Access Journals (Sweden)

Crowell Valerie

2013-01-01

Full Text Available Abstract Background Past experience and modelling suggest that, in most cases, mass treatment strategies are not likely to succeed in interrupting Plasmodium falciparum malaria transmission. However, this does not preclude their use to reduce disease burden. Mass screening and treatment (MSAT is preferred to mass drug administration (MDA, as the latter involves massive over-use of drugs. This paper reports simulations of the incremental cost-effectiveness of well-conducted MSAT campaigns as a strategy for P. falciparum malaria disease-burden reduction in settings with varying receptivity (ability of the combined vector population in a setting to transmit disease and access to case management. Methods MSAT incremental cost-effectiveness ratios (ICERs were estimated in different sub-Saharan African settings using simulation models of the dynamics of malaria and a literature-based MSAT cost estimate. Imported infections were simulated at a rate of two per 1,000 population per annum. These estimates were compared to the ICERs of scaling up case management or insecticide-treated net (ITN coverage in each baseline health system, in the absence of MSAT. Results MSAT averted most episodes, and resulted in the lowest ICERs, in settings with a moderate level of disease burden. At a low pre-intervention entomological inoculation rate (EIR of two infectious bites per adult per annum (IBPAPA MSAT was never more cost-effective than scaling up ITNs or case management coverage. However, at pre-intervention entomological inoculation rates (EIRs of 20 and 50 IBPAPA and ITN coverage levels of 40 or 60%, respectively, the ICER of MSAT was similar to that of scaling up ITN coverage further. Conclusions In all the transmission settings considered, achieving a minimal level of ITN coverage is a “best buy”. At low transmission, MSAT probably is not worth considering. Instead, MSAT may be suitable at medium to high levels of transmission and at moderate ITN coverage

Drivers of imbalance cost of wind power

DEFF Research Database (Denmark)

Obersteiner, C.; Siewierski, T.; Andersen, Anders

2010-01-01

In Europe an increasing share of wind power is sold on the power market. Therefore more and more wind power generators become balancing responsible and face imbalance cost that reduce revenues from selling wind power. A comparison of literature illustrates that the imbalance cost of wind power...... varies in a wide range. To explain differences we indentify parameters influencing imbalance cost and compare them for case studies in Austria, Denmark and Poland. Besides the wind power forecast error also the correlation between imbalance and imbalance price influences imbalance cost significantly...... of imperfect forecast is better suited to reflect real cost incurred due to inaccurate wind power forecasts....

Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

LENUS (Irish Health Repository)

Costello, R W

2011-05-11

BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 ± 0.41 to 0.8 ± 0.37 and the mean number of bed days occupied was reduced from 16.6 ± 2.94 to 5.3 ± 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 ± 0.27 to 1.2 ± 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.

EU Think Tank Fora as Transaction Cost Reducers: A Study of Informal Interest Intermediation in the EU

Directory of Open Access Journals (Sweden)

Marybel Perez

2014-05-01

Full Text Available By examining the organisational structure of EU think tank fora (seminars, workshops and conferences, this article proposes that fora can play the role of transaction cost reducers in EU policymaking. I argue that certain aspects of EU policymaking, including i controlled processes of consultation, ii diminishing costs of management, and iii the risk of state capture, incentivise EU institutions to outsource part of the consultation activity to policy actors that can help EU institutions fulfil their informational and legitimacy needs. I argue that think tanks are able to play this role because they i reduce information asymmetries by connecting a wide variety of policy actors and ii act as intermediaries that mitigate opportunistic behaviour. The empirical assessment reveals that the dimensions characterising transactions are present in EU think tank fora. It shows that policy actors that do not usually participate in formal consultation processes frequently attend fora where they meet representatives of EU institutions, particularly Parliament and Commission representatives.

A chimpanzee recognizes synthetic speech with significantly reduced acoustic cues to phonetic content.

Science.gov (United States)

Heimbauer, Lisa A; Beran, Michael J; Owren, Michael J

2011-07-26

A long-standing debate concerns whether humans are specialized for speech perception, which some researchers argue is demonstrated by the ability to understand synthetic speech with significantly reduced acoustic cues to phonetic content. We tested a chimpanzee (Pan troglodytes) that recognizes 128 spoken words, asking whether she could understand such speech. Three experiments presented 48 individual words, with the animal selecting a corresponding visuographic symbol from among four alternatives. Experiment 1 tested spectrally reduced, noise-vocoded (NV) synthesis, originally developed to simulate input received by human cochlear-implant users. Experiment 2 tested "impossibly unspeechlike" sine-wave (SW) synthesis, which reduces speech to just three moving tones. Although receiving only intermittent and noncontingent reward, the chimpanzee performed well above chance level, including when hearing synthetic versions for the first time. Recognition of SW words was least accurate but improved in experiment 3 when natural words in the same session were rewarded. The chimpanzee was more accurate with NV than SW versions, as were 32 human participants hearing these items. The chimpanzee's ability to spontaneously recognize acoustically reduced synthetic words suggests that experience rather than specialization is critical for speech-perception capabilities that some have suggested are uniquely human. Copyright © 2011 Elsevier Ltd. All rights reserved.

The impact of carbon prices on generation-cycling costs

International Nuclear Information System (INIS)

Denny, Eleanor; O'Malley, Mark

2009-01-01

The introduction of mechanisms aimed at reducing greenhouse gas emissions can have a serious impact on electricity system costs. A carbon mechanism that forces generators to internalise their emissions costs may alter the merit order in which generators are dispatched in the market. Heavy carbon dioxide polluters may switch from operating continuously to having to operate on the margin more often. This results in these units being required to switch on and off and vary their output more frequently, which has a significant impact on their costs. In this paper, the impact of carbon prices on the operating profiles of generators in a real electricity system is investigated. A large number of potential scenarios are considered and it is found that carbon prices significantly increase the cycling costs. These increased cycling costs significantly offset the carbon dioxide reduction benefits of the carbon price

Cost Optimization of Product Families using Analytic Cost Models

DEFF Research Database (Denmark)

Brunø, Thomas Ditlev; Nielsen, Peter

2012-01-01

This paper presents a new method for analysing the cost structure of a mass customized product family. The method uses linear regression and backwards selection to reduce the complexity of a data set describing a number of historical product configurations and incurred costs. By reducing the data...... set, the configuration variables which best describe the variation in product costs are identified. The method is tested using data from a Danish manufacturing company and the results indicate that the method is able to identify the most critical configuration variables. The method can be applied...... in product family redesign projects focusing on cost reduction to identify which modules contribute the most to cost variation and should thus be optimized....

Intensity-modulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy

International Nuclear Information System (INIS)

Braam, Petra M.; Terhaard, Chris H.J. M.D.; Roesink, Judith M.; Raaijmakers, Cornelis P.J.

2006-01-01

Purpose: Xerostomia is a severe complication after radiotherapy for oropharyngeal cancer, as the salivary glands are in close proximity with the primary tumor. Intensity-modulated radiotherapy (IMRT) offers theoretical advantages for normal tissue sparing. A Phase II study was conducted to determine the value of IMRT for salivary output preservation compared with conventional radiotherapy (CRT). Methods and Materials: A total of 56 patients with oropharyngeal cancer were prospectively evaluated. Of these, 30 patients were treated with IMRT and 26 with CRT. Stimulated parotid salivary flow was measured before, 6 weeks, and 6 months after treatment. A complication was defined as a stimulated parotid flow rate <25% of the preradiotherapy flow rate. Results: The mean dose to the parotid glands was 48.1 Gy (SD 14 Gy) for CRT and 33.7 Gy (SD 10 Gy) for IMRT (p < 0.005). The mean parotid flow ratio 6 weeks and 6 months after treatment was respectively 41% and 64% for IMRT and respectively 11% and 18% for CRT. As a result, 6 weeks after treatment, the number of parotid flow complications was significantly lower after IMRT (55%) than after CRT (87%) (p = 0.002). The number of complications 6 months after treatment was 56% for IMRT and 81% for CRT (p = 0.04). Conclusions: IMRT significantly reduces the number of parotid flow complications for patients with oropharyngeal cancer

Costing improvement of remanufacturing crankshaft by integrating Mahalanobis-Taguchi System and Activity based Costing

Science.gov (United States)

Abu, M. Y.; Nor, E. E. Mohd; Rahman, M. S. Abd

2018-04-01

Integration between quality and costing system is very crucial in order to achieve an accurate product cost and profit. Current practice by most of remanufacturers, there are still lacking on optimization during the remanufacturing process which contributed to incorrect variables consideration to the costing system. Meanwhile, traditional costing accounting being practice has distortion in the cost unit which lead to inaccurate cost of product. The aim of this work is to identify the critical and non-critical variables during remanufacturing process using Mahalanobis-Taguchi System and simultaneously estimate the cost using Activity Based Costing method. The orthogonal array was applied to indicate the contribution of variables in the factorial effect graph and the critical variables were considered with overhead costs that are actually demanding the activities. This work improved the quality inspection together with costing system to produce an accurate profitability information. As a result, the cost per unit of remanufactured crankshaft of MAN engine model with 5 critical crankpins is MYR609.50 while Detroit engine model with 4 critical crankpins is MYR1254.80. The significant of output demonstrated through promoting green by reducing re-melting process of damaged parts to ensure consistent benefit of return cores.

Estimating costs and potentials of different methods to reduce the Swedish phosphorus load from agriculture to surface water.

Science.gov (United States)

Malmaeus, J M; Karlsson, O M

2010-01-01

This paper reviews 17 measures to reduce phosphorus leakage from Swedish agriculture to surface waters. Our aim is to evaluate the possible contribution from agriculture to achieve environmental goals including the Baltic Sea Action Plan. Using a regional approach integrating the variability in field specific characteristics, typical costs and national potential for the included measures may be estimated without identifying, e.g., suitable individual fields for implementation. The result may be helpful to select suitable measures but may also influence the design of environmental targets before they are determined. We find that the cheapest measures are reduced phosphorus content in animal food and fertilizer application supervision in pig farms, both measures with annual potentials of around 50t each, and costs of euro7 to euro11 kg(-1)yr(-1). The total potential of the listed measures is an annual phosphorus reduction to surface waters of 242t. If the most expensive measures are excluded (>euro1000 kg(-1)yr(-1)) and including retention in lakes the phosphorus transport to the sea could be reduced by 165 t yr(-1). This amount can be compared with the Swedish commitment in the Baltic Sea Action Plan (BSAP) to reduce input to the Baltic Proper by 290 t yr(-1).

Power generation scenarios for Nigeria: An environmental and cost assessment

International Nuclear Information System (INIS)

Gujba, H.; Mulugetta, Y.; Azapagic, A.

2011-01-01

Exploratory scenarios for the power sector in Nigeria are analysed in this paper using possible pathways within the Nigerian context and then compared against the Government's power expansion plan in the short to medium term. They include two fossil-fuel (FF and CCGT) and two sustainable-development-driven scenarios (SD1 and SD2). The results from the FF scenarios indicate this is the preferred outcome if the aim is to expand electricity access at the lowest capital costs. However, the annual costs and environmental impacts increase significantly as a consequence. The SD1 scenario, characterised by increased penetration of renewables, leads to a reduction of a wide range of environmental impacts while increasing the annual costs slightly. The SD2 scenario, also with an increased share of renewables, is preferred if the aim is to reduce GHG emissions; however, this comes at an increased annual cost. Both the SD1 and SD2 scenarios also show significant increases in the capital investment compared to the Government's plans. These results can be used to help inform future policy in the Nigerian electricity sector by showing explicitly the range of possible trade-offs between environmental impacts and economic costs both in the short and long terms. - Research Highlights: →The power sector in Nigeria is set to grow significantly in near future. →Power sector scenarios are constructed and studied using LCA and economic analysis methods and then compared against the Government's plans. →These include two fossil-fuel and two sustainable-development-driven scenarios. →The results explicitly show the trade-offs between environmental impacts and costs. →Following the fossil fuel paths will reduce capital costs but increase environmental impacts. The renewable energy paths will reduce some environmental impacts but increase the capital costs.

Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

Science.gov (United States)

Malmartel, A; Dutron, M; Ghasarossian, C

2017-09-01

About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

A workplace physical activity program at a public university in Mexico can reduce medical costs associated with type 2 diabetes and hypertension.

Science.gov (United States)

Méndez-Hernández, Pablo; Dosamantes-Carrasco, Darina; Siani, Carole; Flores, Yvonne N; Arredondo, Armando; Lumbreras-Delgado, Irma; Granados-García, Víctor M; Denova-Gutiérrez, Edgar; Gallegos-Carrillo, Katia; Salmerón, Jorge

2012-01-01

To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment. We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico. If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars. This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.

Predicting Market Impact Costs Using Nonparametric Machine Learning Models.

Science.gov (United States)

Park, Saerom; Lee, Jaewook; Son, Youngdoo

2016-01-01

Market impact cost is the most significant portion of implicit transaction costs that can reduce the overall transaction cost, although it cannot be measured directly. In this paper, we employed the state-of-the-art nonparametric machine learning models: neural networks, Bayesian neural network, Gaussian process, and support vector regression, to predict market impact cost accurately and to provide the predictive model that is versatile in the number of variables. We collected a large amount of real single transaction data of US stock market from Bloomberg Terminal and generated three independent input variables. As a result, most nonparametric machine learning models outperformed a-state-of-the-art benchmark parametric model such as I-star model in four error measures. Although these models encounter certain difficulties in separating the permanent and temporary cost directly, nonparametric machine learning models can be good alternatives in reducing transaction costs by considerably improving in prediction performance.

Potential for the Use of Energy Savings Performance Contracts to Reduce Energy Consumption and Provide Energy and Cost Savings in Non-Building Applications

Energy Technology Data Exchange (ETDEWEB)

Williams, Charles; Green, Andrew S.; Dahle, Douglas; Barnett, John; Butler, Pat; Kerner, David

2013-08-01

The findings of this study indicate that potential exists in non-building applications to save energy and costs. This potential could save billions of federal dollars, reduce reliance on fossil fuels, increase energy independence and security, and reduce greenhouse gas emissions. The Federal Government has nearly twenty years of experience with achieving similar energy cost reductions, and letting the energy costs savings pay for themselves, by applying energy savings performance contracts (ESPC) inits buildings. Currently, the application of ESPCs is limited by statute to federal buildings. This study indicates that ESPCs can be a compatible and effective contracting tool for achieving savings in non-building applications.

The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

Energy Technology Data Exchange (ETDEWEB)

Ashcraft, Phillip Lynn [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Fogle, Blythe G. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cummings, Susan M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Lopez, Leon [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-07-29

This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating the request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.

The costs of reducing the excess CO{sub 2} emissions. Reduction potential and costs in certain sector; Hvad koster det at reducere CO{sup 2}-mankoen? - Reduktionspotentiale og omkostninger i udvalgte sektorer

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-07-01

The report presents the results from the project 'The costs of reducing the excess CO{sub 2} emissions - reduction potential and costs in certain sectors'. The aim of the project has been to elucidate the full extent of the reduction potentials and the costs for certain CO{sub 2} reducing initiatives, which are not included in the present projections of the excess CO{sub 2} emissions. The initiatives included in this report are: Accumulation of methane from Danish disposal facilities; Accumulation of methane from disposal facilities in Russia; Reduction in the use of industrial greenhouse gases; Aquifer disposal of CO{sub 2} in the underground; Offshore CO{sub 2} disposal in oil fields in the North Sea. Furthermore, the report presents a general evaluation of the potential of methane accumulation from wastewater treatment. (ba)

Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction.

Science.gov (United States)

McMurray, John J V; Trueman, David; Hancock, Elizabeth; Cowie, Martin R; Briggs, Andrew; Taylor, Matthew; Mumby-Croft, Juliet; Woodcock, Fionn; Lacey, Michael; Haroun, Rola; Deschaseaux, Celine

2018-06-01

Chronic heart failure with reduced ejection fraction (HF-REF) represents a major public health issue and is associated with considerable morbidity and mortality. We evaluated the cost-effectiveness of sacubitril/valsartan (formerly LCZ696) compared with an ACE inhibitor (ACEI) (enalapril) in the treatment of HF-REF from the perspective of healthcare providers in the UK, Denmark and Colombia. A cost-utility analysis was performed based on data from a multinational, Phase III randomised controlled trial. A decision-analytic model was developed based on a series of regression models, which extrapolated health-related quality of life, hospitalisation rates and survival over a lifetime horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). In the UK, the cost per quality-adjusted life-year (QALY) gained for sacubitril/valsartan (using cardiovascular mortality) was £17 100 (€20 400) versus enalapril. In Denmark, the ICER for sacubitril/valsartan was Kr 174 000 (€22 600). In Colombia, the ICER was COP$39.5 million (€11 200) per QALY gained. Deterministic sensitivity analysis showed that results were most sensitive to the extrapolation of mortality, duration of treatment effect and time horizon, but were robust to other structural changes, with most scenarios associated with ICERs below the willingness-to-pay threshold for all three country settings. Probabilistic sensitivity analysis suggested the probability that sacubitril/valsartan was cost-effective at conventional willingness-to-pay thresholds was 68%-94% in the UK, 84% in Denmark and 95% in Colombia. Our analysis suggests that, in all three countries, sacubitril/valsartan is likely to be cost-effective compared with an ACEI (the current standard of care) in patients with HF-REF. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost and Potential of Monolithic CIGS Photovoltaic Modules

Energy Technology Data Exchange (ETDEWEB)

Horowitz, Kelsey; Woodhouse, Michael

2015-06-17

A bottom-up cost analysis of monolithic, glass-glass Cu(In,Ga)(Se,S)2 (CIGS) modules is presented, illuminating current cost drivers for this technology and possible pathways to reduced cost. At 14% module efficiency, for the case of U.S. manufacturing, a manufacturing cost of $0.56/WDC and a minimum sustainable price of $0.72/WDC were calculated. Potential for reduction in manufacturing costs to below $0.40/WDC in the long-term may be possible if module efficiency can be increased without significant increase in $/m2 costs. The levelized cost of energy (LCOE) in Phoenix, AZ under different conditions is assessed and compared to standard c-Si.

Indirect costs of rheumatoid arthritis

Directory of Open Access Journals (Sweden)

Filip Raciborski

2015-12-01

Full Text Available It is estimated that in Poland about 400,000 persons in general suffer from inflammatory joint diseases, including rheumatoid arthritis (RA. Epidemiological surveys documenting the frequency and disturbance of musculoskeletal disorders in the Polish population are few in number. Most of the estimations are based on epidemiological data from other countries (prevalence of 0.5–1%. According to the data of the National Health Fund in Poland 135,000–157,000 persons in total are treated because of rheumatoid arthritis per year [ICD10 (International Statistical Classification of Diseases and Related Health Problems: M05, M06]. In the case of this group of diseases indirect costs significantly outweigh the direct costs. Indirect costs increase together with activity level of the disease. The cost analysis of productivity loss of RA patients indicates that sickness absenteeism and informal care are the most burdensome. At the national level it amounts in total from 1.2 billion to 2.8 billion PLN per year, depending on the method of analysis. These costs could be significantly reduced through early diagnosis and introduction of effective treatment.

INSURANCE AND THE CORPORATE COST OF CAPITAL

Directory of Open Access Journals (Sweden)

Monika Wieczorek-Kosmala

2012-04-01

Full Text Available The purpose of the paper is to provide some support to the thesis that insurance may reduce the cost of capital in a company by influencing both the cost of capital components and the need for rising capital. The problem is here perceived from two perspectives – the classical concept related to the weighted average cost of capital (WACC and a novel concept related to the risk-based capital structure model with the total average cost of capital (TACC. The paper explains the idea of insurance as a retrospective (post-loss risk financing tool and the risk transfer mechanism upon it. As the risk financing tool insurance reduces the need for the balance-sheet capital in a company and thus the financial distress costs. Also, insurance may reduce the level of operating risk and thus influences the required returns of the capital providers. These observations allow emphasising the impact of insurance on the WACC. However, according to the novel concept of the risk-based capital structure, insurance (as a risk financing tool represents an off-balance sheet capital component. As a consequence, it extends the volume of total capital. The presented conceptual model, based on the TACC concept, indicates that large volume of insurance (the insurance sum and its relatively low cost (the insurance premium gives the possibility to the significant reduction of the cost of capital on average. The concluding remarks discuss some dilemmas over the utility of the TACC concept.

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis with Policy Implications

OpenAIRE

Harris, Catherine R.; Osterberg, E. Charles; Sanford, Thomas; Alwaal, Amjad; Gaither, Thomas W.; McAninch, Jack W.; McCulloch, Charles E.; Breyer, Benjamin N.

2016-01-01

To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality.We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear ...

Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark.

Directory of Open Access Journals (Sweden)

Astrid Ledgaard Holm

Full Text Available INTRODUCTION: Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. METHODS: We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. RESULTS: Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. CONCLUSION: Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost

Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark.

Science.gov (United States)

Holm, Astrid Ledgaard; Veerman, Lennert; Cobiac, Linda; Ekholm, Ola; Diderichsen, Finn

2014-01-01

Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs) for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation) were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY) per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost-saving and should thus be first priority for implementation.

Lamb Production Costs: Analyses of Composition and Elasticities Analysis of Lamb Production Costs

Directory of Open Access Journals (Sweden)

C. Raineri

2015-08-01

Full Text Available Since lamb is a commodity, producers cannot control the price of the product they sell. Therefore, managing production costs is a necessity. We explored the study of elasticities as a tool for basing decision-making in sheep production, and aimed at investigating the composition and elasticities of lamb production costs, and their influence on the performance of the activity. A representative sheep production farm, designed in a panel meeting, was the base for calculation of lamb production cost. We then performed studies of: i costs composition, and ii cost elasticities for prices of inputs and for zootechnical indicators. Variable costs represented 64.15% of total cost, while 21.66% were represented by operational fixed costs, and 14.19% by the income of the factors. As for elasticities to input prices, the opportunity cost of land was the item to which production cost was more sensitive: a 1% increase in its price would cause a 0.2666% increase in lamb cost. Meanwhile, the impact of increasing any technical indicator was significantly higher than the impact of rising input prices. A 1% increase in weight at slaughter, for example, would reduce total cost in 0.91%. The greatest obstacle to economic viability of sheep production under the observed conditions is low technical efficiency. Increased production costs are more related to deficient zootechnical indexes than to high expenses.

Reducing Inventory System Costs by Using Robust Demand Estimators

OpenAIRE

Raymond A. Jacobs; Harvey M. Wagner

1989-01-01

Applications of inventory theory typically use historical data to estimate demand distribution parameters. Imprecise knowledge of the demand distribution adds to the usual replenishment costs associated with stochastic demands. Only limited research has been directed at the problem of choosing cost effective statistical procedures for estimating these parameters. Available theoretical findings on estimating the demand parameters for (s, S) inventory replenishment policies are limited by their...

12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment.

Science.gov (United States)

Mundt, Marlon P; Parthasarathy, Sujaya; Chi, Felicia W; Sterling, Stacy; Campbell, Cynthia I

2012-11-01

Adolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use and costs. We used difference-in-difference analysis to compare changes in seven-year follow-up health care use and costs by changes in 12-step participation. Four Kaiser Permanente Northern California AOD treatment programs enrolled 403 adolescents, 13-18-years old, into a longitudinal cohort study upon AOD treatment entry. Participants self-reported 12-step meeting attendance at six-month, one-year, three-year, and five-year follow-up. Outcomes included counts of hospital inpatient days, emergency room (ER) visits, primary care visits, psychiatric visits, AOD treatment costs and total medical care costs. Each additional 12-step meeting attended was associated with an incremental medical cost reduction of 4.7% during seven-year follow-up. The medical cost offset was largely due to reductions in hospital inpatient days, psychiatric visits, and AOD treatment costs. We estimate total medical use cost savings at $145 per year (in 2010 U.S. dollars) per additional 12-step meeting attended. The findings suggest that 12-step participation conveys medical cost offsets for youth who undergo AOD treatment. Reduced costs may be related to improved AOD outcomes due to 12-step participation, improved general health due to changes in social network following 12-step participation, or better compliance to both AOD treatment and 12-step meetings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Additively Manufactured Low Cost Upper Stage Combustion Chamber

Science.gov (United States)

Protz, Christopher; Cooper, Ken; Ellis, David; Fikes, John; Jones, Zachary; Kim, Tony; Medina, Cory; Taminger, Karen; Willingham, Derek

2016-01-01

Over the past two years NASA's Low Cost Upper Stage Propulsion (LCUSP) project has developed Additive Manufacturing (AM) technologies and design tools aimed at reducing the costs and manufacturing time of regeneratively cooled rocket engine components. High pressure/high temperature combustion chambers and nozzles must be regeneratively cooled to survive their operating environment, causing their design fabrication to be costly and time consuming due to the number of individual steps and different processes required. Under LCUSP, AM technologies in Sintered Laser Melting (SLM) GRCop-84 and Electron Beam Freeform Fabrication (EBF3) Inconel 625 have been significantly advanced, allowing the team to successfully fabricate a 25k-class regenerative chamber. Estimates of the costs and schedule of future builds indicate cost reductions and significant schedule reductions will be enabled by this technology. Characterization of the microstructural and mechanical properties of the SLM-produced GRCop-84, EBF3 Inconel 625 and the interface layer between the two has been performed and indicates the properties will meet the design requirements. The LCUSP chamber is to be tested with a previously demonstrated SLM injector in order to advance the Technology Readiness Level (TRL) and demonstrate the capability of the application of these processes. NASA is advancing these technologies to reduce cost and schedule for future engine applications and commercial needs.

Cost-time management: A powerful tool in a new application - cleaning up the weapons complex

International Nuclear Information System (INIS)

Gallagher, J.L.

1992-01-01

Westinghouse Electric Corporation is aggressively applying cost-time management to bolster timely, cost-effective cleanup and waste management activities at sites it manages for the U.S. Department of Energy (DOE). Cost-time management is a diagnostic technique which is applicable to virtually any process. It identifies opportunities to reduce cycle-times and costs. When applied to cleanup and waste management at DOE facilities, cost-time profile analysis helps identify actions to improve productivity and quality. Moreover, by reducing cycle-times and costs, it achieves significant savings to taxpayers. (author)

The operating cost of electrocoagulation

Energy Technology Data Exchange (ETDEWEB)

Donini, J.C.; Kan, J.; Szynkarczuk, J.; Hassan, T.A.; Kar, K.L. (Canadian Centre for Mineral and Energy Technology, Devon, AB (Canada))

1994-12-01

The electrocoagulation of kaolinite and bentonite suspensions was studied in a pilot-scale electrocoagulation system to assess the operating cost and efficiency of the process. Factors affecting the operating cost such as formation of passivation layers on electrode plates, flow velocity, and concentration of NaCl in the suspension were examined. The operating costs investigated were the power cost of the electrocoagulation cell and the material cost due to the consumption of the aluminum electrode. Comparison was based on the settling properties of the treated product: turbidity, settling rate, and cake height. Higher NaCl concentration resulted in greater amounts of Al dissolved chemically and electrochemically into the suspension and thus a better clarity of the supernatant of the treated product. Increased flow velocity could reduce significantly the operating cost while improving both clarity of the supernatant and compactness of the sludge volume. The passivation layers developed quickly with time during the electrocoagulation process and more energy became wasted on the layers. 10 refs., 12 figs.

A Model of Cost Reduction and Standardization: Improved Cost Savings While Maintaining the Quality of Care.

Science.gov (United States)

Guzman, Michael J; Gitelis, Matthew E; Linn, John G; Ujiki, Michael B; Waskerwitz, Matthew; Umanskiy, Konstantin; Muldoon, Joseph P

2015-11-01

Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending. We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction. We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques. This study was conducted in a university-affiliated hospital system. Patients included those undergoing a laparoscopic appendectomy within the hospital system. Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared. During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p day readmissions, postoperative infections, operating time, or reoperations. This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument costs are based on our institution contracts and vary compared with other institutions. In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.

Model improves oil field operating cost estimates

International Nuclear Information System (INIS)

Glaeser, J.L.

1996-01-01

A detailed operating cost model that forecasts operating cost profiles toward the end of a field's life should be constructed for testing depletion strategies and plans for major oil fields. Developing a good understanding of future operating cost trends is important. Incorrectly forecasting the trend can result in bad decision making regarding investments and reservoir operating strategies. Recent projects show that significant operating expense reductions can be made in the latter stages o field depletion without significantly reducing the expected ultimate recoverable reserves. Predicting future operating cost trends is especially important for operators who are currently producing a field and must forecast the economic limit of the property. For reasons presented in this article, it is usually not correct to either assume that operating expense stays fixed in dollar terms throughout the lifetime of a field, nor is it correct to assume that operating costs stay fixed on a dollar per barrel basis

Residential outage cost estimation: Hong Kong

International Nuclear Information System (INIS)

Woo, C.K.; Ho, T.; Shiu, A.; Cheng, Y.S.; Horowitz, I.; Wang, J.

2014-01-01

Hong Kong has almost perfect electricity reliability, the result of substantial investments ultimately financed by electricity consumers who may be willing to accept lower reliability in exchange for lower bills. But consumers with high outage costs are likely to reject the reliability reduction. Our ordered-logit regression analysis of the responses by 1876 households to a telephone survey conducted in June 2013 indicates that Hong Kong residents exhibit a statistically-significant preference for their existing service reliability and rate. Moreover, the average residential cost estimate for a 1-h outage is US$45 (HK$350), topping the estimates reported in 10 of the 11 studies published in the last 10 years. The policy implication is that absent additional compelling evidence, Hong Kong should not reduce its service reliability. - Highlights: • Use a contingent valuation survey to obtain residential preferences for reliability. • Use an ordered logit analysis to estimate Hong Kong's residential outage costs. • Find high outage cost estimates that imply high reliability requirements. • Conclude that sans new evidence, Hong Kong should not reduce its reliability

Defense waste transportation: cost and logistics studies

International Nuclear Information System (INIS)

Andrews, W.B.; Cole, B.M.; Engel, R.L.; Oylear, J.M.

1982-08-01

Transportation of nuclear wastes from defense programs is expected to significantly increase in the 1980s and 1990s as permanent waste disposal facilities come into operation. This report uses models of the defense waste transportation system to quantify potential transportation requirements for treated and untreated contact-handled transuranic (CH-TRU) wastes and high-level defense wastes (HLDW). Alternative waste management strategies in repository siting, waste retrieval and treatment, treatment facility siting, waste packaging and transportation system configurations were examined to determine their effect on transportation cost and hardware requirements. All cost estimates used 1980 costs. No adjustments were made for future changes in these costs relative to inflation. All costs are reported in 1980 dollars. If a single repository is used for defense wastes, transportation costs for CH-TRU waste currently in surface storage and similar wastes expected to be generated by the year 2000 were estimated to be 109 million dollars. Recovery and transport of the larger buried volumes of CH-TRU waste will increase CH-TRU waste transportation costs by a factor of 70. Emphasis of truck transportation and siting of multiple repositories would reduce CH-TRU transportation costs. Transportation of HLDW to repositories for 25 years beginning in 1997 is estimated to cost $229 M in 1980 costs and dollars. HLDW transportation costs could either increase or decrease with the selection of a final canister configuration. HLDW transportation costs are reduced when multiple repositories exist and emphasis is placed on truck transport

National and sub-national analysis of the health benefits and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan.

Science.gov (United States)

Carvalho, Natalie; Salehi, Ahmad Shah; Goldie, Sue J

2013-01-01

Afghanistan has one of the highest rates of maternal mortality in the world. We assess the health outcomes and cost-effectiveness of strategies to improve the safety of pregnancy and childbirth in Afghanistan. Using national and sub-national data, we adapted a previously validated model that simulates the natural history of pregnancy and pregnancy-related complications. We incorporated data on antenatal care, family planning, skilled birth attendance and information about access to transport, referral facilities and quality of care. We evaluated single interventions (e.g. family planning) and strategies that combined several interventions packaged as integrated services (transport, intrapartum care). Outcomes included pregnancy-related complications, maternal deaths, maternal mortality ratios, costs and cost-effectiveness ratios. Model-projected reduction in maternal deaths between 1999-2002 and 2007-08 approximated 20%. Increasing family planning was the most effective individual intervention to further reduce maternal mortality; up to 1 in 3 pregnancy-related deaths could be prevented if contraception use approached 60%. Nevertheless, reductions in maternal mortality reached a threshold (∼30% to 40%) without strategies that assured women access to emergency obstetrical care. A stepwise approach that coupled improved family planning with incremental improvements in skilled attendance, transport, referral and appropriate intrapartum care and high-quality facilities prevented 3 of 4 maternal deaths. Such an approach would cost less than US$200 per year of life saved at the national level, well below Afghanistan's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Similar results were noted sub-nationally. Our findings reinforce the importance of early intensive efforts to increase family planning for spacing and limiting births and to provide control of fertility choices. While significant improvements in health delivery

Predicting Market Impact Costs Using Nonparametric Machine Learning Models.

Directory of Open Access Journals (Sweden)

Saerom Park

Full Text Available Market impact cost is the most significant portion of implicit transaction costs that can reduce the overall transaction cost, although it cannot be measured directly. In this paper, we employed the state-of-the-art nonparametric machine learning models: neural networks, Bayesian neural network, Gaussian process, and support vector regression, to predict market impact cost accurately and to provide the predictive model that is versatile in the number of variables. We collected a large amount of real single transaction data of US stock market from Bloomberg Terminal and generated three independent input variables. As a result, most nonparametric machine learning models outperformed a-state-of-the-art benchmark parametric model such as I-star model in four error measures. Although these models encounter certain difficulties in separating the permanent and temporary cost directly, nonparametric machine learning models can be good alternatives in reducing transaction costs by considerably improving in prediction performance.

Changes in Federal Water Project Repayment Policies Can Reduce Federal Costs.

Science.gov (United States)

1981-08-07

a reimburs - able purpose, the users should share in cost recovery. RECOMMENDATIONS To provide for equitable cost reimbursement on underutilized...Department of the Interior’s Bureau of Reclamation that do not ensure fair and timely recovery of water projects’ reimbursable costs. We made this...such costs for reimbursable project purposes and considering them in future water price determinations, agencies often reas- signed them to

Asynchronous hatching provides females with a means for increasing male care but incurs a cost by reducing offspring fitness.

Science.gov (United States)

Ford, L E; Smiseth, P T

2016-02-01

In species with biparental care, sexual conflict occurs because the benefit of care depends on the total amount of care provided by the two parents while the cost of care depends on each parent's own contribution. Asynchronous hatching may play a role in mediating the resolution of this conflict over parental care. The sexual conflict hypothesis for the evolution of asynchronous hatching suggests that females adjust hatching patterns in order to increase male parental effort relative to female effort. We tested this hypothesis in the burying beetle Nicrophorus vespilloides by setting up experimental broods with three different hatching patterns: synchronous, asynchronous and highly asynchronous broods. As predicted, we found that males provided care for longer in asynchronous broods whereas the opposite was true of females. However, we did not find any benefit to females of reducing their duration of care in terms of increased lifespan or reduced mass loss during breeding. We found substantial negative effects of hatching asynchrony on offspring fitness as larval mass was lower and fewer larvae survived to dispersal in highly asynchronous broods compared to synchronous or asynchronous broods. Our results suggest that, even though females can increase male parental effort by hatching their broods more asynchronously, females pay a substantial cost from doing so in terms of reducing offspring growth and survival. Thus, females should be under selection to produce a hatching pattern that provides the best possible trade-off between the benefits of increased male parental effort and the costs due to reduced offspring fitness. © 2015 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2015 European Society For Evolutionary Biology.

IMPROVING ENERGY EFFICIENCY AND REDUCING COSTS IN THE DRINKING WATER SUPPLY INDUSTRY: An ENERGY STAR Resource Guide for Energy and Plant Managers

Energy Technology Data Exchange (ETDEWEB)

Melody, Moya; Dunham Whitehead, Camilla; Brown, Richard

2010-09-30

As American drinking water agencies face higher production costs, demand, and energy prices, they seek opportunities to reduce costs without negatively affecting the quality of the water they deliver. This guide describes resources for cost-effectively improving the energy efficiency of U.S. public drinking water facilities. The guide (1) describes areas of opportunity for improving energy efficiency in drinking water facilities; (2) provides detailed descriptions of resources to consult for each area of opportunity; (3) offers supplementary suggestions and information for the area; and (4) presents illustrative case studies, including analysis of cost-effectiveness.

Mission possible: creating a technology infrastructure to help reduce administrative costs.

Science.gov (United States)

Alper, Michael

2003-01-01

Controlling administrative costs associated with managed care benefits has traditionally been considered a "mission impossible" in healthcare, with the unreasonably high cost of paperwork and administration pushing past the $420 billion mark. Why administrative costs remain a critical problem in healthcare while other industries have alleviated their administrative burdens must be carefully examined. This article looks at the key factors contributing to high administrative costs and how these costs can be controlled in the future with "mission possible" tools, including business process outsourcing, IT outsourcing, technology that helps to bring "consumerism" to managed care, and an IT infrastructure that improves quality and outcomes.

Cost and cost-effectiveness analysis of a community mobilisation intervention to reduce intimate partner violence in Kampala, Uganda.

Science.gov (United States)

Michaels-Igbokwe, Christine; Abramsky, Tanya; Devries, Karen; Michau, Lori; Musuya, Tina; Watts, Charlotte

2016-02-29

Intimate partner violence (IPV) poses a major public health concern. To date there are few rigorous economic evaluations of interventions aimed at preventing IPV in low-income settings. This study provides a cost and cost effectiveness analysis of SASA!, a community mobilisation intervention to change social norms and prevent IPV. An economic evaluation alongside a cluster randomised controlled trial. Both financial and economic costs were collected retrospectively from the provider's perspective to generate total and unit cost estimates over four years of intervention programming. Univariate sensitivity analysis is conducted to estimate the impact of uncertainty in cost and outcome measures on results. The total cost of developing the SASA! Activist Kit is estimated as US$138,598. Total intervention costs over four years are estimated as US$553,252. The annual cost of supporting 351 activists to conduct SASA! activities was approximately US$389 per activist and the average cost per person reached in intervention communities was US$21 over the full course of the intervention, or US$5 annually. The primary trial outcome was past year experience of physical IPV with an estimated 1201 cases averted (90% CI: 97-2307 cases averted). The estimated cost per case of past year IPV averted was US$460. This study provides the first economic evaluation of a community mobilisation intervention aimed at preventing IPV. SASA! unit costs compare favourably with gender transformative interventions and support services for survivors of IPV. ClinicalTrials.gov # NCT00790959.

The costs of turnover in nursing homes.

Science.gov (United States)

Mukamel, Dana B; Spector, William D; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

2009-10-01

Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The instrumental variable estimate of turnover costs was negative and significant (P = 0.039). The marginal cost savings associated with a 10% point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs.

Mitigation options for reducing nutrient emissions from agriculture : a study amongst European member states of Cost action 869

NARCIS (Netherlands)

Schoumans, O.F.; Chardon, W.J.; Bechmann, M.; Gascuel-Odoux, C.; Hofman, G.; Kronvang, B.; Litaor, I.; Porto, Lo A.; Newell, P.; Rubaek, G.H.

2011-01-01

The Water Framework Directive (WFD) requires improvement to the quality of surface water and groundwater. In the past many measures have been implemented to reduce the contribution of point sources, and as a result diffuse pollution from agricultural became more important. The main objective of COST

Successful pilot of thermosyphon process heater reduces GHG emissions and operating costs

International Nuclear Information System (INIS)

Arnold, W.A.; Neulander, J.I.

1999-01-01

A joint pilot study was conducted by Hudson Products Corporation and PanCanadian Petroleum Ltd. to test the feasibility of using a thermosyphon as a part of a thermal recovery process for cold heavy oil reservoir exploitation in the Western Canada Sedimentary Basin. A thermosyphon process heater can transfer heat from an external combustion chamber to a liquid inside a tank. This paper described the pilot project in which such a heater was successfully tested in a heavy oil field production tank. The field trial was conducted at the Marwayne Field in northeastern Alberta. The results of the pilot study demonstrated that the thermosyphon not only improved process efficiency, but also reduced greenhouse gas (GHG) emissions, lowered operating costs and improved safety. 5 refs., 3 tabs., 1 fig., 3 appendices

Reducing the Requirements and Cost of Astronomical Telescopes

Science.gov (United States)

Smith, W. Scott; Whitakter, Ann F. (Technical Monitor)

2002-01-01

Limits on astronomical telescope apertures are being rapidly approached. These limits result from logistics, increasing complexity, and finally budgetary constraints. In an historical perspective, great strides have been made in the area of aperture, adaptive optics, wavefront sensors, detectors, stellar interferometers and image reconstruction. What will be the next advances? Emerging data analysis techniques based on communication theory holds the promise of yielding more information from observational data based on significant computer post-processing. This paper explores some of the current telescope limitations and ponders the possibilities increasing the yield of scientific data based on the migration computer post-processing techniques to higher dimensions. Some of these processes hold the promise of reducing the requirements on the basic telescope hardware making the next generation of instruments more affordable.

Decommissioning Programme Management: reducing risk and cost while accelerating schedules through improved planning, Earned Value Management and safe work execution

International Nuclear Information System (INIS)

Hansen, S.E.

2008-01-01

CH2M HILL experience includes more than two decades of managing nuclear facilities and providing clean-up and operations support for commercial and government facilities worldwide. Our expertise ranges from decommissioning and defence sector businesses to nuclear technology development and innovation. Our approach places top priority on the safe execution of work while reducing both risk and cost. Our nuclear services include: programme management, nuclear safety analysis, radiological protection, radioactive waste management, nuclear remediation, nuclear materials and waste transportation management, nuclear safeguards and security services, and nuclear decontamination and decommissioning. This paper will discuss our approach which has resulted in a strong track record of accelerating schedules and reducing costs of major nuclear programmes, including Rocky Flats, Idaho, and our work at UKAEA sites. (author)

Deregulation and Nuclear Training: Cost Effective Alternatives

International Nuclear Information System (INIS)

Richard P. Coe; Patricia A. Lake

2000-01-01

Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies

The economic costs of alcohol consumption in Thailand, 2006.

Science.gov (United States)

Thavorncharoensap, Montarat; Teerawattananon, Yot; Yothasamut, Jomkwan; Lertpitakpong, Chanida; Thitiboonsuwan, Khannika; Neramitpitagkul, Prapag; Chaikledkaew, Usa

2010-06-09

There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006. This is a prevalence-based, cost-of-illness study. The estimated costs in this study included both direct and indirect costs. Direct costs included health care costs, costs of law enforcement, and costs of property damage due to road-traffic accidents. Indirect costs included costs of productivity loss due to premature mortality, and costs of reduced productivity due to absenteeism and presenteeism (reduced on-the-job productivity). The total economic cost of alcohol consumption in Thailand in 2006 was estimated at 156,105.4 million baht (9,627 million US$ PPP) or about 1.99% of the total Gross Domestic Product (GDP). Indirect costs outweigh direct costs, representing 96% of the total cost. The largest cost attributable to alcohol consumption is that of productivity loss due to premature mortality (104,128 million baht/6,422 million US$ PPP), followed by cost of productivity loss due to reduced productivity (45,464.6 million baht/2,804 million US$ PPP), health care cost (5,491.2 million baht/339 million US$ PPP), cost of property damage as a result of road traffic accidents (779.4 million baht/48 million US$ PPP), and cost of law enforcement (242.4 million baht/15 million US$ PPP), respectively. The results from the sensitivity analysis revealed that the cost ranges from 115,160.4 million baht to 214,053.0 million baht (7,102.1 - 13,201 million US$ PPP

Reduced computational cost in the calculation of worst case response time for real time systems

OpenAIRE

Urriza, José M.; Schorb, Lucas; Orozco, Javier D.; Cayssials, Ricardo

2009-01-01

Modern Real Time Operating Systems require reducing computational costs even though the microprocessors become more powerful each day. It is usual that Real Time Operating Systems for embedded systems have advance features to administrate the resources of the applications that they support. In order to guarantee either the schedulability of the system or the schedulability of a new task in a dynamic Real Time System, it is necessary to know the Worst Case Response Time of the Real Time tasks ...

Case drilling - an innovative approach to reducing drilling costs

Energy Technology Data Exchange (ETDEWEB)