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Sample records for united states costs

  1. Finding and development costs in the United States

    International Nuclear Information System (INIS)

    Espenshade, S.A.

    1996-01-01

    The finding and development costs, or reserve replacement costs have become important statistics for benchmarking independent oil and gas companies against one another. However, no standard definition for finding costs exists. Every company reports their costs differently because of different accounting practices. The time period a company uses to calculate its finding costs is also important. Since exploring for a field and developing new properties involves a long lead time, costs should be calculated on an annual basis. Reserve replacement costs should include: acquisition costs, developments costs, exploration costs, geological and geophysical costs, general and administrative costs, drilling costs and improved recovery costs. The importance of independent oil and gas companies was emphasized. They drill 85% of all the wells in the United States and produce 64% of the natural gas and 37% of the crude oil. In the lower 48 states alone, they produce 49% of the crude oil. Lightening of regulatory and legislative burdens, opening up access to more public lands, improving the tax situation, and to obtain royalty relief, were considered essential to providing for the energy needs of Americans in the years to come. 12 figs

  2. Nuclear power generation costs in the United States of America

    International Nuclear Information System (INIS)

    Willis, W.F.

    1983-01-01

    Increasing world energy prices and shortages of fuel resources make the utilization of nuclear power extremely important. The United States nuclear power industry represents the largest body of nuclear power experience in the world. Analysis of the recent United States experience of substantial increases in the cost of nuclear power generation provides good insight into the interdependence of technological, financial, and institutional influences and their combined impact on the economic viability of nuclear power generation. The various factors influencing ultimate generation costs, including construction cost, fuel cost, regulatory reviews, and siting considerations are discussed, and their relative impacts are explored, including discussion of design complexity and related regulatory response. A closer look into the recent relatively high escalation of nuclear plant construction costs shows how differing economic conditions can affect the relative cost effectiveness of various methods of power generation. The vulnerability of capital-intensive, long-lead-time projects to changes in economic conditions and uncertainty in future power demands is discussed. Likewise, the pitfalls of new designs and increased sophistication are contrasted to the advantages which result from proven designs, reliable engineering, and shorter lead times. The value of reliable architect-engineers experienced in the design and construction of the plant is discussed. A discussion is presented of additional regulatory requirements stemming from public safety aspects of nuclear power. These include recognition of requirements for the very large effort for quality assurance of materials and workmanship during plant construction and operation. Likewise, a discussion is included of the demanding nature of operations, maintenance, and modification of plants during the operational phase because of the need for highly qualified operations and maintenance personnel and strict quality assurance

  3. Cost analysis of LEED certified United States navy buildings

    OpenAIRE

    Kirar, Carl V.

    2011-01-01

    CIVINS (Civilian Institutions) Thesis document A study was completed at UW-Madison in 2010 that reviewed the energy consumption of US Navy buildings which earned Leadership in Energy and Environmental Design (LEED) certification by the United States Green Building Council (USGBC). The research compared LEED certified buildings to a commercial counterpart within the US Navy inventory against Executive Order (EO) 13423. The EO mandated that all federal agencies meet a 30 percent reduction of...

  4. Costs of occupational injuries in construction in the United States.

    Science.gov (United States)

    Waehrer, Geetha M; Dong, Xiuwen S; Miller, Ted; Haile, Elizabeth; Men, Yurong

    2007-11-01

    This paper presents costs of fatal and nonfatal injuries for the construction industry using 2002 national incidence data from the Bureau of Labor Statistics and a comprehensive cost model that includes direct medical costs, indirect losses in wage and household productivity, as well as an estimate of the quality of life costs due to injury. Costs are presented at the three-digit industry level, by worker characteristics, and by detailed source and event of injury. The total costs of fatal and nonfatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002. Five industries accounted for over half the industry's total fatal and nonfatal injury costs. They were miscellaneous special trade contractors (SIC 179), followed by plumbing, heating and air-conditioning (SIC 171), electrical work (SIC 173), heavy construction except highway (SIC 162), and residential building construction (SIC 152), each with over $1 billion in costs.

  5. Costs for Hospital Stays in the United States, 2011

    Science.gov (United States)

    ... Lauren M. Wier, M.P.H., and Claudia Steiner, M.D., M.P.H. Introduction Health care ... Truven Health Analytics), Wier, LM (Truven Health Analytics), Steiner, C (AHRQ). Costs for Hospital Stays in the ...

  6. Cost Analysis of Leed Certified United States Navy Buildings

    Science.gov (United States)

    2011-08-03

    be accumulated in order to offset initial investment costs - St = Savings in operational costs in year t associated with a given alternative - ∆I0...ior Non-Structural Elements er.o• 2 1 Construction Waste ManagenMnt Oivort 50% fro m Disposal Crocllt 22 Construction Waste Managemen t , Divert 75... Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302. Respondents should be aware that notwithstanding

  7. United States comparative costs and absenteeism of diabetic ophthalmic conditions.

    Science.gov (United States)

    Brook, Richard A; Kleinman, Nathan L; Patel, Sunil; Smeeding, Jim E; Beren, Ian A; Turpcu, Adam

    2015-06-01

    This retrospective cohort study examined the impact of diabetic macular edema (DME), diabetic retinopathy (DR), or diabetes on annual health benefit costs and absenteeism in US employees. Claims data from 2001 to 2012 was extracted from the Human Capital Management Services Group Research Reference Database on annual direct/indirect health benefit costs and absences for employees aged ≥ 18 years. Employees with DME, DR, or diabetes were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Employees were divided into two groups, drivers or nondrivers, and examined in separate analyses. For drivers and nondrivers, the DME, DR, and diabetes cohorts were compared with their respective control groups (without diabetes). Two-part regression models controlled for demographics and job-related characteristics. A total of 39,702 driver and 426,549 nondriver employees were identified as having ≥ 1 year's continuous health plan enrollment. Direct medical costs for drivers with DME, DR, or diabetes were $6470, $8021, and $5102, respectively (>2.8 times higher and statistically significant compared with driver controls). Nondrivers with DME and DR incurred significantly higher sick leave and short-term disability costs compared with the nondrivers with diabetes and nondriver controls. In drivers with DME, the majority of days of absence were for short- and long-term disability (12.41 and 11.43 days, respectively). In drivers with DR, the majority of days of absence were for short-term disability (10.70 days). In nondrivers with DME and nondrivers with DR, the majority of days of absence were for sick leave (5.74 and 4.93 days, respectively) and short-term disability (5.08 and 4.93 days, respectively). DME and DR are associated with substantial direct medical cost and absenteeism in this real-world sample of medically insured employees. This research highlights the negative impact of DME and DR on annual costs and absenteeism

  8. Renewable Energy Cost Modeling. A Toolkit for Establishing Cost-Based Incentives in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Gifford, Jason S. [Sustainable Energy Advantage, LLC, Framington, MA (United States); Grace, Robert C. [Sustainable Energy Advantage, LLC, Framington, MA (United States); Rickerson, Wilson H. [Meister Consultants Group, Inc., Boston, MA (United States)

    2011-05-01

    This report serves as a resource for policymakers who wish to learn more about levelized cost of energy (LCOE) calculations, including cost-based incentives. The report identifies key renewable energy cost modeling options, highlights the policy implications of choosing one approach over the other, and presents recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, FITs, or similar policies. These recommendations shaped the design of NREL's Cost of Renewable Energy Spreadsheet Tool (CREST), which is used by state policymakers, regulators, utilities, developers, and other stakeholders to assist with analyses of policy and renewable energy incentive payment structures. Authored by Jason S. Gifford and Robert C. Grace of Sustainable Energy Advantage LLC and Wilson H. Rickerson of Meister Consultants Group, Inc.

  9. Cryptococcal Meningitis Treatment Strategies Affected by the Explosive Cost of Flucytosine in the United States: A Cost-effectiveness Analysis.

    Science.gov (United States)

    Merry, Matthew; Boulware, David R

    2016-06-15

    In the United States, cryptococcal meningitis causes approximately 3400 hospitalizations and approximately 330 deaths annually. The US guidelines recommend treatment with amphotericin B plus flucytosine for at least 2 weeks, followed by fluconazole for a minimum of 8 weeks. Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22. Cost-effectiveness analysis was performed to determine the value of flucytosine relative to alternative regimens. We estimated the incremental cost-effectiveness ratio (ICER) of 3 cryptococcal induction regimens: (1) amphotericin B deoxycholate for 4 weeks; (2) amphotericin and flucytosine (100 mg/kg/day) for 2 weeks; and (3) amphotericin and fluconazole (800 mg/day) for 2 weeks. Costs of care were calculated using 2015 US prices and the medication costs. Survival estimates were derived from a randomized trial and scaled relative to published US survival data. Cost estimates were $83 227 for amphotericin monotherapy, $75 121 for amphotericin plus flucytosine, and $44 605 for amphotericin plus fluconazole. The ICER of amphotericin plus flucytosine was $23 842 per quality-adjusted life-year. Flucytosine is currently cost-effective in the United States despite a dramatic increase in price in recent years. Combination therapy with amphotericin and flucytosine is the most attractive treatment strategy for cryptococcal meningitis, though the rising price may be creating access issues that will exacerbate if the trend of profiteering continues. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  10. The Economic Cost of Methamphetamine Use in the United States, 2005

    Science.gov (United States)

    Nicosia, Nancy; Pacula, Rosalie Liccardo; Kilmer, Beau; Lundberg, Russell; Chiesa, James

    2009-01-01

    This first national estimate suggests that the economic cost of methamphetamine (meth) use in the United States reached $23.4 billion in 2005. Given the uncertainty in estimating the costs of meth use, this book provides a lower-bound estimate of $16.2 billion and an upper-bound estimate of $48.3 billion. The analysis considers a wide range of…

  11. The societal cost of heroin use disorder in the United States.

    Directory of Open Access Journals (Sweden)

    Ruixuan Jiang

    Full Text Available Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars.An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose.Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user. One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users.The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder.

  12. Health Utilization and Cost Impact of Childhood Constipation in the United States

    NARCIS (Netherlands)

    Liem, Olivia; Harman, Jeffrey; Benninga, Marc; Kelleher, Kelly; Mousa, Hayat; Di Lorenzo, Carlo

    2009-01-01

    Objective To estimate the total health care utilization and costs for children with constipation in the United States. Study design We analyzed data from 2 consecutive years (2003 and 2004) of the Medical Expenditure Panel Survey (MEPS), a nationally representative household survey. We identified

  13. State-level medical and absenteeism cost of asthma in the United States.

    Science.gov (United States)

    Nurmagambetov, Tursynbek; Khavjou, Olga; Murphy, Louise; Orenstein, Diane

    2017-05-01

    For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.

  14. Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

    Science.gov (United States)

    Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto

    2016-01-01

    Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

  15. Is scorpion antivenom cost-effective as marketed in the United States?

    Science.gov (United States)

    Armstrong, Edward P; Bakall, Maja; Skrepnek, Grant H; Boyer, Leslie V

    2013-12-15

    The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. The mean success rate was 99.87% (95% CI 99.64%-99.98%) with scorpion antivenom and 94.31% (95% CI 91.10%-96.61%) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95% CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95% CI $1627 - $5184). Since the 95% CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Short-term costs of preeclampsia to the United States health care system.

    Science.gov (United States)

    Stevens, Warren; Shih, Tiffany; Incerti, Devin; Ton, Thanh G N; Lee, Henry C; Peneva, Desi; Macones, George A; Sibai, Baha M; Jena, Anupam B

    2017-09-01

    Preeclampsia is a leading cause of maternal morbidity and mortality and adverse neonatal outcomes. Little is known about the extent of the health and cost burden of preeclampsia in the United States. This study sought to quantify the annual epidemiological and health care cost burden of preeclampsia to both mothers and infants in the United States in 2012. We used epidemiological and econometric methods to assess the annual cost of preeclampsia in the United States using a combination of population-based and administrative data sets: the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the US Health Care Cost and Utilization Project database, and a commercial claims data set. Preeclampsia increased the probability of an adverse event from 4.6% to 10.1% for mothers and from 7.8% to 15.4% for infants while lowering gestational age by 1.7 weeks (P preeclampsia during the first 12 months after birth was $1.03 billion for mothers and $1.15 billion for infants. The cost burden per infant is dependent on gestational age, ranging from $150,000 at 26 weeks gestational age to $1311 at 36 weeks gestational age. In 2012, the cost of preeclampsia within the first 12 months of delivery was $2.18 billion in the United States ($1.03 billion for mothers and $1.15 billion for infants), and was disproportionately borne by births of low gestational age. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Break-Even Cost for Residential Photovoltaics in the United States: Key Drivers and Sensitivities

    Energy Technology Data Exchange (ETDEWEB)

    Denholm, P.; Margolis, R. M.; Ong, S.; Roberts, B.

    2009-12-01

    Grid parity--or break-even cost--for photovoltaic (PV) technology is defined as the point where the cost of PV-generated electricity equals the cost of electricity purchased from the grid. Break-even cost is expressed in $/W of an installed system. Achieving break-even cost is a function of many variables. Consequently, break-even costs vary by location and time for a country, such as the United States, with a diverse set of resources, electricity prices, and other variables. In this report, we analyze PV break-even costs for U.S. residential customers. We evaluate some key drivers of grid parity both regionally and over time. We also examine the impact of moving from flat to time-of-use (TOU) rates, and we evaluate individual components of the break-even cost, including effect of rate structure and various incentives. Finally, we examine how PV markets might evolve on a regional basis considering the sensitivity of the break-even cost to four major drivers: technical performance, financing parameters, electricity prices and rates, and policies. We find that local incentives rather than ?technical? parameters are in general the key drivers of the break-even cost of PV. Additionally, this analysis provides insight about the potential viability of PV markets.

  18. Cost-effectiveness of human papillomavirus vaccination in the United States.

    Science.gov (United States)

    Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Markowitz, Lauri E

    2008-02-01

    We describe a simplified model, based on the current economic and health effects of human papillomavirus (HPV), to estimate the cost-effectiveness of HPV vaccination of 12-year-old girls in the United States. Under base-case parameter values, the estimated cost per quality-adjusted life year gained by vaccination in the context of current cervical cancer screening practices in the United States ranged from $3,906 to $14,723 (2005 US dollars), depending on factors such as whether herd immunity effects were assumed; the types of HPV targeted by the vaccine; and whether the benefits of preventing anal, vaginal, vulvar, and oropharyngeal cancers were included. The results of our simplified model were consistent with published studies based on more complex models when key assumptions were similar. This consistency is reassuring because models of varying complexity will be essential tools for policy makers in the development of optimal HPV vaccination strategies.

  19. Cost of wind energy: comparing distant wind resources to local resources in the midwestern United States.

    Science.gov (United States)

    Hoppock, David C; Patiño-Echeverri, Dalia

    2010-11-15

    The best wind sites in the United States are often located far from electricity demand centers and lack transmission access. Local sites that have lower quality wind resources but do not require as much power transmission capacity are an alternative to distant wind resources. In this paper, we explore the trade-offs between developing new wind generation at local sites and installing wind farms at remote sites. We first examine the general relationship between the high capital costs required for local wind development and the relatively lower capital costs required to install a wind farm capable of generating the same electrical output at a remote site,with the results representing the maximum amount an investor should be willing to pay for transmission access. We suggest that this analysis can be used as a first step in comparing potential wind resources to meet a state renewable portfolio standard (RPS). To illustrate, we compare the cost of local wind (∼50 km from the load) to the cost of distant wind requiring new transmission (∼550-750 km from the load) to meet the Illinois RPS. We find that local, lower capacity factor wind sites are the lowest cost option for meeting the Illinois RPS if new long distance transmission is required to access distant, higher capacity factor wind resources. If higher capacity wind sites can be connected to the existing grid at minimal cost, in many cases they will have lower costs.

  20. Energy Savings and Breakeven Costs for Residential Heat Pump Water Heaters in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Maguire, Jeff [National Renewable Energy Lab. (NREL), Golden, CO (United States); Burch, Jay [National Renewable Energy Lab. (NREL), Golden, CO (United States); Merrigan, Tim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ong, Sean [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-07-01

    Heat pump water heaters (HPWHs) have recently re-emerged in the U.S. residential water heating market and have the potential to provide homeowners with significant energy savings. However, there are questions as to the actual performance and energy savings potential of these units, in particular in regards to the heat pump's performance in unconditioned space and the impact of the heat pump on space heating and cooling loads when it is located in conditioned space. To help answer these questions, NREL performed simulations of a HPWH in both conditioned and unconditioned space at over 900 locations across the continental United States and Hawaii. Simulations included a Building America benchmark home so that any interaction between the HPWH and the home's HVAC equipment could be captured. Comparisons were performed to typical gas and electric water heaters to determine the energy savings potential and cost effectiveness of a HPWH relative to these technologies. HPWHs were found to have a significant source energy savings potential when replacing typical electric water heaters, but only saved source energy relative to gas water heater in the most favorable installation locations in the southern United States. When replacing an electric water heater, the HPWH is likely to break even in California, the southern United States, and parts of the northeast in most situations. However, the HPWH will only break even when replacing a gas water heater in a few southern states.

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

    Science.gov (United States)

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

    2014-11-13

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

  2. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

    Science.gov (United States)

    Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

    2018-05-01

    The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data. This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and

  3. Enhancing Groundwater Cost Estimation with the Interpolation of Water Tables across the United States

    Science.gov (United States)

    Rosli, A. U. M.; Lall, U.; Josset, L.; Rising, J. A.; Russo, T. A.; Eisenhart, T.

    2017-12-01

    Analyzing the trends in water use and supply across the United States is fundamental to efforts in ensuring water sustainability. As part of this, estimating the costs of producing or obtaining water (water extraction) and the correlation with water use is an important aspect in understanding the underlying trends. This study estimates groundwater costs by interpolating the depth to water level across the US in each county. We use Ordinary and Universal Kriging, accounting for the differences between aquifers. Kriging generates a best linear unbiased estimate at each location and has been widely used to map ground-water surfaces (Alley, 1993).The spatial covariates included in the universal Kriging were land-surface elevation as well as aquifer information. The average water table is computed for each county using block kriging to obtain a national map of groundwater cost, which we compare with survey estimates of depth to the water table performed by the USDA. Groundwater extraction costs were then assumed to be proportional to water table depth. Beyond estimating the water cost, the approach can provide an indication of groundwater-stress by exploring the historical evolution of depth to the water table using time series information between 1960 and 2015. Despite data limitations, we hope to enable a more compelling and meaningful national-level analysis through the quantification of cost and stress for more economically efficient water management.

  4. United States cost of military force projection in the Persian Gulf, 1976-2007

    Energy Technology Data Exchange (ETDEWEB)

    Stern, Roger J. [Oil, Energy and the Middle East Program, Department of Near Eastern Studies and Princeton Environmental Institute, Guyot Hall, Princeton University, Princeton, NJ 08544 (United States)

    2010-06-15

    This paper presents the first estimate of United States military cost for Persian Gulf force (C{sub PGfp}) derived entirely by a quantitative method. An activity-based cost (ABC) model uses geographic distribution of aircraft carriers as a proxy allocator of Department of Defense (DoD) baseline cost to regional operations. Allocation follows simply from DoD data that since 1990 no less than one aircraft carrier has been continuously on-station in the Persian Gulf; that eight are required to keep one on-station there; that the Navy has had eleven-fifteen carriers since 1990; and that Army and Air Force units are virtually never deployed to combat operations without Navy units. For 1976-2007 C{sub PGfp} is estimated to be $6.8 x 10{sup 12} and for 2007 $0.5 x 10{sup 12} (2008$). This substantial military investment is not a remedy for the market failure at the heart of regional security problem, which is oil market power. When C{sub PGfp} is added to economic losses attributed to market power in another recent study, the severity of this market failure becomes more apparent. (author)

  5. United States cost of military force projection in the Persian Gulf, 1976-2007

    International Nuclear Information System (INIS)

    Stern, Roger J.

    2010-01-01

    This paper presents the first estimate of United States military cost for Persian Gulf force (C PGfp ) derived entirely by a quantitative method. An activity-based cost (ABC) model uses geographic distribution of aircraft carriers as a proxy allocator of Department of Defense (DoD) baseline cost to regional operations. Allocation follows simply from DoD data that since 1990 no less than one aircraft carrier has been continuously on-station in the Persian Gulf; that eight are required to keep one on-station there; that the Navy has had eleven-fifteen carriers since 1990; and that Army and Air Force units are virtually never deployed to combat operations without Navy units. For 1976-2007 C PGfp is estimated to be $6.8 x 10 12 and for 2007 $0.5 x 10 12 (2008$). This substantial military investment is not a remedy for the market failure at the heart of regional security problem, which is oil market power. When C PGfp is added to economic losses attributed to market power in another recent study, the severity of this market failure becomes more apparent. (author)

  6. Health-resource use and costs associated with fibromyalgia in France, Germany, and the United States

    Directory of Open Access Journals (Sweden)

    Chandran A

    2013-04-01

    a significant proportion of total costs in all countries. Conclusion: The significant HRU and costs associated with FM in the US, France, and Germany documented in this study highlight the substantial global economic burden of FM. Indirect costs represented a significant proportion of the total costs, particularly in Europe. Comparisons between the three countries show differences in HRU, with significantly higher direct costs in the US compared with France and Germany. Keywords: fibromyalgia, cost, burden of illness, United States, France, Germany

  7. Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States.

    Science.gov (United States)

    Chen, Han-Yang; Chauhan, Suneet P; Blackwell, Sean C

    2018-05-03

     The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization.  We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs.  Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1-2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM.  The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. The cost-effectiveness of male HPV vaccination in the United States.

    Science.gov (United States)

    Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

    2011-10-26

    The objective of this study was to estimate the cost-effectiveness of adding human papillomavirus (HPV) vaccination of 12-year-old males to a female-only vaccination program for ages 12-26 years in the United States. We used a simplified model of HPV transmission to estimate the reduction in the health and economic burden of HPV-associated diseases in males and females as a result of HPV vaccination. Estimates of the incidence, cost-per-case, and quality-of-life impact of HPV-associated health outcomes were based on the literature. The HPV-associated outcomes included were: cervical intraepithelial neoplasia (CIN); genital warts; juvenile-onset recurrent respiratory papillomatosis (RRP); and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers. The cost-effectiveness of male vaccination depended on vaccine coverage of females. When including all HPV-associated outcomes in the analysis, the incremental cost per quality-adjusted life year (QALY) gained by adding male vaccination to a female-only vaccination program was $23,600 in the lower female coverage scenario (20% coverage at age 12 years) and $184,300 in the higher female coverage scenario (75% coverage at age 12 years). The cost-effectiveness of male vaccination appeared less favorable when compared to a strategy of increased female vaccination coverage. For example, we found that increasing coverage of 12-year-old girls would be more cost-effective than adding male vaccination even if the increased female vaccination strategy incurred program costs of $350 per additional girl vaccinated. HPV vaccination of 12-year-old males might potentially be cost-effective, particularly if female HPV vaccination coverage is low and if all potential health benefits of HPV vaccination are included in the analysis. However, increasing female coverage could be a more efficient strategy than male vaccination for reducing the overall health burden of HPV in the population. Published by Elsevier Ltd.

  9. Economic benefits, external costs and the regulation of unconventional gas in the United States

    International Nuclear Information System (INIS)

    Cronshaw, Ian; Grafton, R. Quentin

    2016-01-01

    We review the economic benefits and external costs of unconventional gas production (UCG) in the United States from a policy perspective. Based on an overview of state regulation in Pennsylvania, a state that has witnessed very rapid growth of gas production over the past 5 years, and global experiences we present 10 key principles that are proposed to reduce the risks and to increase the net rewards of UCG. Application of these principles has the potential to reduce the risks of UCG, especially at a local level, while maximizing the benefits of gas developments. - Highlights: • SWOT summary of unconventional gas developments. • Risks and returns of unconventional gas highlighted. • 10 principles given to reduce risks and increase rewards of gas extraction.

  10. Decommissioning cost recovery in the United States: lessons learned from Connecticut Yankee NPP

    International Nuclear Information System (INIS)

    Joosten, J.

    1999-01-01

    The international audience at ICONE-7 is already familiar with the roles of the owner and the NRC in ensuring the technical and safety performance goals of nuclear plant decommissioning. This paper addresses the role of the economic regulator since the pursuit of technical and safety goals must necessarily carry with them -a price tag- and owners must be concerned with the recovery of those costs. Answers to questions about how to pay and who should pay for decommissioning can very often influence nuclear power plant owner's decision-making. In the United States, most nuclear power plants are privately owned. Nevertheless, their owners are not totally free to determine the plant's economics or profitability. Instead, plant owners must sell their electricity to consumers in a regulated market wherein the price of electricity and terms of sale are controlled by the government. Under this regulatory regime, utilities are generally allowed to recover their investment costs -including decommissioning costs- provided that such costs are prudently, incurred. However, when an owner retires the plant prematurely, the prudence of his actions -up to and including the shutdown- are likely to be challenged. In 1997, for example, the owners of the Connecticut Yankee reactor faced a stiff challenge to the recovery of decommissioning costs when they shut down the plant ten years before license expiration. The Connecticut Yankee case thus provides valuable insights into the role of economic regulation on a nuclear plant's decommissioning strategy. (author)

  11. Unit Cost Compendium Calculations

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Unit Cost Compendium (UCC) Calculations raw data set was designed to provide for greater accuracy and consistency in the use of unit costs across the USEPA...

  12. Health and cost impact of air pollution from biomass burning over the United States

    Science.gov (United States)

    Eslami, E.; Sadeghi, B.; Choi, Y.

    2017-12-01

    Effective assessment of health and cost effects of air pollution associated with wildfire events is critical for supporting sustainable management and policy analysis to reduce environmental damages. Since biomass burning events result in higher ozone, PM2.5, and NOx concentration values in urban regions due to long-range transport, preliminary results indicated that wildfire events cause a considerable increase in incident estimates and costs. This study aims to evaluate the health and cost impact of biomass burning events over the continental United States using combined air quality and health impact modeling. To meet this goal, a comprehensive air quality modeling scenarios containing biomass burning emissions were conducted using the Community Multiscale Air Quality (CMAQ) modeling system from 2011 to 2014 with a spatial resolution of 12 km. The modeling period includes fire seasons between April and October over the course of four years. By using modeled pollutants concentrations, the USEPA's GIS-based computer program Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) provides an inclusive figure of health and cost impact caused by changing gaseous and particulate air pollution due to fire events. The basis of BenMAP-CE is the use of a damage-function approach to estimate the health impact of an applied change in air quality by comparing a biomass burning scenario (the one that includes wildfire events) with a baseline scenario (without biomass emissions). This approach considers several factors containing population, exposure to the pollutants, adverse health effects of a particular pollutant, and economic costs. Hence, this study made it capable of showing how biomass burning across U.S. influences people's health in different months, seasons, and regions. Besides, the cost impact of the wildfire events during study periods has also been estimated at both national and regional levels. The results of this study demonstrate the

  13. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis.

    Science.gov (United States)

    Bartick, Melissa; Reinhold, Arnold

    2010-05-01

    A 2001 study revealed that $3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives. It studied 3 diseases and totaled direct and indirect costs and cost of premature death. The 2001 study can be updated by using current breastfeeding rates and adding additional diseases analyzed in the 2007 breastfeeding report from the Agency for Healthcare Research and Quality. Using methods similar to those in the 2001 study, we computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars. If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.

  14. Cost of managing an episode of relapse in multiple sclerosis in the United States

    Directory of Open Access Journals (Sweden)

    Ward Alexandra J

    2003-09-01

    Full Text Available Abstract Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female. Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

  15. Benefit/cost analysis of plutonium recycle options in the United States of America

    International Nuclear Information System (INIS)

    Lowenberg, H.; Burnham, J.B.; Fisher, F.D.; Ray, W.H.

    1977-01-01

    Beginning in 1973, the USAEC started the analysis of the benefit/cost balance of Pu recycling in light-water reactors and the US Nuclear Regulatory Commission has continued this effort to the present time. A study of the United States nuclear industry from 1975 until 2000 was summarized in a final environmental statement called GESMO - Generic Environmental Statement on Mixed Oxide, NUREG-0002. Cumulative environmental and economic effects for several industry growth patterns were determined. Five alternatives were evaluated, covering the basic options of recycling uranium and plutonium; recycling uranium; and no recycling. The NRC findings, excluding consideration of proliferation and safeguards questions, are: the safety of reactors and fuel-cycle facilities are not significantly affected by recycle; excluding consideration of radiological effects, the environmental effects of recycle are slightly less than those from a non-recycle system; plutonium recycling extends uranium resources and reduces environmental impacts at the same time requiring reprocessing and Pu-handling facilities; despite uncertainties, recycling has probable economic advantages over other fuel concepts; differences in health effects attributable to recycling provide no basis for selecting a particular fuel-cycle option; no waste-management considerations appear that could be a basis for the selection of any particular option. The NRC studies on health, safety and environmental considerations of Pu recycling in the United States of America show that the differences in benefits/costs between the alternative fuel cycles are small and hence do not provide a clear basis for a decision on Pu recycle at this time. Safeguards and international proliferation implications appear to be the controlling factors in reaching a decision. President Carter's statement indefinitely deferring reprocessing and Pu recycle in the United States of America has resulted in a re-evaluation by NRC of its programme to

  16. Feasibility Study and Cost Benefit Analysis of Thin-Client Computer System Implementation Onboard United States Navy Ships

    National Research Council Canada - National Science Library

    Arbulu, Timothy D; Vosberg, Brian J

    2007-01-01

    The purpose of this MBA project was to conduct a feasibility study and a cost benefit analysis of using thin-client computer systems instead of traditional networks onboard United States Navy ships...

  17. Cost-effectiveness of programs to eliminate disparities in elderly vaccination rates in the United States.

    Science.gov (United States)

    Michaelidis, Constantinos I; Zimmerman, Richard K; Nowalk, Mary Patricia; Smith, Kenneth J

    2014-07-15

    There are disparities in influenza and pneumococcal vaccination rates among elderly minority groups and little guidance as to which intervention or combination of interventions to eliminate these disparities is likely to be most cost-effective. Here, we evaluate the cost-effectiveness of four hypothetical vaccination programs designed to eliminate disparities in elderly vaccination rates and differing in the number of interventions. We developed a Markov model in which we assumed a healthcare system perspective, 10-year vaccination program and lifetime time horizon. The cohort was the combined African-American and Hispanic 65 year-old birth cohort in the United States in 2009. We evaluated five different vaccination strategies: no vaccination program and four vaccination programs that varied from "low intensity" to "very high intensity" based on the number of interventions deployed in each program, their cumulative cost and their cumulative impact on elderly minority influenza and pneumococcal vaccination rates. The very high intensity vaccination program ($24,479/quality-adjusted life year; QALY) was preferred at willingness-to-pay-thresholds of $50,000 and $100,000/QALY and prevented 37,178 influenza cases, 342 influenza deaths, 1,158 invasive pneumococcal disease (IPD) cases and 174 IPD deaths over the birth cohort's lifetime. In one-way sensitivity analyses, the very high intensity program only became cost-prohibitive (>$100,000/QALY) at less likely values for the influenza vaccination rates achieved in year 10 of the high intensity (>73.5%) or very high intensity (eliminate disparities in elderly minority vaccination rates and including four interventions would be cost-effective.

  18. Hydropower Impacts on Electrical System Production Costs in the Southwest United States

    Directory of Open Access Journals (Sweden)

    Dominique M. Bain

    2018-02-01

    Full Text Available The Colorado River is an important natural resource for the Southwestern United States. Predicted climate change impacts include increased temperature, decreased rainfall and increased probability of drought in this region. Given the large amount of hydropower on the Colorado River and its importance to the bulk electricity system, this purpose of this study was to quantify the value hydropower in operating the electrical system, and examined changes in hydropower value and electricity costs under different possible future drought conditions and regional generation scenarios. The goal was to better understand how these scenarios affect operating costs of the bulk electrical system, as well as the value of the hydropower produced, and proposed a method for doing so. The calculated value of the hydroelectric power was nearly double the mean locational marginal price in the study area, about $73 to $75 for most scenarios, demonstrating a high value of the hydropower. In general, it was found that reduced water availability increased operating costs, and increased the value of the hydropower. A calculated value factor showed that when less hydroelectric power is available, the hydropower is more valuable. Furthermore, the value factor showed that the value of hydro increases with the addition of solar or the retirement of thermal generating resources.

  19. Energy Savings and Breakeven Cost for Residential Heat Pump Water Heaters in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Maguire, J.; Burch, J.; Merrigan, T.; Ong, S.

    2013-07-01

    Heat pump water heaters (HPWHs) have recently reemerged in the U.S. residential water heating market and have the potential to provide homeowners with significant energy savings. However, there are questions as to the actual performance and energy savings potential of these units, in particular in regards to the heat pump's performance in unconditioned space and the impact of the heat pump on space heating and cooling loads when it is located in conditioned space. To help answer these questions, simulations were performed of a HPWH in both conditioned and unconditioned space at over 900 locations across the continental United States and Hawaii. Simulations included a Building America benchmark home so that any interaction between the HPWH and the home's HVAC equipment could be captured. Comparisons were performed to typical gas and electric water heaters to determine the energy savings potential and cost effectiveness of a HPWH relative to these technologies. HPWHs were found to have a significant source energy savings potential when replacing typical electric water heaters, but only saved source energy relative to gas water heater in the most favorable installation locations in the southern US. When replacing an electric water heater, the HPWH is likely to break even in California, the southern US, and parts of the northeast in most situations. However, the HPWH will only break even when replacing a gas water heater in a few southern states.

  20. Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United States.

    Science.gov (United States)

    Korbel, Lindsey; Spencer, John David

    2015-03-01

    The objective of this study is to evaluate the number of diabetics that seek medical treatment in emergency departments or require hospitalization for infection management in the United States. This study also assesses the socioeconomic impact of inpatient infection management among diabetics. We accessed the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample database and the Nationwide Inpatient Sample database to perform a retrospective analysis on diabetics presenting to the emergency department or hospitalized for infection management from 2006 to 2011. Emergency Department: Since 2006, nearly 10 million diabetics were annually evaluated in the emergency department. Infection was the primary reason for presentation in 10% of these visits. Among those visits, urinary tract infection was the most common infection, accounting for over 30% of emergency department encounters for infections. Other common infections included sepsis, skin and soft tissue infections, and pneumonia. Diabetics were more than twice as likely to be hospitalized for infection management than patients without diabetes. Hospitalization: Since 2006, nearly 6 million diabetics were annually hospitalized. 8-12% of these patients were hospitalized for infection management. In 2011, the inpatient care provided to patients with DM, and infection was responsible for over $48 billion dollars in aggregate hospital charges. Diabetics commonly present to the emergency department and require hospitalization for infection management. The care provided to diabetics for infection management has a large economic impact on the United States healthcare system. More efforts are needed to develop cost-effective strategies for the prevention of infection in patients with diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Feasibility and Costs of Natural Gas as a Bridge to Deep Decarbonization in the United States

    Science.gov (United States)

    Jones, A. D.; McJeon, H. C.; Muratori, M.; Shi, W.

    2015-12-01

    Achieving emissions reductions consistent with a 2 degree Celsius global warming target requires nearly complete replacement of traditional fossil fuel combustion with near-zero carbon energy technologies in the United States by 2050. There are multiple technological change pathways consistent with this deep decarbonization, including strategies that rely on renewable energy, nuclear, and carbon capture and storage (CCS) technologies. The replacement of coal-fired power plants with natural gas-fired power plants has also been suggested as a bridge strategy to achieve near-term emissions reduction targets. These gas plants, however, would need to be replaced by near-zero energy technologies or retrofitted with CCS by 2050 in order to achieve longer-term targets. Here we examine the costs and feasibility of a natural gas bridge strategy. Using the Global Change Assessment (GCAM) model, we develop multiple scenarios that each meet the recent US Intended Nationally Determined Contribution (INDC) to reduce GHG emissions by 26%-28% below its 2005 levels in 2025, as well as a deep decarbonization target of 80% emissions reductions below 1990 levels by 2050. We find that the gas bridge strategy requires that gas plants be retired on average 20 years earlier than their designed lifetime of 45 years, a potentially challenging outcome to achieve from a policy perspective. Using a more idealized model, we examine the net energy system costs of this gas bridge strategy compared to one in which near-zero energy technologies are deployed in the near tem. We explore the sensitivity of these cost results to four factors: the discount rate applied to future costs, the length (or start year) of the gas bridge, the relative capital cost of natural gas vs. near-zero energy technology, and the fuel price of natural gas. The discount rate and cost factors are found to be more important than the length of the bridge. However, we find an important interaction as well. At low discount rates

  2. Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.

    Science.gov (United States)

    Hartwell, T D; Steele, P; French, M T; Potter, F J; Rodman, N F; Zarkin, G A

    1996-06-01

    Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.

  3. Comparative costs of coal and nuclear-generated electricity in the united states

    International Nuclear Information System (INIS)

    Brandfon, W.W.

    1987-01-01

    This paper compares the future first-year operating costs and lifetime levelized costs of producing baseload coal- and nuclear-generated electricity under schedules shorter than those recently experienced at U.S. plants. Nuclear appears to have a clear economic advantage. Coal is favorable only when it is assumed that the units will operate at very low capacity factors and/or when the capital cost differential between nuclear and coal is increased far above the recent historical level. Nuclear is therefore a cost-competitive electric energy option for utilities and should be considered as an alternative to coal when large baseload capacity is required. (author)

  4. Renewable Energy Cost Modeling: A Toolkit for Establishing Cost-Based Incentives in the United States; March 2010 -- March 2011

    Energy Technology Data Exchange (ETDEWEB)

    Gifford, J. S.; Grace, R. C.; Rickerson, W. H.

    2011-05-01

    This report is intended to serve as a resource for policymakers who wish to learn more about establishing cost-based incentives. The report will identify key renewable energy cost modeling options, highlight the policy implications of choosing one approach over the other, and present recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, feed-in tariffs (FITs), or similar policies. These recommendations will be utilized in designing the Cost of Renewable Energy Spreadsheet Tool (CREST). Three CREST models will be publicly available and capable of analyzing the cost of energy associated with solar, wind, and geothermal electricity generators. The CREST models will be developed for use by state policymakers, regulators, utilities, developers, and other stakeholders to assist them in current and future rate-setting processes for both FIT and other renewable energy incentive payment structures and policy analyses.

  5. Replacement energy costs for nuclear electricity-generating units in the United States: 1997--2001. Volume 4

    International Nuclear Information System (INIS)

    VanKuiken, J.C.; Guziel, K.A.; Tompkins, M.M.; Buehring, W.A.

    1997-09-01

    This report updates previous estimates of replacement energy costs for potential short-term shutdowns of 109 US nuclear electricity-generating units. This information was developed to assist the US Nuclear Regulatory Commission (NRC) in its regulatory impact analyses, specifically those that examine the impacts of proposed regulations requiring retrofitting of or safety modifications to nuclear reactors. Such actions might necessitate shutdowns of nuclear power plants while these changes are being implemented. The change in energy cost represents one factor that the NRC must consider when deciding to require a particular modification. Cost estimates were derived from probabilistic production cost simulations of pooled utility system operations. Factors affecting replacement energy costs, such as random unit failures, maintenance and refueling requirements, and load variations, are treated in the analysis. This report describes an abbreviated analytical approach as it was adopted to update the cost estimates published in NUREG/CR-4012, Vol. 3. The updates were made to extend the time frame of cost estimates and to account for recent changes in utility system conditions, such as change in fuel prices, construction and retirement schedules, and system demand projects

  6. The cost of karst subsidence and sinkhole collapse in the United States compared with other natural hazards

    Science.gov (United States)

    Weary, David J.

    2015-01-01

    Rocks with potential for karst formation are found in all 50 states. Damage due to karst subsidence and sinkhole collapse is a natural hazard of national scope. Repair of damage to buildings, highways, and other infrastructure represents a significant national cost. Sparse and incomplete data show that the average cost of karst-related damages in the United States over the last 15 years is estimated to be at least $300,000,000 per year and the actual total is probably much higher. This estimate is lower than the estimated annual costs for other natural hazards; flooding, hurricanes and cyclonic storms, tornadoes, landslides, earthquakes, or wildfires, all of which average over $1 billion per year. Very few state organizations track karst subsidence and sinkhole damage mitigation costs; none occurs at the Federal level. Many states discuss the karst hazard in their State hazard mitigation plans, but seldom include detailed reports of subsidence incidents or their mitigation costs. Most State highway departments do not differentiate karst subsidence or sinkhole collapse from other road repair costs. Amassing of these data would raise the estimated annual cost considerably. Information from insurance organizations about sinkhole damage claims and payouts is also not readily available. Currently there is no agency with a mandate for developing such data. If a more realistic estimate could be made, it would illuminate the national scope of this hazard and make comparison with costs of other natural hazards more realistic.

  7. Break-Even Cost for Residential Solar Water Heating in the United States: Key Drivers and Sensitivities

    Energy Technology Data Exchange (ETDEWEB)

    Cassard, H.; Denholm, P.; Ong, S.

    2011-02-01

    This paper examines the break-even cost for residential rooftop solar water heating (SWH) technology, defined as the point where the cost of the energy saved with a SWH system equals the cost of a conventional heating fuel purchased from the grid (either electricity or natural gas). We examine the break-even cost for the largest 1,000 electric and natural gas utilities serving residential customers in the United States as of 2008. Currently, the break-even cost of SWH in the United States varies by more than a factor of five for both electricity and natural gas, despite a much smaller variation in the amount of energy saved by the systems (a factor of approximately one and a half). The break-even price for natural gas is lower than that for electricity due to a lower fuel cost. We also consider the relationship between SWH price and solar fraction and examine the key drivers behind break-even costs. Overall, the key drivers of the break-even cost of SWH are a combination of fuel price, local incentives, and technical factors including the solar resource location, system size, and hot water draw.

  8. Benefit/cost analysis of plutonium recycle options in the United States

    International Nuclear Information System (INIS)

    Lowenberg, H.; Burnham, J.B.; Fisher, F.; Ray, W.H.

    1977-01-01

    Predictable effects of the recycle of plutonium and uranium recovered from spent LWR fuels were assessed in a final environmental statement (GESMO). Five alternative dispositions of LWR-produced plutonium ranging from prompt recycle of recovered plutonium and uranium to no recovery and no recycle are compared. The assessments consider cumulative effects for the period 1975 through 2000, and are centered on a conservative low growth rate resulting in about 500 LWR's in the U.S. in 2000. A more optimistic growth projection resulting in about 800 LWR's in 2000 is also analyzed in order to assess the effects of industry size upon the impacts. Demands for fuel cycle services were calculated with an ERDA program, NUFUEL, which was modified to include penalties for 236 U and 242 Pu. Unit cost data, including a simulation of market place reaction to supply-demand functions for uranium costs, were combined with the NUFUEL demand data in an economics code, NUCOST. Environmental impacts were also based upon NUFUEL demand data and were developed using a model plant industry concept. Using the most likely unit costs with a 10% discount rate, present worth incentives for prompt recycle over no recycle of $3.2 billion for the lower growth and about $6 billion for the higher growth were indicated. Present worth costs of delays in recycle of up to 5 years were less than $1 billion. Sensitivity of the economic assessments to unit cost variations and discount rates were also evaluated. Environmental impacts other than radiological were lowest for prompt Pu recycle and highest for no recycle. Radiological impacts for the total world wide total body exposure from U.S. industry for the 26 year period were estimated to be: - No recycle-8.2 million person-rem; U only recycle-9.5 million person-rem; Pu and U recycle-8.8 million person-rem. Comparison of the decreased radiological impact of the no recycle option with its increased costs relative to prompt plutonium recycle resulted in a

  9. Cost and Operational Effectiveness Analysis of Aiternative Force Structures for Fulfillment of the United States Marine Corps Operational Support Airlift and Search and Rescue Missions

    National Research Council Canada - National Science Library

    Chase, Eric

    2000-01-01

    This thesis provides a preliminary cost and operational effectiveness analysis of alternative force structures for the United States Marine Corps operational support airlift and search and rescue missions...

  10. Decommissioning Unit Cost Data

    International Nuclear Information System (INIS)

    Sanford, P. C.; Stevens, J. L.; Brandt, R.

    2002-01-01

    The Rocky Flats Closure Site (Site) is in the process of stabilizing residual nuclear materials, decommissioning nuclear facilities, and remediating environmental media. A number of contaminated facilities have been decommissioned, including one building, Building 779, that contained gloveboxes used for plutonium process development but did little actual plutonium processing. The actual costs incurred to decommission this facility formed much of the basis or standards used to estimate the decommissioning of the remaining plutonium-processing buildings. Recent decommissioning activities in the first actual production facility, Building 771, implemented a number of process and procedural improvements. These include methods for handling plutonium contaminated equipment, including size reduction, decontamination, and waste packaging, as well as management improvements to streamline planning and work control. These improvements resulted in a safer working environment and reduced project cost, as demonstrated in the overall project efficiency. The topic of this paper is the analysis of how this improved efficiency is reflected in recent unit costs for activities specific to the decommissioning of plutonium facilities. This analysis will allow the Site to quantify the impacts on future Rocky Flats decommissioning activities, and to develop data for planning and cost estimating the decommissioning of future facilities. The paper discusses the methods used to collect and arrange the project data from the individual work areas within Building 771. Regression and data correlation techniques were used to quantify values for different types of decommissioning activities. The discussion includes the approach to identify and allocate overall project support, waste management, and Site support costs based on the overall Site and project costs to provide a ''burdened'' unit cost. The paper ultimately provides a unit cost basis that can be used to support cost estimates for

  11. Tracking the Sun III; The Installed Cost of Photovoltaics in the United States from 1998-2009

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen; Darghouth, Naim; Wiser, Ryan

    2010-12-13

    Installations of solar photovoltaic (PV) systems have been growing at a rapid pace in recent years. In 2009, approximately 7,500 megawatts (MW) of PV were installed globally, up from approximately 6,000 MW in 2008, consisting primarily of grid-connected applications. With 335 MW of grid-connected PV capacity added in 2009, the United States was the world's fourth largest PV market in 2009, behind Germany, Italy, and Japan. The market for PV in the United States is driven by national, state, and local government incentives, including up-front cash rebates, production-based incentives, requirements that electricity suppliers purchase a certain amount of solar energy, and federal and state tax benefits. These programs are, in part, motivated by the popular appeal of solar energy, and by the positive attributes of PV - modest environmental impacts, avoidance of fuel price risks, coincidence with peak electrical demand, and the possible deployment of PV at the point of use. Given the relatively high cost of PV, however, a key goal of these policies is to encourage cost reductions over time. Therefore, as policy incentives have become more significant and as PV deployment has accelerated, so too has the desire to track the installed cost of PV systems over time, by system characteristics, by system location, and by component. Despite the significant year-on-year growth, however, the share of global and U.S. electricity supply met with PV remains small, and annual PV additions are currently modest in the context of the overall electric system. To address this need, Lawrence Berkeley National Laboratory initiated a report series focused on describing trends in the installed cost of grid-connected PV systems in the United States. The present report, the third in the series, describes installed cost trends from 1998 through 2009, and provides preliminary cost data for systems installed in 2010. The analysis is based on project-level cost data from approximately 78

  12. Smoking in the United States Air Force: Trends, Most Prevalent Diseases and their Association with Cost

    Science.gov (United States)

    2011-09-01

    alcohol use (University of Minnesota, 2010). Tobacco use is one of the most significant health issues that the U.S. military faces today . In 2002, it...rates among the active duty members of the Air Force of the United States. Smoking is a severe phenomenon for the Air Force today because it is...allurement. In addition, they launch special tobacco products for women, the so called “ feminized cigarettes”, trying to create more female smokers

  13. A Cost-Benefit Analysis of Low-Dose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States.

    Science.gov (United States)

    Werner, Erika F; Hauspurg, Alisse K; Rouse, Dwight J

    2015-12-01

    To develop a decision model to evaluate the risks, benefits, and costs of different approaches to aspirin prophylaxis for the approximately 4 million pregnant women in the United States annually. We created a decision model to evaluate four approaches to aspirin prophylaxis in the United States: no prophylaxis, prophylaxis per American College of Obstetricians and Gynecologists (the College) recommendations, prophylaxis per U.S. Preventive Services Task Force recommendations, and universal prophylaxis. We included the costs associated with aspirin, preeclampsia, preterm birth, and potential aspirin-associated adverse effects. TreeAge Pro 2011 was used to perform the analysis. The estimated rate of preeclampsia would be 4.18% without prophylaxis compared with 4.17% with the College approach in which 0.35% (n=14,000) of women receive aspirin, 3.83% with the U.S. Preventive Services Task Force approach in which 23.5% (n=940,800) receive aspirin, and 3.81% with universal prophylaxis. Compared with no prophylaxis, the U.S. Preventive Services Task Force approach would save $377.4 million in direct medical care costs annually, and universal prophylaxis would save $365 million assuming 4 million births each year. The U.S. Preventive Services Task Force approach is the most cost-beneficial in 79% of probabilistic simulations. Assuming a willingness to pay of $100,000 per neonatal quality-adjusted life-year gained, the universal approach is the most cost-effective in more than 99% of simulations. Both the U.S. Preventive Services Task Force approach and universal prophylaxis would reduce morbidity, save lives, and lower health care costs in the United States to a much greater degree than the approach currently recommended by the College.

  14. Internalizing social costs in power plant siting: some examples for coal and nuclear plants in the United States

    International Nuclear Information System (INIS)

    Peelle, E.

    1976-01-01

    Selected aspects of the United States experience in one particular type of energy development project, the siting of nuclear and fossil fueled power generating facilities, are examined in terms of how well community-level impacts are internalized. New institutional arrangements being devised and new requirements being made at local, state, regional, and federal levels in response to these dissociations of cost and benefits from large energy development projects are discussed. Selected examples of these new institutional responses are analyzed for adequacy and significance

  15. Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States.

    Science.gov (United States)

    Chhatwal, Jagpreet; Kanwal, Fasiha; Roberts, Mark S; Dunn, Michael A

    2015-03-17

    Sofosbuvir and ledipasvir, which have recently been approved for treatment of chronic hepatitis C virus (HCV) infection, are more efficacious and safer than the old standard of care (oSOC) but are substantially more expensive. Whether and in which patients their improved efficacy justifies their increased cost is unclear. To evaluate the cost-effectiveness and budget impact of sofosbuvir and ledipasvir. Microsimulation model of the natural history of HCV infection. Published literature. Treatment-naive and treatment-experienced HCV population defined on the basis of HCV genotype, age, and fibrosis distribution in the United States. Lifetime. Third-party payer. Simulation of sofosbuvir-ledipasvir compared with the oSOC (interferon-based therapies). Quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and 5-year spending on antiviral drugs. Sofosbuvir-based therapies added 0.56 QALY relative to the oSOC at an ICER of $55 400 per additional QALY. The ICERs ranged from $9700 to $284 300 per QALY depending on the patient's status with respect to treatment history, HCV genotype, and presence of cirrhosis. At a willingness-to-pay threshold of $100 000 per QALY, sofosbuvir-based therapies were cost-effective in 83% of treatment-naive and 81% of treatment-experienced patients. Compared with the oSOC, treating eligible HCV-infected persons in the United States with the new drugs would cost an additional $65 billion in the next 5 years, whereas the resulting cost offsets would be $16 billion. Results were sensitive to drug price, drug efficacy, and quality of life after successful treatment. Data on real-world effectiveness of new antivirals are lacking. Treatment of HCV is cost-effective in most patients, but additional resources and value-based patient prioritization are needed to manage patients with HCV. National Institutes of Health.

  16. Mapping water availability, projected use and cost in the western United States

    Science.gov (United States)

    Tidwell, Vincent C.; Moreland, Barbara D.; Zemlick, Katie M.; Roberts, Barry L.; Passell, Howard D.; Jensen, Daniel; Forsgren, Christopher; Sehlke, Gerald; Cook, Margaret A.; King, Carey W.; Larsen, Sara

    2014-05-01

    New demands for water can be satisfied through a variety of source options. In some basins surface and/or groundwater may be available through permitting with the state water management agency (termed unappropriated water), alternatively water might be purchased and transferred out of its current use to another (termed appropriated water), or non-traditional water sources can be captured and treated (e.g., wastewater). The relative availability and cost of each source are key factors in the development decision. Unfortunately, these measures are location dependent with no consistent or comparable set of data available for evaluating competing water sources. With the help of western water managers, water availability was mapped for over 1200 watersheds throughout the western US. Five water sources were individually examined, including unappropriated surface water, unappropriated groundwater, appropriated water, municipal wastewater and brackish groundwater. Also mapped was projected change in consumptive water use from 2010 to 2030. Associated costs to acquire, convey and treat the water, as necessary, for each of the five sources were estimated. These metrics were developed to support regional water planning and policy analysis with initial application to electric transmission planning in the western US.

  17. Statin cost effectiveness in primary prevention: A systematic review of the recent cost-effectiveness literature in the United States

    Directory of Open Access Journals (Sweden)

    Mitchell Aaron P

    2012-07-01

    Full Text Available Abstract Background The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins. Findings We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive. Conclusions Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

  18. The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

    Science.gov (United States)

    Mason, Rodney J; Moroney, Jolene R; Berne, Thomas V

    2013-10-01

    To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.

  19. Cost consideration in the clinical guidance documents of physician specialty societies in the United States.

    Science.gov (United States)

    Schwartz, Jennifer A T; Pearson, Steven D

    2013-06-24

    Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Qualitative document review. Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

  20. Utility-Scale Solar 2014. An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-09-01

    Other than the nine Solar Energy Generation Systems (“SEGS”) parabolic trough projects built in the 1980s, virtually no large-scale or “utility-scale” solar projects – defined here to include any groundmounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar thermal power (“CSP”) project larger than 5 MWAC – existed in the United States prior to 2007. By 2012 – just five years later – utility-scale had become the largest sector of the overall PV market in the United States, a distinction that was repeated in both 2013 and 2014 and that is expected to continue for at least the next few years. Over this same short period, CSP also experienced a bit of a renaissance in the United States, with a number of large new parabolic trough and power tower systems – some including thermal storage – achieving commercial operation. With this critical mass of new utility-scale projects now online and in some cases having operated for a number of years (generating not only electricity, but also empirical data that can be mined), the rapidly growing utility-scale sector is ripe for analysis. This report, the third edition in an ongoing annual series, meets this need through in-depth, annually updated, data-driven analysis of not just installed project costs or prices – i.e., the traditional realm of solar economics analyses – but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects in the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are presented where appropriate.

  1. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States.

    Science.gov (United States)

    Stranges, Paul M; Hutton, David W; Collins, Curtis D

    2013-01-01

    Fidaxomicin is a novel treatment for Clostridium difficile infections (CDIs). This new treatment, however, is associated with a higher acquisition cost compared with alternatives. The objective of this study was to evaluate the cost-effectiveness of fidaxomicin or oral vancomycin for the treatment of CDIs. We performed a cost-utility analysis comparing fidaxomicin with oral vancomycin for the treatment of CDIs in the United States by creating a decision analytic model from the third-party payer perspective. The incremental cost-effectiveness ratio with fidaxomicin compared with oral vancomycin was $67,576/quality-adjusted life-year. A probabilistic Monte Carlo sensitivity analysis showed that fidaxomicin had an 80.2% chance of being cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Fidaxomicin remained cost-effective under all fluctuations of both fidaxomicin and oral vancomycin costs. The decision analytic model was sensitive to variations in clinical cure and recurrence rates. Secondary analyses revealed that fidaxomicin was cost-effective in patients receiving concominant antimicrobials, in patients with mild to moderate CDIs, and when compared with oral metronidazole in patients with mild to moderate disease. Fidaxomicin was dominated by oral vancomycin if CDI was caused by the NAP1/Bl/027 Clostridium difficile strain and was dominant in institutions that did not compound oral vancomycin. Results of our model showed that fidaxomicin may be a more cost-effective option for the treatment of CDIs when compared with oral vancomycin under most scenarios tested. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. Economic burden of mucormycosis in the United States: can a vaccine be cost-effective?

    Science.gov (United States)

    Ibrahim, Ashraf S; Edwards, John E; Bryant, Richard; Spellberg, Brad

    2009-01-01

    Mucormycosis is a life-threatening infection which causes unacceptably high morbidity and mortality despite treatment. Therefore, a vaccine to prevent mucormycosis is desirable. A major barrier to developing an anti-mucormycosis vaccine is the perception that such a vaccine would not be cost-effective to deploy because the disease is rare. We used data from a recent retrospective study to calculate the annual cost to the US healthcare system caused by mucormycosis infections. We created a model to estimate the cost-efficacy of a niche, anti-mucormycosis vaccine deployed in a targeted manner to high-risk patients. We found that each case of mucormycosis results in an average direct cost to the US healthcare system of $97,743, for an overall cost of mucormycosis of $50 million per year. In the base case scenario, targeted deployment of an anti-mucormycosis vaccine would result in a net cost per quality adjusted life year saved (QUALY) of $17,249. Variations in the price of the vaccine, its market penetration, or the cost of infection could dramatically decrease the net cost, and could even result in net savings per QUALY. In conclusion, mucormycosis causes considerable cost to the US health care system. Targeted deployment of a niche vaccine could decrease infection rates and mortality from mucormycosis in a cost-effective manner.

  3. Direct medical cost of overweight and obesity in the United States: a quantitative systematic review

    Science.gov (United States)

    Tsai, Adam Gilden; Williamson, David F.; Glick, Henry A.

    2010-01-01

    Objectives To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. Methods PubMed (1968–2009), EconLit (1969–2009), and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. Results A total of 33 U.S. studies met review criteria. Among the 4 highest quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimate included: use of national samples versus more selected populations; age groups examined; inclusion of all medical costs versus obesity-related costs only; and BMI cutoffs for defining overweight and obesity. Conclusions Depending on the source of total national health care expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of U.S. health care spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs, and use standard BMI cutoffs. PMID:20059703

  4. Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States.

    Science.gov (United States)

    Peterson, Cora; Grosse, Scott D; Li, Rui; Sharma, Andrea J; Razzaghi, Hilda; Herman, William H; Gilboa, Suzanne M

    2015-01-01

    Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC)-preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States. Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs. We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost. Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care. Published by Elsevier Inc.

  5. Health-resource use and costs associated with fibromyalgia in France, Germany, and the United States

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Chandran, Arthi; Zlateva, Gergana; Winkelmann, Andreas; Perrot, Serge

    2013-01-01

    Background Fibromyalgia (FM) is a chronic disorder characterized by widespread, persistent pain. Prospective and retrospective studies have demonstrated substantial health-care costs associated with FM in a number of countries. This study evaluated and compared health-resource use (HRU) and associated costs related to FM in routine clinical practice across the US, France, and Germany. Methods Two separate, cross-sectional, observational studies of subjects with FM were conducted: one in the US and one in France and Germany. HRU related to prescription medication, physician office visits, diagnostic tests, and hospitalizations was abstracted from chart review; patient out-of-pocket costs and lost productivity were collected via subject self-report. Costs were assigned to HRU based on standard algorithms. Direct and indirect costs were evaluated and compared by simple linear regression. Results A total of 442 subjects (203 US, 70 France, 169 Germany) with FM were analyzed. The mean (standard deviation) age in the US, France, and Germany was 47.9 (10.9), 51.2 (9.5), and 49.2 (9.8), respectively (P = 0.085). Most subjects were female (95% US, 83% France, 80% Germany) (P < 0.001). Adjusted annual direct costs per subject for FM were significantly higher in the US ($7087) than in France ($481, P < 0.001) or Germany ($2417, P < 0.001). Adjusted mean annual indirect costs per subject for FM were lower in the US ($6431) than in France ($8718) or Germany ($10,001), but represented a significant proportion of total costs in all countries. Conclusion The significant HRU and costs associated with FM in the US, France, and Germany documented in this study highlight the substantial global economic burden of FM. Indirect costs represented a significant proportion of the total costs, particularly in Europe. Comparisons between the three countries show differences in HRU, with significantly higher direct costs in the US compared with France and Germany. PMID:23637545

  6. The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

    Science.gov (United States)

    Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

    2014-09-01

    Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

  7. Cost of reactive nitrogen release from human activities to the environment in the United States

    Science.gov (United States)

    The leakage of reactive nitrogen (N) from human activities to the environment can cause human health and ecological problems. Often these harmful effects are not reflected in the costs of food, fuel, and fiber that derive from N use. Spatial analyses of economic costs and benef...

  8. Incidence and Cost of Ankle Sprains in United States Emergency Departments

    Science.gov (United States)

    Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

    2016-01-01

    Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

  9. Return to 1990: The cost of mitigating United States carbon emissions in the post-2000 period

    Energy Technology Data Exchange (ETDEWEB)

    Edmonds, J.A.; Kim, S.H.; MacCracken, C.N.; Sands, R.D.; Wise, M.A.

    1997-10-01

    The Second Generation Model (SGM) is employed to examine four hypothetical agreements to reduce emissions in Annex 1 nations (OECD nations plus most of the nations of Eastern Europe and the former Soviet Union) to levels in the neighborhood of those which existed in 1990, with obligations taking effect in the year 2010. The authors estimate the cost to the US of complying with such agreements under three distinct conditions: no trading of emissions rights, trading of emissions rights only among Annex 1 nations, and a fully global trading regime. The authors find that the marginal cost of returning to 1990 emissions levels in the US in the absence of trading opportunities is approximately $108 per metric ton carbon in 2010. The total cost in that year is approximately 0.2% of GDP. International trade in emissions permits lowers the cost of achieving any mitigation objective by equalizing the marginal cost of carbon mitigation among countries. For the four mitigation scenarios in this study, economic costs to the US remain below 1% of GDP through at least the year 2020.

  10. Impact of selection of cord blood units from the United States and swiss registries on the cost of banking operations.

    Science.gov (United States)

    Bart, Thomas; Boo, Michael; Balabanova, Snejana; Fischer, Yvonne; Nicoloso, Grazia; Foeken, Lydia; Oudshoorn, Machteld; Passweg, Jakob; Tichelli, Andre; Kindler, Vincent; Kurtzberg, Joanne; Price, Thomas; Regan, Donna; Shpall, Elizabeth J; Schwabe, Rudolf

    2013-02-01

    Over the last 2 decades, cord blood (CB) has become an important source of blood stem cells. Clinical experience has shown that CB is a viable source for blood stem cells in the field of unrelated hematopoietic blood stem cell transplantation. Studies of CB units (CBUs) stored and ordered from the US (National Marrow Donor Program (NMDP) and Swiss (Swiss Blood Stem Cells (SBSQ)) CB registries were conducted to assess whether these CBUs met the needs of transplantation patients, as evidenced by units being selected for transplantation. These data were compared to international banking and selection data (Bone Marrow Donors Worldwide (BMDW), World Marrow Donor Association (WMDA)). Further analysis was conducted on whether current CB banking practices were economically viable given the units being selected from the registries for transplant. It should be mentioned that our analysis focused on usage, deliberately omitting any information about clinical outcomes of CB transplantation. A disproportionate number of units with high total nucleated cell (TNC) counts are selected, compared to the distribution of units by TNC available. Therefore, the decision to use a low threshold for banking purposes cannot be supported by economic analysis and may limit the economic viability of future public CB banking. We suggest significantly raising the TNC level used to determine a bankable unit. A level of 125 × 10(7) TNCs, maybe even 150 × 10(7) TNCs, might be a viable banking threshold. This would improve the return on inventory investments while meeting transplantation needs based on current selection criteria.

  11. Costs and Risk Factors for Hospital Readmission After Periprosthetic Knee Fractures in the United States.

    Science.gov (United States)

    Reeves, Russell A; Schairer, William W; Jevsevar, David S

    2018-02-01

    Periprosthetic fractures (PPFX) around total knee arthroplasty (TKA) are devastating complications with significant morbidity. With growing healthcare costs, hospital readmissions have become a marker for quality healthcare delivery. However, little is known about the risk factors or costs associated with readmission after treatment of PPFX. We sought to identify the patient demographics, prevalence of treatment types (open reduction internal fixation [ORIF] vs revision TKA), 30 and 90-day readmission rates, costs of initial treatment and readmission, and risk factors for readmission. We used the 2013 Nationwide Readmissions Database to select patients who underwent TKA, revision TKA, and treatment of PPFX with either ORIF or revision TKA. The 90-day readmission rate was determined through a survival analysis, and risk factors were identified using a cox proportional hazards model that adjusted for patient and hospital characteristics. We identified 1526 patients with PPFX treated with ORIF and 1458 treated with revision TKA. Ninety-day readmissions were 20.5% and 21.8%, respectively. Patients with ORIF were more often female and had multiple medical comorbidities. Patient factors associated with readmission included advanced age, male gender, comorbidities, discharge to a skilled nursing facility or home with health aide, and Medicare or Medicaid insurance. Treatment at a teaching hospital was the only hospital-associated risk factor identified. ORIF cost USD 25,539 and revision THA cost USD 37,680, with associated readmissions costing 15,269 and 16,806, respectively. PPFX results in greater costs compared to primary and revision TKA. This study highlights risk factors for readmission after PPFX treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-12-01

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

  13. The benefits and costs of new fuels and engines for light-duty vehicles in the United States.

    Science.gov (United States)

    Keefe, Ryan; Griffin, James P; Graham, John D

    2008-10-01

    Rising oil prices and concerns about energy security and climate change are spurring reconsideration of both automobile propulsion systems and the fuels that supply energy to them. In addition to the gasoline internal combustion engine, recent years have seen alternatives develop in the automotive marketplace. Currently, hybrid-electric vehicles, advanced diesels, and flex-fuel vehicles running on a high percentage mixture of ethanol and gasoline (E85) are appearing at auto shows and in driveways. We conduct a rigorous benefit-cost analysis from both the private and societal perspective of the marginal benefits and costs of each technology--using the conventional gasoline engine as a baseline. The private perspective considers only those factors that influence the decisions of individual consumers, while the societal perspective accounts for environmental, energy, and congestion externalities as well. Our analysis illustrates that both hybrids and diesels show promise for particular light-duty applications (sport utility vehicles and pickup trucks), but that vehicles running continuously on E85 consistently have greater costs than benefits. The results for diesels were particularly robust over a wide range of sensitivity analyses. The results from the societal analysis are qualitatively similar to the private analysis, demonstrating that the most relevant factors to the benefit-cost calculations are the factors that drive the individual consumer's decision. We conclude with a brief discussion of marketplace and public policy trends that will both illustrate and influence the relative adoption of these alternative technologies in the United States in the coming decade.

  14. Social cost of CO2 abatement from energy efficiency and solar power in the United States

    International Nuclear Information System (INIS)

    Hall, D.C.

    1992-01-01

    Frequently cited empirical analysis ask whether we should make the transition from reliance on fossil fuels to reduce greenhouse gas emissions, and conclude that the transition is too costly so we should, instead, focus policy on how to adapt to global warming. This paper makes two improvements in the analysis. First, this empirical analysis accounts for existing low-cost alternatives that are substitutes for fossil fuels. Second, this empirical analysis incorporates existing estimates of externalities from fossil fuels. These two basic improvements in the analysis alter the conclusion; policy should focus on how rapidly and extensively to make the transition from reliance on fossil fuels to the alternatives. The corollary is that we should focus on the efficacy and cost of policy options that are designed to accomplish the transition. 4 tabs., 1 app., 45 refs

  15. Prevalence and cost of hospital medical errors in the general and elderly United States populations.

    Science.gov (United States)

    Mallow, Peter J; Pandya, Bhavik; Horblyuk, Ruslan; Kaplan, Harold S

    2013-12-01

    The primary objective of this study was to quantify the differences in the prevalence rate and costs of hospital medical errors between the general population and an elderly population aged ≥65 years. Methods from an actuarial study of medical errors were modified to identify medical errors in the Premier Hospital Database using data from 2009. Visits with more than four medical errors were removed from the population to avoid over-estimation of cost. Prevalence rates were calculated based on the total number of inpatient visits. There were 3,466,596 total inpatient visits in 2009. Of these, 1,230,836 (36%) occurred in people aged ≥ 65. The prevalence rate was 49 medical errors per 1000 inpatient visits in the general cohort and 79 medical errors per 1000 inpatient visits for the elderly cohort. The top 10 medical errors accounted for more than 80% of the total in the general cohort and the 65+ cohort. The most costly medical error for the general population was postoperative infection ($569,287,000). Pressure ulcers were most costly ($347,166,257) in the elderly population. This study was conducted with a hospital administrative database, and assumptions were necessary to identify medical errors in the database. Further, there was no method to identify errors of omission or misdiagnoses within the database. This study indicates that prevalence of hospital medical errors for the elderly is greater than the general population and the associated cost of medical errors in the elderly population is quite substantial. Hospitals which further focus their attention on medical errors in the elderly population may see a significant reduction in costs due to medical errors as a disproportionate percentage of medical errors occur in this age group.

  16. International trade and air pollution: estimating the economic costs of air emissions from waterborne commerce vessels in the United States.

    Science.gov (United States)

    Gallagher, Kevin P

    2005-10-01

    Although there is a burgeoning literature on the effects of international trade on the environment, relatively little work has been done on where trade most directly effects the environment: the transportation sector. This article shows how international trade is affecting air pollution emissions in the United States' shipping sector. Recent work has shown that cargo ships have been long overlooked regarding their contribution to air pollution. Indeed, ship emissions have recently been deemed "the last unregulated source of traditional air pollutants". Air pollution from ships has a number of significant local, national, and global environmental effects. Building on past studies, we examine the economic costs of this increasing and unregulated form of environmental damage. We find that total emissions from ships are largely increasing due to the increase in foreign commerce (or international trade). The economic costs of SO2 pollution range from dollars 697 million to dollars 3.9 billion during the period examined, or dollars 77 to dollars 435 million on an annual basis. The bulk of the cost is from foreign commerce, where the annual costs average to dollars 42 to dollars 241 million. For NOx emissions the costs are dollars 3.7 billion over the entire period or dollars 412 million per year. Because foreign trade is driving the growth in US shipping, we also estimate the effect of the Uruguay Round on emissions. Separating out the effects of global trade agreements reveals that the trade agreement-led emissions amounted to dollars 96 to dollars 542 million for SO2 between 1993 and 2001, or dollars 10 to dollars 60 million per year. For NOx they were dollars 745 million for the whole period or dollars 82 million per year. Without adequate policy responses, we predict that these trends and costs will continue into the future.

  17. A travel cost analysis of nonconsumptive wildlife-associated recreation in the United States

    Science.gov (United States)

    William T. Zawacki; Allan Marsinko; J. Michael Bowker

    2000-01-01

    Increased emphasis on sustainable resource management in forestry has effectuated a demand for various nontimber values. Nonconsumptive wildlife recreation is an important nontimber service produced on forest and rangeland. Travel cost models and data from the 1991 National Survey of Fishing, Hunting and Wildlife-Associated Recreation are used to estimate the demand...

  18. Medical cost of type 2 diabetes attributable to physical inactivity in the United States in 2012.

    Science.gov (United States)

    Shah, Priyank; Shamoon, Fayez; Bikkina, Mahesh; Kohl, Harold W

    Type 2 diabetes has grown to epidemic proportions in the U.S. and physical activity levels in the population continues to remain low, although it is one of the primary preventive strategies for diabetes. The objectives of this study were to estimate the direct medical costs of type 2 diabetes attributable to not meeting physical activity Guidelines and to physical inactivity in the U.S. in 2012. This was a cross sectional study that used physical activity prevalence data from the Behavioral Risk Factor Surveillance System to estimate the population attributable risk percentage for type 2 diabetes. These data were combined with the prevalence and cost data of type 2 diabetes to estimate the cost of type 2 diabetes attributable to not meeting physical activity Guidelines and to inactivity in 2012. The cost of type 2 diabetes in the U.S. in 2012, attributable to not meeting physical activity guidelines was estimated to be $18.3 billion, and that attributable to physical inactivity was estimated to be $4.65 billion. Based on sensitivity analyses, these estimates ranged from $10.19 billion to $27.43 billion for not meeting physical activity guidelines and $2.59 billion-$6.98 billion for physical inactivity in the year 2012. This study shows that billions of dollars could be saved annually just in terms of type 2 diabetes cost in the U.S., if the entire adult population met physical activity guidelines. Physical activity promotion, particularly at the environmental and policy level should be a priority in the population. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  19. United States advanced technologies

    International Nuclear Information System (INIS)

    Longenecker, J.R.

    1985-01-01

    In the United States, the advanced technologies have been applied to uranium enrichment as a means by which it can be assured that nuclear fuel cost will remain competitive in the future. The United States is strongly committed to the development of advanced enrichment technology, and has brought both advanced gas centrifuge (AGC) and atomic vapor laser isotope separation (AVLIS) programs to a point of significant technical refinement. The ability to deploy advanced technologies is the basis for the confidence in competitive future price. Unfortunately, the development of advanced technologies is capital intensive. The year 1985 is the key year for advanced technology development in the United States, since the decision on the primary enrichment technology for the future, AGC or AVLIS, will be made shortly. The background on the technology selection process, the highlights of AGC and AVLIS programs and the way to proceed after the process selection are described. The key objective is to maximize the sales volume and minimize the operating cost. This will help the utilities in other countries supply low cost energy on a reliable, long term basis. (Kako, I.)

  20. Design and Implementation of the Intensive Care Unit Quality Management Registry: Monitoring Quality and Cost of an Adult Intensive Care Unit in a Greek State Hospital.

    Science.gov (United States)

    Kosmidis, Dimitrios; Koutsouki, Sotiria; Lampiri, Klairi; Nagy, Eva Ottilia; Papaioannou, Vasilios; Pneumatikos, Ioannis; Anastassopoulos, George

    2017-11-01

    Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.

  1. Cost-Effectiveness of Pazopanib Versus Sunitinib for Renal Cancer in the United States.

    Science.gov (United States)

    Benedict, Agnes; Ramaswamy, Krishnan; Sandin, Rickard

    2015-09-01

    We write to comment on a recently published study by Delea et al. in the January 2015 issue of JMCP that evaluated the cost-effectiveness (CE) of sunitinib (SU) versus pazopanib (PAZ) as first-line treatment for metastatic renal cell carcinoma (mRCC) from a U.S. third-party payer perspective.1 This analysis was based on COMPARZ and PISCES, clinical trials that compared SU and PAZ2,3 and led the authors to conclude that PAZ is cost-effective (in fact, dominant, according to the base-case results) compared with SU. Such assessment of economic value is clearly important for deciding between therapies to ensure fair access; therefore, we welcome a comparative evaluation of SU and PAZ. However, we believe that some of the key assumptions and inputs used in the model by Delea et al. render their results and conclusions invalid.  Best practice requires that results from a health economic model should reflect the most likely outcomes based on sound methodology and robust evidence for its inputs, as recommended by the International Society of Pharmacoeconomics and Outcomes Research (ISPOR).4 Here, we focus on 2 key areas (utilities and survival modeling) where, in our view, the analysis by Delea et al. falls short of this standard, and a third area (treatment costs) where the basis for the data derived is unclear.

  2. Mortality and Costs in Clostridium difficile Infection Among the Elderly in the United States.

    Science.gov (United States)

    Shorr, Andrew F; Zilberberg, Marya D; Wang, Li; Baser, Onur; Yu, Holly

    2016-11-01

    OBJECTIVE To examine attributable mortality and costs of Clostridium difficile infection (CDI) in the Medicare population. DESIGN A population-based cohort study among US adults aged at least 65 years in the 2008-2010 Medicare 5% sample, with follow-up of 12 months. PATIENTS Incident CDI episode was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code of 008.45 and no other occurrences within the preceding 12 months. To quantify the adjusted mortality and costs we developed a 1:1 propensity-matched sample of CDI and non-CDI patients. RESULTS Among 1,165,165 patients included, 6,838 (0.6%) had a CDI episode in 2009 (82.5% healthcare-associated). Patients with CDI were older (mean [SD] age, 81.0±8.0 vs 77.0±7.7 years, Pcosts ($64,807±$66,480 vs $38,128±$46,485, Pcosts following a CDI episode. Nationwide annually this equals 240,000 patients with CDI, 46,000 potential deaths, and more than $6 billion in costs. Infect Control Hosp Epidemiol 2016;1-6.

  3. United States Marine Corps Cost Reduction and the Joint Battle Command Platform

    Science.gov (United States)

    2013-09-01

    2013) ...................... 20   Figure 4.   Hierarchical multi- level representation of the JBC-P FoS capability areas and metrics (After Han et...Technician FY Fiscal Year GAO Government Accountability Office GCE Ground Combat Element GOTS Government off the Shelf HMMWV High...widely dispersed units across the battlefield (HQMC, 2013). This control is desired to be extended down to the company level and below. The vision

  4. Efficiency in the United States electric industry: Transaction costs, deregulation, and governance structures

    Science.gov (United States)

    Peterson, Carl

    Transaction costs economics (TCE) posits that firms have an incentive to bypass the market mechanisms in situations where the cost of using the market is prohibitive. Vertical integration, among other governance mechanisms, can be used to minimize the transactions costs associated with the market mechanism. The study analyses different governance mechanisms, which range from complete vertical integration to the use of market mechanisms, for firms in the US electric sector. This sector has undergone tremendous change in the past decade including the introduction of retail competition in some jurisdictions. As a result of the push toward deregulation of the industry, vertically integration, while still significant in the sector, has steadily been replaced by alternative governance structures. Using a sample of 136 investor-owned electric utilities that reported data the US Federal Energy Regulatory Commission between 1996 and 2002, this study estimates firm level efficiency using Data Envelopment Analysis (DEA) and relates these estimates to governance structure and public policies. The analysis finds that vertical integration is positively related to firm efficiency, although in a non-linear fashion suggesting that hybrid governance structures tend to be associated with lower efficiency scores. In addition, while some evidence is found for negative short-term effects on firm efficiency from the choice to deregulate, this result is sensitive to DEA model choice. Further, competition in retail markets is found to be positively related to firm level efficiency, but the retreat from deregulation, which occurred after 2000, is negatively associated with firm-level efficiency. These results are important in the ongoing academic and public policy debates concerning deregulation of the electric section and indicate that vertical economies remain in the industry, but that competition has provided incentives for improving firm level efficiency.

  5. The economic costs and benefits of potassium iodide prophylaxis for a reference LWR facility in the United States

    International Nuclear Information System (INIS)

    Behling, U.H.; Behling, K.

    1995-01-01

    Policy decisions relating to radiation protection are commonly based on an evaluation in which the benefits of exposure reduction are compared to the economic costs of the protective measure. A generic difficulty countered in cost-benefit analyses, however, is the quantification of major elements that define the costs and the benefits in commensurate units. In this study, the costs of making KI (potassium iodine) available for public use and the avoidance of thyroidal health effects (i.e., the benefit) in the event of nuclear emergency are defined in the commensurate units of dollars. (Authors). 11 refs., 15 tabs

  6. United States experience in environmental cost-benefit analysis for nuclear power plants with implications for developing countries

    International Nuclear Information System (INIS)

    Spangler, M.B.

    1980-08-01

    Environmental cost-benefit analysis in the United States involves a comparison of diverse societal impacts of the proposed developments and its alternatives. Regarding nuclear power plant licensing actions, such analyses include the need for base-load electrical generating capacity versus the no-action alternative; alternative sources of energy; alternative sites for the proposed nuclear plants; and alternative technologies for mitigating environmental impacts. Many U.S. experiences and environmental assessment practices and comparative resource requirements presented in this report will not provide a wholly reliable reflection of the precise situation of each country. Nevertheless, the procedural and substantive issues encountered by the United States in nuclear power plant licensing may exhibit a number of important, if rough, parallelisms for other countries. Procedural issues dealt with include: the scoping of alternatives and impact issues; the problem of balancing incommensurable impacts; and treating uncertainty in measuring or forecasting certain kinds of environmental impacts. Although substantive environmental impact issues will vary appreciably among nations, it is to be expected that many of the substantive impact issues such as impacts on biota, community-related effects, and aesthetic impacts will also have some measure of universal interest to other countries

  7. Utility-Scale Solar 2015: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2016-08-17

    The utility-scale solar sector—defined here to include any ground-mounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar power (“CSP”) project that is larger than 5 MWAC in capacity—has led the overall U.S. solar market in terms of installed capacity since 2012. It is expected to maintain its market-leading position for at least another five years, driven in part by December 2015’s three-year extension of the 30% federal investment tax credit (“ITC”) through 2019 (coupled with a favorable switch to a “start construction” rather than a “placed in service” eligibility requirement, and a gradual phase down of the credit to 10% by 2022). In fact, in 2016 alone, the utility-scale sector is projected to install more than twice as much new capacity as it ever has previously in a single year. This unprecedented boom makes it difficult, yet more important than ever, to stay abreast of the latest utility-scale market developments and trends. This report—the fourth edition in an ongoing annual series—is intended to help meet this need, by providing in-depth, annually updated, data-driven analysis of the utility-scale solar project fleet in the United States. Drawing on empirical project-level data from a wide range of sources, this report analyzes not just installed project costs or prices—i.e., the traditional realm of most solar economic analyses—but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects throughout the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are also presented where appropriate.

  8. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

    Science.gov (United States)

    Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

    2014-07-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  9. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  10. Salmonellosis Hospitalizations in the United States: Associated Chronic Conditions, Costs, and Hospital Outcomes, 2011, Trends 2000-2011.

    Science.gov (United States)

    Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Shafir, Shira; Wang, May; Sorvillo, Frank

    2016-01-01

    Hospitalized salmonellosis patients with concurrent chronic conditions may be at increased risk for adverse outcomes, increasing the costs associated with hospitalization. Identifying important modifiable risk factors for this predominantly foodborne illness may assist hospitals, physicians, and public health authorities to improve management of these patients. The objectives of this study were to (1) quantify the burden of salmonellosis hospitalizations in the United States, (2) describe hospitalization characteristics among salmonellosis patients with concurrent chronic conditions, and (3) examine the relationships between salmonellosis and comorbidities by four hospital-related outcomes. A retrospective analysis of salmonellosis discharges was conducted using the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample for 2011. A supplemental trend analysis was performed for the period 2000-2011. Hospitalization characteristics were examined using multivariable regression modeling, with a focus on four outcome measures: in-hospital death, total amount billed by hospitals for services, length of stay, and disease severity. In 2011, there were 11,032 total salmonellosis diagnoses; 7496 were listed as the primary diagnosis, with 86 deaths (case-fatality rate = 1.2%). Multivariable regression analyses revealed a greater number of chronic conditions (≥4) among salmonellosis patients was associated with higher mean total amount billed by hospitals for services, longer length of stay, and greater disease severity (p ≤ 0.05). From 2000 to 2011, hospital discharges for salmonellosis increased by 27.2%, and the mean total amount billed by hospitals increased nearly threefold: $9,777 (2000) to $29,690 (2011). Observed increases in hospitalizations indicate the burden of salmonellosis remains substantial in the United States. The positive association between increased number of chronic conditions and the four hospital-related outcomes affirms

  11. An Economic Evaluation of Tofacitinib Treatment in Rheumatoid Arthritis: Modeling the Cost of Treatment Strategies in the United States.

    Science.gov (United States)

    Claxton, Lindsay; Jenks, Michelle; Taylor, Matthew; Wallenstein, Gene; Mendelsohn, Alan M; Bourret, Jeffrey A; Singh, Amitabh; Moynagh, Dermot; Gerber, Robert A

    2016-09-01

    Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). Tofacitinib is approved in the United States for use in adults with moderately to severely active RA and an inadequate response or intolerance to methotrexate. To (a) evaluate, using an economic model, the treatment costs of an RA strategy including tofacitinib, compared with adalimumab, etanercept, certolizumab and tocilizumab biologic RA treatment strategies, which are commonly prescribed in the United States, and (b) assess the economic impact of monotherapy and combination therapy in patients who had an inadequate response to methotrexate therapy (MTX-IR analysis) and to combination therapy in patients who had an inadequate response to a tumor necrosis factor inhibitor (TNF-IR analysis). A transparent, Excel-based economic model with a decision-tree approach was developed to evaluate costs over a 1- and 2-year time horizon. The model compared tofacitinib 5 mg twice a day (BID) either as monotherapy or in combination with MTX with similarly labeled biologic therapies. Response to treatment was modeled as American College of Rheumatology (ACR) 20/50/70 response. ACR20 represented clinical response and determined whether patients continued therapy. ACR response rates at 6-month intervals were sourced from prescribing information and safety event rates from a published meta-analysis. Following an adverse event or a lack of response to treatment, it was assumed that 75% of patients switched to the next line of treatment (first to abatacept and then to rituximab). The perspective was that of a U.S. payer. Costs were reported in 2015 U.S. dollars and included drug wholesale acquisition costs, monitoring, drug administration, and treatment for minor and serious adverse events. The patient population eligible for treatment was based on the total number of members (i.e., RA and non-RA) in a payer organization; members with RA treated with biologic therapies were estimated using

  12. United States rejoin ITER

    International Nuclear Information System (INIS)

    Roberts, M.

    2003-01-01

    Upon pressure from the United States Congress, the US Department of Energy had to withdraw from further American participation in the ITER Engineering Design Activities after the end of its commitment to the EDA in July 1998. In the years since that time, changes have taken place in both the ITER activity and the US fusion community's position on burning plasma physics. Reflecting the interest in the United States in pursuing burning plasma physics, the DOE's Office of Science commissioned three studies as part of its examination of the option of entering the Negotiations on the Agreement on the Establishment of the International Fusion Energy Organization for the Joint Implementation of the ITER Project. These were a National Academy Review Panel Report supporting the burning plasma mission; a Fusion Energy Sciences Advisory Committee (FESAC) report confirming the role of ITER in achieving fusion power production, and The Lehman Review of the ITER project costing and project management processes (for the latter one, see ITER CTA Newsletter, no. 15, December 2002). All three studies have endorsed the US return to the ITER activities. This historical decision was announced by DOE Secretary Abraham during his remarks to employees of the Department's Princeton Plasma Physics Laboratory. The United States will be working with the other Participants in the ITER Negotiations on the Agreement and is preparing to participate in the ITA

  13. Malaria Treatment (United States)

    Science.gov (United States)

    ... Providers, Emergency Consultations, and General Public. Contact Us Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  14. The Direct Cost of Managing a Rare Disease: Assessing Medical and Pharmacy Costs Associated with Duchenne Muscular Dystrophy in the United States.

    Science.gov (United States)

    Thayer, Sarah; Bell, Christopher; McDonald, Craig M

    2017-06-01

    A Duchenne muscular dystrophy (DMD) cohort was identified using a claims-based algorithm to estimate health care utilization and costs for commercially insured DMD patients in the United States. Previous analyses have used broad diagnosis codes that include a range of muscular dystrophy types as a proxy to estimate the burden of DMD. To estimate DMD-associated resource utilization and costs in a sample of patients identified via a claims-based algorithm using diagnosis codes, pharmacy prescriptions, and procedure codes unique to DMD management based on DMD clinical milestones. DMD patients were selected from a commercially insured claims database (2000-2009). Patients with claims suggestive of a non-DMD diagnosis or who were aged 30 years or older were excluded. Each DMD patient was matched by age, gender, and region to controls without DMD in a 1:10 ratio (DMD patients n = 75; controls n = 750). All-cause health care resource utilization, including emergency department, inpatient, outpatient, and physician office visits, and all-cause health care costs were examined over a minimum 1-year period. Costs were computed as total health-plan and patient-paid amounts of adjudicated medical claims (in annualized U.S. dollars). The average age of the DMD cohort was 13 years. Patients in the DMD cohort had a 10-fold increase in health care costs compared with controls ($23,005 vs. $2,277, P McDonald has been a consultant for GSK, Sarepta, PTC Therapeutics, Biomarin, and Catabasis on clinical trials regarding Duchenne muscular dystrophy clinical trial design, endpoint selection, and data analysis; Mitobridge for drug development; and Eli Lilly as part of a steering committee for clinical trials. Study concept and design were contributed primarily by Bell, along with Thayer and McDonald. Thayer collected the data, and data interpretation was performed by Thayer and Bell, along with McDonald. The manuscript was written by Thayer and Bell, along with McDonald, and revised by

  15. Unit labour costs, productivity and international competitiveness

    NARCIS (Netherlands)

    Ark, Bart van; Stuivenwold, Edwin; Ypma, Gerard

    2005-01-01

    This paper provides international comparisons of relative levels of unit labour costs (ULC) for several OECD countries relative to the United States. The estimates are based on the Total Economy Database and the 60-Industry Database of the Groningen Growth and Development Centre (GGDC), and are also

  16. Utility-Scale Solar 2016: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Seel, Joachim; LaCommare, Kristina Hamachi

    2017-09-19

    The utility-scale solar sector has led the overall U.S. solar market in terms of installed capacity since 2012. In 2016, the utility-scale sector installed more than 2.5 times as much new capacity as did the residential and commercial sectors combined, and is expected to maintain its dominant position for at least another five years. This report—the fifth edition in an ongoing annual series—provides data-driven analysis of the utility-scale solar project fleet in the United States. We analyze not just installed project prices, but also operating costs, capacity factors, and power purchase agreement ("PPA") prices from a large sample of utility-scale PV and CSP projects throughout the United States. Highlights from this year's edition include the following: Installation Trends: The use of solar tracking devices dominated 2016 installations, at nearly 80% of all new capacity. In a reflection of the ongoing geographic expansion of the market beyond California and the Southwest, the median long-term average insolation level at newly built project sites declined again in 2016. While new fixed-tilt projects are now seen predominantly in less-sunny regions, tracking projects are increasingly pushing into these same regions. The median inverter loading ratio has stabilized in 2016 at 1.3 for both tracking and fixed-tilt projects. Installed Prices: Median installed PV project prices within a sizable sample have fallen by two-thirds since the 2007-2009 period, to $2.2/WAC (or $1.7/WDC) for projects completed in 2016. The lowest 20th percentile of projects within our 2016 sample were priced at or below $2.0/WAC, with the lowest-priced projects around $1.5/WAC. Overall price dispersion across the entire sample and across geographic regions decreased significantly in 2016. Operation and Maintenance (“O&M”) Costs: What limited empirical O&M cost data are publicly available suggest that PV O&M costs were in the neighborhood of $18/kWAC-year, or $8/MWh, in 2016. These

  17. Geological studies of the COST No. B-3 Well, United States Mid-Atlantic continental slope area

    Science.gov (United States)

    Scholle, Peter A.

    1980-01-01

    The COST No. B-3 well is the first deep stratigraphic test to be drilled on the Continental Slope off the Eastern United States. The well was drilled in 2,686 ft (819 m) of water in the Baltimore Canyon trough area to a total depth of 15,820 ft (4,844 m) below the drill platform. It penetrated a section composed of mudstones, calcareous mudstones, and limestones of generally deep water origin to a depth of about 8.200 ft (2,500 m) below the drill floor. Light-colored, medium- to coarse-grained sandstones with intercalated gray and brown shales, micritic limestones, and minor coal and dolomite predominate from about 8,200 to 12,300 ft (2,500 to 3,750 m). From about 12,300 ft (3,750 m) to the bottom, the section consists of limestones (including oolitic and intraclastic grainstones) with interbedded fine-to medium-grained sandstones, dark-colored fissile shales, and numerous coal seams. Biostratigraphic examination has shown that the section down to approximately 6,000 ft (1,830 m) is Tertiary. The boundary between the Lower and Upper Cretaceous sections is placed between 8,600 and 9,200 ft (2,620 and 2,800 m) by various workers. Placement of the Jurassic-Cretaceous boundary shows an even greater range based on different organisms; it is placed variously between 12,250 and 13,450 ft (3,730 and 5,000 m). The oldest unit penetrated in the well is considered to be Upper Jurassic (Kimmeridgian) by some workers and Middle Jurassic (Callovian) by others. The Lower Cretaceous and Jurassic parts of the section represent nonmarine to shallow-marine shelf sedimentation. Upper Cretaceous and Tertiary units reflect generally deeper water conditions at the B-3 well site and show a general transition from deposition at shelf to slope water depths. Examination of cores, well cuttings, and electric logs indicates that potential hydrocarbon-reservoir units are present throughout the Jurassic and Cretaceous section. Porous and moderately permeable limestones and sandstones have been

  18. Structural interventions to prevent HIV/sexually transmitted disease: are they cost-effective for women in the southern United States?

    Science.gov (United States)

    Cohen, Deborah A; Wu, Shin-Yi; Farley, Thomas A

    2006-07-01

    Structural interventions are theoretically promising for populations with a low prevalence of HIV, because they can reach large numbers of people to influence their social norms and collective risky behaviors for a relatively low cost per person. Because HIV transmission is continuing to increase among women in the southern United States, interventions to stem this epidemic are particularly warranted. This study explores whether structural interventions may be a cost-effective way to prevent HIV in this population. We used the cost-effectiveness estimator, "Maximizing the Benefit" to determine the relative cost-effectiveness of 6 structural HIV prevention interventions. "Maximizing the Benefit" is a spreadsheet tool using mathematical models to estimate the cost per HIV infection prevented taking into account the epidemiologic contexts, behavioral change as a result of an intervention, and the costs of intervention. We applied estimates of HIV prevalence related to blacks in the southern United States. All the structural interventions were cost-effective compared with average lifetime treatment costs of HIV, but mass media, condom availability, and alcohol taxes theoretically prevented the largest numbers of HIV infections. Although the assumptions used in cost-effectiveness estimates have many limitations, they do allow for a relative comparison of different interventions and help to inform policy decisions related to the allocation of HIV prevention resources. Structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.

  19. Tracking the Sun IV: An Historical Summary of the Installed Cost of Photovoltaics in the United States from 1998 to 2010

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim; Wiser, Ryan

    2011-09-07

    The present report describes installed cost trends for grid-connected PV projects installed from 1998 through 2010 (with some limited and preliminary results presented for projects installed in the first six months of 2011). The analysis is based on project-level cost data from approximately 116,500 residential, non-residential, and utility-sector PV systems in the United States. The inclusion of utility-sector PV is a new element in this year’s report. The combined capacity of all systems in the data sample totals 1,685 MW, equal to 79% of all grid-connected PV capacity installed in the United States through 2010 and representing one of the most comprehensive sources of installed PV cost data for the U.S. Based on this dataset, the report describes historical installed cost trends over time, and by location, market segment, technology type, and component. The report also briefly compares recent PV installed costs in the United States to those in Germany and Japan, and describes trends in customer incentives for PV installations and net installed costs after receipt of such incentives. The analysis presented here focuses on descriptive trends in the underlying data, serving primarily to summarize the data in tabular and graphical form.

  20. Further Validation of the Psychosocial Costs of Racism to Whites Scale on a Sample of University Students in the Southeastern United States

    Science.gov (United States)

    Sifford, Amy; Ng, Kok-Mun; Wang, Chuang

    2009-01-01

    We examined the factor structure of the Psychosocial Costs of Racism to Whites Scale (PCRW; Spanierman & Heppner, 2004) on 766 White American university students from the southeastern United States. Results from confirmatory factor analyses supported the 3-factor model proposed by Spanierman and Heppner (2004). The construct validity of the…

  1. United States housing, 2012

    Science.gov (United States)

    Delton Alderman

    2013-01-01

    Provides current and historical information on housing market in the United States. Information includes trends for housing permits and starts, housing completions for single and multifamily units, and sales and construction. This report will be updated annually.

  2. Synthesis on construction unit cost development : technical report.

    Science.gov (United States)

    2009-01-01

    Availability of historical unit cost data is an important factor in developing accurate project cost estimates. : State highway agencies (SHAs) collect data on historical bids and/or production rates, crew sizes and mixes, : material costs, and equip...

  3. IEA Wind Task 26. Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007–2012

    Energy Technology Data Exchange (ETDEWEB)

    Vitina, Aisma [Ea Energy Analyses, Copenhagen (Denmark); Lüers, Silke [Deutsche WindGuard, Varel (Germany); Wallasch, Anna-Kathrin [Deutsche WindGuard, Varel (Germany); Berkhout, Volker [Fraunhofer IWES, Kassel (Germany); Duffy, Aidan [Dublin Inst. of Technology and Dublin Energy Lab. (Ireland); Cleary, Brendan [Dublin Inst. of Technology and Dublin Energy Lab. (Ireland); Husabø, Lief I. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Weir, David E. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Lacal-Arántegui, Roberto [European Commission, Ispra (Italy). Joint Research Centre; Hand, Maureen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Lantz, Eric [National Renewable Energy Lab. (NREL), Golden, CO (United States); Belyeu, Kathy [Belyeu Consulting, Takoma Park, MD (United States); Wiser, Ryan H [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hoen, Ben [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-06-01

    The International Energy Agency Implementing Agreement for cooperation in Research, Development, and Deployment of Wind Energy Systems (IEA Wind) Task 26—The Cost of Wind Energy represents an international collaboration dedicated to exploring past, present and future cost of wind energy. This report provides an overview of recent trends in wind plant technology, cost, and performance in those countries that are currently represented by participating organizations in IEA Wind Task 26: Denmark, Germany, Ireland, Norway, and the United States as well as the European Union.

  4. The Cost of Distribution System Upgrades to Accommodate Increasing Penetrations of Distributed Photovoltaic Systems on Real Feeders in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Horowitz, Kelsey A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Ding, Fei [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mather, Barry A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Palmintier, Bryan S [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-04-05

    The increasing deployment of distributed photovoltaic systems (DPV) can impact operations at the distribution level and the transmission level of the electric grid. It is important to develop and implement forward-looking approaches for calculating distribution upgrade costs that can be used to inform system planning, market and tariff design, cost allocation, and other policymaking as penetration levels of DPV increase. Using a bottom-up approach that involves iterative hosting capacity analysis, this report calculates distribution upgrade costs as a function of DPV penetration on three real feeders - two in California and one in the Northeastern United States.

  5. A Bicultural Analysis of the Cost of Caring: Nursing Burnout in the United States and the Philippines.

    Science.gov (United States)

    Turnipseed, David L.; Turnipseed, Patricia H.

    1997-01-01

    Questionnaires completed by 129 U.S. nurses and 71 from the Philippines revealed higher levels of emotional exhaustion and feelings of personal accomplishment in the United States. The Filipino work environment was rated higher for supervisor support, autonomy, control, and innovation. U.S. nurses reported greater work pressure. (SK)

  6. The Japanese Labor Market in a Comparative Perspective with the United States. A Transaction-Cost Interpretation.

    Science.gov (United States)

    Hashimoto, Masanori

    A comparison is made of some of the notable features of the Japanese and U.S. labor markets. In Japan, as compared to the United States, for example, levels of employment tenure are higher, employer-employee attachment stronger, earnings-tenure profiles more steeply sloped, layoffs and dismissals much less frequent, and joint consultation and…

  7. Utility-Scale Solar 2013: An empirical analysis of project cost, performance, and pricing trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Weaver, Samantha [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-09-17

    Other than the SEGS I-IX parabolic trough projects built in the 1980s, virtually no large-scale or "utility-scale" solar projects-defined here to include any ground-mounted photovoltaic ("PV"), concentrating photovoltaic ("CPV"), or concentrating solar power ("CSP" or solar thermal) project larger than 5 MWAC-existed in the United States prior to 2007.

  8. Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States

    OpenAIRE

    Stewart, Alexandra M.; Lindley, Megan C.; Chang, Kristen H.M.; Cox, Marisa A.

    2013-01-01

    Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs’ policies related to benefit coverage and, copa...

  9. 31 CFR 515.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 515.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including the Trust Territory of...

  10. 31 CFR 500.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 500.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including U.S. trust territories...

  11. 31 CFR 535.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 535.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof including the Trust Territory of...

  12. Low cost balancing unit design

    Science.gov (United States)

    Golembiovsky, Matej; Dedek, Jan; Slanina, Zdenek

    2017-06-01

    This article deals with the design of a low-cost balancing system which consist of battery balancing units, accumulator pack units and coordinator unit with interface for higher level of battery management system. This solution allows decentralized mode of operation and the aim of this work is implementation of controlling and diagnostic mechanism into an electric scooter project realized at Technical university of Ostrava. In todays world which now fully enjoys the prime of electromobility, off-grid battery systems and other, it is important to seek the optimal balance between functionality and the economy side of BMS that being electronics which deals with secondary cells of batery packs. There were numerous sophisticated, but not too practical BMS models in the past, such as centralized system or standalone balance modules of individual cells. This article aims at development of standalone balance modules which are able to communicate with the coordinator, adjust their parameters and ensure their cells safety in case of a communication failure. With the current worldwide cutting cost trend in mind, the emphasis was put on the lowest price possible for individual component. The article is divided into two major categories, the first one being desing of power electronics with emphasis on quality, safety (cooling) and also cost. The second part describes development of a communication interface with reliability and cost in mind. The article contains numerous graphs from practical measurements. The outcome of the work and its possible future is defined in the conclusion.

  13. When renewable energy met sustainable growth. Regulation, cost reduction, and the rise of renewable energy in the United States

    International Nuclear Information System (INIS)

    Stephens, Samantha

    2016-01-01

    Historically and famously fossil-fuel dependent, the U.S. energy and electricity mixes are evolving quickly as costs fall for renewables, regulations mandate their implementation, and fiscal policy incentivizes their installation. The investment and production tax credits (ITC and PTC) as well as power purchase agreements (PPAs) are well-known for their contributions to the development of solar and wind capacity, and the recent extensions of these credits has led to a positive outlook for continued growth in installations and generation. In addition, the green power market is experiencing record participation, as tracking the positive environmental externalities of renewable power has become important to meet renewable portfolio standards, which mandate implementation of renewable energy by state. Cost reduction is further taking place globally due to technological advances and economies of scale, which serves as another key driver for development. Of course, challenges are still present, particularly due to a plentiful and inexpensive domestic fossil fuel supply, uneven application of regulation and incentives state-by-state, and the uncertainty of continued political support. Even so, a progressive lowering of traditional barriers is leading to the potential for widespread deployment of renewables across the American landscape. (author)

  14. Severe hypoglycemia rates and associated costs among type 2 diabetics starting basal insulin therapy in the United States.

    Science.gov (United States)

    Ganz, Michael L; Wintfeld, Neil S; Li, Qian; Lee, Yuan-Chi; Gatt, Elyse; Huang, Joanna C

    2014-10-01

    To derive current real-world data on the rates and costs of severe hypoglycemia (SH) for people with type 2 diabetes mellitus (T2D) who have initiated basal insulin therapy and to examine differences in SH rates and costs stratified by history of prior SH events. We used a nation-wide electronic health records database that included encounter and laboratory data, as well as clinical notes, to estimate the rates and costs of SH events among adults with T2D who initiated basal insulin between 2008 and 2011. Unadjusted and regression-adjusted rates and quarterly costs were calculated for all patients as well as stratified by history of a SH event before starting basal insulin and history of a SH event during the basal insulin titration period. We identified 7235 incident cases of basal insulin use among patients with T2D who did not use insulin during the previous 12 months. Regression-adjusted incidence and total event rates were 10.36 and 11.21 per 100 patient-years, respectively. A history of SH events during the pre-index baseline and post-index titration periods were statistically significantly associated with both the incidence and total event rates (p history of previous SH or SH events during the titration period were not statistically significantly associated with costs. These results suggest that the real-world burden of SH is high among people with T2D who start using basal insulin and that history of previous SH events, both before starting insulin and during the insulin titration period, influences future SH. These results can also provide insights into interventions that can prevent or delay SH. These results should, however, be interpreted in light of the key limitations of our study: not all SH events may have been captured or coded in the database, data on filled prescriptions were not available, and the post-titration follow-up period could have been divided into time units other than quarters (3 month blocks) resulting in potentially different

  15. IEA Wind Task 26. Wind Technology, Cost and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States. 2007 - 2012

    Energy Technology Data Exchange (ETDEWEB)

    Vitina, Aisma [Ea Energy Analyses, Copenhagen (Denmark); Luers, Silke [Deutsche WindGuard, Varel (Germany); Wallasch, Anna-Kathrin [Deutsche WindGuard, Varel (Germany); Berkhout, Volker [Fraunhofer IWES (Germany); Duffy, Aidan [Dublin Inst. of Technology and Dublin Energy Lab (Ireland); Cleary, Brendan [Dublin Inst. of Technology and Dublin Energy Lab (Ireland); Husabo, Leif I. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Weir, David E. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Lacal-Arantegui, Roberto [European Commission, Ispra (Italy). Joint Research Centre; Hand, M. Maureen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Lantz, Eric [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Belyeu, Kathy [Belyeu Consulting, Tacoma Park, MD (United States); Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hoen, Ben [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-06-12

    This report builds from a similar previous analysis (Schwabe et al., 2011) exploring the differences in cost of wind energy in 2008 among countries participating in IEA Wind Task 26 at that time. The levelized cost of energy (LCOE) is a widely recognized metric for understanding how technology, capital investment, operations, and financing impact the life-cycle cost of building and operating a wind plant. Schwabe et al. (2011) apply a spreadsheet-based cash flow model developed by the Energy Research Centre of the Netherlands (ECN) to estimate LCOE. This model is a detailed, discounted cash flow model used to represent the various cost structures in each of the participating countries from the perspective of a financial investor in a domestic wind energy project. This model is used for the present analysis as well, and comparisons are made for those countries who contributed to both reports, Denmark, Germany, and the United States.

  16. Residential, Commercial, and Utility-Scale Photovoltaic (PV) System Prices in the United States: Current Drivers and Cost-Reduction Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Goodrich, A.; James, T.; Woodhouse, M.

    2012-02-01

    The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has dropped precipitously in recent years, led by substantial reductions in global PV module prices. However, system cost reductions are not necessarily realized or realized in a timely manner by many customers. Many reasons exist for the apparent disconnects between installation costs, component prices, and system prices; most notable is the impact of fair market value considerations on system prices. To guide policy and research and development strategy decisions, it is necessary to develop a granular perspective on the factors that underlie PV system prices and to eliminate subjective pricing parameters. This report's analysis of the overnight capital costs (cash purchase) paid for PV systems attempts to establish an objective methodology that most closely approximates the book value of PV system assets.

  17. Utility-Scale Solar 2013: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    OpenAIRE

    Bolinger, M; Weaver, S

    2014-01-01

    The utility-scale solar sector has led the overall U.S. solar market in terms of installed capacity since 2012. In 2016, the utility-scale sector installed more than 2.5 times as much new capacity as did the residential and commercial sectors combined, and is expected to maintain its dominant position for at least another five years. This report—the fifth edition in an ongoing annual series—provides data-driven analysis of the utility-scale solar project fleet in the United States. We analyze...

  18. A cross-sectional study of emergency care utilization and associated costs of violent-related (assault) injuries in the United States.

    Science.gov (United States)

    Monuteaux, Michael C; Fleegler, Eric W; Lee, Lois K

    2017-11-01

    Violent-related (assault) injuries are a leading cause of death and disability in the United States. Many violent injury victims seek treatment in the emergency department (ED). Our objectives were to (1) estimate rates of violent-related injuries evaluated in United States EDs, (2) estimate linear trends in ED visits for violent-related injuries from 2000 to 2010, and (3) to determine the associated health care and work-loss costs. We examined adults 18 years and older from a nationally representative survey (the National Hospital Ambulatory Medical Care Survey) of ED visits, from 2000 to 2010. Violent injury was defined using International Classification of Diseases-9th Rev.-Clinical Modification, diagnosis and mechanism of injury codes. We calculated rates of ED visits for violent injuries. Medical and work-loss costs accrued by these injuries were calculated for 2005, inflation-adjusted to 2011 dollars using the WISQARS Cost of Injury Reports. An annual average of 1.4 million adults were treated for violent injuries in EDs from 2000 to 2010, comprising 1.6% (95% confidence interval, 1.5%-1.6%) of all US adult ED visits. Young adults (18-25 years), men, nonwhites, uninsured or publically insured patients, and those residing in high poverty urban areas were at increased risk for ED visits for violent injury. The 1-year, inflation-adjusted medical and work-loss cost of violent-inflicted injuries in adults in the United States was US $49.5 billion. Violent injuries account for over one million ED visits annually among adults, with no change in rates over the past decade. Young black men are at especially increased risk for ED visits for violent injuries. Overall, violent-related injuries resulted in substantial financial and societal costs. Epidemiological study, level III.

  19. Cost estimating for CERCLA remedial alternatives a unit cost methodology

    International Nuclear Information System (INIS)

    Brettin, R.W.; Carr, D.J.; Janke, R.J.

    1995-06-01

    The United States Environmental Protection Agency (EPA) Guidance for Conducting Remedial Investigations and Feasibility Studies Under CERCLA, Interim Final, dated October 1988 (EPA 1988) requires a detailed analysis be conducted of the most promising remedial alternatives against several evaluation criteria, including cost. To complete the detailed analysis, order-of-magnitude cost estimates (having an accuracy of +50 percent to -30 percent) must be developed for each remedial alternative. This paper presents a methodology for developing cost estimates of remedial alternatives comprised of various technology and process options with a wide range of estimated contaminated media quantities. In addition, the cost estimating methodology provides flexibility for incorporating revisions to remedial alternatives and achieves the desired range of accuracy. It is important to note that the cost estimating methodology presented here was developed as a concurrent path to the development of contaminated media quantity estimates. This methodology can be initiated before contaminated media quantities are estimated. As a result, this methodology is useful in developing cost estimates for use in screening and evaluating remedial technologies and process options. However, remedial alternative cost estimates cannot be prepared without the contaminated media quantity estimates. In the conduct of the feasibility study for Operable Unit 5 at the Fernald Environmental Management Project (FEMP), fourteen remedial alternatives were retained for detailed analysis. Each remedial alternative was composed of combinations of remedial technologies and processes which were earlier determined to be best suited for addressing the media-specific contaminants found at the FEMP site, and achieving desired remedial action objectives

  20. Rapanos v. United States & Carabell v. United States

    Science.gov (United States)

    Documents associated with guidance for implementing the definition of waters of the United States under the Clean Water Act following the Rapanos v. United States, and Carabell v. United States Supreme Court decision.

  1. Cost-Benefit Analysis of Nanoparticle Albumin-Bound Paclitaxel versus Solvent-Based Paclitaxel for the Treatment of Metastatic Breast Cancer in the United States

    Science.gov (United States)

    Vichansavakul, Kittaya

    had some limitations because they were conducted from a narrow perspective such as payer and provider point of views. The studies also considered only direct costs in their analysis. In fact, conducting economic evaluations from a narrow perspective and leaving out indirect costs might undermine the true benefit of the interventions for society. A cost-benefit analysis measures all costs and benefits in monetary units. It incorporates both health outcomes gained from individuals and the value gained to society in order to maximize the usage of resources effectively. This thesis conducted a cost-benefit analysis to compare nab-paclitaxel and generic paclitaxel in treating metastatic breast cancer from a societal perspective in the United States. The results showed that nab-paclitaxel is a cost-benefit strategy regardless of the different costs and benefits due to the extra 3 years of living it provides. In all models, when nab-paclitaxel was compared to generic paclitaxel, nab-paclitaxel showed cost-benefit to society. However, the results of generic paclitaxel were dependent on the total medical costs. Performing a cost-benefit analysis of nab-paclitaxel from a societal perspective is important to understand the true benefit of interventions. Furthermore, considering both direct and indirect costs, as well as benefits, of this drug is vital because the economic profile of nab-paclitaxel would be improved.

  2. United States Attorney Prosecutions

    Science.gov (United States)

    1993-10-01

    property of CocaCola Bottling Company, Fayetteville, North Carolina, of a value in excess of $100.00, in violation of Title 18 United States Code, Section...another, to-wit: a Cocacola soft drink machine, the amount of damage to said personal property being more than $200.00, in violation of North Carolina

  3. International differences in health care costs in Europe and the United States: Do these affect the cost-effectiveness of diagnostic strategies for pulmonary embolism?

    International Nuclear Information System (INIS)

    Erkel, A.R. van; Pattynama, P.M.T.; Hout, W.B. van den

    1999-01-01

    The aim of this study was to assess whether potential differences in costs for diagnostic procedures and treatment of pulmonary embolism (PE) among European and U. S. hospitals alter the optimal cost-effective diagnostic strategy for PE. A standardized questionnaire was used to obtain cost data for the diagnosis and treatment of PE in participating European and U. S. hospitals. Costs for diagnostic tests and treatment of PE were then calculated in a standardized manner for all participating hospitals, from the hospital perspective. Costs were used in an existing cost-effectiveness analysis (CEA) model to determine the most cost-effective diagnostic strategy in participating hospitals. There were considerable differences in costs for diagnostic and therapeutic procedures for PE among the participating centers. These differences, however, did not affect the most cost-effective strategy based on incremental cost-effectiveness. In all hospitals the most cost-effective strategy appeared to be ultrasound followed by helical CT. International differences in cost of diagnostic and therapeutic procedures certainly exist and should be considered before applying a published CEA. Nevertheless, despite these cost differences, the diagnostic strategy for PE of ultrasound followed by helical CT appears most cost-effective. (orig.)

  4. Cost-effectiveness of combination daclatasvir-sofosbuvir for treatment of genotype 3 chronic hepatitis C infection in the United States.

    Science.gov (United States)

    Saint-Laurent Thibault, Catherine; Moorjaney, Divya; Ganz, Michael L; Sill, Bruce; Hede, Shalini; Yuan, Yong; Gorsh, Boris

    2017-07-01

    A phase III trial evaluated the efficacy and safety of Daklinza (daclatasvir or DCV) in combination with sofosbuvir (SOF) for treatment of genotype (GT) 3 hepatitis C virus (HCV) patients. This study evaluated the cost-effectiveness of DCV + SOF vs SOF in combination with ribavirin (RBV) over a 20-year time horizon from the perspective of a United States (US) payer. A published Markov model was adapted to reflect US demographic characteristics, treatment patterns, costs of drug acquisition, monitoring, disease and adverse event management, and mortality risks. Clinical inputs came from the ALLY-3 and VALENCE trials. The primary outcome was the incremental cost-utility ratio. Life-years, incidence of complications, number of patients achieving sustained virological response (SVR), and the total cost per SVR were secondary outcomes. Costs (2014 USD) and quality-adjusted life years (QALYs) were discounted at 3% per year. Deterministic, probabilistic, and scenario sensitivity analyses were conducted. DCV + SOF was associated with lower costs and better effectiveness than SOF + RBV in the base case and in almost all scenarios (i.e. treatment-experienced, non-cirrhotic, time horizons of 5, 10, and 80 years). DCV + SOF was less costly, but also slightly less effective than SOF + RBV in the cirrhotic and treatment-naïve population scenarios. Results were sensitive to variations in the probability of achieving SVR for both treatment arms. DCV + SOF costs less than $50,000 per QALY gained in 79% of all probabilistic iterations compared with SOF + RBV. DCV + SOF is a dominant option compared with SOF + RBV in the US for the overall GT 3 HCV patient population.

  5. Modeling the Unites States government's economic cost of noise-induced hearing loss for a military population.

    Science.gov (United States)

    Tufts, Jennifer B; Weathersby, Paul K; Rodriguez, Francisco A

    2010-05-01

    The purpose of this paper is to demonstrate the feasibility and utility of developing economic cost models for noise-induced hearing loss (NIHL). First, we outline an economic model of NIHL for a population of US Navy sailors with an "industrial"-type noise exposure. Next, we describe the effect on NIHL-related cost of varying the two central model inputs--the noise-exposure level and the duration of exposure. Such an analysis can help prioritize promising areas, to which limited resources to reduce NIHL-related costs should be devoted. NIHL-related costs borne by the US government were computed on a yearly basis using a finite element approach that took into account varying levels of susceptibility to NIHL. Predicted hearing thresholds for the population were computed with ANSI S3.44-1996 and then used as the basis for the calculation of NIHL-related costs. Annual and cumulative costs were tracked. Noise-exposure level and duration were systematically varied to determine their effects on the expected lifetime NIHL-related cost of a specific US Navy sailor population. Our nominal noise-exposure case [93 dB(A) for six years] yielded a total expected lifetime cost of US $13,472 per sailor, with plausible lower and upper bounds of US $2,500 and US $26,000. Starting with the nominal case, a decrease of 50% in exposure level or duration would yield cost savings of approximately 23% and 19%, respectively. We concluded that a reduction in noise level would be more somewhat more cost-effective than the same percentage reduction in years of exposure. Our economic cost model can be used to estimate the changes in NIHL-related costs that would result from changes in noise-exposure level and/or duration for a single military population. Although the model is limited at present, suggestions are provided for adapting it to civilian populations.

  6. Mapping water availability, cost and projected consumptive use in the eastern United States with comparisons to the west

    Science.gov (United States)

    Tidwell, Vincent C.; Moreland, Barbie D.; Shaneyfelt, Calvin R.; Kobos, Peter

    2018-01-01

    The availability of freshwater supplies to meet future demand is a growing concern. Water availability metrics are needed to inform future water development decisions. With the help of water managers, water availability was mapped for over 1300 watersheds throughout the 31 contiguous states in the eastern US complimenting a prior study of the west. The compiled set of water availability data is unique in that it considers multiple sources of water (fresh surface and groundwater, wastewater and brackish groundwater); accommodates institutional controls placed on water use; is accompanied by cost estimates to access, treat and convey each unique source of water; and is compared to projected future growth in consumptive water use to 2030. Although few administrative limits have been set on water availability in the east, water managers have identified 315 fresh surface water and 398 fresh groundwater basins (with 151 overlapping basins) as areas of concern (AOCs) where water supply challenges exist due to drought related concerns, environmental flows, groundwater overdraft, or salt water intrusion. This highlights a difference in management where AOCs are identified in the east which simply require additional permitting, while in the west strict administrative limits are established. Although the east is generally considered ‘water rich’ roughly a quarter of the basins were identified as AOCs; however, this is still in strong contrast to the west where 78% of the surface water basins are operating at or near their administrative limit. Little effort was noted on the part of eastern or western water managers to quantify non-fresh water resources.

  7. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010.

    Science.gov (United States)

    Rehm, Colin D; Monsivais, Pablo; Drewnowski, Adam

    2015-04-01

    Food prices may be one reason for the growing socioeconomic disparities in diet quality. To evaluate the association between diet costs and the Healthy Eating Index-2010 (HEI-2010). Cross-sectional study based on 11,181 adults from the 2007-2010 National Health and Nutrition Examination Survey, analyzed in spring 2014. Diet cost was estimated by linking dietary data with a national food price database. The HEI-2010, a measure of adherence to the dietary guidelines, was the outcome. The population ratio method was used to estimate the average HEI-2010 scores by quintile of energy-adjusted diet cost. Additional analyses evaluated the association between cost and HEI-2010 components. There was a strong positive association between lower energy-adjusted diet costs and lower HEI-2010 scores. The association was stronger among women (p-interaction=0.003). Lower diet costs were associated with lower consumption of vegetables, fruits, whole grains, and seafood, and higher consumption of refined grains and solid fat, alcohol and added sugars. Lower energy-adjusted diet costs were associated with lower-quality diets. Future efforts to improve the nutritional status of the US public should take food prices and diet costs into account. Copyright © 2015. Published by Elsevier Inc.

  8. The Social Cost of Trading: Measuring the Increased Damages from Sulfur Dioxide Trading in the United States

    Science.gov (United States)

    Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.

    2011-01-01

    The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…

  9. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007-2010

    Science.gov (United States)

    Rehm, Colin D.; Monsivais, Pablo; Drewnowski, Adam

    2016-01-01

    Background Food prices may be one reason for the growing socioeconomic disparities in diet quality. Objective To evaluate the association between diet costs and the Healthy Eating Index-2010 (HEI-2010). Methods Cross-sectional study based on 11,181 adults from the 2007-2010 National Health and Nutrition Examination Survey, analyzed in spring 2014. Diet cost was estimated by linking dietary data with a national food price database. The HEI-2010, a measure of adherence to the Dietary Guidelines, was the outcome. The population ratio method was used to estimate the average HEI-2010 scores by quintile of energy-adjusted diet cost. Additional analyses evaluated the association between cost and HEI-2010 components. Results There was a strong positive association between lower energy-adjusted diet costs and lower HEI-2010 scores. The association was stronger among women (p-interaction=0.003). Lower diet costs were associated with lower consumption of vegetables, fruit, whole grains, and seafood, and higher consumption of refined grains and solid fat, alcohol and added sugars. Conclusions Lower energy-adjusted diet costs were associated with lower-quality diets. Future efforts to improve the nutritional status of the US public should take food prices and diet costs into account. PMID:25625693

  10. Cost-savings for biosimilars in the United States: a theoretical framework and budget impact case study application using filgrastim.

    Science.gov (United States)

    Grewal, Simrun; Ramsey, Scott; Balu, Sanjeev; Carlson, Josh J

    2018-05-18

    Biosimilars can directly reduce the cost of treating patients for whom a reference biologic is indicated by offering a highly similar, lower priced alternative. We examine factors related to biosimilar regulatory approval, uptake, pricing, and financing and the potential impact on drug expenditures in the U.S. We developed a framework to illustrate how key factors including regulatory policies, provider and patient perception, pricing, and payer policies impact biosimilar cost-savings. Further, we developed a budget impact cost model to estimate savings from filgrastim biosimilars under various scenarios. The model uses publicly available data on disease incidence, treatment patterns, market share, and drug prices to estimate the cost-savings over a 5-year time horizon. We estimate five-year cost savings of $256 million, of which 18% ($47 million) are from reduced patient out-of-pocket costs, 34% ($86 million) are savings to commercial payers, and 48% ($123 million) are savings for Medicare. Additional scenarios demonstrate the impact of uncertain factors, including price, uptake, and financing policies. A variety or interrelated factors influence the development, uptake, and cost-savings for Biosimilars use in the U.S. The filgrastim case is a useful example that illustrates these factors and the potential magnitude of costs savings.

  11. The estimated economic burden of genital herpes in the United States. An analysis using two costing approaches

    Directory of Open Access Journals (Sweden)

    Fisman David N

    2001-06-01

    Full Text Available Abstract Background Only limited data exist on the costs of genital herpes (GH in the USA. We estimated the economic burden of GH in the USA using two different costing approaches. Methods The first approach was a cross-sectional survey of a sample of primary and secondary care physicians, analyzing health care resource utilization. The second approach was based on the analysis of a large administrative claims data set. Both approaches were used to generate the number of patients with symptomatic GH seeking medical treatment, the average medical expenditures and estimated national costs. Costs were valued from a societal and a third party payer's perspective in 1996 US dollars. Results In the cross-sectional study, based on an estimated 3.1 million symptomatic episodes per year in the USA, the annual direct medical costs were estimated at a maximum of $984 million. Of these costs, 49.7% were caused by drug expenditures, 47.7% by outpatient medical care and 2.6% by hospital costs. Indirect costs accounted for further $214 million. The analysis of 1,565 GH cases from the claims database yielded a minimum national estimate of $283 million direct medical costs. Conclusions GH appears to be an important public health problem from the health economic point of view. The observed difference in direct medical costs may be explained with the influence of compliance to treatment and possible undersampling of subpopulations in the claims data set. The present study demonstrates the validity of using different approaches in estimating the economic burden of a specific disease to the health care system.

  12. Comparison of 2-Dose and 3-Dose 9-Valent Human Papillomavirus Vaccine Schedules in the United States: A Cost-effectiveness Analysis.

    Science.gov (United States)

    Laprise, Jean-François; Markowitz, Lauri E; Chesson, Harrell W; Drolet, Mélanie; Brisson, Marc

    2016-09-01

    A recent clinical trial using the 9-valent human papillomavirus virus (HPV) vaccine has shown that antibody responses after 2 doses are noninferior to those after 3 doses, suggesting that 2 and 3 doses may have comparable vaccine efficacy. We used an individual-based transmission-dynamic model to compare the population-level effectiveness and cost-effectiveness of 2- and 3-dose schedules of 9-valent HPV vaccine in the United States. Our model predicts that if 2 doses of 9-valent vaccine protect for ≥20 years, the additional benefits of a 3-dose schedule are small as compared to those of 2-dose schedules, and 2-dose schedules are likely much more cost-efficient than 3-dose schedules. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  13. Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

    Science.gov (United States)

    Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

    2014-01-01

    Objective We determined the minimum mortality reduction that helicopter emergency medical services (HEMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of minor injury patients. Methods We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective over a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality adjusted life year (QALY) gained compared to ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma (NSCOT), National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. Results HEMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the NSCOT cohort) to cost less than $100,000 per QALY gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per QALY. HEMS becomes more cost-effective with significant reductions in minor injury patients triaged to air transport or if long-term disability outcomes are improved. Conclusions HEMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably to other interventions considered cost-effective. Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction. Reducing overtriage of minor injury patients to HEMS would improve its cost-effectiveness. PMID:23582619

  14. Cost-Effectiveness of Alternative Blood-Screening Strategies for West Nile Virus in the United States.

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available BACKGROUND: West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist. METHODS AND FINDINGS: We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding US$1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings. CONCLUSIONS: In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations

  15. Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.

    Science.gov (United States)

    Zhang, Shanshan; Palazuelos-Munoz, Sarah; Balsells, Evelyn M; Nair, Harish; Chit, Ayman; Kyaw, Moe H

    2016-08-25

    Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain. We conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005-2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation. The average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90 % CI: $39,886, $44,765) and $21,448 (90 % CI: $21,152, $21,744) in 2015 US dollars. Hospital-onset CDI-attributable cost per case was $34,157 (90 % CI: $33,134, $35,180), which was 1.5 times the cost of community-onset CDI ($20,095 [90 % CI: $4991, $35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7-13.6) and 9.7 (90 % CI: 9.6-9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range: $1.9-$7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay. This review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.

  16. Cost-effectiveness of alternative blood-screening strategies for West Nile Virus in the United States.

    Directory of Open Access Journals (Sweden)

    Caroline T Korves

    2006-02-01

    Full Text Available West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist.We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding USD 1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings.In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients is cost

  17. Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States.

    Science.gov (United States)

    Sun, Shawn X; Liu, Gordon G; Christensen, Dale B; Fu, Alex Z

    2007-10-01

    To review the literature addressing the economic outcomes of nonadherence in the treatment of schizophrenia, and to utilize the review results to provide an update on the economic impact of hospitalizations among schizophrenia patients related to antipsychotic nonadherence. A structured search of EMBASE, Ovid MEDLINE, PubMed and PsycINFO for years 1995-2007 was conducted to identify published English-language articles addressing the economic impact of antipsychotic nonadherence in schizophrenia. The following key words were used in the search: compliance, noncompliance, adherence, nonadherence, relapse, economic, cost, and schizophrenia. A bibliographic search of retrieved articles was performed to identify additional studies. For a study to be included, the date of publication had to be from 1/1/1995 to 6/1/2007, and the impact of nonadherence had to be measured in terms of direct healthcare costs or inpatient days. Subsequently, an estimate of incremental hospitalization costs related to antipsychotic non adherence was extrapolated at the US national level based on the reviewed studies (nonadherence rate and hospitalization rate) and the National Inpatient Sample of Healthcare Cost and Utilization Project (average daily hospitalization costs). Seven studies were identified and reviewed based on the study design, measurement of medication nonadherence, study setting, and cost outcome results. Despite the varied adherence measures across studies, all articles reviewed showed that antipsychotic nonadherence was related to an increase in hospitalization rate, hospital days or hospital costs. We also estimated that the national rehospitalization costs related to antipsychotic nonadherence was $1479 million, ranging from $1392 million to $1826 million in the US in 2005. The estimate of rehospitalization costs was restricted to schizophrenia patients from the Medicaid program. Additionally, the studies we reviewed did not capture the newer antipsychotic drugs

  18. Comparing the cost effectiveness of nature-based and coastal adaptation: A case study from the Gulf Coast of the United States.

    Science.gov (United States)

    Reguero, Borja G; Beck, Michael W; Bresch, David N; Calil, Juliano; Meliane, Imen

    2018-01-01

    Coastal risks are increasing from both development and climate change. Interest is growing in the protective role that coastal nature-based measures (or green infrastructure), such as reefs and wetlands, can play in adapting to these risks. However, a lack of quantitative information on their relative costs and benefits is one principal factor limiting their use more broadly. Here, we apply a quantitative risk assessment framework to assess coastal flood risk (from climate change and economic exposure growth) across the United States Gulf of Mexico coast to compare the cost effectiveness of different adaptation measures. These include nature-based (e.g. oyster reef restoration), structural or grey (e.g., seawalls) and policy measures (e.g. home elevation). We first find that coastal development will be a critical driver of risk, particularly for major disasters, but climate change will cause more recurrent losses through changes in storms and relative sea level rise. By 2030, flooding will cost $134-176.6 billion (for different economic growth scenarios), but as the effects of climate change, land subsidence and concentration of assets in the coastal zone increase, annualized risk will more than double by 2050 with respect to 2030. However, from the portfolio we studied, the set of cost-effective adaptation measures (with benefit to cost ratios above 1) could prevent up to $57-101 billion in losses, which represents 42.8-57.2% of the total risk. Nature-based adaptation options could avert more than $50 billion of these costs, and do so cost effectively with average benefit to cost ratios above 3.5. Wetland and oyster reef restoration are found to be particularly cost-effective. This study demonstrates that the cost effectiveness of nature-based, grey and policy measures can be compared quantitatively with one another, and that the cost effectiveness of adaptation becomes more attractive as climate change and coastal development intensifies in the future. It also

  19. Cost-effectiveness of multidisciplinary care in mild to moderate chronic kidney disease in the United States: A modeling study

    Science.gov (United States)

    Malcolm, Elizabeth; Goldhaber-Fiebert, Jeremy D.

    2018-01-01

    Background Multidisciplinary care (MDC) programs have been proposed as a way to alleviate the cost and morbidity associated with chronic kidney disease (CKD) in the US. Methods and findings We assessed the cost-effectiveness of a theoretical Medicare-based MDC program for CKD compared to usual CKD care in Medicare beneficiaries with stage 3 and 4 CKD between 45 and 84 years old in the US. The program used nephrologists, advanced practitioners, educators, dieticians, and social workers. From Medicare claims and published literature, we developed a novel deterministic Markov model for CKD progression and calibrated it to long-term risks of mortality and progression to end-stage renal disease. We then used the model to project accrued discounted costs and quality-adjusted life years (QALYs) over patients’ remaining lifetime. We estimated the incremental cost-effectiveness ratio (ICER) of MDC, or the cost of the intervention per QALY gained. MDC added 0.23 (95% CI: 0.08, 0.42) QALYs over usual care, costing $51,285 per QALY gained (net monetary benefit of $23,100 at a threshold of $150,000 per QALY gained; 95% CI: $6,252, $44,323). In all subpopulations analyzed, ICERs ranged from $42,663 to $72,432 per QALY gained. MDC was generally more cost-effective in patients with higher urine albumin excretion. Although ICERs were higher in younger patients, MDC could yield greater improvements in health in younger than older patients. MDC remained cost-effective when we decreased its effectiveness to 25% of the base case or increased the cost 5-fold. The program costed less than $70,000 per QALY in 95% of probabilistic sensitivity analyses and less than $87,500 per QALY in 99% of analyses. Limitations of our study include its theoretical nature and being less generalizable to populations at low risk for progression to ESRD. We did not study the potential impact of MDC on hospitalization (cardiovascular or other). Conclusions Our model estimates that a Medicare-funded MDC

  20. Cost-effectiveness of multidisciplinary care in mild to moderate chronic kidney disease in the United States: A modeling study.

    Directory of Open Access Journals (Sweden)

    Eugene Lin

    2018-03-01

    Full Text Available Multidisciplinary care (MDC programs have been proposed as a way to alleviate the cost and morbidity associated with chronic kidney disease (CKD in the US.We assessed the cost-effectiveness of a theoretical Medicare-based MDC program for CKD compared to usual CKD care in Medicare beneficiaries with stage 3 and 4 CKD between 45 and 84 years old in the US. The program used nephrologists, advanced practitioners, educators, dieticians, and social workers. From Medicare claims and published literature, we developed a novel deterministic Markov model for CKD progression and calibrated it to long-term risks of mortality and progression to end-stage renal disease. We then used the model to project accrued discounted costs and quality-adjusted life years (QALYs over patients' remaining lifetime. We estimated the incremental cost-effectiveness ratio (ICER of MDC, or the cost of the intervention per QALY gained. MDC added 0.23 (95% CI: 0.08, 0.42 QALYs over usual care, costing $51,285 per QALY gained (net monetary benefit of $23,100 at a threshold of $150,000 per QALY gained; 95% CI: $6,252, $44,323. In all subpopulations analyzed, ICERs ranged from $42,663 to $72,432 per QALY gained. MDC was generally more cost-effective in patients with higher urine albumin excretion. Although ICERs were higher in younger patients, MDC could yield greater improvements in health in younger than older patients. MDC remained cost-effective when we decreased its effectiveness to 25% of the base case or increased the cost 5-fold. The program costed less than $70,000 per QALY in 95% of probabilistic sensitivity analyses and less than $87,500 per QALY in 99% of analyses. Limitations of our study include its theoretical nature and being less generalizable to populations at low risk for progression to ESRD. We did not study the potential impact of MDC on hospitalization (cardiovascular or other.Our model estimates that a Medicare-funded MDC program could reduce the need for

  1. 76 FR 38700 - United States, et al.

    Science.gov (United States)

    2011-07-01

    ... prices in advertisements, in-store displays, and online. Consumer World believes these rules should be... has ruled on that motion. I. Procedural History The United States and seven Plaintiff States filed the... Restraints result in higher merchant costs, and merchants generally pass costs on to consumers, retail prices...

  2. Cost-effectiveness of a 12-dose regimen for treating latent tuberculous infection in the United States

    Science.gov (United States)

    Shepardson, D.; Marks, S. M.; Chesson, H.; Kerrigan, A.; Holland, D. P.; Scott, N.; Tian, X.; Borisov, A. S.; Shang, N.; Heilig, C. M.; Sterling, T. R.; Villarino, M. E.; Mac Kenzie, W. R.

    2017-01-01

    SUMMARY SETTING A large randomized controlled trial recently showed that for treating latent tuberculous infection (LTBI) in persons at high risk of progression to tuberculosis (TB) disease, a 12-dose regimen of weekly rifapentine plus isoniazid (3HP) administered as directly observed treatment (DOT) can be as effective as 9 months of daily self-administered isoniazid (9H). OBJECTIVES To assess the cost-effectiveness of 3HP compared to 9H. DESIGN A computational model was designed to simulate individuals with LTBI treated with 9H or 3HP. Costs and health outcomes were estimated to determine the incremental costs per active TB case prevented and per quality-adjusted life year (QALY) gained by 3HP compared to 9H. RESULTS Over a 20-year period, treatment of LTBI with 3HP rather than 9H resulted in 5.2 fewer cases of TB and 25 fewer lost QALYs per 1000 individuals treated. From the health system and societal perspectives, 3HP would cost respectively US$21 525 and $4294 more per TB case prevented, and respectively $4565 and $911 more per QALY gained. CONCLUSIONS 3HP may be a cost-effective alternative to 9H, particularly if the cost of rifapentine decreases, the effectiveness of 3HP can be maintained without DOT, and 3HP treatment is limited to those with a high risk of progression to TB disease. PMID:24200264

  3. Outcomes, utilization, and costs among thalassemia and sickle cell disease patients receiving deferoxamine therapy in the United States.

    Science.gov (United States)

    Delea, Thomas E; Hagiwara, May; Thomas, Simu K; Baladi, Jean-Francois; Phatak, Pradyumna D; Coates, Thomas D

    2008-04-01

    Deferoxamine mesylate (DFO) reduces morbidity and mortality associated with transfusional iron overload. Data on the utilization and costs of care among U.S. patients receiving DFO in typical clinical practice are limited however. This was a retrospective study using a large U.S. health insurance claims database spanning 1/97-12/04 and representing 40 million members in >70 health plans. Study subjects (n = 145 total, 106 sickle cell disease [SCD], 39 thalassemia) included members with a diagnosis of thalassemia or SCD, one or more transfusions (whole blood or red blood cells), and one or more claims for DFO. Mean transfusion episodes were 12 per year. Estimated mean DFO use was 307 g/year. Central venous access devices were required by 20% of patients. Cardiac disease was observed in 16% of patients. Mean total medical costs were $59,233 per year including $10,899 for DFO and $8,722 for administration of chelation therapy. In multivariate analyses, potential complications of iron overload were associated with significantly higher medical care costs. In typical clinical practice, use of DFO in patients with thalassemia and SCD receiving transfusions is low. Administration costs represent a large proportion of the cost of chelation therapy. Potential complications of iron overload are associated with increased costs. (c) 2007 Wiley-Liss, Inc.

  4. Cost-effectiveness of 2009 pandemic influenza A(H1N1 vaccination in the United States.

    Directory of Open Access Journals (Sweden)

    Lisa A Prosser

    Full Text Available Pandemic influenza A(H1N1 (pH1N1 was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination.A computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY gained. Sensitivity analyses were conducted.For vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000-$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery.Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of

  5. Expanding the usefulness of unit supply cost

    International Nuclear Information System (INIS)

    McKenzie, M.B.; Petr, K.

    1992-01-01

    Unit supply cost is a widely used tool in the energy business for providing a one number-unit cost description. For example, controllable costs such as finding costs, development costs and operating costs have traditionally been described in an average cost per unit of reserves format for the oil and gas industry, however using this approach on more specific applications is not always informative. Projects with widely varying controllable parameters can still yield the same unit cost, making comparisons difficult. The application of unit supply cost can be readily expanded by adding a new unit cost component termed cost of capital. This element introduces the impacts of timing and return on investment into the supply cost determination through discounting annual costs. The cost of capital component adds the ability to represent a project's unique characteristics, particularly reserves' depletion rate and the timing or phasing of development. Introducing the cost of capital element into the supply cost analysis provides additional information and improves the likelihood of drawing correct conclusions when comparing and ranking projects. 4 figs., 6 tabs

  6. The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model.

    Science.gov (United States)

    Chesson, Harrell W; Markowitz, Lauri E; Hariri, Susan; Ekwueme, Donatus U; Saraiya, Mona

    2016-06-02

    The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information. Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV. Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.

  7. Analysis of real-world health care costs among immunocompetent patients aged 50 years or older with herpes zoster in the United States.

    Science.gov (United States)

    Meyers, Juliana L; Madhwani, Shweta; Rausch, Debora; Candrilli, Sean D; Krishnarajah, Girishanthy; Yan, Songkai

    2017-08-03

    Few peer-reviewed publications present real-world United States (US) data describing resource utilization and costs associated with herpes zoster (HZ) and postherpetic neuralgia (PHN). The primary objective of this analysis (GSK study identifier: HO-14-14270) was to assess direct costs associated with HZ and PHN in the US using a retrospective managed care insurance claims database. Patients ≥ 50 y at HZ diagnosis were selected. Patients were excluded if they were immunocompromised before diagnosis or received an HZ vaccine at any time. A subsample of patients with PHN was identified. Each patient with HZ was matched to ≤ 4 controls without HZ based on age, sex, and health plan enrollment. Incremental differences in mean HZ-related costs ("incremental costs") were assessed overall and stratified by age. Multivariable regression models controlled for the effect of demographic characteristics, prediagnosis costs, and comorbidity burden on costs using a recycled predictions approach. Overall, 142,519 patients with HZ (9,470 patients [6.6%] had PHN) and 357,907 matched controls without HZ were identified. Resource utilization was greater among patients with HZ than controls. After adjusting for demographic and clinical characteristics, annual incremental health care costs for HZ patients vs. controls were $1,210 for patients aged 50-59 years, $1,629 for those 60-64 years, $1,876 for those 65-69 years, $2,643 for those 70-79 years, and $3,804 for those 80+ years; adjusted annual incremental costs among PHN patients vs. controls were $4,670 for patients 50-59 years, $6,133 for those 60-64 years, $6,451 for those 65-69 years, $8,548 for those 70-79 years, and $11,147 for those 80+ years. HZ is associated with a significant cost burden, which increases with advancing patient age. Vaccination may reduce costs associated with HZ through case avoidance.

  8. Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States.

    Science.gov (United States)

    Li, Qian; Blume, Steven W; Huang, Joanna C; Hammer, Mette; Ganz, Michael L

    2015-01-01

    This study estimated the economic burden of obesity-related comorbidities (ORCs) in the US, at both the person and population levels. The Geisinger Health System provided electronic medical records and claims between January 2004 and May 2013 for a sample of 153,561 adults (50% males and 97% white). Adults with A total of 21 chronic conditions, with established association with obesity in the literature, were identified by diagnosis codes and/or lab test results. The total healthcare costs were measured in each year. The association between annual costs and ORCs was assessed by a regression, which jointly considered all the ORCs. The per-person incremental costs of a single comorbidity, without any of the other ORCs, were calculated. The population-level economic burden was the product of each ORC's incremental costs and the annual prevalence of the ORC among 100,000 individuals. The prevalence of ORCs was stratified by obesity status to estimate the economic burden among 100,000 individuals with obesity and among those without. This study identified 56,895 adults (mean age = 47 years; mean BMI = 29.6 kg/m(2)). The annual prevalence of ORCs ranged from 0.5% for pulmonary embolism (PE) to 41.8% for dyslipidemia. The per-person annual incremental costs of a single ORC ranged from $120 for angina to $1665 for PE. Hypertensive diseases (HTND), dyslipidemia, and osteoarthritis were the three most expensive ORCs at the population level; each responsible for ≥$18 million annually among 100,000 individuals. HTND and osteoarthritis were much more costly among individuals with obesity than those without obesity. Data were from a small geographic region. ORCs are associated with substantial economic burden, especially for those requiring continuous treatments.

  9. Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States.

    Science.gov (United States)

    Zhang, Dongmu; Prabhu, Vimalanand S; Marcella, Stephen W

    2018-04-17

    The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI). This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs). A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01-5.39) and 1.95 days (95% CI, 1.48-2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436-$25013) and $10580 (95% CI, $8849-$12446), respectively. The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI.

  10. The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

    OpenAIRE

    Chesson, Harrell W.; Markowitz, Lauri E.; Hariri, Susan; Ekwueme, Donatus U.; Saraiya, Mona

    2016-01-01

    Introduction: The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. Methods: We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined w...

  11. Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States.

    Science.gov (United States)

    Padula, William V; Larson, Richard A; Dusetzina, Stacie B; Apperley, Jane F; Hehlmann, Rudiger; Baccarani, Michele; Eigendorff, Ekkehard; Guilhot, Joelle; Guilhot, Francois; Hehlmann, Rudiger; Mahon, Francois-Xavier; Martinelli, Giovanni; Mayer, Jiri; Müller, Martin C; Niederwieser, Dietger; Saussele, Susanne; Schiffer, Charles A; Silver, Richard T; Simonsson, Bengt; Conti, Rena M

    2016-07-01

    We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs. We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP. © The Author 2016. Published by Oxford University Press.

  12. An evaluation of cost estimates of nuclear power reactor decommissioning in Sweden, Germany and the United States

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, S O; Varley, G; Heibel, R; Rusch, C [NAC International, Zurich (Switzerland)

    1995-11-01

    Nominal base decommissioning cost estimates in Sweden, Germany and the US differ by large amounts. Even after adjustments to normalize the work scopes, significant cost differences remain. Variations in national cost structures, achievable productivity, the extent of preexisting infrastructure and institutional factors all contribute to make up the differences. Exchange rate aberrations are a complication for which appropriate adjustments have to be made in order to achieve a meaningful comparison. Our analyses demonstrate that virtually all these differences between the Swedish, German and US estimates can be explained by these factors. In terms of the overall reasonableness of the Swedish estimate as a basis for making financial provisions, there remain some issues that may warrant further investigation. One is the potential for and financial consequences of a serious interruption to the proposed sea transportation system. Secondly, the limited number of individual system analyses we have performed indicated some significant potential underestimates. For example, dismantling of the reactor pressure vessel costs appear to be underestimated by up to 70 MSEK (about 10 MUSD) per reactor, or up to 900 MSEK for the whole Swedish program of 12 reactors. Overall, the Swedish estimates appear to be built up in a logical and reasonable way. Our analyses indicate that some internal inconsistencies exist and that some specific input data assumptions may not be valid. In summary, the credibility of the estimates would benefit from further refinement of the scenarios and assumptions. 21 refs., 15 figs., 42 tabs.

  13. An evaluation of cost estimates of nuclear power reactor decommissioning in Sweden, Germany and the United States

    International Nuclear Information System (INIS)

    Andersson, S.O.; Varley, G.; Heibel, R.; Rusch, C.

    1995-11-01

    Nominal base decommissioning cost estimates in Sweden, Germany and the US differ by large amounts. Even after adjustments to normalize the work scopes, significant cost differences remain. Variations in national cost structures, achievable productivity, the extent of preexisting infrastructure and institutional factors all contribute to make up the differences. Exchange rate aberrations are a complication for which appropriate adjustments have to be made in order to achieve a meaningful comparison. Our analyses demonstrate that virtually all these differences between the Swedish, German and US estimates can be explained by these factors. In terms of the overall reasonableness of the Swedish estimate as a basis for making financial provisions, there remain some issues that may warrant further investigation. One is the potential for and financial consequences of a serious interruption to the proposed sea transportation system. Secondly, the limited number of individual system analyses we have performed indicated some significant potential underestimates. For example, dismantling of the reactor pressure vessel costs appear to be underestimated by up to 70 MSEK (about 10 MUSD) per reactor, or up to 900 MSEK for the whole Swedish program of 12 reactors. Overall, the Swedish estimates appear to be built up in a logical and reasonable way. Our analyses indicate that some internal inconsistencies exist and that some specific input data assumptions may not be valid. In summary, the credibility of the estimates would benefit from further refinement of the scenarios and assumptions. 21 refs., 15 figs., 42 tabs

  14. 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.

  15. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

  16. CHARACTERIZING COSTS, SAVINGS AND BENEFITS OF A SELECTION OF ENERGY EFFICIENT EMERGING TECHNOLOGIES IN THE UNITED STATES

    Energy Technology Data Exchange (ETDEWEB)

    Xu, T.; Slaa, J.W.; Sathaye, J.

    2010-12-15

    Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing CO2 emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing the costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world. Successful implementation of emerging technologies not only can help advance productivities and competitiveness but also can play a significant role in mitigation efforts by saving energy. Providing evaluation and estimation of the costs and energy savings potential of emerging technologies is the focus of our work in this project. The overall goal of the project is to identify and select emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. This report contains the results from performing Task 2"Technology evaluation" for the project titled"Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies," which was sponsored by California Energy Commission and managed by CIEE. The project purpose is to analyze market status, market potential, and economic viability of selected technologies applicable to the U.S. In this report, LBNL first performed re-assessments of all of the 33 emerging energy-efficient industrial technologies, including re-evaluation of the 26 technologies that were previously identified by Martin et al. (2000) and

  17. The United States

    International Nuclear Information System (INIS)

    Art, R.J.

    1991-01-01

    This paper reports that at least in the national security arena, the outcomes of bureaucratic infighting and domestic political struggles are not determined wholly by what goes on with the state. Rather struggles among contending groups are greatly affected by what is perceived to be happening outside the nation. Because external conditions give greater potency to some domestic forces over other, the external environment is never neutral in its domestic impact. The decisions of the period 1950-53 discussed above illustrate the point. But so too do the decisions of 1947, 1960-61 and 1969-72. In the 1947 case, Soviet intransigence provoked US nuclear rearmament. In the 1960-61 case, extended deterrent considerations pushed the United States to preserve its again newly discovered nuclear superiority. In the 1969-72 case, a Soviet determination to remain equal forced US acceptance of nuclear equality. And perhaps the best evidence of all, the perpetuation of parity ended the US inclination to resort to nuclear brinkmanship. In each instance, concerns about relative position heavily affected nuclear choice. Finally, the events of the past three years testify to the effects of international events on domestic choice. Under the terms of the 1987 INF Treaty, the two superpowers decided to dismantle and destroy an entire class of missiles of intermediate range (500-3000 kilometers) that both had deployed in Europe in the 1970s and 1980s, and in their June 1990 joint statement on strategic nuclear weapons, President Gorbachev and Brush agreed to cut the number of Soviet and US long range nuclear forces by 30 per cent. This agreement marks a watershed in US-Soviet strategic arm negotiations because for the first time the United States and the Soviet Union agreed in principals to reduce the number of weapons aimed at one another. Between 1985 and 1990 the cold war was brought to a close

  18. Healthcare Data Analytics for Parkinson's Disease Patients: A Study of Hospital Cost and Utilization in the United States.

    Science.gov (United States)

    Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette

    2016-01-01

    Parkinson's Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients.

  19. Forest management units through cost

    Directory of Open Access Journals (Sweden)

    Cristina Tenovici

    2010-12-01

    Full Text Available Costs minimizing and profit maximizing make the costs adjustment seems to be a vital necessity when the activity developed within the company does not assure the maintenance and stability of the necessary relation between consuming factors and costs. In such circumstances, approaching differing sides of the production cost and improving the methods of calculation has much significance in determining the most appropriate measures necessary for its adjustment and for profit increasing. The whole informational process of costs – formation, control and analysis of costs – involves a careful use the methodological concepts known under the name of classical methods and modern or complementary methods, as well as of other proceedings. Such methods and proceedings cannot be applied separately, only conjugated and integrated in a unitary methodological system, each of these methods and proceedings participating at achieving one or more objectives. Only by their unitary action they can fulfill all the system objective.

  20. Hydrologic Change during the Colonial Era of the United States: Beavers and the Energy Cost of Impoundments (Invited)

    Science.gov (United States)

    Green, M. B.; Bain, D. J.; Arrigo, J. S.; Duncan, J. M.; Kumar, S.; Parolari, A.; Salant, N.; Vorosmarty, C. J.; Aloysius, N. R.; Bray, E. N.; Ruffing, C. M.; Witherell, B. B.

    2009-12-01

    Europeans colonized North America in the early 17th century with intentions ranging between long-term inhabitation and quick extraction of resources for economic gain in Europe. Whatever the intentions, the colonists relied on the landscape for resources resulting in dramatic change to the forest and fur-bearing mammal population. We demonstrate that initial exploitation of North American forest and furs caused a substantial decrease in mean water residence time (τ) between 1600 and 1800 A.D. That loss, which regionally changed from 51 to 41 days, contrasts with conventional wisdom that humans tend to diminish variability in water resources by increasing storage capacity and thus increasing τ. The loss of τ resulted from over-hunted beaver for the hat market in Europe. Analysis suggests that colonial era demographics and economics did not allow human resource allocation to impoundment construction on a level matching the historic beaver effort. However, the τ appears to have regionally increased during the 19th century, suggesting that humans eventually began replacing the water storage lost with the beaver. The analysis highlights the energy cost of impounding water, which is likely to continue to be an important factor given the increasing need for stable water resources and finite energy resources.

  1. The Epidemiology, Diagnosis, and Cost of Dyspepsia and Helicobater pylori Gastritis: A Case–Control Analysis in the Southwestern United States

    Science.gov (United States)

    Mapel, Douglas; Roberts, Melissa; Overhiser, Andrew; Mason, Andrew

    2013-01-01

    Background Dyspepsia is among the most common complaints evaluated by gastroenterologists, but there are few studies examining its current epidemiology, evaluation, and costs. We examined these issues in a large managed care system in the Southwestern United States. Methods We conducted a retrospective case–control analysis of adults with incident dyspepsia or a Helicobacter pylori-related condition in years 2006 through 2010 using utilization data. Medical record abstraction of 400 cases was conducted to obtain additional clinical information. Results A total of 6989 cases met all inclusion and exclusion criteria. Women had a substantially higher risk of dyspepsia than men (14 per 1000 per year vs 10 per 1000; p < .001), and the incidence of dyspepsia increased with age such that persons in their seventh decade had almost twice the risk of those aged 18–29. Hispanic persons had a significantly higher risk of dyspepsia and positive H. pylori testing. Dyspepsia cases had a higher prevalence of other chronic comorbidities than their matched controls. Dyspepsia patients had healthcare costs 54% higher than controls even before the diagnosis was made, and costs in the initial diagnostic period were $483 greater per person, but subsequent costs were not greatly affected. Among those aged 55 and younger, the “test and treat” approach was used in 53% and another 18% had an initial esophagogastroduodenoscopy, as compared to 47 and 27%, respectively, among those over the age of 55. Conclusions Women and older adults have a higher incidence of dyspepsia than previously appreciated, and Hispanics in this region also have a higher risk. Current guidelines for dyspepsia evaluation are only loosely followed. PMID:23067108

  2. A GIS cost model to assess the availability of freshwater, seawater, and saline groundwater for algal biofuel production in the United States.

    Science.gov (United States)

    Venteris, Erik R; Skaggs, Richard L; Coleman, Andre M; Wigmosta, Mark S

    2013-05-07

    A key advantage of using microalgae for biofuel production is the ability of some algal strains to thrive in waters unsuitable for conventional crop irrigation such as saline groundwater or seawater. Nonetheless, the availability of sustainable water supplies will provide significant challenges for scale-up and development of algal biofuels. We conduct a partial techno-economic assessment based on the availability of freshwater, saline groundwater, and seawater for use in open pond algae cultivation systems. We explore water issues through GIS-based models of algae biofuel production, freshwater supply (constrained to less than 5% of mean annual flow per watershed) and costs, and cost-distance models for supplying seawater and saline groundwater. We estimate that, combined, these resources can support 9.46 × 10(7) m(3) yr(-1) (25 billion gallons yr(-1)) of renewable biodiesel production in the coterminous United States. Achievement of larger targets requires the utilization of less water efficient sites and relatively expensive saline waters. Despite the addition of freshwater supply constraints and saline water resources, the geographic conclusions are similar to our previous results. Freshwater availability and saline water delivery costs are most favorable for the coast of the Gulf of Mexico and Florida peninsula, where evaporation relative to precipitation is moderate. As a whole, the barren and scrub lands of the southwestern U.S. have limited freshwater supplies, and large net evaporation rates greatly increase the cost of saline alternatives due to the added makeup water required to maintain pond salinity. However, this and similar analyses are particularly sensitive to knowledge gaps in algae growth/lipid production performance and the proportion of freshwater resources available, key topics for future investigation.

  3. 45 CFR 212.7 - Repayment to the United States.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Repayment to the United States. 212.7 Section 212... UNITED STATES CITIZENS RETURNED FROM FOREIGN COUNTRIES § 212.7 Repayment to the United States. (a) An..., any or all of the cost of such assistance to the United States, except insofar as it is determined...

  4. State cost sharing of training

    International Nuclear Information System (INIS)

    Montgomery, J.M.; Flater, D.A.; Hughes, D.R. Sr.; Lubenau, J.O.; Merges, P.J.; Mobley, M.H.; Raglin, K.A.

    1989-08-01

    In March 1988, The Office of Governmental and Public Affairs (GPA) completed a report (NUREG-1311) entitled, ''Funding the NRC Training Program for States.'' This report responded to a Commission's request for study of NRC's long-standing practice of paying the travel and per diem of state personnel who attend NRC sponsored training. In May 1988, the Chairman endorsed the report in most respects but asked for further study of a cost sharing of travel and per diem costs. As a result, the Director of GPA's State, Local and Indian Tribe Programs (SLITP) established a Task Force comprised of representatives from the Conference of Radiation Control Program Directors, Inc., the Agreement States and the NRC to look at ways that the states can share the costs of NRC training, particularly travel and per diem. At the request of the Director, GPA, the Task Force also looked at related cost and quantity issues associated with the NRC training program for state personnel. This report includes a discussion of NRC and state perspectives on the issue of sharing travel and per diem costs, a discussion of options, and recommendations for likely cost savings and quality of training improvement. 1 ref., 3 figs., 2 tabs

  5. Overcoming the Challenges in Implementing Type 2 Diabetes Mellitus Prevention Programs Can Decrease the Burden on Healthcare Costs in the United States

    Directory of Open Access Journals (Sweden)

    Kritika Subramanian

    2017-01-01

    Full Text Available Theoretically, identifying prediabetics would reduce the diabetic burden on the American healthcare system. As we expect the prevalence rate of prediabetes to continue increasing, we wonder if there is a better way of managing prediabetics and reducing the economic cost on the healthcare system. To do so, understanding the demographics and behavioral factors of known prediabetics was important. For this purpose, responses of prediabetic/borderline diabetes patients from the most recent publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS survey were analyzed. The findings showed that there was a correlation between household income, geographic residence in the US, and risk for developing diabetes mellitus type 2, aside from the accepted risk factors such as high BMI. In conclusion, implementation of the National Diabetes Prevention Program is a rational way of reducing the burden of DM on the healthcare system both economically and by prevalence. However, difficulties arise in ensuring patient compliance to the program and providing access to all regions and communities of the United States. Technology incorporation in the NDPP program would maintain a low-cost implementation by the healthcare system, be affordable and accessible for all participants, and decrease economic burden attributed to diabetes mellitus.

  6. The United States Special Operations Command Civil Military Engagement Program - A Model for Military-Interagency Low Cost / Small Footprint Activities

    Science.gov (United States)

    2014-05-02

    advance United States goals and objectives with less than optimal budgets. Gabriel Marcella provides an interagency perspective regarding the United...The Department of State mission is to “integrate 9 Gabriel Marcella , “Affairs of the State,” In...Christopher. "Implementing the QDDR." Interagency Journal 3-1 (Winter), 2012: 8. Marcella , Gabriel. Strategic Studies Institute: The Interagency

  7. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-02-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

  8. Assessment of cost of innovation versus the value of health gains associated with treatment of chronic hepatitis C in the United States: The quality-adjusted cost of care.

    Science.gov (United States)

    Younossi, Zobair M; Park, Haesuk; Dieterich, Douglas; Saab, Sammy; Ahmed, Aijaz; Gordon, Stuart C

    2016-10-01

    New direct-acting antiviral (DAA) therapy has dramatically increased cure rates for patients infected with hepatitis C virus (HCV), but has also substantially raised treatment costs. The aim of this analysis was to evaluate the therapeutic benefit and net costs (i.e. efficiency frontier) and the quality-adjusted cost of care associated with the evolution of treatment regimens for patients with HCV genotype 1 in the United States. A decision-analytic Markov model. Published literature and clinical trial data. Life Time. Third-party payer. This study compared four approved regimens in treatment-naïve genotype 1 chronic hepatitis C patients, including pegylated interferon and ribavirin (PR), first generation triple therapy (boceprevir + PR and telaprevir + PR), second generation triple therapy (sofosbuvir + PR and simeprevir + PR) and all-oral DAA regimens (ledipasvir/sofosbuvir and ombitasvir + paritaprevir/ritonavir + dasabuvir ± ribavirin). Quality-adjusted cost of care (QACC). QACC was defined as the increase in treatment cost minus the increase in the patient's quality-adjusted life years (QALYs) when valued at $50,000 per QALY. All-oral therapy improved the average sustained virologic response (SVR) rate to 96%, thereby offsetting the high drug acquisition cost of $85,714, which resulted in the highest benefit based on the efficiency frontier. Furthermore, while oral therapies increased HCV drug costs by $48,350, associated QALY gains decreased quality-adjusted cost of care by $14,120 compared to dual therapy. When the value of a QALY was varied from $100,000 to $300,000, the quality adjusted cost of care compared to dual therapy ranged from - $21,234 to - $107,861, - $89,007 to - $293,130, - $176,280 to - $500,599 for first generation triple, second generation triple, and all-oral therapies, respectively. Primary efficacy and safety measurements for drug regimens were sourced from clinical trials data rather than a real

  9. Regional Comparative Unit Cost Studies for Maintenance and Operation of Physical Plants in Universities and Colleges in Central States Region and Rocky Mountain Region.

    Science.gov (United States)

    Association of Physical Plant Administrators, Corvallis, OR.

    Presented in this document are data pertaining to maintenance and operations costs at colleges and universities in the central states region and the Rocky Mountain region. The major accounts included in the cost analysis are: (1) physical plant administration, (2) building maintenance, (3) custodial services, (4) utilities, (5) landscape and…

  10. Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States.

    Science.gov (United States)

    Kumar, Krishna; Bishop, Sharon

    2009-06-01

    Many institutions with spinal cord stimulation (SCS) programs fail to realize that besides the initial implantation cost, budgetary allocation must be made to address annual maintenance costs as well as complications as they arise. Complications remain the major contributing factor to the overall expense of SCS. The authors present a formula that, when applied, provides a realistic representation of the actual costs necessary to implant and maintain SCS systems in Canada and the US. The authors performed a retrospective analysis of 197 cases involving SCS (161 implanted and 36 failed trial stimulations) between 1995 and 2006. The cost of patient workup, initial implantation, annual maintenance, and resources necessary to resolve complications were assessed for each case and a unit cost applied. The total cost allocated for each case was determined by summing across healthcare resource headings. Using the same parameters, the unit cost was calculated in both Canadian (CAD) and US dollars (USD) at 2007 prices. The cost of implanting a SCS system in Canada is $21,595 (CAD), in US Medicare $32,882 (USD), and in US Blue Cross Blue Shield (BCBS) $57,896 (USD). The annual maintenance cost of an uncomplicated case in Canada is $3539 (CAD), in US Medicare $5071 (USD), and in BCBS $7277 (USD). The mean cost of a complication was $5191 in Canada (range $136-18,837 [CAD]). In comparison, in the US the figures were $9649 (range $381-28,495) for Medicare and $21,390 (range $573-54,547) for BCBS (both USD). Using these calculations a formula was derived as follows: the annual maintenance cost (a) was added to the average annual cost per complication per patient implanted (b); the sum was then divided by the implantation cost (c); and the result was multiplied by 100 to obtain a percentage (a + b / c x 100). To make this budgetary cap universally applicable, the results from the application of the formula were averaged, resulting in an 18% premium. For budgeting purposes the

  11. 7 CFR 1160.104 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1160.104 Section 1160.104 Agriculture... Definitions § 1160.104 United States. United States means the 48 contiguous states in the continental United States and the District of Columbia, except that United States means the 50 states of the United States...

  12. United States mineral resources

    Science.gov (United States)

    Brobst, Donald A.; Pratt, Walden P.

    1973-01-01

    650 of the U.S. Bureau of Mines) ; indeed, we regard that book and the present volume as being complementary. In the examination of the geologic possibilities for finding new deposits-in many respects the principal innovative contributions of this volume-we asked the authors to frankly apply the limits of their ingenuity and not only to summarize current theories but also to express their own intuitive ideas, however speculative and unconventional they may seem, that have come from years of study devoted to the origin of mineral deposits. Readers will see that some authors have speculated more courageously than others. In any case, we believe readers will find all the chapters interesting, and many stimulating; and a few we believe can be frankly characterized as intellectually exciting. Most chapters include a section on prospecting techniques, and a summary of geologic or related problems on which the authors believe research might be most fruitful in the continuing efforts to find new resources. An integral part of the book is the bibliographic material cited at the conclusion of each chapter, in lieu of repetition of detailed descriptions already in print. Index and "spot" maps are not included in most chapters because they are available elsewhere, and in many cases with more detail than could possibly be included here. Maps showing the distribution of known deposits of many commodities in the United States are available in the Mineral Resource (MR) map series of the U.S. Geological Survey and in the National Atlas of the United States. The first three chapters deal not with resources of specific commodities but with general information that is pertinent to the study of mineral resources. In the introductory chapter we discuss the purposes of the book, the distinctions between reserves and various categories of resources, and some general conclusions drawn from our view of the book in its entirety. In the second chapter V. E. McKelvey discusses the problems of

  13. Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis.

    Directory of Open Access Journals (Sweden)

    Cora L Bernard

    2017-05-01

    Full Text Available The risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID a public health priority. Some of these programs have benefits beyond prevention of HIV-a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT, needle and syringe programs (NSPs, HIV testing and treatment (Test & Treat, and oral HIV pre-exposure prophylaxis (PrEP.We adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars, health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs], and incremental cost-effectiveness ratios (ICERs of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000 infections and cost US$18,000 (95% CI: US$14,000, US$24,000 per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000 infections and cost US$25,000 (95% CI: US

  14. Low-cost inertial measurement unit.

    Energy Technology Data Exchange (ETDEWEB)

    Deyle, Travis Jay

    2005-03-01

    Sandia National Laboratories performs many expensive tests using inertial measurement units (IMUs)--systems that use accelerometers, gyroscopes, and other sensors to measure flight dynamics in three dimensions. For the purpose of this report, the metrics used to evaluate an IMU are cost, size, performance, resolution, upgradeability and testing. The cost of a precision IMU is very high and can cost hundreds of thousands of dollars. Thus the goals and results of this project are as follows: (1) Examine the data flow in an IMU and determine a generic IMU design. (2) Discuss a high cost IMU implementation and its theoretically achievable results. (3) Discuss design modifications that would save money for suited applications. (4) Design and implement a low cost IMU and discuss its theoretically achievable results. (5) Test the low cost IMU and compare theoretical results with empirical results. (6) Construct a more streamlined printed circuit board design reducing noise, increasing capabilities, and constructing a self-contained unit. Using these results, we can compare a high cost IMU versus a low cost IMU using the metrics from above. Further, we can examine and suggest situations where a low cost IMU could be used instead of a high cost IMU for saving cost, size, or both.

  15. United States panel presentations

    International Nuclear Information System (INIS)

    Beyea, J.

    1990-01-01

    Before I begin I have to make a disclaimer. That is that I am going to be talking about public perception because I think that is very important. But I do not want to give the impression that I think the public is wrong. I happen to agree with the public's perception of nuclear power, and I want to make that clear. I do not like the current generation of nuclear plants as I have made clear in many statements that I have made. On the other hand, in the long term, I feel that we have only two choices on the supply side, and that is nuclear power and solar electricity. And although I think solar electricity has the best chance, I am realistic enough to know that technologies do not always work the way I want. And so I think it is necessary to have at least some kind of nuclear option available. On the other hand, I do not think just any kind of nuclear technology will do. I want to talk to you about the conditions that I think you have to take into account when you try to design reactors that are publicly acceptable. I look at this as an insurance policy. Again, I do not want to be misquoted: I think nuclear power should be considered as an insurance policy, not as our first line of defense. Having made those disclaimers, what we need to do is set out a problem statement. The problem statement I set out is, 'How could one design and demonstrate a nuclear reactor that would regain public confidence in the United States, if one chose to do that?' By regaining confidence, I mean regaining sufficient confidence to site reactors at a number of locations. It is a pretty heavy task because the public cannot judge the technical issues. They have to judge the players by their characters and their histories, just as the way we calibrate anyone that knows things that we do not. I have three theses that I think are crucial. The first is that people do not believe in the claims of advocates, of any point of view, not just nuclear power, once the advocates have been proved wrong on

  16. Nuclear power in the United States

    International Nuclear Information System (INIS)

    Johnston, J.B.

    1985-01-01

    All over the world except in the United States, nuclear energy is a low cost, secure, environmentally acceptable form of energy. In the United States, civilian nuclear power is dead. 112 nuclear power plants have been abandoned or cancelled in the last decade, and there has been no new order for nuclear plants since 1978. It will be fortunate to have 125 operating nuclear plants in the United States in the year 2000. There are almost 90 completed nuclear power plants and about 45 under construction in the United States, but several of those under construction will eventually be abandoned. About 20 % of the electricity in the United States will be generated by nuclear plants in 2000 as compared with 13 % supplied in the last year. Under the present regulatory and institutional arrangement, American electric utilities would not consider to order a new nuclear power plant. Post-TMI nuclear plants became very expensive, and there is also ideological opposition to nuclear power. Coal-firing plants are also in the similar situation. The uncertainty about electric power demand, the cost of money, the inflation of construction cost and regulation caused the situation. (Kako, I.)

  17. United States panel presentations

    International Nuclear Information System (INIS)

    Young, H.

    1990-01-01

    The Department of Energy is supporting a number of programs directed at improving nuclear power's ability to compete by the mid 1990s in providing some of what will be urgently needed new baseload capacity, and at meeting both utility requirements and public goals. More specifically, we are co-funding demonstration by 1993 of the process for life extension of current nuclear plants. We are supporting the development of new ALWR designs which rely more on methods such as natural circulation, gravity, reduced power density, or the characteristics of materials, rather than engineered systems to provide safety. These designs will meet the criteria set forth in EPRI's Utility Requirements Documents. We have established a cost-sharing program to demonstrate the success of the nuclear plant standardization and licensing process by obtaining NRC certification by 1992 or 1993 of two evolutionary 1300MWe ALWR designs. We are also cost-sharing a program to certify by 1995 passively safe 600MWe ALWRs employing more natural safety features and modular construction. These programs will involve a rule-making hearing process. We are supporting the development and possible certification early in the next century of modular high temperature gas reactor and advanced liquid metal reactor plant designs. We are planning to demonstrate the early site approval licensing process through a cost-sharing arrangement with the private sector by 1995. In developing the National Energy Strategy, we are examining the issue of a fully satisfactory regulatory process, including the possibility of legislation codifying 10 CFR Part 52, limiting the possible delays associated with a potential second hearing and dealing with emergency planning issues before start of construction. We recently announced a restructured plan to develop a permanent waste repository by 2010. By 1995 we expect to have made significant progress in evaluating the suitability of Yucca Mountain. We expect to have selected a

  18. Unit Commitment With Dynamic Cycling Costs

    OpenAIRE

    Troy, Niamh; Flynn, Damian; Milligan, Michael R.; et al.

    2012-01-01

    Increased competition in the electricity sector and the integration of variable renewable energy sources is resulting in more frequent cycling of thermal plant. Thus, the wear-and-tear to generator components and the related costs are a growing concern for plant owners and system operators alike. This paper presents a formulation that can be implemented in a MIP dispatch model to dynamically model cycling costs based on unit operation. When implemented for a test system, the results show that...

  19. Legislative update: United States

    International Nuclear Information System (INIS)

    Anon.

    2007-01-01

    The US Senate consented to the ratification of the Convention on Supplementary Compensation for Nuclear Damage (CSC) on 4 August 2006. The entry into force of the Convention on Supplementary Compensation will substantially change the face of the international nuclear liability regime. The CSC is a free-standing instrument, open to all states. This means that countries can become party to a new global regime providing for liability and compensation for victims of a nuclear incident, without also having to become a contracting party to the Paris Convention or the Vienna Convention. This is certainly a major step forward given that at the present time, over half of the world's reactors in operation or under construction are not covered by any of the international nuclear third party liability conventions. The CSC creates an instrument by which states can ensure that more money will be made available to compensate more victims for a broader range of damage than ever before. The CSC provides for two tiers of compensation. The first tier, fixed at 300 million Special Drawing Rights, is to be provided by the liable operator. This tier is to be distributed on a non-discriminatory basis to victims both inside and outside of the Installation State. If 300 million SDRs are insufficient to compensate all damage, then contracting parties will be required to contribute to the second tier (the international fund). The amount of this second tier is not fixed, but rather will depend on the number of operating nuclear power plants in contracting parties, and is designed to increase as the number of such plants increases

  20. NCHS - Injury Mortality: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset describes injury mortality in the United States beginning in 1999. Two concepts are included in the circumstances of an injury death: intent of injury...

  1. 77 FR 48542 - United States

    Science.gov (United States)

    2012-08-14

    ... litigation.'' United States v. Armour and Co., 402 U.S. 673, 681 (1971). Section 5 of the Clayton Act... relief in consent judgment that contained recitals in which defendants asserted their innocence); Armour...

  2. United States Strategy for Mexico

    National Research Council Canada - National Science Library

    Centner, Robert C

    2005-01-01

    The security and stability of Mexico is of national interest to the United States, and a strong, effective alliance between the two countries is pivotal to our national defense strategy and economic prosperity...

  3. 31 CFR 800.225 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 800.225 Section 800... TAKEOVERS BY FOREIGN PERSONS Definitions § 800.225 United States. The term United States or U.S. means the United States of America, the States of the United States, the District of Columbia, and any commonwealth...

  4. 7 CFR 1220.615 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.615 Section 1220.615... CONSUMER INFORMATION Procedures To Request a Referendum Definitions § 1220.615 State and United States. State and United States include the 50 States of the United States of America, the District of Columbia...

  5. 7 CFR 1220.129 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.129 Section 1220.129... CONSUMER INFORMATION Soybean Promotion and Research Order Definitions § 1220.129 State and United States. The terms State and United States include the 50 States of the United States of America, the District...

  6. State nuclear initiatives in the United States

    International Nuclear Information System (INIS)

    Strauss, P.L.; Stoiber, C.R.

    1977-01-01

    The paper deals with State nuclear initiatives regarding the role of nuclear power in the energy future of the United States. The question of whether and under what circumstances nuclear facilities should be used to generate electricity was put to the popular vote in several States in 1976. Some general principles of Federal-State relations are discussed with specific reference to nuclear regulations. The initiative mechanism itself is described as well as its legal form and background. The parallel developments in the State and Federal legislative consideration of nuclear issues is reviewed and the suggested reasons for the defeat of the proposals in the seven States concerned are discussed. Finally, the author draws some conclusions on the effects of the 1976 initiatives on future decision-making in the US on energy policy in general and nuclear power in particular. (NEA) [fr

  7. Cost-Effectiveness of Nivolumab-Ipilimumab Combination Therapy Compared with Monotherapy for First-Line Treatment of Metastatic Melanoma in the United States.

    Science.gov (United States)

    Oh, Anna; Tran, Dang M; McDowell, Leann C; Keyvani, Dor; Barcelon, Jay Andrew; Merino, Oscar; Wilson, Leslie

    2017-06-01

    The approval of new immunotherapies has dramatically changed the treatment landscape of metastatic melanoma. These survival gains come with trade-offs in side effects and costs, as well as important considerations for third-party payer systems, physicians, and patients. To develop a Markov model to determine the cost-effectiveness of nivolumab, ipilimumab, and nivolumab-ipilimumab combination as firstline therapy in metastatic melanoma, while accounting for differential effectiveness in programmed death-ligand 1 (PD-L1) positive and negative patients. A 3-state Markov model (PD-L1 positive stable disease, PD-L1 negative stable disease, and progression and/or death) was developed using a U.S. societal perspective with a lifetime time horizon of 14.5 years. Transition probabilities were calculated from progression-free (PF) survival data reported in the CheckMate-067 trial. Costs were expressed in 2015 U.S. dollars and were determined using national sources. Adverse event (AE) management was determined using immune-related AE (irAE) data from CheckMate-067, irAE management guides for nivolumab and ipilimumab, and treatment guidelines. Utilities were obtained from published literature, using melanoma-specific studies when available, and were weighted based on incidence and duration of irAEs. Base case, one-way sensitivity, and probabilistic sensitivity analyses were conducted. Nivolumab-ipilimumab combination therapy was not the cost-effective choice ($454,092 per PF quality-adjusted life-year [QALY]) compared with nivolumab monotherapy in a base case analysis at a willingness-to-pay threshold of $100,000 per PFQALY. Combination therapy and nivolumab monotherapy were cost-effective choices compared with ipilimumab monotherapy. PD-L1 positive status, utility of nivolumab and combination therapy, and medication costs contributed the most uncertainty to the model. In a population of 100% PD-L1 negative patients, nivolumab was still the optimal treatment, but combination

  8. An Analysis of Unit Costs at a Consolidated Supply Depot

    Science.gov (United States)

    1990-12-01

    Not-For-Profit Setting,"The Accounting Review,July 1990. Horngren , C. T., Cost Accountinq:A Managerial Emphasis,3rd ed, Prentice-Hall Inc.,1972...sector has used concepts of unit costs for 4 decades. Any managerial or cost accounting text discusses in some length unit costs . For Defense contractors...the Cost Accounting Standards Board (CASB) provides guidance for contract costs . Unit costs include direct, indirect, and general and administrative

  9. THE UNITED STATES EDUCATIONAL SYSTEM

    OpenAIRE

    David Suriñach Fernández

    2017-01-01

    The United States educational system is very complex. Due to the fact a big number of agents take play of its regulation, the differences between the education from one State compared to the education from another, or even between school districts, might be considerable. The last two largest federal education initiatives, No Child Left Behind and Race to the Top, have had a huge impact on the American education system. The escalation of the standardized test throughout the whole country as a ...

  10. AREVA in the United States

    International Nuclear Information System (INIS)

    2007-01-01

    nuclear. The trend in favor of 'green energies' could accelerate and become a major source of economic growth in the coming years. In 2007, the United States have 104 nuclear reactors with a total installed capacity of 100,3 GWe. The technology was split as follows: 34 boiling water reactors (BWR) with a capacity of 32 GWe and 70 pressurized water reactors (PWR) with a capacity of 68 GWe. Nuclear reactors are located in 31 of the 50 states, mainly in the eastern half of the country. On December 31, 2006 nuclear power generated 810 TWh, or 19% of total electrical production. Installed nuclear capacity represented 9% of the country's total electrical capacity. In 2006, 103 nuclear reactors were connected to the grid, compared to 104 nuclear reactors in 2007: after a long shutdown, Browns Ferry 1 reactor (PWR, 1 065 MWe) has been re-connected to the grid on June, 2, 2007. The nuclear power plants in the United States' fleet have an average age of 26 years. The oldest power plants that are still in service are Nine Mile Point 1 and Oyster Creek (both use BWR technology), which began operations in December 1969. Watts Bar 1 (PWR technology) is the newest nuclear power plant, having commenced operations in 1996. Although energy consumption has continued to grow, the contribution of nuclear power to the energy mix has remained steady despite the lack of new construction. This is mainly due to continuous performance improvements in reactor safety and availability. These performance improvements are, to a great extent, due to the deregulation of the U.S. electricity market in the 1990's and subsequent mergers and acquisitions, which led to a consolidation in the number of operators. The economies of scale achieved and the major investments made possible by the pooling of resources promoted the continuous improvement of reactor operations while reducing reactor operating and maintenance costs. In June 2005, George W. Bush sent a public message about his determination to revive the

  11. AREVA in the United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    , but also hydrogen and nuclear. The trend in favor of 'green energies' could accelerate and become a major source of economic growth in the coming years. In 2007, the United States have 104 nuclear reactors with a total installed capacity of 100,3 GWe. The technology was split as follows: 34 boiling water reactors (BWR) with a capacity of 32 GWe and 70 pressurized water reactors (PWR) with a capacity of 68 GWe. Nuclear reactors are located in 31 of the 50 states, mainly in the eastern half of the country. On December 31, 2006 nuclear power generated 810 TWh, or 19% of total electrical production. Installed nuclear capacity represented 9% of the country's total electrical capacity. In 2006, 103 nuclear reactors were connected to the grid, compared to 104 nuclear reactors in 2007: after a long shutdown, Browns Ferry 1 reactor (PWR, 1 065 MWe) has been re-connected to the grid on June, 2, 2007. The nuclear power plants in the United States' fleet have an average age of 26 years. The oldest power plants that are still in service are Nine Mile Point 1 and Oyster Creek (both use BWR technology), which began operations in December 1969. Watts Bar 1 (PWR technology) is the newest nuclear power plant, having commenced operations in 1996. Although energy consumption has continued to grow, the contribution of nuclear power to the energy mix has remained steady despite the lack of new construction. This is mainly due to continuous performance improvements in reactor safety and availability. These performance improvements are, to a great extent, due to the deregulation of the U.S. electricity market in the 1990's and subsequent mergers and acquisitions, which led to a consolidation in the number of operators. The economies of scale achieved and the major investments made possible by the pooling of resources promoted the continuous improvement of reactor operations while reducing reactor operating and maintenance costs. In June 2005, George W. Bush sent a

  12. Norovirus in the United States

    Centers for Disease Control (CDC) Podcasts

    2013-09-09

    Dr. Aron Hall, a CDC epidemiologist specializing in norovirus, discusses the impact of norovirus in the United States.  Created: 9/9/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/17/2013.

  13. United States Navy DL Perspective

    Science.gov (United States)

    2010-08-10

    United States Navy DL Perspective CAPT Hank Reeves Navy eLearning Project Director 10 August 2010 Report Documentation Page Form ApprovedOMB No...Marine Corps (USMC) Navy eLearning Ongoing Shared with USMC, Coast Guard 9 NeL Help Site https://ile-help.nko.navy.mil/ile/ https://s-ile

  14. Cholera in the United States

    Centers for Disease Control (CDC) Podcasts

    2011-11-08

    Anna Newton, Surveillance Epidemiologist at CDC, discusses cholera that was brought to the United States during an outbreak in Haiti and the Dominican Republic (Hispaniola).  Created: 11/8/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/8/2011.

  15. 7 CFR 1250.308 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1250.308 Section 1250.308 Agriculture... Research and Promotion Order Definitions § 1250.308 United States. United States means the 48 contiguous States of the United States of America and the District of Columbia. ...

  16. 31 CFR 592.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 592.311 Section 592... § 592.311 United States. The term United States, when used in the geographic sense, means the several States, the District of Columbia, and any commonwealth, territory, or possession of the United States. ...

  17. 7 CFR 1205.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.23 Section 1205.23 Agriculture... Procedures for Conduct of Sign-up Period Definitions § 1205.23 United States. The term United States means the 50 states of the United States of America. Procedures ...

  18. 31 CFR 597.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 597.318 Section 597... General Definitions § 597.318 United States. The term United States means the United States, its territories, states, commonwealths, districts, and possessions, and all areas under the jurisdiction or...

  19. 7 CFR 1150.106 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1150.106 Section 1150.106 Agriculture... Order Definitions § 1150.106 United States. United States means the 48 contiguous States in the continental United States. ...

  20. 7 CFR 1219.26 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1219.26 Section 1219.26 Agriculture..., AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.26 United States. United States means collectively the several 50 States of the United States, the District of...

  1. 22 CFR 120.13 - United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false United States. 120.13 Section 120.13 Foreign... United States. United States, when used in the geographical sense, includes the several states, the Commonwealth of Puerto Rico, the insular possessions of the United States, the District of Columbia, the...

  2. 7 CFR 1205.313 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.313 Section 1205.313 Agriculture... Research and Promotion Order Definitions § 1205.313 United States. United States means the 50 States of the United States of America. [31 FR 16758, Dec. 31, 1966. Redesignated at 56 FR 64472, Dec. 10, 1991] ...

  3. 7 CFR 1209.21 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1209.21 Section 1209.21... Definitions § 1209.21 State and United States. (a) State means any of the several States, the District of Columbia, and the Commonwealth of Puerto Rico. (b) United States means collectively the several States of...

  4. Emetogenicity-risk procedures in same day surgery center of an academic university hospital in United States: a retrospective cost-audit of postoperative nausea vomiting management.

    Science.gov (United States)

    Gupta, Deepak; Haber, Halim

    2014-06-01

    Despite the variable results of published studies, it is imperative for ambulatory surgery centers to self-audit local cost-implications for post-operative nausea and vomiting (PONV) management. Our retrospective cost-audit assessed if there were comparative peri-anesthesia care cost-trends among patients who had undergone Low-Emetogenicity-Risk Procedures (LERP), Moderate-Emetogenicity-Risk Procedures (MERP) and Severe-Emetogenicity-Risk Procedures (SERP). This study was a review of Same Day Surgery Center practices in an academic university hospital setting during a three-year period (2010-2012). The patient lists were accessed from CIS and CITRIX App Bar for time audit and OR (operating room) schedule reports. Subsequently, OR pharmacy department ran a search for peri-operative anti-emetics and opioids that were billed for the patients at Same Day Surgery Center for the review period. The primary outcomes were the comparative costs/charges of these medications and comparative durations/ charges for these patients' stay in the post-anesthesia care unit (PACU). Secondary outcomes analyzed in the study included peri-anesthesia durations. A total of 8,657 patient records were analyzed. Almost all analyzed variables revealed statistically significant inter-variable positive correlations. The patients' age was significantly (P < 0.001) different among LERP/MERP/SERP patients (LERP: 48.8 +/- 14.7 years; MERP: 61.8 +/- 14.6 years; SERP: 51.3 +/- 14.5 years). In regards to primary and secondary outcomes, the statistical significant differences among LERP/MERP/SERP patients (after correcting for both patients' age as well as patients' sex) were only achieved for preoperative times (P = 0.002; Power = 0.9), operating room recovery times (P = 0.003; Power = 0.9), PACU stay times (P < 0.001; Power = 1.0), and PACU charges (P < 0.001; Power = 1.0). PACU stay times and PACU charges were significantly higher in patients who had undergone SERP as compared to patients who had

  5. Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States.

    Science.gov (United States)

    Burger, Charles D; Ozbay, A Burak; Lazarus, Howard M; Riehle, Ellen; Montejano, Leslie B; Lenhart, Gregory; White, R James

    2018-02-13

    -month post-index period with any inpatient admission decreased, 42% versus 30% (P < 0.001). In addition, PAH-related inpatient admissions decreased in the 6-month post-index period from 7% to 3% (P < 0.001). After treatment initiation, patients' nonpharmacy medical costs decreased from $48,200 (SD = $117,686) to $33,962 (SD = $90,294; P < 0.001), mainly attributable to reduced inpatient costs. However, total average medical costs including pharmacy costs remained comparable after treatment initiation (pre-index period = $51,455 vs. post-index period = $53,923; P = 0.213). This study found that while patients' PAH-related pharmacy costs increased after treatment initiation, the increase was offset by reduced inpatient utilization; therefore, total health care costs remained constant. While the majority of patients in this study were treated with monotherapy, the recently completed AMBITION study indicated that initial combination therapy with ambrisentan plus tadalafil reduced PAH-related hospitalizations compared with initial monotherapy with either of these agents. Future cost analyses of patients treated with combination therapy will be required to determine the economic effect of initial combination therapy. This study was sponsored and funded by Gilead Sciences. Ozbay is an employee of Gilead Sciences. At the time that this project and manuscript were developed, Lazarus was an employee of Gilead Sciences and may own stock/stock options. Riehle, Montejano, and Lenhart are employees of Truven Health Analytics, an IBM company, which received funding from Gilead Sciences to conduct this study. Burger and White do research with, and are paid consultants for, Gilead Sciences; they do not own equity and received no personal compensation for the work here. Burger also reports consultancy and advisory board work for Actelion Pharmaceuticals and grants from Gilead Sciences, Actelion Pharmaceuticals, Bayer, and United Therapeutics. Study concept and design were contributed by

  6. 31 CFR 598.317 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 598.317 Section 598.317 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 598.317 United States. The term United States means the United States, its territories and...

  7. 31 CFR 596.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 596.312 Section 596.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 596.312 United States. The term United States means the United States, including its...

  8. 31 CFR 538.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 538.314 Section 538.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 538.314 United States. The term United States means the United States, its territories and possessions...

  9. 31 CFR 543.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 543.310 Section 543.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 543.310 United States. The term United States means the United States, its territories and...

  10. 31 CFR 542.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 542.310 Section 542.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and possessions...

  11. 31 CFR 548.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 548.310 Section 548.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and possessions...

  12. 7 CFR 65.255 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false United States. 65.255 Section 65.255 Agriculture..., PEANUTS, AND GINSENG General Provisions Definitions § 65.255 United States. United States means the 50... United States. ...

  13. 31 CFR 546.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 546.310 Section 546.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and possessions...

  14. 31 CFR 594.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 594.313 Section 594.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 594.313 United States. The term United States means the United States, its territories and...

  15. 31 CFR 588.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 588.310 Section 588.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 588.310 United States. The term United States means the United States, its territories and...

  16. 31 CFR 536.315 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 536.315 Section 536.315 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 536.315 United States. The term United States means the United States, its territories and...

  17. 31 CFR 544.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 544.310 Section 544.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 544.310 United States. The term United States means the United States, its...

  18. 31 CFR 545.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 545.313 Section 545.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 545.313 United States. The term United States means the United States, its territories and...

  19. 31 CFR 595.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 595.314 Section 595.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 595.314 United States. The term United States means the United States, its territories and possessions...

  20. 31 CFR 586.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 586.318 Section 586...) KOSOVO SANCTIONS REGULATIONS General Definitions § 586.318 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or authority...

  1. 31 CFR 537.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 537.318 Section 537.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....318 United States. The term United States means the United States, its territories and possessions...

  2. 31 CFR 560.307 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 560.307 Section 560.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 560.307 United States. The term United States means the United States, including its territories and...

  3. 31 CFR 593.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 593.311 Section 593.311 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 593.311 United States. The term United States means the United States, its...

  4. 31 CFR 585.316 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 585.316 Section 585.316 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 585.316 United States. The term United States means the United States, its...

  5. 31 CFR 575.319 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 575.319 Section 575.319 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....319 United States. The term United States means the United States, its territories and possessions...

  6. 7 CFR 1212.31 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1212.31 Section 1212.31 Agriculture..., Consumer Education, and Industry Information Order Definitions § 1212.31 United States. “United States... territories and possessions of the United States. ...

  7. 31 CFR 539.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 539.312 Section 539.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 539.312 United States. The term United States means the United States, its...

  8. 31 CFR 551.309 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 551.309 Section 551.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....309 United States. The term United States means the United States, its territories and possessions...

  9. 31 CFR 587.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 587.310 Section 587...) MILOSEVIC SANCTIONS REGULATIONS General Definitions § 587.310 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or authority...

  10. 31 CFR 541.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 541.310 Section 541.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 541.310 United States. The term United States means the United States, its territories and possessions...

  11. 31 CFR 540.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 540.313 Section 540.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 540.313 United States. The term United States means the United States, its...

  12. 31 CFR 547.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 547.310 Section 547.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 547.310 United States. The term United States means the United States, its...

  13. Masturbation in the United States.

    Science.gov (United States)

    Das, Aniruddha

    2007-01-01

    Using data from the nationally representative National Health and Social Life Survey, this study queried the correlates of masturbation in the United States in 1992. Among those aged 18-60, 38% (CI, 35-41) of women and 61% (CI, 57-65) of men reported any masturbation over the preceding year. The system of factors underlying masturbation was similar for both genders, consistent with a convergence in gender patterns of sexual expression in the United States. Among both women and men, masturbation responded to a stable sexualized personality pattern, catalyzed by early-life factors and manifested in current sexual traits. Strikingly, the masturbation-partnered sex linkage, often conceptualized either as compensating for unsatisfying sex or complementing a satisfactory sex life, appeared to be bimodal for both genders. For some, masturbation complemented an active and pleasurable sex life, while among others, it compensated for a lack of partnered sex or satisfaction in sex.

  14. Environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' effort to manage its environment including air, water nature, and biodiversity to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 40 figs., 21 tabs.

  15. United States National Seismographic Network

    International Nuclear Information System (INIS)

    Buland, R.

    1993-09-01

    The concept of a United States National Seismograph Network (USNSN) dates back nearly 30 years. The idea was revived several times over the decades. but never funded. For, example, a national network was proposed and discussed at great length in the so called Bolt Report (U. S. Earthquake Observatories: Recommendations for a New National Network, National Academy Press, Washington, D.C., 1980, 122 pp). From the beginning, a national network was viewed as augmenting and complementing the relatively dense, predominantly short-period vertical coverage of selected areas provided by the Regional Seismograph Networks (RSN's) with a sparse, well-distributed network of three-component, observatory quality, permanent stations. The opportunity finally to begin developing a national network arose in 1986 with discussions between the US Geological Survey (USGS) and the Nuclear Regulatory Commission (NRC). Under the agreement signed in 1987, the NRC has provided $5 M in new funding for capital equipment (over the period 1987-1992) and the USGS has provided personnel and facilities to develop. deploy, and operate the network. Because the NRC funding was earmarked for the eastern United States, new USNSN station deployments are mostly east of 105 degree W longitude while the network in the western United States is mostly made up of cooperating stations (stations meeting USNSN design goals, but deployed and operated by other institutions which provide a logical extension to the USNSN)

  16. Taxation of United States general aviation

    Science.gov (United States)

    Sobieralski, Joseph Bernard

    General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and

  17. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States.

    Science.gov (United States)

    Elbasha, E; Greaves, W; Roth, D; Nwankwo, C

    2017-04-01

    Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once-daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost-effectiveness of EBR/GZR in treatment-naïve and treatment-experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg-IFN/RBV) using a computer-based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000-2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg-INF/RBV were based on wholesale acquisition cost. All costs were from a third-party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver-related complications, liver transplantation, kidney transplantation, end-stage live disease mortality and end-stage renal disease mortality; lifetime quality-adjusted life years (QALY); and incremental cost-utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg-IFN/RBV. EBR/GZR-based regimens resulted in higher average remaining QALYs and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg-INF/RBV (10.2857, $186 701). Peg-IFN/RBV is not cost-effective, and the ICUR of EBR/GZR compared with NoTx was $13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR ($217 000/QALY). Assuming a threshold of $100 000 per QALY gained for cost-effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost

  18. 7 CFR 1206.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1206.23 Section 1206.23 Agriculture... INFORMATION Mango Promotion, Research, and Information Order Definitions § 1206.23 United States. United... Rico, and the territories and possessions of the United States. ...

  19. Both Europe's and the United States' electrification

    International Nuclear Information System (INIS)

    Matly, M.

    2006-01-01

    While the United States quickly had the largest electrical indus in the world, electrification in rural areas ended about thirty years after most European countries. Public intervention is a deciding factor in completing electrification, and the late involvement by the American authorities explains the gap. However it would be wrong to oppose in Europe and in the United States a motivated public sector and little involved private companies. In both continents indeed, major private and public urban distributors were almost not involved in rural electrification processes, where local players prevailed: local communities around Europe, small and medium size business in some European countries such as France, co-operative companies in the United States. Additionally, there is an essential difference between electrification in Europe and in the United States. The former does not provide much more than lighting and its success leaves few traces in popular memories; the latter includes many facilities and services, changes the lives of rural populations and is celebrated a such. Whereas the colonial venture keep European economies away from their domestic markets, while in the United States the urban market growth contents large companies, the American co-operative movement is right to believe in the existence of a large electrical equipment market among farmers then considered poor and behind. It even uses the market to complete a more profitable and less costly electrification. Electricity stories that offer food for the thoughts of Third World decision makers and power companies, when they entrust most rural electrification to their large urban companies and deny the existence of a real equipment market in their own rural world. (author)

  20. Estimates of Parainfluenza Virus-Associated Hospitalizations and Cost Among Children Aged Less Than 5 Years in the United States, 1998–2010

    Science.gov (United States)

    Abedi, Glen R.; Prill, Mila M.; Langley, Gayle E.; Wikswo, Mary E.; Weinberg, Geoffrey A.; Curns, Aaron T.; Schneider, Eileen

    2018-01-01

    Background Parainfluenza virus (PIV) is the second leading cause of hospitalization for respiratory illness in young children in the United States. Infection can result in a full range of respiratory illness, including bronchiolitis, croup, and pneumonia. The recognized human subtypes of PIV are numbered 1–4. This study calculates estimates of PIV-associated hospitalizations among US children younger than 5 years using the latest available data. Methods Data from the National Respiratory and Enteric Virus Surveillance System were used to characterize seasonal PIV trends from July 2004 through June 2010. To estimate the number of PIV-associated hospitalizations that occurred annually among US children aged PIV among young children enrolled in the New Vaccine Surveillance Network. Estimates of hospitalization charges attributable to PIV infection were also calculated. Results Parainfluenza virus seasonality follows type-specific seasonal patterns, with PIV-1 circulating in odd-numbered years and PIV-2 and -3 circulating annually. The average annual estimates of PIV-associated bronchiolitis, croup, and pneumonia hospitalizations among children aged PIV-associated bronchiolitis, croup, and pneumonia hospitalizations were approximately $43 million, $58 million, and $158 million, respectively. Conclusions The majority of PIV-associated hospitalizations in young children occur among those aged 0 to 2 years. When vaccines for PIV become available, immunization would be most effective if realized within the first year of life. PMID:26908486

  1. Comparison of the Cost-Effectiveness of Biologic Drugs Used for Moderate-to-Severe Psoriasis Treatment in the United States.

    Science.gov (United States)

    Wu, Jashin J; Feldman, Steven R; Rastogi, Shipra; Menges, Brandy; Lingohr-Smith, Melissa; Lin, Jay

    2018-04-16

    To compare the cost-effectiveness of the newly approved biologic drug, brodalumab, with other commonly used biologics for the treatment of moderate-to-severe psoriasis in the U.S. An economic model was constructed in Excel to compare average costs to achieve Psoriasis Area and Severity Index (PASI) 75, 90, and 100 among moderate-to-severe psoriasis patients treated with biologics. Total annual costs to health plans associated with treatment with 5 different biologics were estimated and cost-effectiveness compared using the estimated average cost per PASI 75, PASI 90, and PASI 100. Total annual costs to a health plan per patient with adalimumab, brodalumab, ixekizumab, secukinumab, and ustekinumab were estimated at $51,246, $38,538, $65,484, $57,510, and $57,013. Mean annual treatment costs per PASI 75, 90, and 100 were the lowest for brodalumab, with the annual cost per PASI 75 for brodalumab, adalimumab, ixekizumab, secukinumab, and ustekinumab estimated at $48,782, $82,655, $77,957, $75,671, and $87,243, per PASI 90 at $51,383, $119,178, $94,904, $108,509, and $130,615, and per PASI 100 at $87,585, $284,702, $176,983, $205,393, and $366,645. Brodalumab, which had the lowest drug cost and high drug efficacy, was associated with the lowest cost per PASI 75, 90, and 100 among the biologics evaluated.

  2. 7 CFR 1215.20 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1215.20 Section 1215.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... United States. United States means all of the States. Popcorn Board ...

  3. 7 CFR 1260.108 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1260.108 Section 1260.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Promotion and Research Order Definitions § 1260.108 United States. United States means the 50 States and the...

  4. 7 CFR 1280.127 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1280.127 Section 1280.127 Agriculture... INFORMATION ORDER Lamb Promotion, Research, and Information Order Definitions § 1280.127 United States. United States means collectively the 50 States and the District of Columbia. ...

  5. 7 CFR 1210.315 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1210.315 Section 1210.315 Agriculture... PLAN Watermelon Research and Promotion Plan Definitions § 1210.315 United States. United States means each of the several States and the District of Columbia. [60 FR 10797, Feb. 28, 1995] National...

  6. 7 CFR 1221.32 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1221.32 Section 1221.32 Agriculture... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.32 United States. United States or U.S. means collectively the 50 States, the District of Columbia, the Commonwealth of...

  7. 7 CFR 1216.30 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1216.30 Section 1216.30 Agriculture... INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.30 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto Rico...

  8. 7 CFR 1218.22 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1218.22 Section 1218.22 Agriculture... INFORMATION ORDER Blueberry Promotion, Research, and Information Order Definitions § 1218.22 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto Rico...

  9. Malaria Surveillance - United States, 2015.

    Science.gov (United States)

    Mace, Kimberly E; Arguin, Paul M; Tan, Kathrine R

    2018-05-04

    Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles species mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to provide information on its occurrence (e.g., temporal, geographic, and demographic), guide prevention and treatment recommendations for travelers and patients, and facilitate transmission control measures if locally acquired cases are identified. This report summarizes confirmed malaria cases in persons with onset of illness in 2015 and summarizes trends in previous years. Malaria cases diagnosed by blood film microscopy, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff members. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS), the National Notifiable Diseases Surveillance System (NNDSS), or direct CDC consultations. CDC reference laboratories provide diagnostic assistance and conduct antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. This report summarizes data from the integration of all NMSS and NNDSS cases, CDC reference laboratory reports, and CDC clinical consultations. CDC received reports of 1,517 confirmed malaria cases, including one congenital case, with an onset of symptoms in 2015 among persons who received their diagnoses in the United States. Although the number of

  10. Calculating the Unit Cost Factors for Decommissioning Cost Estimation of the Nuclear Research Reactor

    International Nuclear Information System (INIS)

    Jeong, Kwan Seong; Lee, Dong Gyu; Jung, Chong Hun; Lee, Kune Woo

    2006-01-01

    The estimated decommissioning cost of nuclear research reactor is calculated by applying a unit cost factor-based engineering cost calculation method on which classification of decommissioning works fitted with the features and specifications of decommissioning objects and establishment of composition factors are based. Decommissioning cost of nuclear research reactor is composed of labor cost, equipment and materials cost. Labor cost of decommissioning costs in decommissioning works are calculated on the basis of working time consumed in decommissioning objects. In this paper, the unit cost factors and work difficulty factors which are needed to calculate the labor cost in estimating decommissioning cost of nuclear research reactor are derived and figured out.

  11. Environmental Investments: The Cost of a Clean Environment, Report of the Administrator of the Environmental Protection Agency to the Congress of the United States (1990)

    Science.gov (United States)

    Presents data on environmental pollution control costs during the period 1972--1987, projects these costs for each subsequent year to the year 2000 under a number of assumptions, and breaks them down in a variety of ways (capital, operating; media; etc.)

  12. A novel cost-effectiveness model of prescription eicosapentaenoic acid extrapolated to secondary prevention of cardiovascular diseases in the United States.

    Science.gov (United States)

    Philip, Sephy; Chowdhury, Sumita; Nelson, John R; Benjamin Everett, P; Hulme-Lowe, Carolyn K; Schmier, Jordana K

    2016-10-01

    Given the substantial economic and health burden of cardiovascular disease and the residual cardiovascular risk that remains despite statin therapy, adjunctive therapies are needed. The purpose of this model was to estimate the cost-effectiveness of high-purity prescription eicosapentaenoic acid (EPA) omega-3 fatty acid intervention in secondary prevention of cardiovascular diseases in statin-treated patient populations extrapolated to the US. The deterministic model utilized inputs for cardiovascular events, costs, and utilities from published sources. Expert opinion was used when assumptions were required. The model takes the perspective of a US commercial, third-party payer with costs presented in 2014 US dollars. The model extends to 5 years and applies a 3% discount rate to costs and benefits. Sensitivity analyses were conducted to explore the influence of various input parameters on costs and outcomes. Using base case parameters, EPA-plus-statin therapy compared with statin monotherapy resulted in cost savings (total 5-year costs $29,393 vs $30,587 per person, respectively) and improved utilities (average 3.627 vs 3.575, respectively). The results were not sensitive to multiple variations in model inputs and consistently identified EPA-plus-statin therapy to be the economically dominant strategy, with both lower costs and better patient utilities over the modeled 5-year period. The model is only an approximation of reality and does not capture all complexities of a real-world scenario without further inputs from ongoing trials. The model may under-estimate the cost-effectiveness of EPA-plus-statin therapy because it allows only a single event per patient. This novel model suggests that combining EPA with statin therapy for secondary prevention of cardiovascular disease in the US may be a cost-saving and more compelling intervention than statin monotherapy.

  13. Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States.

    Science.gov (United States)

    Adam, E A; Collier, S A; Fullerton, K E; Gargano, J W; Beach, M J

    2017-10-01

    National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.

  14. Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

    Science.gov (United States)

    Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

    2014-01-01

    Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD. PMID:24672234

  15. Teen Pregnancy in the United States

    Science.gov (United States)

    ... United States: the contribution of abstinence and improved contraceptive use. Am J Public Health. 2007;97(1):150-6. Lindberg LD, Santelli JS, Desai, S. Understanding the Decline in Adolescent Fertility in the United States, 2007–2012. J ...

  16. Regulatory practices - United States example

    International Nuclear Information System (INIS)

    Shapar, M.

    1976-01-01

    In 1954, the Atomic Energy Act of 1946 was revised to do away with the federal state monopoly in this field and to enable private industry to develop nuclear power. This evolution led the federal authorities to give the Atomic Energy Commission the powers to control the design, licensing and operation of nuclear reactors. These powers were constantly strengthened and are now exercised by the Nuclear Regulatory Commission (NRC). Since its creation in 1975, the Commission has amended the regulations on licensing of nuclear reactors in the light of experience acquired so as to shorten the duration of this procedure. These amendments concern the standardization of nuclear power plants, limited work authorizations, the methods for issuing licenses. The objective of the Commission aim to make the licensing procedure for nuclear power plants simpler and more efficient and hence, less costly, while ensuring that a very high level for safety standards and environmental protection is maintained. (NEA) [fr

  17. Cost-Effectiveness Analysis of Microscopic and Endoscopic Transsphenoidal Surgery Versus Medical Therapy in the Management of Microprolactinoma in the United States.

    Science.gov (United States)

    Jethwa, Pinakin R; Patel, Tapan D; Hajart, Aaron F; Eloy, Jean Anderson; Couldwell, William T; Liu, James K

    2016-03-01

    Although prolactinomas are treated effectively with dopamine agonists, some have proposed curative surgical resection for select cases of microprolactinomas to avoid life-long medical therapy. We performed a cost-effectiveness analysis comparing transsphenoidal surgery (either microsurgical or endoscopic) and medical therapy (either bromocriptine or cabergoline) with decision analysis modeling. A 2-armed decision tree was created with TreeAge Pro Suite 2012 to compare upfront transsphenoidal surgery versus medical therapy. The economic perspective was that of the health care third-party payer. On the basis of a literature review, we assigned plausible distributions for costs and utilities to each potential outcome, taking into account medical and surgical costs and complications. Base-case analysis, sensitivity analysis, and Monte Carlo simulations were performed to determine the cost-effectiveness of each strategy at 5-year and 10-year time horizons. In the base-case scenario, microscopic transsphenoidal surgery was the most cost-effective option at 5 years from the time of diagnosis; however, by the 10-year time horizon, endoscopic transsphenoidal surgery became the most cost-effective option. At both time horizons, medical therapy (both bromocriptine and cabergoline) were found to be more costly and less effective than transsphenoidal surgery (i.e., the medical arm was dominated by the surgical arm in this model). Two-way sensitivity analysis demonstrated that endoscopic resection would be the most cost-effective strategy if the cure rate from endoscopic surgery was greater than 90% and the complication rate was less than 1%. Monte Carlo simulation was performed for endoscopic surgery versus microscopic surgery at both time horizons. This analysis produced an incremental cost-effectiveness ratio of $80,235 per quality-adjusted life years at 5 years and $40,737 per quality-adjusted life years at 10 years, implying that with increasing time intervals, endoscopic

  18. Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States.

    Directory of Open Access Journals (Sweden)

    Dahye L Song

    Full Text Available Two behavioral HIV prevention interventions for people who inject drugs (PWID infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+, a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+ Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST, to the status quo in the U.S.A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy.Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY, and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone.Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.

  19. Cost-effectiveness of carfilzomib plus dexamethasone compared with bortezomib plus dexamethasone for patients with relapsed or refractory multiple myeloma in the United States.

    Science.gov (United States)

    Jakubowiak, Andrzej J; Houisse, Ivan; Májer, István; Benedict, Ágnes; Campioni, Marco; Panjabi, Sumeet; Ailawadhi, Sikander

    2017-12-01

    We assessed the economic value of carfilzomib 56 mg/m 2 and dexamethasone (Kd56) vs. bortezomib and dexamethasone (Vd) for relapsed/refractory multiple myeloma (R/RMM) using ENDEAVOR trial results. Cost-effectiveness of Kd56 vs. Vd was assessed using a partitioned survival model by estimating progression-free survival, overall survival, and direct costs over a lifetime horizon. Surveillance Epidemiology and End Results (SEER) survival data were extrapolated after matching registry and ENDEAVOR patients. Utilities were sourced from the literature and mapped from patient-reported quality of life in ENDEAVOR to estimate quality-adjusted life-years (QALYs) from life-years (LYs). The model predicted an average gain of 1.66 LYs and 1.50 QALYs with Kd56 vs. Vd, and lifetime additional costs of $182,699, resulting in an incremental cost-effectiveness ratio (ICER) of $121,828/QALY gained. The ICER was $114,793/QALY in patients with 1 prior treatment; $99,263/QALY in those not transplanted, and discount in bortezomib price. Kd56 is cost-effective for patients with R/RMM at a willingness-to-pay threshold of $150,000/QALY. Trial data in the model may limit generalizability; however, SEER registry data mitigates this challenge. Kd56 provides additional value in key subgroups, and remains cost-effective after steep comparator discounts.

  20. Fracking in the United States

    International Nuclear Information System (INIS)

    Cho, Renee

    2015-01-01

    Over the last decade, advances in technology have made it profitable to extract natural gas from shale, leading to a boom in shale gas development in the United States. Hydraulic fracturing, or fracking, the controversial method for extracting natural gas, offers numerous benefits: relatively cheap energy, enhanced energy security, job creation, tax revenues and decreased dependence on dirty coal. Fracking, however, can also increase greenhouse gas emissions, pollute the air and result in health effects, consume huge quantities of water, and cause earthquakes. While some areas welcome fracking for the economic benefits it brings, other communities are attempting to ban fracking altogether. This article examines the benefits and risks of fracking in the U.S

  1. United States uranium enrichment policies

    International Nuclear Information System (INIS)

    Roberts, R.W.

    1977-01-01

    ERDA's uranium enrichment program policies governing the manner in which ERDA's enrichment complex is being operated and expanded to meet customer requirements for separative work, research and development activities directed at providing technology alternatives for future enrichment capacity, and establishing the framework for additional domestic uranium enrichment capacity to meet the domestic and foreign nuclear industry's growing demand for enrichment services are considered. The ERDA enrichment complex consists of three gaseous diffusion plants located in Oak Ridge, Tennessee; Paducah, Kentucky; and Portsmouth, Ohio. Today, these plants provide uranium enrichment services for commercial nuclear power generation. These enrichment services are provided under contracts between the Government and the utility customers. ERDA's program involves a major pilot plant cascade, and pursues an advanced isotope separation technique for the late 1980's. That the United States must develop additional domestic uranium enrichment capacity is discussed

  2. Oil Vulnerabilities and United States Strategy

    Science.gov (United States)

    2007-02-08

    Mazda, Mercedes - Benz , Ford, Mercury, and Nissan offer flexible fuel vehicles in the United States. Ethanol is currently produced in the United States...USAWC STRATEGY RESEARCH PROJECT OIL VULNERABILITIES AND UNITED STATES STRATEGY by Colonel Shawn P. Walsh...Colleges and Schools, 3624 Market Street, Philadelphia, PA 19104, (215) 662-5606. The Commission on Higher Education is an institutional accrediting

  3. Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

    Directory of Open Access Journals (Sweden)

    Patel JG

    2014-03-01

    Full Text Available Jeetvan G Patel,1,2 Saurabh P Nagar,2 Anand A Dalal2 1Pharmacy Administration and Public Health, University of Houston, Houston, TX, 2US Health Outcomes, GlaxoSmithKline, Durham, NC, USA Objective: To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD in the US. Methods: Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results: Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars with COPD ($1,521–$3,348 in 2010 [US dollars] and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions: COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability

  4. Malaria Surveillance - United States, 2014.

    Science.gov (United States)

    Mace, Kimberly E; Arguin, Paul M

    2017-05-26

    Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. This report summarizes cases in persons with onset of illness in 2014 and trends during previous years. Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report. CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively

  5. State laws on tobacco control--United States, 1998.

    Science.gov (United States)

    Fishman, J A; Allison, H; Knowles, S B; Fishburn, B A; Woollery, T A; Marx, W T; Shelton, D M; Husten, C G; Eriksen, M P

    1999-06-25

    State laws addressing tobacco use, the leading preventable cause of death in the United States, are summarized. Laws address smoke-free indoor air, minors' access to tobacco products, advertising of tobacco products, and excise taxes on tobacco products. Legislation effective through December 31, 1998. CDC identified laws addressing tobacco control by using an on-line legal research database. CDC's findings were verified with the National Cancer Institute's State Cancer Legislative Database. Since a previous surveillance summary on state tobacco-control laws published in November 1995 (covering legislation effective through June 30, 1995), several states have enacted new restrictions or strengthened existing legislation that addresses smoke-free indoor air, minors' access to tobacco, tobacco advertising, and tobacco taxes. Five states strengthened their smoke-free indoor air legislation. All states and Washington, D.C., continued to prohibit the sale and distribution of tobacco products to minors; however, 21 states expanded minors' access laws by designating enforcement authorities, adding license suspension or revocation for sale to minors, or requiring signage. Since the 1995 report, eight additional states (a total of 19 states and Washington, D.C.) now ban vending machines from areas accessible to minors. Thirteen states restrict advertising of tobacco products, an increase of four states since the 1995 report. Although the number of states that tax cigarettes and smokeless tobacco did not change, 13 states increased excise taxes on cigarettes, and five states increased excise taxes on smokeless tobacco products. The average state excise tax on cigarettes is 38.9 cents per pack, an increase of 7.4 cents compared with the average tax in the 1995 report. State laws addressing tobacco control vary in relation to restrictiveness, enforcement and penalties, preemptions, and exceptions. The data summarizing state tobacco-control laws are available through CDC

  6. Low birth weight in the United States.

    Science.gov (United States)

    Goldenberg, Robert L; Culhane, Jennifer F

    2007-02-01

    Pregnancy outcomes in the United States and other developed countries are considerably better than those in many developing countries. However, adverse pregnancy outcomes are generally more common in the United States than in other developed countries. Low-birth-weight infants, born after a preterm birth or secondary to intrauterine growth restriction, account for much of the increased morbidity, mortality, and cost. Wide disparities exist in both preterm birth and growth restriction among different population groups. Poor and black women, for example, have twice the preterm birth rate and higher rates of growth restriction than do most other women. Low birth weight in general is thought to place the infant at greater risk of later adult chronic medical conditions, such as diabetes, hypertension, and heart disease. Of interest, maternal thinness is a strong predictor of both preterm birth and fetal growth restriction. However, in the United States, several nutritional interventions, including high-protein diets, caloric supplementation, calcium and iron supplementation, and various other vitamin and mineral supplementations, have not generally reduced preterm birth or growth restriction. Bacterial intrauterine infections play an important role in the etiology of the earliest preterm births, but, at least to date, antibiotic treatment either before labor for risk factors such as bacterial vaginosis or during preterm labor have not consistently reduced the preterm birth rate. Most interventions have failed to reduce preterm birth or growth restriction. The substantial improvement in newborn survival in the United States over the past several decades is mostly due to better access to improved neonatal care for low-birth-weight infants.

  7. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

    Science.gov (United States)

    Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

    2016-01-01

    The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

  8. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

    Directory of Open Access Journals (Sweden)

    Mathieu Boulin

    Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

  9. 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…

  10. Fusion reactor design studies: standard unit costs and cost scaling rules

    International Nuclear Information System (INIS)

    Schulte, S.C.; Bickford, W.E.; Willingham, C.E.; Ghose, S.K.; Walker, M.G.

    1979-09-01

    This report establishes standard unit costs and scaling rules for estimating costs of material, equipment, land, and labor components used in magnetic confinement fusion reactor plant construction and operation. Use of the standard unit costs and scaling rules will add uniformity to cost estimates, and thus allow valid comparison of the economic characteristics of various reactor concepts

  11. New York State interim waste management cost evaluation

    International Nuclear Information System (INIS)

    Ma, M.S.; Watts, R.J.; Jorgensen, J.R.; Rochester Gas and Electric Corp., NY)

    1985-01-01

    The purpose of this study is to investigate and quantify the comparative costs associated with including or excluding Class A utility wastes at a centralized interim waste management facility in New York State. The objective of the study is to assess the unit costs and total statewide costs associated with two distinct scenarios: (1) the case where non-utility Class A LLRW is received, incinerated and stored at the centralized interim facility, and utility Class A wastes are held without incineration at respective nuclear power plant interim onsite facilities without incineration; and (2) the alternative case where both utility and non-utility Class A wastes are accepted, incinerated and stored at the centralized facility. Unit costs to waste generators are estimated for each of the two cases described. This is followed by an estimation of the statewide cost impact to the public. The cost impact represents the cost differential resulting from the exclusion of utility Class A waste from the centralized NYS interim waste management facility. The principal factors comprising the cost differential include (1) higher unit disposal fees charged to non-utility waste generators, which are passed along in the costs of products and services; and (2) costs to utilities due to construction of additional onsite storage capacity, which in turn are charged to electric rate payers

  12. Cost-Effectiveness of Single- Versus Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the United States.

    Directory of Open Access Journals (Sweden)

    Donna E Sweet

    Full Text Available The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs, may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings.A comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years--QALYs and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs. The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz.Life expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61 with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained.STRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S.

  13. United States electric industry : restructuring in review

    International Nuclear Information System (INIS)

    Slocum Hollis, S.

    2004-01-01

    This paper provides a detailed review of the United States electric power industry. The aim of the review was to clarify and better define current industry procedures and practices in light of significant and recent restructuring. In addition, recent bankruptcies and the power blackout in 2003 have raised concerns over industry practices. Issues concerning Independent System Operators (ISO) and regional transmission organizations were evaluated, with reference to an evolution and implementation of Regional Transmission Organization (RTO) policy, including a cost-benefit analysis. A background of RTO formations was provided with reference to consolidation, selection process and transfer of assets. Standard market design, network access and pricing issues were reviewed, as well as market and reliability concerns. Issues concerning affiliate treatment, shortages and the effect of sale of securities were presented. Various approaches to congestion management were examined, with examples from California and New England. Market monitoring issues, investigations and hearings were also examined, with examples and orders, including details of refunds. Measures to improve reliability were reviewed, including: management systems, benefit margins, requirements, assurance agreements and reserve markets. Issues concerning information access were presented, including: Open Access Same-time Information System (OASIS) requirements; tagging; standard business practices and protocols; and quarterly report practices and protocols. Interconnection policies were reviewed with reference to applicability, service options and pricing. The issue of variations was examined, with case examples concerning cost allocation, contract rights and treatment of specific costs. Jurisdiction issues concerning corporate realignments and power exchanges were presented, as well as specific services and state-federal relations. Issues concerning mergers and merger policy were also discussed, with reference

  14. License renewal in the United States

    International Nuclear Information System (INIS)

    Brons, Jack

    2002-01-01

    Full text: Nuclear plants in the United States are licensed for 40 years, a length specified in the Atomic Energy Act of 1954, which laid out much of the regulatory basis for the commercial nuclear industry. The Act, however, made provision for license renewal. The original 40-year license period was chosen arbitrarily by the U.S. Congress because it was the typical period over which utilities recovered their investment in electricity generating plants. Nuclear plants, however, are subject to a rigorous program of Nuclear Regulatory Commission oversight, maintenance and equipment replacement. In effect, they must be in the same operating condition on the last day of their licenses as they were on the first. As the industry matured, it became apparent that there was no physical limitation on the continued operation of nuclear plants past 40 years. The industry turned its attention toward license renewal. When the issue was first raised, the NRC considered stringent process equivalent to seeking a new operating license for each plant. The complexity, length and cost of the process made it unlikely that many nuclear plants would seek license renewal. The nuclear industry worked successfully with NRC on the application of generic principles to license renewal, however, and in 1995, the NRC issued an efficient, tightly-focused rule that made license renewal a safe, viable option. To extend the operating license for a reactor, a company must demonstrate to the NRC that aging effects will be adequately managed during the renewal terms, thus ensuring equipment functionality. The rule allows licensees to apply for extensions of up to 20 years. The first license renewal application was filed in 1998 by the owner of the two-unit Calvert Cliffs plant. Shortly thereafter, an application was filed for the three-unit Oconee Nuclear Station. The NRC renewed the licenses for all five units in 2000, and since then, five more licenses have been renewed. The NRC has received 37

  15. Predictors of Hospitalization, Length of Stay, and Costs of Care Among Adult and Pediatric Inpatients With Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2018-01-01

    household income, Medicaid or no insurance and fewer chronic conditions. Increased cost of care and prolonged length of stay were also associated with nonwhite race/ethnicities, lowest-quartile annual household income, Medicaid or no insurance, and having a higher number of chronic conditions. In conclusion...

  16. Community Air Sensor Network (CAIRSENSE) project: Evaluation of low-cost sensor performance in a suburban environment in the southeastern United States

    Science.gov (United States)

    Advances in air pollution sensor technology have enabled the development of small and low cost systems to measure outdoor air pollution. The deployment of a large number of sensors across a small geographic area would have potential benefits to supplement traditional monitoring n...

  17. The development of natural gas supply costs to Europe, the United States and Japan in a globalizing gas market-Model-based analysis until 2030

    International Nuclear Information System (INIS)

    Lochner, Stefan; Bothe, David

    2009-01-01

    Quickly declining natural gas reserves in some parts of the world, increasing demand in today's major gas consuming regions, the emergence of new demand centres and the globalization of natural gas markets caused by the rising importance of liquefied natural gas (LNG) are changing global gas supply structures and will continue to do so over the next decades. Applying a global gas market model, we produce a forecast for global gas supply to 2030 and determine the supplier-specific long-run average costs of gas supplied to three major consuming regions. Results for the three regions are compared and analysed with a focus on costs, supply diversification and the different roles of LNG. We find that while European and Japanese external gas supply will be less diversified in international comparison, gas can be supplied at relatively low costs due to the regions' favourable locations in geographic proximity to large gas producers. The US market's supply structure on the other hand will significantly change from its current situation. The growing dependency on LNG imports from around the world will lead to significantly higher supply costs but will also increase diversification as gas will originate from an increasing number of LNG exporting countries

  18. Better Cash Management Can Reduce the Cost of the National Direct Student Loan Program. Report to the Congress by the Comptroller General of the United States.

    Science.gov (United States)

    Comptroller General of the U.S., Washington, DC.

    The Office of Education has allowed schools participating in the National Direct Student Loan Program to hold more than an annual average of $63 million in federal funds in excess of their 30-day needs. The General Accounting Office estimates that if the Treasury had this money it could save the government interest costs of as much as $4 million,…

  19. Continued urbanization of the United States is causing the deterioration of the central city; costly suburban developments; and increases in congestion, pollution, crime, violence and alienation

    Science.gov (United States)

    1975-01-01

    It is shown that urban sprawl and the abuses of technological industries result in substantial environmental and economic costs at the expense of center city locations and populations. Socioeconomic deterioration and modification of the biosphere triggers climatic and environmental changes leading to ecosystem damage and destruction, health consequences and international conflict.

  20. In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States

    Science.gov (United States)

    2014-01-01

    Background The purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care. Methods Data on arthroscopy procedures in the US for deep seated pathology in the knee and shoulder were used (Calendar Year 2012). These procedures represent approximately 25-30% of all arthroscopic procedures performed annually. Sensitivities, specificities, positive predictive, and negative predictive values for MRI analysis of this deep seated pathology from systematic reviews and meta-analyses were used in assessing for false positive and false negative MRI findings. The costs of performing diagnostic and surgical arthroscopy procedures (using 2013 Medicare reimbursement amounts); costs associated with false negative findings; and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were then assessed. Results In patients presenting with medial meniscal pathology (ICD9CM diagnosis 836.0 over 540,000 procedures in CY 2012); use of the VSI system in place of MRI assessment (standard of care) resulted in a net cost savings to the system of $151 million. In patients presenting with rotator cuff pathology (ICD9CM 840.4 over 165,000 procedures in CY2012); use of VSI in place of MRI similarly saved $59 million. These savings were realized along with more appropriate care as; fewer patients were exposed to higher risk surgical arthroscopic procedures. Conclusions The use of an in-office arthroscopy system can: possibly save the US healthcare system money; shorten the diagnostic odyssey for patients; potentially better prepare clinicians for arthroscopic surgery (when needed) and; eliminate unnecessary outpatient arthroscopy procedures, which commonly result in surgical intervention. PMID:24885678

  1. TRAINING OF THE STATE PRESIDENT'S UNIT

    African Journals Online (AJOL)

    The primary function of the State President's Unit is to protect the head of state - not his person as is generally believed, but his authority over the state. Ironically, the ceremonial performances of the State President's Unit lead people to believe that they are only capable of doing drill exer- cises. However, upon investigating.

  2. Analisis Unit Cost Sectio Caesaria dengan Metode Activity Based Costing di Rumah Sakit Bhayangkara Yogyakarta

    Directory of Open Access Journals (Sweden)

    Tsalisah Damayanti

    2017-01-01

    Full Text Available This study aims to analyze the unit cost of sectio Caesaria by ABC method, second to analyze the differences between the unit cost calculation of Sectio Caesaria by ABC method with applied cost. Unit cost analysis was conducted at Sectio Caesaria procedure without comorbidities or complications. Data that used in the form of primary data interviews with specialists Obgyn and secondary data financial data and hospitals profiles. The result of the calculation of unit cost of Sectio Caesaria service through Activity Based Costing approach is still lower than INA CBG’s tariff.

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

    Science.gov (United States)

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

    2016-01-01

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

  4. Cost-effectiveness analysis of risk-factor guided and birth-cohort screening for chronic hepatitis C infection in the United States.

    Directory of Open Access Journals (Sweden)

    Shan Liu

    Full Text Available No consensus exists on screening to detect the estimated 2 million Americans unaware of their chronic hepatitis C infections. Advisory groups differ, recommending birth-cohort screening for baby boomers, screening only high-risk individuals, or no screening. We assessed one-time risk assessment and screening to identify previously undiagnosed 40-74 year-olds given newly available hepatitis C treatments.A Markov model evaluated alternative risk-factor guided and birth-cohort screening and treatment strategies. Risk factors included drug use history, blood transfusion before 1992, and multiple sexual partners. Analyses of the National Health and Nutrition Examination Survey provided sex-, race-, age-, and risk-factor-specific hepatitis C prevalence and mortality rates. Nine strategies combined screening (no screening, risk-factor guided screening, or birth-cohort screening and treatment (standard therapy-peginterferon alfa and ribavirin, Interleukin-28B-guided (IL28B triple-therapy-standard therapy plus a protease inhibitor, or universal triple therapy. Response-guided treatment depended on HCV genotype. Outcomes include discounted lifetime costs (2010 dollars and quality adjusted life-years (QALYs. Compared to no screening, risk-factor guided and birth-cohort screening for 50 year-olds gained 0.7 to 3.5 quality adjusted life-days and cost $168 to $568 per person. Birth-cohort screening provided more benefit per dollar than risk-factor guided screening and cost $65,749 per QALY if followed by universal triple therapy compared to screening followed by IL28B-guided triple therapy. If only 10% of screen-detected, eligible patients initiate treatment at each opportunity, birth-cohort screening with universal triple therapy costs $241,100 per QALY. Assuming treatment with triple therapy, screening all individuals aged 40-64 years costs less than $100,000 per QALY.The cost-effectiveness of one-time birth-cohort hepatitis C screening for 40-64 year olds

  5. Unit costs of waste management operations

    International Nuclear Information System (INIS)

    Kisieleski, W.E.; Folga, S.M.; Gillette, J.L.; Buehring, W.A.

    1994-04-01

    This report provides estimates of generic costs for the management, disposal, and surveillance of various waste types, from the time they are generated to the end of their institutional control. Costs include monitoring and surveillance costs required after waste disposal. Available data on costs for the treatment, storage, disposal, and transportation of spent nuclear fuel and high-level radioactive, low-level radioactive, transuranic radioactive, hazardous, mixed (low-level radioactive plus hazardous), and sanitary wastes are presented. The costs cover all major elements that contribute to the total system life-cycle (i.e., ''cradle to grave'') cost for each waste type. This total cost is the sum of fixed and variable cost components. Variable costs are affected by operating rates and throughput capacities and vary in direct proportion to changes in the level of activity. Fixed costs remain constant regardless of changes in the amount of waste, operating rates, or throughput capacities. Key factors that influence cost, such as the size and throughput capacity of facilities, are identified. In many cases, ranges of values for the key variables are presented. For some waste types, the planned or estimated costs for storage and disposal, projected to the year 2000, are presented as graphics

  6. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2013-11-01

    Full Text Available Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Covance Market Access Services Inc, Sydney, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The economic burden associated with the treatment of low back pain (LBP in the United States is significant. LBP caused by sacroiliac (SI joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS options may offer potential cost savings to Medicare.Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG payments of $46,700 (with major complications - DRG 459 and $27,800 (without major complications - DRG 460, weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were

  7. Development and Implications of a Predictive Cost Methodology for Modular Pumped Storage Hydropower (m-PSH) Projects in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Witt, Adam [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Chalise, Dol Raj [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hadjerioua, Boualem [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Manwaring, Michael [MWH, Broomfield, CO (United States); Bishop, Norm [Knight Piesold, Denver, CO (United States)

    2016-10-01

    The slow pace of Pumped Storage Hydropower development in the US over the past twenty years has led to widespread interest in the feasibility and viability of alternative PSH designs, development schemes, and technologies. Since 2011, Oak Ridge National Lab has been exploring the economic viability of modular Pumped Storage Hydropower (m-PSH) development through targeted case studies, revenue simulations, and analysis of innovative configurations and designs. This paper outlines the development and supporting analysis of a scalable, comprehensive cost modeling tool designed to simulate the initial capital costs for a variety of potential m-PSH projects and deployment scenarios. The tool is used to explore and determine innovative research strategies that can improve the economic viability of m-PSH in US markets.

  8. The Feto-Maternal Health Cost of Intimate Partner Violence Among Delivery-Related Discharges in the United States, 2002-2009.

    Science.gov (United States)

    Mogos, Mulubrhan F; Araya, Winta N; Masho, Saba W; Salemi, Jason L; Shieh, Carol; Salihu, Hamisu M

    2016-02-01

    Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost. © The Author(s) 2014.

  9. Comparison of costs and discharge outcomes for patients hospitalized for ischemic or hemorrhagic stroke with or without atrial fibrillation in the United States.

    Science.gov (United States)

    Pan, Xianying; Simon, Teresa A; Hamilton, Melissa; Kuznik, Andreas

    2015-05-01

    This retrospective analysis investigated the impact of baseline clinical characteristics, including atrial fibrillation (AF), on hospital discharge status (to home or continuing care), mortality, length of hospital stay, and treatment costs in patients hospitalized for stroke. The analysis included adult patients hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke between January 2006 and June 2011 from the premier alliance database, a large nationally representative database of inpatient health records. Patients included in the analysis were categorized as with or without AF, based on the presence or absence of a secondary listed diagnosis of AF. Irrespective of stroke type (ischemic or hemorrhagic), AF was associated with an increased risk of mortality during the index hospitalization event, as well as a higher probability of discharge to a continuing care facility, longer duration of stay, and higher treatment costs. In patients hospitalized for a stroke event, AF appears to be an independent risk factor of in-hospital mortality, discharge to continuing care, length of hospital stay, and increased treatment costs.

  10. United States Stateplane Zones - NAD27

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1927) represents the State Plane Coordinate System (SPCS) Zones for the 1927 North American Datum within United States.

  11. United States Stateplane Zones - NAD83

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1983) represents the State Plane Coordinate System (SPCS) Zones for the 1983 North American Datum within United States.

  12. Death in the United States, 2011

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

  13. Data report: western United States

    International Nuclear Information System (INIS)

    Cook, J.R.; Fay, W.M.

    1982-04-01

    This abbreviated summary data report, presents results of ground water and stream surface sediment reconnaissance in the western United States. Surface sediment samples were collected at 67,741 sites, at a target sampling density of one site per 13 square kilometers. Ground water samples were collected at 13,979 sites, and surface water samples were collected at 2,958 sites. Neutron activaton analysis results are given for uranium and 16 other elements in sediments, and for uranium and 9 other elements in waters. Mass spectrometry results are given for helium in ground waters. Supplemental analyses of the sediments for extractable uranium and 22 other elements are given where they are available. Supplemental analyses of water samples for 33 additional elements are also reported where they are available. Analytical data and field measurements are presented in tables on microfiche. Data from ground water sites (on microfiche in pocket) include (1) water chemistry measurements (pH, conductivity, and alkalinity), (2) physical measurements where applicable (water temperature, well description, and scintillometer reading), and (3) elemental analyses (U, Al, Br Cl, Dy, F, Mg, Mn, Na, and V by neutron activation and Ag, Al, As, B, Ba, Be, Ca, Ce, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Nb, Ni, P, Sc, Se, Si, Sr, Th, Ti, V, Y, Zn, and Zr by spectrophotometry). Helium analyses are given for ground water

  14. Health care resource utilization and medical costs of spinal cord injury with neuropathic pain in a commercially insured population in the United States.

    Science.gov (United States)

    Margolis, Jay M; Juneau, Paul; Sadosky, Alesia; Cappelleri, Joseph C; Bryce, Thomas N; Nieshoff, Edward C

    2014-12-01

    To evaluate health care resource use, costs, and cost drivers among patients with neuropathic pain (NeP) after spinal cord injury (SCI) in a commercially insured population. Retrospective longitudinal cohort study comparing SCI patients with and without NeP. Truven Health MarketScan commercial claims database from 2005 through 2012. Commercially insured SCI patients with NeP (n=3524) propensity score matched to SCI patients without NeP (n=3524). Not applicable. Health care resource utilization and expenditures for the 12 months after NeP onset (index event; identified through International Classification of Diseases, 9th Revision, Clinical Modification diagnosis 338.0x or use of NeP-specific antiepileptic drugs or NeP-specific antidepressants) in patients with SCI compared with matched patients without NeP. Utilization over 12 months postindex among patients with SCI-associated NeP was higher than among SCI-only patients for inpatient admissions (27.4% vs 22.1%), emergency department visits (36.7% vs 26.4%), and office visits per patient (mean ± SD: 13.0±9.5 vs 9.5±8.3); all P values were patient with SCI-associated NeP during the 12-month postindex period. Patients with evidence of NeP secondary to SCI have significantly higher health care utilization and total costs compared with SCI patients without evidence of NeP. Factors contributing to NeP in patients with SCI need to be clinically assessed to determine the optimal approach for treating these individuals. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. A proposed United States resource classification system

    International Nuclear Information System (INIS)

    Masters, C.D.

    1980-01-01

    Energy is a world-wide problem calling for world-wide communication to resolve the many supply and distribution problems. Essential to a communication problem are a definition and comparability of elements being communicated. The US Geological Survey, with the co-operation of the US Bureau of Mines and the US Department of Energy, has devised a classification system for all mineral resources, the principles of which, it is felt, offer the possibility of world communication. At present several other systems, extant or under development (Potential Gas Committee of the USA, United Nations Resource Committee, and the American Society of Testing and Materials) are internally consistent and provide easy communication linkage. The system in use by the uranium community in the United States of America, however, ties resource quantities to forward-cost dollar values rendering them inconsistent with other classifications and therefore not comparable. This paper develops the rationale for the new USGS resource classification and notes its benefits relative to a forward-cost classification and its relationship specifically to other current classifications. (author)

  16. 76 FR 14637 - State Medicaid Fraud Control Units; Data Mining

    Science.gov (United States)

    2011-03-17

    ...] State Medicaid Fraud Control Units; Data Mining AGENCY: Office of Inspector General (OIG), HHS. ACTION... and analyzing State Medicaid claims data, known as data mining. To support and modernize MFCU efforts... (FFP) in the costs of defined data mining activities under specified conditions. In addition, we...

  17. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2013-01-01

    Introduction The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare. Methods An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum. Results The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient). Conclusion Treating Medicare

  18. Electric trade in the United States 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1994, the wholesale trade market totaled 1.9 trillion kilowatthours, about 66% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1994 (ELECTRA), is the fifth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1994.

  19. Radiation protection standards in the United States

    International Nuclear Information System (INIS)

    Mills, W.A.; Arsenault, F.J.; Conti, E.F.

    1988-01-01

    Standards to protect workers and members of the general public against any harmful effects of ionizing radiation are numerous and complex in the United States. Many Federal agencies have protection responsibilities, our Congress limits the discretionary authority given to these agencies in providing for this protection, and our court system appears at times to render judgments that are illogical to our sense of the degree of radiological protection required. To many our standards appear to be overprotective in that they have, at best, marginal health benefits and without question are costly to implement. Government agencies, the Congress, industry, professional organizations, and others have expressed their concerns and interests regarding standards in a variety of ways

  20. Electric trade in the United States 1994

    International Nuclear Information System (INIS)

    1998-08-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1994, the wholesale trade market totaled 1.9 trillion kilowatthours, about 66% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1994 (ELECTRA), is the fifth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1994

  1. 48 CFR 1845.7101-3 - Unit acquisition cost.

    Science.gov (United States)

    2010-10-01

    ... production inventory and include programmed extra units to cover replacement during the fabrication process... ADMINISTRATION CONTRACT MANAGEMENT GOVERNMENT PROPERTY Forms Preparation 1845.7101-3 Unit acquisition cost. (a... production costs (for assets produced or constructed). (5) Engineering, architectural, and other outside...

  2. Contemporary United States Foreign Policy Towards Indonesia

    National Research Council Canada - National Science Library

    McAslan, Hugh

    2004-01-01

    United States national interests in Indonesia have traditionally being based on strategic security requirements given Indonesia's geographic location between the Indian and Pacific Oceans, and strong...

  3. COST BUDGETING WITH THE ROMANIAN BAKERY UNITS

    Directory of Open Access Journals (Sweden)

    RĂSCOLEAN ILIE

    2017-11-01

    Full Text Available A primary objective of management accounting is the possibility to estimate the total costs of a product or service works, which determines the development and implementation of specific managerial accounting systems that in addition to quantifying the immediate results aimed at achieving objectives such as customer orientation, labor productivity growth, the improvement of economic entities’ performance, establishing optimal outlets and prices and abandoning production-manufacture products that generate losses. Based on the progress of the investigations undertaken in the literature, the authors article demonstrates the need for achieving cost budgeting in the context of economic entities from the milling and bakeries industry, as mean of management control - by the example of S.C. AVANTI SRL Lupeni. The research in the field has led to the conduct of the study are awaited, being capable of demonstrating the viability of the management accounting organization at economic entities in the milling and bakery industry from Romania, in order to increase their performances. The results obtained by applying the costs budgeting allowed a rigorous cost control, which ultimately leads to an increase in the performance of the economic entity under study, as well as to the economic entities in the field that will apply the costs budgeting. At the end, the authors conclude regarding the importance of extending the framework for successfully implementing cost budgeting in the context of economic entities across the country.

  4. The costs of producing a unit of blood in Zimbabwe

    NARCIS (Netherlands)

    Mafirakureva, Nyashadzaishe; Nyoni, Herbert; Nkomo, Sisodwa Z; Jacob, Jeffery S; Chikwereti, Radhi; Musekiwa, Zamile; Khoza, Star; Mvere, David A; Emmanuel, Jean C; Postma, Maarten J; van Hulst, Marinus

    2015-01-01

    BACKGROUND: There is lack of published data on the costs of blood and blood transfusion in sub-Saharan Africa. This study aimed to assess the unit costs of producing blood in Zimbabwe using an activity-based costing (ABC) method. STUDY DESIGN AND METHODS: A management accounting approach, based on

  5. Drug Poisoning Mortality by State: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset describes drug poisoning deaths at the U.S. and state level by selected demographic characteristics, and includes age-adjusted death rates for drug...

  6. Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  7. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital

    Science.gov (United States)

    Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

    2016-01-01

    Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974

  8. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

    Science.gov (United States)

    Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

    2015-05-17

    Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

  9. Commerical electric power cost studies. Capital cost addendum multi-unit coal and nuclear stations

    International Nuclear Information System (INIS)

    1977-09-01

    This report is the culmination of a study performed to develop designs and associated capital cost estimates for multi-unit nuclear and coal commercial electric power stations, and to determine the distribution of these costs among the individual units. This report addresses six different types of 2400 MWe (nominal) multi-unit stations as follows: Two Unit PWR Station-1139 MWe Each, Two Unit BWR Station-1190 MWe Each, Two Unit High Sulfur Coal-Fired Station-1232 MWe Each, Two Unit Low Sulfur Coal-Fired Station-1243 MWe Each, Three Unit High Sulfur Coal-Fired Station-794 MWe Each, Three Unit Low Sulfur Coal-Fired Station-801 MWe Each. Recent capital cost studies performed for ERDA/NRC of single unit nuclear and coal stations are used as the basis for developing the designs and costs of the multi-unit stations. This report includes the major study groundrules, a summary of single and multi-unit stations total base cost estimates, details of cost estimates at the three digit account level and plot plan drawings for each multi-unit station identified

  10. PV Project Finance in the United States, 2016

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, David; Lowder, Travis; Schwabe, Paul

    2016-09-01

    This brief is a compilation of data points and market insights that reflect the state of the project finance market for solar photovoltaic (PV) assets in the United States as of the third quarter of 2016. This information can generally be used as a simplified benchmark of the costs associated with securing financing for solar PV as well as the cost of the financing itself (i.e., the cost of capital). Three sources of capital are considered -- tax equity, sponsor equity, and debt -- across three segments of the PV marketplace.

  11. The United Kingdom: Issues for the United States

    National Research Council Canada - National Science Library

    Archick, Kristin

    2007-01-01

    ...; and more recently, from the UK's strong support in countering terrorism and confronting Iraq. The United States and Britain also share a mutually beneficial trade and economic relationship, and are each other's biggest foreign direct investors...

  12. 78 FR 4439 - United States

    Science.gov (United States)

    2013-01-22

    ... prices for chiropractic services in Oklahoma. Antitrust law treats naked agreements among competitors that set prices as per se illegal.\\2\\ Where competitors economically integrate in a joint venture... that is designed to control costs and assure quality of care by monitoring over-utilization of health...

  13. Violence in the United States

    Science.gov (United States)

    Sumner, Steven A.; Mercy, James A.; Dahlberg, Linda L.; Hillis, Susan D.; Klevens, Joanne; Houry, Debra

    2015-01-01

    IMPORTANCE Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence. OBJECTIVES To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities. DATA SOURCES We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigation’s Uniform Crime Reports, the US Justice Department’s National Crime Victimization Survey, the National Survey of Children’s Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System—All Injury Program. RESULTS Homicide rates have decreased from a peak of 10.7 per 100 000 persons in 1980 to 5.1 per 100 000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100 000 in 1992 to 242 per 100 000 in 2012. Nevertheless, annually, there are more than 16 000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example

  14. Global Entrepreneurship and the United States

    Science.gov (United States)

    2010-09-01

    Global Entrepreneurship and the United States by Zoltan J. Acs Laszlo Szerb Ruxton, MD 21204 for under contract number SBAHQ-09...SUBTITLE Global Entrepreneurship and the United States 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...3 2.1. Assessing Entrepreneurship ..................................................................................4 2.2. Stages of Development

  15. Immigration Enforcement Within the United States

    Science.gov (United States)

    2006-04-06

    Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Policy Issues...Remained in the United States, (Washington: Center for Immigration Studies, May 2002). Immigration Enforcement Within the United States Introduction ...interior enforcement lack a border component. For example, fugitive taskforces, investigations of alien slavery and sweatshops , and employer sanctions do

  16. 75 FR 25925 - United States Mint

    Science.gov (United States)

    2010-05-10

    ... Committee May 25, 2010 Public Meeting. SUMMARY: Pursuant to United States Code, Title 31, section 5135(b)(8... scheduled for May 25, 2010. Date: May 25, 2010. Time: 9 a.m. to 12 p.m. Location: 8th Floor Board Room, United States Mint, 801 9th Street, NW., Washington, DC 20220. Subject: Review and discuss obverse and...

  17. Electric trade in the United States, 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1996, the wholesale trade market totaled 2.3 trillion kilowatthours, over 73% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1996 (ELECTRA), is the sixth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1996. The electric trade data collected and presented in this report furnish important information on the wholesale structure found within the US electric power industry. The patterns of interutility trade in the report support analyses of wholesale power transactions and provide input for a broader understanding of bulk power market issues that define the emerging national electric energy policies. The report includes information on the quantity of power purchased, sold, exchanged, and wheeled; the geographical locations of transactions and ownership classes involved; and the revenues and costs. 1 fig., 43 tabs.

  18. Latino College Completion: United States

    Science.gov (United States)

    Excelencia in Education (NJ1), 2012

    2012-01-01

    In 2009, Excelencia in Education launched the Ensuring America's Future initiative to inform, organize, and engage leaders in a tactical plan to increase Latino college completion. An executive summary of Latino College Completion in 50 states synthesizes information on 50 state factsheets and builds on the national benchmarking guide. Each…

  19. Climatography of the United States

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Numbered series of NOAA publications that contain environmental information climate summaries and station normals. Each series contains a volume for each state,...

  20. The economic burden of skin disease in the United States.

    Science.gov (United States)

    Dehkharghani, Seena; Bible, Jason; Chen, John G; Feldman, Steven R; Fleischer, Alan B

    2003-04-01

    Skin diseases and their complications are a significant burden on the nation, both in terms of acute and chronic morbidities and their related expenditures for care. Because accurately calculating the cost of skin disease has proven difficult in the past, we present here multiple comparative techniques allowing a more expanded approach to estimating the overall economic burden. Our aims were to (1) determine the economic burden of primary diseases falling within the realm of skin disease, as defined by modern clinical disease classification schemes and (2) identify the specific contribution of each component of costs to the overall expense. Costs were taken as the sum of several factors, divided into direct and indirect health care costs. The direct costs included inpatient hospital costs, ambulatory visit costs (further divided into physician's office visits, outpatient department visits, and emergency department visits), prescription drug costs, and self-care/over-the-counter drug costs. Indirect costs were calculated as the outlay of days of work lost because of skin diseases. The economic burden of skin disease in the United States is large, estimated at approximately $35.9 billion for 1997, including $19.8 billion (54%) in ambulatory care costs; $7.2 billion (20.2%) in hospital inpatient charges; $3.0 billion (8.2%) in prescription drug costs; $4.3 billion (11.7%) in over-the-counter preparations; and $1.6 billion (6.0%) in indirect costs attributable to lost workdays. Our determination of the economic burden of skin care in the United States surpasses past estimates several-fold, and the model presented for calculating cost of illness allows for tracking changes in national expenses for skin care in future studies. The amount of estimated resources devoted to skin disease management is far more than required to treat conditions such as urinary incontinence ($16 billion) and hypertension ($23 billion), but far less than required to treat musculoskeletal

  1. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2016-07-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on USimports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  2. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

  3. Unit Cost of Medical Services at Different Hospitals in India

    Science.gov (United States)

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  4. Cancer insurance policies in Japan and the United States.

    Science.gov (United States)

    Bennett, C L; Weinberg, P D; Lieberman, J J

    1998-01-01

    Cancer care in the United States often results in financial hardship for patients and their families. Standard health insurance covers most medical costs, but nonmedical costs (such as lost wages, deductibles, copayments, and travel to and from caregivers) are paid out of pocket. Over the course of treatment, these costs can become substantial. Insurance companies have addressed the burden of these out-of-pocket costs by offering supplemental cancer insurance policies that, upon diagnosis of cancer, pay cash benefits for items that usually require out-of-pocket expenditures and are distinct from reimbursements made by traditional health insurance. Limitations associated with managed care have fostered increased consumer awareness and interest in the United States for cancer insurance and its ability to defray treatment expenditures that usually require out-of-pocket payments. Marketing campaigns are becoming more aggressive, and the number of cancer insurance policies sold has been steadily rising. While cancer insurance is only recently gaining popularity in the United States, it has been a successful product in Japan for over twenty years. In Japan, approximately one-quarter of the population own cancer insurance, and ten-year retention rates are estimated at 75%. As a result, individuals are afforded good access to nonmedical cancer services. Understanding the factors that led to the success of cancer insurance in Japan may assist policymakers in evaluating cancer insurance policies as they become more prevalent in the United States.

  5. Investor perceptions of potential IFRS adoption in the United States

    NARCIS (Netherlands)

    Leung, P.Y.E.; Joos, P.P.M.

    2013-01-01

    This paper examines the stock market reaction to 15 events relating to IFRS adoption in the United States. The goal is to assess whether investors perceive the switch to IFRS as beneficial or costly. Our findings suggest that investors' reaction to IFRS adoption is more positive in cases where IFRS

  6. Braille in the United States: Its Production, Distribution, and Use.

    Science.gov (United States)

    Goldish, Louis Harvey

    The braille production system in the United States is described. Aspects treated are the following: the need for braille (the braille system), the market for braille (size and characteristics), sources of braille (producers and braille book source information), and present methods and costs of producing braille. Technological advances are…

  7. Nuclear development in the United States

    International Nuclear Information System (INIS)

    Brewer, S.

    1983-01-01

    The history of the nuclear development in the United States has been one of international cooperation relations so far. The United States is to offer the technical information on atomic energy utilization to foreign countries in exchange for the guarantee that they never attempt to have or develop nuclear weapons. Actually, the United States has supplied the technologies on nuclear fuel cycle and other related fields to enable other countries to achieve economical and social progress. The Department of Energy clarified the public promise of the United States regarding the idea of international energy community. The ratio of nuclear power generation to total electric power supply in the United States exceeded 12%, and will exceed 20% by 1990. Since 1978, new nuclear power station has not been ordered, and some of the contracted power stations were canceled. The atomic energy industry in the United States prospered at the beginning of 1970s, but lost the spirit now, mainly due to the institutional problems rather than the technical ones. As the policy of the government to eliminate the obstacles, the improvement of the procedure for the permission and approval, the establishment of waste disposal capability, the verification of fast breeder reactor technology and the promotion of commercial fuel reprocessing were proposed. The re-establishment of the United States as the reliable supplier of atomic energy service is the final aim. (Kako, I.)

  8. The United States of America

    International Nuclear Information System (INIS)

    Taylor, J.J.

    1987-01-01

    The development of nuclear power in the USA is recounted. Starting with the making of the nuclear bomb during the Second World War, the next phase (1947-1954) was the development of the peaceful atom. The commercial origins of the nuclear electric power demonstration programme during 1954-1961 are recalled. The years 1961-1968 saw the building of Westinghouse pressurized water reactors both in the USA and overseas. 1968-1975 saw the construction and operation of more nuclear power plants and the development of a regulatory framework. However, problems also began to emerge in this period; licensing changes and delays, construction delays, equipment modifications, escalating costs, public hearing and legal delays and reliability issues. These led in 1975-1979 to a cessation of growth and increased public opposition. The accidents at the Three Mile Island nuclear power plant in 1979 and Chernobyl in 1986 and their impacts are discussed. (U.K.)

  9. Household pesticide usage in the United States.

    Science.gov (United States)

    Savage, E P; Keefe, T J; Wheeler, H W; Mounce, L; Helwic, L; Applehans, F; Goes, E; Goes, T; Mihlan, G; Rench, J; Taylor, D K

    1981-01-01

    A total of 10,000 U.S. households in 25 standard metropolitan statistical areas and 25 counties were included in the United States. More than 8,200 households granted an interview. Nine of every ten households in the United States used some types of pesticide in their house, garden, or yard. Households in the southeastern United States used the most pesticides. Although more than 500 different pesticide formulations were used by the sampled households, 15 pesticides accounted for 65.5% of all pesticides reported in this study. Thirteen of these 15 pesticides were insecticides, one was a herbicide, and one was a rodenticide.

  10. The unit cost factors and calculation methods for decommissioning - Cost estimation of nuclear research facilities

    International Nuclear Information System (INIS)

    Kwan-Seong Jeong; Dong-Gyu Lee; Chong-Hun Jung; Kune-Woo Lee

    2007-01-01

    Available in abstract form only. Full text of publication follows: The uncertainties of decommissioning costs increase high due to several conditions. Decommissioning cost estimation depends on the complexity of nuclear installations, its site-specific physical and radiological inventories. Therefore, the decommissioning costs of nuclear research facilities must be estimated in accordance with the detailed sub-tasks and resources by the tasks of decommissioning activities. By selecting the classified activities and resources, costs are calculated by the items and then the total costs of all decommissioning activities are reshuffled to match with its usage and objectives. And the decommissioning cost of nuclear research facilities is calculated by applying a unit cost factor method on which classification of decommissioning works fitted with the features and specifications of decommissioning objects and establishment of composition factors are based. Decommissioning costs of nuclear research facilities are composed of labor cost, equipment and materials cost. Of these three categorical costs, the calculation of labor costs are very important because decommissioning activities mainly depend on labor force. Labor costs in decommissioning activities are calculated on the basis of working time consumed in decommissioning objects and works. The working times are figured out of unit cost factors and work difficulty factors. Finally, labor costs are figured out by using these factors as parameters of calculation. The accuracy of decommissioning cost estimation results is much higher compared to the real decommissioning works. (authors)

  11. Defense Finance and Accounting Service Administration of Unit Costs

    National Research Council Canada - National Science Library

    Lay, F

    1996-01-01

    ...) of products or outputs produced. Audit Objectives. We conducted this part of our audit to find out whether unit costs for goods and services provided by DFAS were determined in accordance with DoD policies and based on actual costs incurred...

  12. A functional intranet for the United States Coast Guard Unit

    OpenAIRE

    Hannah, Robert Todd.

    1998-01-01

    Approved for public release; distribution in unlimited. This thesis describes the complete development process of a friendly functional Intranet for an operational United States Coast Guard (USCG) electronic Support Unit (ESU) in Alameda, California. The final product is suitable for immediate use. It may also be used as a prototype for future Intranet development efforts. The methodology used to develop a finished, working product provides the core subject matter for this thesis. The disc...

  13. United Kingdom and United States Tourism Demand for Malaysia:A Cointegration Analysis

    OpenAIRE

    Habibi, Fateh; Abdul Rahim, Khalid; Chin, Lee

    2008-01-01

    Tourism industry has been an important contributor to the Malaysia economy. In this paper we inspect variations in the long run demand for tourism from United Kingdom and United States to Malaysia. The demand for tourism has been explained by macroeconomic variables, including income in origin countries, tourism prices in Malaysia, and travel cost between the two countries. Annual data from 1972 to 2006 are used for the analysis. Augmented Dickey-Fuller and Johansen’s maximum likelihood tests...

  14. Analysis of United States' Broadband Policy

    National Research Council Canada - National Science Library

    Uzarski, Joel S

    2007-01-01

    .... With every month that passes, the United States fails to close the gap in the digital divide both inside its borders as well as among the other countries that lead the world in broadband penetration...

  15. 2012 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2012 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  16. 2014 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2014 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  17. Health, United States, 2012: Men's Health

    Science.gov (United States)

    ... Mailing List Previous Reports Suggested Citation Related Sites Purchase Health, United States Behavioral Health Report Children’s ... with Internet Explorer may experience difficulties in directly accessing links to Excel files ...

  18. Improving the United States' Strategic Communication Strategy

    National Research Council Canada - National Science Library

    Risberg, Robert H

    2008-01-01

    ...? Much of the answer to this question is the failure of the United States Government to effectively use strategic communication to inform and influence populations to recognize the value of American...

  19. United States Interagency Elevation Inventory (USIEI)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The U.S. Interagency Elevation Inventory displays high-accuracy topographic and bathymetric data for the United States and its territories. The project is a...

  20. 2009 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2009 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  1. NCHS - Leading Causes of Death: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset presents the age-adjusted death rates for the 10 leading causes of death in the United States beginning in 1999. Data are based on information from all...

  2. The United States and Europe: Current Issues

    National Research Council Canada - National Science Library

    Archick, Kristin; Morelli, Vince L

    2006-01-01

    The United States and Europe share a long and intertwined history. Both sides of the Atlantic face a common set of international concerns, have few other comparable partners, and share a deep economic relationship...

  3. Dengue Fever in the United States

    Centers for Disease Control (CDC) Podcasts

    Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States.

  4. Climate change indicators in the United States

    Science.gov (United States)

    2010-04-01

    The U.S. Environmental Protection Agency (EPA) has published this report, Climate Change Indicators in the United States, to help readers interpret a set of important indicators to better understand climate change. The report presents 24 indicators, ...

  5. Surveillance for Viral Hepatitis - United States, 2014

    Science.gov (United States)

    ... Resource Center Anonymous Feedback Viral Hepatitis Surveillance for Viral Hepatitis – United States, 2014 Recommend on Facebook Tweet Share ... Cases Hepatitis A Hepatitis B Hepatitis C Discussion Hepatitis A virus Index PAGE DESCRIPTION Table 2.1 Reported ...

  6. 2010 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2010 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  7. 2011 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2011 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  8. A longitudinal cohort study of the relationship between Thimerosal-containing hepatitis B vaccination and specific delays in development in the United States: Assessment of attributable risk and lifetime care costs

    Directory of Open Access Journals (Sweden)

    David A. Geier

    2016-06-01

    Full Text Available Epidemiological evidence suggests a link between mercury (Hg exposure from Thimerosal-containing vaccines and specific delays in development. A hypothesis-testing longitudinal cohort study (n = 49,835 using medical records in the Vaccine Safety Datalink (VSD was undertaken to evaluate the relationship between exposure to Hg from Thimerosal-containing hepatitis B vaccines (T-HBVs administered at specific intervals in the first 6 months of life and specific delays in development [International Classification of Disease, 9th revision (ICD-9: 315.xx] among children born between 1991 and 1994 and continuously enrolled from birth for at least 5.81 years. Infants receiving increased Hg doses from T-HBVs administered within the first month, the first 2 months, and the first 6 months of life were significantly more likely to be diagnosed with specific delays in development than infants receiving no Hg doses from T-HBVs. During the decade in which T-HBVs were routinely recommended and administered to US infants (1991–2001, an estimated 0.5–1 million additional US children were diagnosed with specific delays in development as a consequence of 25 μg or 37.5 μg organic Hg from T-HBVs administered within the first 6 months of life. The resulting lifetime costs to the United States may exceed $1 trillion.

  9. United States housing, first quarter 2013

    Science.gov (United States)

    Delton Alderman

    2014-01-01

    Provides current and historical information on housing market in the United States. Information includes trends for housing permits and starts, housing under construction, and housing completions for single and multifamily units, and sales and construction. This report will be updated regularly.

  10. Energy problems of the United States

    International Nuclear Information System (INIS)

    Pertuzio, A.

    2006-01-01

    The united states are the third world producer of oil which accounts for 440% of world production and 20 million barrels/day of which 60% are imported. That dependence on imports is likely to increase in the next decades. Such supplies and their security are therefore a fundamental factor of the United States foreign policy in combination with their political, economic and strategic objectives in a world both unsure and dangerous

  11. Trial by jury in the United States

    Directory of Open Access Journals (Sweden)

    Lochhead Robert

    2015-10-01

    Full Text Available Th e Republic of Moldova is considering the adoption of trial by jury in select criminal cases. Th e following article is intended to contribute to the discussion of that proposal. Th e article will briefl y describe the history of juries under the English common law and as adopted by the United States. It will then outline some of the basic procedures in trials by jury as currently practiced in the United States federal court system.

  12. Reinventing primary care: lessons from Canada for the United States.

    Science.gov (United States)

    Starfield, Barbara

    2010-05-01

    Canada is, in many respects, culturally and economically similar to the United States, and until relatively recently, the two countries had similar health systems. However, since passage of the Canada Health Act in the 1970s, that nation's health statistics have become increasingly superior. Although the costs of Canada's health system are high by international standards, they are much lower than U.S. costs. This paper describes several factors likely to be responsible for Canada's better health at lower cost: universal financial coverage through a so-called single payer; features conducive to a strong primary care infrastructure; and provincial autonomy under general principles set by national law.

  13. Unit costs in international economic evaluations: resource costing of the Schizophrenia Outpatient Health Outcomes Study.

    Science.gov (United States)

    Urdahl, H; Knapp, M; Edgell, E T; Ghandi, G; Haro, J M

    2003-01-01

    We present unit costs corresponding to resource information collected in the Schizophrenia Outpatient Health Outcomes (SOHO) Study. The SOHO study is a 3-year, prospective, observational study of health outcomes associated with antipsychotic treatment in out-patients treated for schizophrenia. The study is being conducted across 10 European countries (Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Portugal, Spain and the UK) and includes over 10,800 patients and over 1000 investigators. To identify the best available unit costs of hospital admissions, day care and psychiatrist out-patient visits, a tariff-based approach was used. Unit costs were obtained for nine of the 10 countries and were adjusted to 2000 price levels by consumer price indices and converted to US dollars using purchasing power parity rates (and on to Euro). The paper illustrates the need to balance the search for sound unit costs with pragmatic solutions in the costing of international economic evaluations.

  14. The United Mexican States: an update.

    Science.gov (United States)

    Hakkert, R; Aguirre, E J

    1988-09-01

    Although the popular North American opinion of Mexico is one that paints a picture of a poor, disadvantaged country, South America sees Mexico has a richer more prosperous nation. It is observed that only in the Latin American countries of Venezuela, Suriname and Trinidad and Tobago do consumers have higher incomes than Mexican consumers. Moreover, while millions of Mexicans migrate to the United States to seek a better standard of living, several thousand Central American refugees illegally migrate to Mexico in search of a better life. This better life includes an increased age of lie expectancy from 51 years in the 1950s to 64 years in the late 1970s. There have also been improvements in health care and school enrollments and in the low cost availability of education. Tourism and the prospect of the manufacturing of energy are significant, positive factors working in favor of an improved Mexican economy and a higher overall quality of life. However, Mexico faces serious problems such as a mounting foreign debt. Also rising is Mexico's population which has doubled since 1964 and which continues to grow at a rate of 1.9%. Economic programs and reforms and family development planning have been instituted in response to the countries' current recession and population growth and have begun to show positive results.

  15. Basic Research about Calculation of the Decommissioning Unit Cost based on The KRR-2 Decommissioning Project

    International Nuclear Information System (INIS)

    Song, Chan-Ho; Park, Hee-Seong; Ha, Jea-Hyun; Jin, Hyung-Gon; Park, Seung-Kook

    2015-01-01

    The KAERI be used to calculate the decommissioning cost and manage the data of decommissioning activity experience through systems such as the decommissioning information management system (DECOMMIS), Decommissioning Facility Characterization DB System (DEFACS), decommissioning work-unit productivity calculation system (DEWOCS). Some country such as Japan and The United States have the information for decommissioning experience of the NPP and publish reports on decommissioning cost analysis. These reports as valuable data be used to compare with the decommissioning unit cost. In particular, need a method to estimate the decommissioning cost of the NPP because there is no decommissioning experience of NPP in case of Korea. makes possible to predict the more precise prediction about the decommissioning unit cost. But still, there are many differences on calculation for the decommissioning unit cost in domestic and foreign country. Typically, it is difficult to compare with data because published not detailed reports. Therefore, field of estimation for decommissioning cost have to use a unified framework in order to the decommissioning cost be provided to exact of the decommissioning cost

  16. Basic Research about Calculation of the Decommissioning Unit Cost based on The KRR-2 Decommissioning Project

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chan-Ho; Park, Hee-Seong; Ha, Jea-Hyun; Jin, Hyung-Gon; Park, Seung-Kook [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-05-15

    The KAERI be used to calculate the decommissioning cost and manage the data of decommissioning activity experience through systems such as the decommissioning information management system (DECOMMIS), Decommissioning Facility Characterization DB System (DEFACS), decommissioning work-unit productivity calculation system (DEWOCS). Some country such as Japan and The United States have the information for decommissioning experience of the NPP and publish reports on decommissioning cost analysis. These reports as valuable data be used to compare with the decommissioning unit cost. In particular, need a method to estimate the decommissioning cost of the NPP because there is no decommissioning experience of NPP in case of Korea. makes possible to predict the more precise prediction about the decommissioning unit cost. But still, there are many differences on calculation for the decommissioning unit cost in domestic and foreign country. Typically, it is difficult to compare with data because published not detailed reports. Therefore, field of estimation for decommissioning cost have to use a unified framework in order to the decommissioning cost be provided to exact of the decommissioning cost.

  17. Green electricity policies in the United States: case study

    International Nuclear Information System (INIS)

    Menz, Fredric C.

    2005-01-01

    While there has been interest in promoting the use of renewable energy in electricity production for a number of years in the United States, the market share of non-hydro renewable energy sources in electricity production has remained at about 2 percent over the past decade. The paper reviews the principal energy resources used for electricity production, considers the changing regulatory environment for the electricity industry, and describes government policies that have been used to promote green electricity in the United States, with an emphasis on measures adopted by state governments. Factors influencing the development of green power markets are also discussed, including underlying economic issues, public policy measures, the regulatory environment, external costs, and subsidies. Without significant increases in fossil fuel prices, much more stringent environmental regulations, or significant changes in electricity customer preferences, green electricity markets are likely to develop slowly in the United States

  18. Estimated United States Transportation Energy Use 2005

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Simon, A J; Belles, R D

    2011-11-09

    A flow chart depicting energy flow in the transportation sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 31,000 trillion British Thermal Units (trBTUs) of energy were used throughout the United States in transportation activities. Vehicles used in these activities include automobiles, motorcycles, trucks, buses, airplanes, rail, and ships. The transportation sector is powered primarily by petroleum-derived fuels (gasoline, diesel and jet fuel). Biomass-derived fuels, electricity and natural gas-derived fuels are also used. The flow patterns represent a comprehensive systems view of energy used within the transportation sector.

  19. Exporting Rambutan to United States: One Reality?

    International Nuclear Information System (INIS)

    Ahmad Zainuri Mohd Dzomir; Zainon Othman; Mohd Sidek Othman

    2011-01-01

    Rambutan is a one of commodity that are passed by United States of America authority to be market in that states. The main condition for the approval is the exporter must use irradiation technology as quarantine treatment to monitor the insects in there. United States of America's Agriculture Department (USDA-APHIS) has make early survey to the facilities involved in exporting process chain to overview Malaysia preparedness for this purpose. This paper work will discussed the possibility of this exporting implemented based on conditions rule by the USDA. (author)

  20. Incremental cost of PACS in a medical intensive care unit

    Science.gov (United States)

    Langlotz, Curtis P.; Cleff, Bridget; Even-Shoshan, Orit; Bozzo, Mary T.; Redfern, Regina O.; Brikman, Inna; Seshadri, Sridhar B.; Horii, Steven C.; Kundel, Harold L.

    1995-05-01

    Our purpose is to determine the incremental costs (or savings) due to the introduction of picture archiving and communication systems (PACS) and computed radiology (CR) in a medical intensive care unit (MICU). Our economic analysis consists of three measurement methods. The first method is an assessment of the direct costs to the radiology department, implemented in a spreadsheet model. The second method consists of a series of brief observational studies to measure potential changes in personnel costs that might not be reflected in administrative claims. The third method (results not reported here) is a multivariate modeling technique which estimates the independent effect of PACS/CR on the cost of care (estimated from administrative claims data), while controlling for clinical case- mix variables. Our direct cost model shows no cost savings to the radiology department after the introduction of PACS in the medical intensive care unit. Savings in film supplies and film library personnel are offset by increases in capital equipment costs and PACS operation personnel. The results of observational studies to date demonstrate significant savings in clinician film-search time, but no significant change in technologist time or lost films. Our model suggests that direct radiology costs will increase after the limited introduction of PACS/CR in the MICU. Our observational studies show a small but significant effect on clinician film search time by the introduction of PACS/CR in the MICU, but no significant effect on other variables. The projected costs of a hospital-wide PACS are currently under study.

  1. Radiation therapy facilities in the United States

    International Nuclear Information System (INIS)

    Ballas, Leslie K.; Elkin, Elena B.; Schrag, Deborah; Minsky, Bruce D.; Bach, Peter B.

    2006-01-01

    Purpose: About half of all cancer patients in the United States receive radiation therapy as a part of their cancer treatment. Little is known, however, about the facilities that currently deliver external beam radiation. Our goal was to construct a comprehensive database of all radiation therapy facilities in the United States that can be used for future health services research in radiation oncology. Methods and Materials: From each state's health department we obtained a list of all facilities that have a linear accelerator or provide radiation therapy. We merged these state lists with information from the American Hospital Association (AHA), as well as 2 organizations that audit the accuracy of radiation machines: the Radiologic Physics Center (RPC) and Radiation Dosimetry Services (RDS). The comprehensive database included all unique facilities listed in 1 or more of the 4 sources. Results: We identified 2,246 radiation therapy facilities operating in the United States as of 2004-2005. Of these, 448 (20%) facilities were identified through state health department records alone and were not listed in any other data source. Conclusions: Determining the location of the 2,246 radiation facilities in the United States is a first step in providing important information to radiation oncologists and policymakers concerned with access to radiation therapy services, the distribution of health care resources, and the quality of cancer care

  2. Fragmentation of Continental United States Forests

    Science.gov (United States)

    Kurt H. Riitters; James D. Wickham; Robert V. O' Neill; K. Bruce Jones; Elizabeth R. Smith; John W. Coulston; Timothy G. Wade; Jonathan H. Smith

    2002-01-01

    We report a multiple-scale analysis of forest fragmentation based on 30-m (0.09 ha pixel-1) land- cover maps for the conterminous United States. Each 0.09-ha unit of forest was classified according to fragmentation indexes measured within the surrounding landscape, for five landscape sizes including 2.25, 7.29, 65.61, 590.49, and 5314.41 ha....

  3. Toll Facilities in the United States - Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  4. Understanding human trafficking in the United States.

    Science.gov (United States)

    Logan, T K; Walker, Robert; Hunt, Gretchen

    2009-01-01

    The topic of modern-day slavery or human trafficking has received increased media and national attention. However, to date there has been limited research on the nature and scope of human trafficking in the United States. This article describes and synthesizes nine reports that assess the U.S. service organizations' legal representative knowledge of, and experience with, human trafficking cases, as well as information from actual cases and media reports. This article has five main goals: (a) to define what human trafficking is, and is not; (b) to describe factors identified as contributing to vulnerability to being trafficked and keeping a person entrapped in the situation; (c) to examine how the crime of human trafficking differs from other kinds of crimes in the United States; (d) to explore how human trafficking victims are identified; and, (e) to provide recommendations to better address human trafficking in the United States.

  5. Homicides - United States, 2007 and 2009.

    Science.gov (United States)

    Logan, Joseph E; Hall, Jeffrey; McDaniel, Dawn; Stevens, Mark R

    2013-11-22

    According to 1981-2009 data, homicide accounts for 16,000-26,000 deaths annually in the United States and ranks within the top four leading causes of death among U.S. residents aged 1-40 years. Homicide can have profound long-term emotional consequences on families and friends of victims and on witnesses to the violence, as well as cause excessive economic costs to residents of affected communities. For years, homicide rates have been substantially higher among certain populations. Previous reports have found that homicides are higher among males, adolescents and young adults, and certain racial/ethnic groups, such as non-Hispanic blacks, non-Hispanic American Indian/Alaska Natives (AI/ANs), and Hispanics. The 2011 CDC Health Disparities and Inequalities Report (CHDIR) described similar findings for the year 2007. For example, the 2011 report showed that the 2007 homicide rate was highest among non-Hispanic blacks (23.1 deaths per 100,000), followed by AI/ANs (7.8 deaths per 100,000), Hispanics (7.6 deaths per 100,000), non-Hispanic whites (2.7 deaths per 100,000), and Asian/Pacific Islanders (A/PIs) (2.4 deaths per 100,000). In addition, non-Hispanic black men aged 20-24 years were at greatest risk for homicide in 2007, with a rate that exceeded 100 deaths per 100,000 population. Other studies have reported that community factors such as poverty and economic inequality and individual factors such as unemployment and involvement in criminal activities can play a substantial role in these persistent disparities in homicide rates. Public health strategies are needed in communities at high risk for homicide to prevent violence and save lives.

  6. Enrichment situation outside the United States

    International Nuclear Information System (INIS)

    Anon.

    1979-01-01

    Different enrichment technologies are briefly characterized which include gaseous diffusion, which is presently the production mainstay of the United States and France; the gaseous centrifuge which is the production plant for Urenco and the technology for future United States enrichment expansion; the aero-dynamic processes which include the jet nozzle (also known as the Becker process) and the fixed-wall centrifuge (also known as the Helikon process); chemical processes; laser isotope separation processes (also referred to in the literature as LIS); and plasma technology

  7. Solar energy in the United States

    International Nuclear Information System (INIS)

    Ochoa, D.; Slaoui, A.; Soler, R.; Bermudez, V.

    2009-01-01

    Written by a group of five French experts who visited several research centres, innovating companies and solar power stations in the United States, this report first proposes an overview of solar energy in the United States, indicating and commenting the respective shares of different renewable energies in the production, focusing on the photovoltaic energy production and its RD sector. The second part presents industrial and research activities in the solar sector, and more specifically photovoltaic technologies (silicon and thin layer technology) and solar concentrators (thermal solar concentrators, photovoltaic concentrators). The last chapter presents the academic research activities in different universities (California Tech Beckman Institute, Stanford, National Renewable Energy Laboratory, Colorado School of Mines)

  8. Food irradiation in the United States

    International Nuclear Information System (INIS)

    Pauli, G.H.

    1991-01-01

    Since 1963, some irradiated foods have been permitted for sale in the United States. Yet, at this time, commercial application has been limited to irradiation of a relatively small fraction of the spices and seasonings used as ingredients in other foods. The current situation regarding irradiated foods in the United States and how it developed is discussed. The author writes from experience gained as a Government regulator concerned primarily with ensuring safety of food and therefore this is stressed together with the crucial role played by consumers and industry. (author)

  9. Employers mexican migrants in the United States

    Directory of Open Access Journals (Sweden)

    Eduardo Fernández Guzmán

    2013-09-01

    Full Text Available You might think that by definition the migrant labor plays in less profitable niches and meager social mobility. However, a large group of migrants in different economically developed countries have successfully launched businesses of diverse nature and volume. This is why entrepreneurship of migrants is an issue that has received increasing attention in recent years. Compared to other immigrant groups in the United States, Mexicans show low levels of entrepreneurial activity. The aim of this paper is to, through a general literature review of official statistical data, a preliminary analysis of mexican migrant entrepreneurship in the United States, that is to say in recent years has been growing in importance.

  10. Cost Indexing and Unit Price Adjustments for Construction Materials

    Science.gov (United States)

    2012-10-30

    This project was focused on the assimilation of information regarding unit price adjustment clauses, or PACs, : that are offered for construction materials at the state Departments of Transportation (DOTs). It is intended to : provide the South Carol...

  11. 31 CFR 596.313 - United States person.

    Science.gov (United States)

    2010-07-01

    ... FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM LIST GOVERNMENTS SANCTIONS REGULATIONS General Definitions § 596.313 United States person. The term United States person means any United States...

  12. A large economic liquid metal reactor for United States utilities

    International Nuclear Information System (INIS)

    Rodwell, E.

    1985-01-01

    The United States has demonstrated its ability to build and operate small and medium sized liquid metal reactors and continues to operate the Experimental Breeder Reactor II and the Fast Flux Test Facility to demonstrate long life fuel designs. Similar-sized liquid metal reactors in Europe have been followed by a step-up to the 1200 MWe capacity of the Superphenix plant. To permit the United States to make a similar step-up in capacity, a 1320 MWe liquid metal reactor plant has been designed with the main emphasis on minimizing the specific capital cost in order to be competitive with light water reactor plant and fossil plant alternatives. The design is based on a four parallel heat transport loops arrangement and complies with current regulatory requirements. The primary heat transport loops are now being integrated into the reactor vessel to achieve further reduction in the capital cost

  13. Environmental aspects of engineering geological mapping in the United States

    Science.gov (United States)

    Radbruch-Hall, Dorothy H.

    1979-01-01

    Many engineering geological maps at different scales have been prepared for various engineering and environmental purposes in regions of diverse geological conditions in the United States. They include maps of individual geological hazards and maps showing the effect of land development on the environment. An approach to assessing the environmental impact of land development that is used increasingly in the United States is the study of a single area by scientists from several disciplines, including geology. A study of this type has been made for the National Petroleum Reserve in northern Alaska. In the San Francisco Bay area, a technique has been worked out for evaluating the cost of different types of construction and land development in terms of the cost of a number of kinds of earth science factors. ?? 1979 International Association of Engineering Geology.

  14. Cost of umbilical cord blood units released for transplantation.

    Science.gov (United States)

    Sirchia, G; Rebulla, P; Tibaldi, S; Lecchi, L

    1999-06-01

    A large number of institutions have started programs banking umbilical cord blood (UCB) for allogeneic unrelated-donor and related-donor transplantation. However, limited information is available on the financial issues surrounding these activities. The aim of this study was to determine the fee per UCB unit released for transplantation that would allow cost recovery after 10 years. Three organizational models were considered suitable to provide units for five UCB transplants per 1 million population per year, a figure that would translate into an annual need for 280 units in Italy. Models A, B, and C included, respectively, seven networked banks, each with an inventory of 1,500 units; two networked banks, each with an inventory of 5,000 units; and one bank with an inventory of 10,000 units. It was estimated that it would take 3 years to develop the cryopreserved inventory and that approximately 3 percent of the inventory could be released and replaced each year during the 7-year interval between the fourth and tenth years of activity. The data on the costs of labor, reagents and diagnostics, disposables, depreciation and maintenance, laboratory tests, and overhead, as well as the operational data used in the analysis were collected at the Milano Cord Blood Bank in 1996. Fees of US $15,061, $12,666, and $11,602 per unit released during the fourth through the tenth years of activity allow full cost recovery (principle and interest) under Models A, B, and C, respectively. Although UCB procurement costs compare favorably with those of other hematopoietic cell sources, these results and the current fee of US $15,300 used in some institutions show that UCB is an expensive resource. Therefore, judicious planning of banking programs with high quality standards is necessary to prevent economic losses. The advantages of lower fees associated with the centralized banking approach of Model C should be balanced with the more flexible collection offered by Model A.

  15. Obesity: A United States Strategic Imperative

    Science.gov (United States)

    2013-04-01

    States Department of Veterans Affairs 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) Dr. Thomas ...Army Ms. Karen Malebranche United States Department of Veterans Affairs Project Adviser Dr. Thomas Williams U.S. Army War...per American has increased by 57 pounds per year ( poultry representing 46 pounds).86 Surprisingly however, the percentage of calories from meat

  16. The Development of Logistics Services in the United States

    OpenAIRE

    Yang, Yeonglin H; San Diego State University

    2015-01-01

    This research studies third party logistics (3PL) providers in the United States to investigate how the industry has strategically developed its service offerings in response to the customers’ growing needs in managing global supply chains. Logistics management has significant impacts on various aspects of supply chains such as response time, total supply chain cost, sourcing risk, customer service, security, etc. The results show that 3PL services vary based on industry served, region served...

  17. Dengue Fever in the United States

    Centers for Disease Control (CDC) Podcasts

    2012-04-09

    Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States.  Created: 4/9/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/16/2012.

  18. THE UNITED STATES AND NIGERIAN RELATIONS:

    African Journals Online (AJOL)

    Mrs. I.D

    2009-12-25

    Dec 25, 2009 ... response from the Nigerian government. ... domestic crises that negatively impacts state stability, the US government ... Harrison C. Ajebon, Department of Political Science, University of Calabar, ..... Sweden. United Kingdom. Switzerland. Asia & far East. Japan ..... case Study of Nigeria, in Ikonnechidi and.

  19. Fragmentation of eastern United States forest types

    Science.gov (United States)

    Kurt H. Riitters; John W. Coulston

    2013-01-01

    Fragmentation is a continuing threat to the sustainability of forests in the Eastern United States, where land use changes supporting a growing human population are the primary driver of forest fragmentation (Stein and others 2009). While once mostly forested, approximately 40 percent of the original forest area has been converted to other land uses, and most of the...

  20. Nuclear accidents. Three mile Island (United States)

    International Nuclear Information System (INIS)

    Duco, J.

    2004-01-01

    This paper describes the accident of Three Miles Island power plant which occurred the 28 march 1979 in the United States. The accident scenario, the consequences and the reactor core and vessel, after the accident, are analyzed. (A.L.B.)

  1. Energy policy in the United States

    Energy Technology Data Exchange (ETDEWEB)

    McCormack, M

    1978-06-01

    Energy policy in the United States is examined with particular regard to the nuclear power industry. The advantages of nuclear power over conventional and other sources are presented and the vigorous expansion of research and development is advocated. Future energy supplies are discussed and the author stresses the necessity for continued research into breeder technology.

  2. Political initiative needed in the United States

    International Nuclear Information System (INIS)

    Hollister, K.

    1979-01-01

    The financing of nuclear power stations in the United States is in trouble mainly because of the long lead times caused by licensing. It will again become feasible when legislation reduces the construction time to eight years or less. The overriding need to protect the dollar by reducing oil imports, will lead the US Government to embrace nuclear power openly. (U.K.)

  3. Motorcycle trends in the United States

    Science.gov (United States)

    2009-05-01

    During the last decade there has been a significant increase in the number of motorcycle sales and registrations in the United States. At the same time there has been a shift in the demographics of motorcycle users and increased focus on motorcycle s...

  4. Social science findings in the United States

    Science.gov (United States)

    Sarah McCaffrey; Eric Toman; Melanie Stidham; Bruce. Shindler

    2015-01-01

    The rising number of acres burned annually and growing number of people living in or adjacent to fire-prone areas in the United States make wildfire management an increasingly complex and challenging problem. Given the prominence of social issues in shaping the current challenges and determining paths forward, it will be important to have an accurate understanding of...

  5. 76 FR 18783 - United States et al.

    Science.gov (United States)

    2011-04-05

    ... customers based on existing supplier-customer relationships. d. Neither Supply Responses Nor Entry Would... Final Judgment, Stipulation and Competitive Impact Statement Notice is hereby given pursuant to the... Competitive Impact Statement have been filed with the United States District Court for the Eastern District of...

  6. Overview of United States synchrotron radiation facilities

    International Nuclear Information System (INIS)

    Watson, R.E.

    1983-01-01

    There has been considerable activity within the past year involving the creation of new and the improvement of existing capabilities for research with synchrotron light. The purpose of this review is to summarize what has happened within the United States. Being a status report, some of the information necessarily has a date attached to it - the date, in this case, being early September 1983

  7. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Multilocus DNA sequence data was used to retrospectively assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically dist...

  8. Friendships of Indonesian and United States Youth

    Science.gov (United States)

    French, Doran C.; Pidada, Sri; Victor, Andrea

    2005-01-01

    Issues in the study of friendship across cultures were explored by reviewing a set of studies focusing on the friendships of Indonesian and United States youth. Four topics are considered: similarity of friendships across cultures, dimensions of friendships that vary across cultures, the utility of the individualism/collectivism dimension for…

  9. Woody encroachment in the Central United States

    Science.gov (United States)

    Greg C. Liknes; Dacia M. Meneguzzo; Kevin. Nimerfro

    2015-01-01

    The landscape of the central United States is dominated by cropland and rangeland mixed with remnants of short- and tall-grass prairies that were once prevalent. Since the last ice age, these areas had sparse tree cover due to cyclical severe droughts, intentional fires used by indigenous people as a land management tool, and natural fires caused by lightning. More...

  10. Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States.

    Science.gov (United States)

    Agrawal, Pooja; Venkatesh, Arjun Krishna

    2016-04-01

    We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees. We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States.

  11. Radioactive waste management in the United States

    International Nuclear Information System (INIS)

    Smiley, J.L.

    1985-01-01

    In the United States, efforts to dispose of the nation's high- and low-level radioactive wastes are based on somewhat different approaches.The individual States are responsible for disposing of low-level wastes with the Federal Government providing technical and financial support to help the States in the early phases of their efforts. The Federal Government has responsibility for developing facilities for the disposal of high-level waste. However, both efforts show a common need to meet national objectives while satisfying the concerns of the public. (author)

  12. Environmental remediation cost in Fukushima area. Trial calculation using the unit cost factor method

    International Nuclear Information System (INIS)

    Ishikura, Takeshi; Fujita, Reiko

    2013-01-01

    In order to perform environmental remediation in Fukushima area in a swift and adequate way, it is necessary to obtain perspective of total cost and allocate resources adequately. At present such had not been fixed as what decontamination method should be applied to relevant contaminated places in Fukushima area or what disposition and processing process should be applied to radioactive soils and wastes produced by decontamination, it would be difficult to assess the cost exactly. But it would be better to calculate rough cost on trial and then upgrade the accuracy of the cost gradually based on latest knowledge. Cleanup subcommittee of AESJ utilized published process flow and unit cost and based on original proposed scenario: soils produced by decontamination were classified into intermediate storage facility and controllable processing place based on their contamination concentration and with limited reuse, rough estimated cost was obtained as 6 - 9 trillion yen for basic case. (T. Tanaka)

  13. Economic impacts of oil spills: Spill unit costs for tankers, pipelines, refineries, and offshore facilities

    International Nuclear Information System (INIS)

    1993-01-01

    The impacts of oil spills -- ranging from the large, widely publicized Exxon Valdez tanker incident to smaller pipeline and refinery spills -- have been costly to both the oil industry and the public. For example, the estimated costs to Exxon of the Valdez tanker spill are on the order of $4 billion, including $2.8 billion (in 1993 dollars) for direct cleanup costs and $1.125 billion (in 1992 dollars) for settlement of damages claims caused by the spill. Application of contingent valuation costs and civil lawsuits pending in the State of Alaska could raise these costs appreciably. Even the costs of the much smaller 1991 oil spill at Texaco's refinery near Anacortes, Washington led to costs of $8 to 9 million. As a result, inexpensive waming, response and remediation technologies could lower oil spin costs, helping both the oil industry, the associated marine industries, and the environment. One means for reducing the impact and costs of oil spills is to undertake research and development on key aspects of the oil spill prevention, warming, and response and remediation systems. To target these funds to their best use, it is important to have sound data on the nature and size of spills, their likely occurrence and their unit costs. This information could then allow scarce R ampersand D dollars to be spent on areas and activities having the largest impact. This report is intended to provide the ''unit cost'' portion of this crucial information. The report examines the three key components of the US oil supply system, namely, tankers and barges; pipelines and refineries; and offshore production facilities. The specific purpose of the study was to establish the unit costs of oil spills. By manipulating this key information into a larger matrix that includes the size and frequency of occurrence of oil spills, it will be possible' to estimate the likely future impacts, costs, and sources of oil spills

  14. Antiabortion violence in the United States.

    Science.gov (United States)

    Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D

    2012-11-01

    This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Availability and cost functions for periodically inspected preventively maintained units

    International Nuclear Information System (INIS)

    Vaurio, J.K.

    1999-01-01

    Unavailability and cost rate functions are developed for components whose failures can occur randomly but they are detected only by periodic testing or inspections. If a failure occurs between consecutive inspections, the unit remains failed until the next inspection. Components are renewed by preventive maintenance periodically, or by repair or replacement after a failure, whichever occurs first (age-replacement). The model takes into account finite repair and maintenance durations as well as costs due to testing, repair, maintenance and lost production or accidents. For normally operating units the time-related penalty is loss of production. For standby safety equipment it is the expected cost of an accident that can happen when the component is down due to a dormant failure, repair or maintenance. The objective of maintenance optimization is to minimize the total cost rate by proper selection of two intervals, one for inspections and one for replacements. General conditions and techniques are developed for solving optimal test and maintenance intervals, with and without constraints on the production loss or accident rate. Insights are gained into how the optimal intervals depend on various cost parameters and reliability characteristics

  16. State of pine decline in the southeastern United States

    Science.gov (United States)

    Lori Eckhardt; Mary Anne Sword Sayer; Don Imm

    2010-01-01

    Pine decline is an emerging forest health issue in the southeastern United States. Observations suggest pine decline is caused by environmental stress arising from competition, weather, insects and fungi, anthropogenic disturbances, and previous management. The problem is most severe for loblolly pine on sites that historically supported longleaf pine, are highly...

  17. The State of Homeless Children in the United States

    Science.gov (United States)

    Kabler, Brenda; Weinstein, Elana

    2009-01-01

    Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…

  18. Pakistan: Can the United States Secure an Insecure State?

    Science.gov (United States)

    2010-01-01

    do not have female staff; the male-to-female staff ratio in the health field is 7 to 1.130 More nurses and female staff are needed, especially to...exercise was rescheduled for 2009. 9 Interview with Ninth Air Force personnel, September 12, 2008. 200 Pakistan: Can the United States Secure an Insecure

  19. 20 CFR 416.215 - You leave the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for 30...

  20. 31 CFR 515.330 - Person within the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Person within the United States. 515... Definitions § 515.330 Person within the United States. (a) The term person within the United States, includes: (1) Any person, wheresoever located, who is a resident of the United States; (2) Any person actually...

  1. 39 CFR 221.1 - The United States Postal Service.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false The United States Postal Service. 221.1 Section 221.1 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.1 The United States Postal Service. The United States Postal Service was established as an...

  2. 75 FR 13345 - Pricing for Certain United States Mint Products

    Science.gov (United States)

    2010-03-19

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of First Spouse Bronze Medals and 2010 First Spouse Bronze Medal Series: Four...

  3. 7 CFR 1212.32 - United States Customs Service.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States Customs Service. 1212.32 Section 1212... § 1212.32 United States Customs Service. “United States Customs Service” or “Customs” means the United States Customs and Border Protection, an agency of the Department of Homeland Security. Honey Packers and...

  4. 37 CFR 1.412 - The United States Receiving Office.

    Science.gov (United States)

    2010-07-01

    ... Information § 1.412 The United States Receiving Office. (a) The United States Patent and Trademark Office is a Receiving Office only for applicants who are residents or nationals of the United States of America. (b) The... “United States Receiving Office” or by the abbreviation “RO/US.” (c) The major functions of the Receiving...

  5. The United States and world energy markets

    International Nuclear Information System (INIS)

    Ramsay, W.C.

    1992-01-01

    The United States, dominating the world's energy markets as a producer and consumer, is sensitive to changes in this market and intends to influence the development of global energy policy. Supply will be increased by nations such as Venezuela, Indonesia and perhaps in the future a United Yemen and the Commonwealth of Independent States, moving to freer market economies which will allow investment opportunities previously inaccessible to foreign companies. Although world energy demand will grow, little of this will be in the US where, under the National Energy Strategy, comprehensive measures are being introduced to improve energy efficiency. The US energy security will be further improved by such measures as diversification of supply, larger domestic production and increasing interdependence between suppliers, traders and consumers. (author)

  6. United States of America National Report

    International Nuclear Information System (INIS)

    1992-01-01

    The United States has produced this report as part of the preparations for the United Nations Conference on Environment and Development (UNCED) to be held in Brazil in June 1992. It summarizes this nation's efforts to protect and enhance the quality of the human environment in concert with its efforts to provide economic well-being during the two decades since the United Nations Conference on the Human Environment was held in Stockholm. The information presented in this report is primarily and deliberately retrospective. It is an attempt to portray the many human, economic and natural resources of the United States, to describe resource use and the principal national laws and programs established to protect these resources, and to analyze key issues on the agenda of UNCED. This analysis is presented in terms of past and present conditions and trends, measures of progress made in responding to the key issues, and a summary of government activities, underway or pending, to address ongoing or newly emerging national environmental and resource management problems

  7. United States Holocaust Museums: Pathos, Possession, Patriotism

    OpenAIRE

    Baum, Rob

    2011-01-01

    This article examines the role of United States holocaust museums in directing (American) knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and...

  8. The United States toward Energy Independence?

    International Nuclear Information System (INIS)

    Nardon, Laurence

    2013-01-01

    The U.S.'s exploitation of 'unconventional' domestic oil reserves is reviving its economy. It will also have effects on the country's energy independence and thus its geopolitical position. While it is unlikely that the relationship between Washington and the Middle East region will be fundamentally altered, the U.S.'s relationships with China, Russia, and Europe could be affected. The United States will have to incorporate these changes into its global strategies

  9. OECD environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' efforts to manage its environment including air, water, nature, and biodiversity; to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 47 figs., 20 tabs.

  10. Diesel fuel in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bensaid, B.; Saint-Antonin, V

    2003-07-01

    In the 1970's, Diesel technology had a poor image in the United States owing to the inadequate performance and reliability observed in certain models. The 1990's brought increased awareness of greenhouse effect issues. Greater Diesel penetration of the American automobile market could represent a short-term solution for reducing CO{sub 2} emissions, along with the use of hybrid vehicles, but the impact on American refining plant would be substantial. (author)

  11. Diesel fuel in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bensaid, B; Saint-Antonin, V

    2003-07-01

    In the 1970's, Diesel technology had a poor image in the United States owing to the inadequate performance and reliability observed in certain models. The 1990's brought increased awareness of greenhouse effect issues. Greater Diesel penetration of the American automobile market could represent a short-term solution for reducing CO{sub 2} emissions, along with the use of hybrid vehicles, but the impact on American refining plant would be substantial. (author)

  12. Diesel fuel in the United States

    International Nuclear Information System (INIS)

    Bensaid, B.; Saint-Antonin, V.

    2003-01-01

    In the 1970's, Diesel technology had a poor image in the United States owing to the inadequate performance and reliability observed in certain models. The 1990's brought increased awareness of greenhouse effect issues. Greater Diesel penetration of the American automobile market could represent a short-term solution for reducing CO 2 emissions, along with the use of hybrid vehicles, but the impact on American refining plant would be substantial. (author)

  13. Electric trade in the United States 1990

    International Nuclear Information System (INIS)

    1992-01-01

    Electric Trade in the United States 1990 (ELECTRA) is the third in a series of reports on wholesale power transactions prepared by the Electric Data Systems Branch, Survey Management Division, Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data. The second report contained data for 1988. This report provides information on the industry during 1990

  14. The United States facing their petroleum dependence

    International Nuclear Information System (INIS)

    Noel, P.

    2002-06-01

    In the framework of ''the energy crisis of 2000-2001'', the Cheney report and the petroleum dependence, this study presents a critical examination of the United States petroleum situation, its perception in the american political milieu and the public policies implementing during the last ten years. The first section is devoted to the petroleum supply. In the second section, the american petroleum policy and the energy safety are studied. (A.L.B.)

  15. United States Energy Policy: Security Not Independence

    Science.gov (United States)

    2013-03-01

    on leased land, ensuring fracking is done responsibly, and getting more natural gas and hybrid systems into U.S. mass transit. Internationally, the...fewer environ disturbances -Can store underground -Environ impacts of fracking unknown -uses large amount of water -potential for saline...from shale continues to rise as the United States determines how to drill safely. However, the impact of fracking on the environment is still

  16. ISO developments in the United States

    International Nuclear Information System (INIS)

    Hogan, William W.

    1998-01-01

    An important feature of the restructuring process in the United States is the creation of independent system operators (ISOs) to coordinate dispatch and access to transmission grids. A number of ISOs have been proposed and are summarized here. Perhaps the greatest challenge is the pricing of transmission to give proper economic signals to market participants, and the locational pricing scheme now operating in the PJM system offers the best hope for efficient pricing. (author)

  17. Burnup credit activities in the United States

    International Nuclear Information System (INIS)

    Lake, W.H.; Thomas, D.A.; Doering, T.W.

    2001-01-01

    This report covers progress in burnup credit activities that have occurred in the United States of America (USA) since the International Atomic Energy Agency's (IAEA's) Advisory Group Meeting (AGM) on Burnup Credit was convened in October 1997. The Proceeding of the AGM were issued in April 1998 (IAEA-TECDOC-1013, April 1998). The three applications of the use of burnup credit that are discussed in this report are spent fuel storage, spent fuel transportation, and spent fuel disposal. (author)

  18. United States steps up waste isolation programme

    Energy Technology Data Exchange (ETDEWEB)

    Smedes, H W [Department of Energy, Germantown, MD (USA). Office of Waste Isolation; Carbiener, W A [Battelle Columbus Labs., OH (USA)

    1982-11-01

    A description is given of the United States' waste isolation programme which now involves tests of specific sites. The US Department of Energy plans to build a system of mined geological repositories for the disposal of commercially generated high-level and transuranic radioactive waste. It is hoped that the first repository will be available by 1998. Studies of the geology and hydrology of the proposed sites, the waste packaging and the repository design are reported.

  19. The United States and the Kurds: Case Studies in United States Engagement

    National Research Council Canada - National Science Library

    Lambert, Peter

    1997-01-01

    ..., between 1969- 1975, and 1990-1996. Both eras saw the United States able to influence events relating to the Kurds in support of a larger regional policy, only to find no easy solution to the Kurdish quest for autonomy...

  20. CALCULATION PECULIARITIES OF RE-PROCESSED ROAD COVERING UNIT COST

    Directory of Open Access Journals (Sweden)

    Dilyara Kyazymovna Izmaylova

    2017-09-01

    Full Text Available In the article there are considered questions of economic expediency of non-waste technology application for road covering repair and restoration. Determined the conditions of asphalt-concrete processing at plants. Carried out cost changing analysis of asphalt granulate considering the conditions of transportation and preproduction processing. Given an example of expense calculation of one conventional unit of asphalt-concrete mixture volume preparation with and without processing.

  1. United States position on severe accidents

    International Nuclear Information System (INIS)

    Ross, D.F.

    1988-01-01

    The United States policy on severe accidents was published in 1985 for both new plant applications and for existing plants. Implementation of this policy is in progress. This policy, aided by a related safety goal policy and by analysis capabilities emerging from improved understanding of accident phenomenology, is viewed as a logical development from the pioneering work in the WASH-1400 Reactor Safety Study published by the United States Nuclear Regulatory Commission (NRC) in 1975. This work provided an estimate of the probability and consequences of severe accidents which, prior to that time, had been mostly evaluated by somewhat arbitrary assumptions dating back 30 years. The early history of severe accident evaluation is briefly summarized for the period 1957-1979. Then, the galvanizing action of Three Mile Island Unit 2 (TMI-2) on severe accident analysis, experimentation and regulation is reviewed. Expressions of US policy in the form of rulemaking, severe accident policy, safety research, safety goal policy and court decisions (on adequacy of safety) are discussed. Finally, the NRC policy as of March 1988 is stated, along with a prospective look at the next few years. (author). 19 refs

  2. PERMITTING LEADERSHIP IN THE UNITED STATES

    International Nuclear Information System (INIS)

    Ken Nemeth

    2002-01-01

    In accordance with the Southern States Energy Board (SSEB) proposal, as incorporated into NETL/DE-FC26-97FT34199, the objective of this agreement is to streamline the environmental technology permitting process site-to-site, state-to-state, and industry-to-industry to achieve remediation and waste processing faster, better and cheaper. SSEB is working with member Governors, legislators and regulators to build consensus on streamlining the permitting process for new and innovative technologies for addressing the legacy of environmental problems from 50 years of weapons research, development and production. This report reviews mechanisms whereby industry consortiums and the Department of Energy (DOE) have been working with State regulators and other officials in technology deployment decisions within the DOE complex. The historic development of relationships with State regulators is reviewed and the current nature of the relationships examined. The report contains observations from internal DOE reviews as well as recommendations from the General Accounting Office (GAO) and other external organizations. The report discusses reorganization initiatives leading up to a DOE Top-to-Bottom review of the Environmental Management (EM) Program and highlights points of consideration for maintaining effective linkages with State regulators. It notes how the proposed changes will place new demands upon the National Energy Technology Laboratory (NETL) and how NETL can leverage its resources by refocusing existing EM efforts specifically to states that have DOE facilities within their borders (host-states). Finally, the report discusses how SSEB's Permitting Leadership in the United States (PLUS) program can provide the foundation for elements of NETL's technical assistance program that are delivered to regulators and other decision- makers in host-states. As a regional compact commission, SSEB provides important direct linkages to regulators and stakeholders who need technical

  3. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  4. Human prion diseases in the United States.

    Directory of Open Access Journals (Sweden)

    Robert C Holman

    Full Text Available BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD, occurs worldwide. Variant CJD (vCJD, a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths. The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8% of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%; the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively. Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.

  5. The Mini-Trial: A Valuable Alternative Dispute Resolution Tool for the United States Navy

    National Research Council Canada - National Science Library

    Morgan, Steven

    1997-01-01

    In order to avoid unnecessary, time consuming, and costly litigation, the Department of Defense, and more specifically the United States Navy, has adopted the use of alternative dispute resolution (ADR...

  6. 78 FR 59817 - Revision to United States Marshals Service Fees for Services

    Science.gov (United States)

    2013-09-30

    .... 4(b). When a statute does not address issues of how to calculate fees or what costs to include in..., investment, productivity, innovation, or on the ability of United States-based enterprises to compete with...

  7. Present state of electric power business in United States and Europe

    International Nuclear Information System (INIS)

    Onishi, Kenichi

    2011-01-01

    This article reported present state of nuclear power and electric power business in United States and Europe after Fukushima Daiichi Accident. As for the trend of demand and supply of electric power and policy, the accident forced Germany possibly to proceed with phase-out of nuclear power, but France and United States to sustain nuclear power with no great change of energy policy at this moment. As for the trend of electric power market, there was not state in United States with liberalized retail market of electric power after rolling blackouts occurred in California State in the early 2000s. In Germany proceeding with renewable energy introduction, renewable electricity fed into the grid was paid for by the network operators at fixed tariffs and the costs passed on to electricity consumers were increasing. Renewable Portfolio Standards (RPS) in United States forced the state to introduction of renewable energy to some ratio, and Feed-in Tariff (FIT) introduced in EU in 1990s lead to introduction of a large amount of renewable electricity targeted in 2020. Huge amount of wind power introduction brought about several problems to solve such that excess electric power above domestic demand had bad effects on grids in neighboring region. Enforcement of power transmission lines was also needed with increase of maximum electric power as well as introduction of a large amount of renewable electricity. (T. Tanaka)

  8. Case law: Canada, France, Switzerland, United States

    International Nuclear Information System (INIS)

    Anon.

    2012-01-01

    Canada: Appellate decision upholding nuclear regulatory licensing process and practices for consultation with aboriginal groups: Fond du Lac Denesuline First Nation v. Canada (Attorney General). France: Court of Appeal of Nimes regarding the SOCATRI incident in July 2008; Conseil d'Etat regarding the association Reseau 'Sortir du nucleaire'. Switzerland: Judgement of the Federal Administrative Court in the matter of Balmer-Schafroth a.o.v. BKW FMB Energy Ltd on the repeal of the time limitation with respect to the operating licence for the Muehleberg nuclear power plant. United States: Judgement of a US District Court granting a permanent injunction against the State of Vermont in order to prevent certain State laws from prohibiting Vermont Yankee nuclear power plant's continued operation

  9. WIC's promotion of infant formula in the United States

    Directory of Open Access Journals (Sweden)

    Kent George

    2006-04-01

    Full Text Available Abstract Background The United States' Special Supplemental Nutrition Program for Women, Infants and Children (WIC distributes about half the infant formula used in the United States at no cost to the families. This is a matter of concern because it is known that feeding with infant formula results in worse health outcomes for infants than breastfeeding. Discussion The evidence that is available indicates that the WIC program has the effect of promoting the use of infant formula, thus placing infants at higher risk. Moreover, the program violates the widely accepted principles that have been set out in the International Code of Marketing of Breast-milk Substitutes and in the human right to adequate food. Summary There is no good reason for an agency of government to distribute large quantities of free infant formula. It is recommended that the large-scale distribution of free infant formula by the WIC program should be phased out.

  10. State review United States of America. Risks and risk assessment according to the law of the United States of America

    International Nuclear Information System (INIS)

    Feldmann, F.J.

    1980-01-01

    In the chapter 'Risk Assessment in Atomic Energy Law of the United States' of this report you find among other things the Atomic Energy Act, the approval conditions, General Design Criteria for Nuclear Power Plants, the defense-in-depth concept, probabilistic safety studies, probabilistic probability assessments in the case of external influences onto nuclear power plants, quantitative analyses of the consequences of conceivable accidents, reduction of radiation exposure, the National Environmental Policy Act, the environmental compatibility declaration, the so-called residual risk under the environmental aspect, the classification of the accidents into 9 types, new developments concerning accident analysis, effects of the nuclear fuel cycle on environment, indicial decisions. The chapter about 'Risk Assessment in Civil Law, Criminal Law and Law on Protection of the Environment', deals among other things with the Law on nuisance, the Clean Air Act, the Federal Environmental Pesticide Control Act. In 'Problems of the Cost-Efficiency-Analysis' the significance and purpose of this analysis, the availability of data and information, the monetary quantification of risks and costs, alternatives and the danger of misuse are illustrated. (HSCH) [de

  11. The Future Potential of Waver Power in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Mirko Previsic; Jeff Epler; Maureen Hand; Donna Heimiller; Walter Short; Kelly Eurek

    2012-09-20

    The theoretical ocean wave energy resource potential exceeds 50% of the annual domestic energy demand of the United States, is located close to coastal population centers, and, although variable in nature, may be more consistent and predictable than some other renewable generation technologies. As a renewable electricity generation technology, ocean wave energy offers a low air pollutant option for diversifying the U.S. electricity generation portfolio. Furthermore, the output characteristics of these technologies may complement other renewable technologies. This study addresses the following: (1) The theoretical, technical and practical potential for electricity generation from wave energy (2) The present lifecycle cost profile (Capex, Opex, and Cost of Electricity) of wave energy conversion technology at a reference site in Northern California at different plant scales (3) Cost of electricity variations as a function of deployment site, considering technical, geo-spatial and and electric grid constraints (4) Technology cost reduction pathways (5) Cost reduction targets at which the technology will see significant deployment within US markets, explored through a series of deployment scenarios RE Vision Consulting, LLC (RE Vision), engaged in various analyses to establish current and future cost profiles for marine hydrokinetic (MHK) technologies, quantified the theoretical, technical and practical resource potential, performed electricity market assessments and developed deployment scenarios. RE Vision was supported in this effort by NREL analysts, who compiled resource information, performed analysis using the ReEDSa model to develop deployment scenarios, and developed a simplified assessment of the Alaska and Hawaii electricity markets.

  12. State cigarette minimum price laws - United States, 2009.

    Science.gov (United States)

    2010-04-09

    Cigarette price increases reduce the demand for cigarettes and thereby reduce smoking prevalence, cigarette consumption, and youth initiation of smoking. Excise tax increases are the most effective government intervention to increase the price of cigarettes, but cigarette manufacturers use trade discounts, coupons, and other promotions to counteract the effects of these tax increases and appeal to price-sensitive smokers. State cigarette minimum price laws, initiated by states in the 1940s and 1950s to protect tobacco retailers from predatory business practices, typically require a minimum percentage markup to be added to the wholesale and/or retail price. If a statute prohibits trade discounts from the minimum price calculation, these laws have the potential to counteract discounting by cigarette manufacturers. To assess the status of cigarette minimum price laws in the United States, CDC surveyed state statutes and identified those states with minimum price laws in effect as of December 31, 2009. This report summarizes the results of that survey, which determined that 25 states had minimum price laws for cigarettes (median wholesale markup: 4.00%; median retail markup: 8.00%), and seven of those states also expressly prohibited the use of trade discounts in the minimum retail price calculation. Minimum price laws can help prevent trade discounting from eroding the positive effects of state excise tax increases and higher cigarette prices on public health.

  13. The state of amphibians in the United States

    Science.gov (United States)

    Muths, E.; Adams, M.J.; Grant, E.H.C.; Miller, D.; Corn, P.S.; Ball, L.C.

    2012-01-01

    More than 25 years ago, scientists began to identify unexplained declines in amphibian populations around the world. Much has been learned since then, but amphibian declines have not abated and the interactions among the various threats to amphibians are not clear. Amphibian decline is a problem of local, national, and international scope that can affect ecosystem function, biodiversity, and commerce. This fact sheet provides a snapshot of the state of the amphibians and introduces examples to illustrate the range of issues in the United States.

  14. 31 CFR 103.39 - Person outside the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Person outside the United States. 103... Person outside the United States. For the purposes of this subpart, a remittance or transfer of funds, or... the United States, shall be deemed to be a remittance or transfer to a person outside the United...

  15. States of Confusion: Regulation of Surrogacy in the United States

    OpenAIRE

    Mohapatra, Seema

    2017-01-01

    Introduction Some countries, including Switzerland, Germany, Spain, France, Greece, and Norway, ban commercial surrogacy (Patton 2010, 523). Others, such as India and the Ukraine, have actively tried to be seen as commercial surrogacy destinations (Mohapatra 2012, 412, 432–437, 441–448). Unlike either of these approaches, the United States (US) has no national stance on surrogacy. In fact, there are no national laws or regulations related to surrogacy in the US (Margalit 2014). Instea...

  16. Assessment report on uranium in the United States of America

    International Nuclear Information System (INIS)

    1980-10-01

    Assessment of the uranium resources in the United States as of October 1, 1980, indicates a range of reserves, in mean values, from 645 thousand tons of U 3 O 8 (in the $30 per pound of U 3 O 8 cost category) to 1.122 million tons (in the $100 per pound of U 3 O 8 category). Ranges of potential resources are also shown for the same cost categories: from 885 thousand to over 2 million tons of U 3 O 8 in the probable class; 346 thousand to over 1 million tons in the possible class; and 311 thousand to nearly 700 thousand tons in the speculative class. There are an estimated 140 thousand tons of U 3 O 8 that could be recovered as a byproduct of phosphate and copper mining through the year 2009. Production capability studies indicate that the demand could be satisfied from currently estimated resources if there is a transition from current production of lower cost resources to production from the $50 per pound of U 3 O 8 resources by the mid 1990s. If, due to foreign competition or other market forces, production incentives are not maintained, domestic production potential will not be realized, and the United States could become dependent on foreign sources for much of its U 3 O 8

  17. Pesticide risk assessment in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Hill, Richard N [Environmental Protection Agency, Washington, DC (United States)

    1992-07-01

    In recognition of potential risks, all pesticides distributed and sold in the United States must fulfil extensive registration requirements for the Environmental Protection Agency (EPA). Registration is a licensing procedure where industry must submit data to demonstrate the safety of pesticidal substances and products before they can be used commercially. The regulatory control of pesticides is unique among chemicals in the U.S. in that testing beyond initial registration may be imposed by the Agency throughout the commercial life of the chemical, as long as there is adequate justification. Registration requirements are gauged to the nature of potential exposures. For instance, more data are generally needed for food use registrations than for non-food uses because of direct consumption of treated foods by the whole U.S. population. Unlike pesticide practices in many countries and authorities, as in the European Community where agricultural pesticides, non-agricultural pesticides and genetically engineered microbial agents are handled by separate directives, all pesticide activities are covered in the U.S. by the Federal Insecticide, Fungicide and Rodenticide Act. This statute covers pesticide uses on foods and animal feed and a number of non-food applications like forest and horticultural uses, residential lawn care, in-home applications, and disinfectants/sterilants. Traditional inorganic and organic chemicals are covered, as well as biological agents like pheromones. Naturally occurring and genetically altered microorganisms also come under the definition of pesticides, but multicellular animals are exempt from regulation as pesticides. Pesticide registration in the U.S. as in many other countries may be a long-term, resource intensive undertaking. Not uncommonly the process from beginning to complete registration may take 4 to 10 years and cost about $10 million. To meet the responsibilities of reviewing studies, overseeing 400 active ingredients and 35

  18. Pesticide risk assessment in the United States

    International Nuclear Information System (INIS)

    Hill, Richard N.

    1992-01-01

    In recognition of potential risks, all pesticides distributed and sold in the United States must fulfil extensive registration requirements for the Environmental Protection Agency (EPA). Registration is a licensing procedure where industry must submit data to demonstrate the safety of pesticidal substances and products before they can be used commercially. The regulatory control of pesticides is unique among chemicals in the U.S. in that testing beyond initial registration may be imposed by the Agency throughout the commercial life of the chemical, as long as there is adequate justification. Registration requirements are gauged to the nature of potential exposures. For instance, more data are generally needed for food use registrations than for non-food uses because of direct consumption of treated foods by the whole U.S. population. Unlike pesticide practices in many countries and authorities, as in the European Community where agricultural pesticides, non-agricultural pesticides and genetically engineered microbial agents are handled by separate directives, all pesticide activities are covered in the U.S. by the Federal Insecticide, Fungicide and Rodenticide Act. This statute covers pesticide uses on foods and animal feed and a number of non-food applications like forest and horticultural uses, residential lawn care, in-home applications, and disinfectants/sterilants. Traditional inorganic and organic chemicals are covered, as well as biological agents like pheromones. Naturally occurring and genetically altered microorganisms also come under the definition of pesticides, but multicellular animals are exempt from regulation as pesticides. Pesticide registration in the U.S. as in many other countries may be a long-term, resource intensive undertaking. Not uncommonly the process from beginning to complete registration may take 4 to 10 years and cost about $10 million. To meet the responsibilities of reviewing studies, overseeing 400 active ingredients and 35

  19. Advanced Reactor Development in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Giessing, D. F.; Griffith, J. D.; McGoff, D. J.; Rosen, Sol [U. S. Department of Energy, Texas (United States)

    1990-04-15

    In the United States, three technologies are employed for the new generation of advanced reactors. These technologies are Advanced Light Water Reactors (A LWRs) for the 1990s and beyond, the Modular High Temperature Gas Reactor (M HTGR) for commercial use after the turn of the century, and Liquid Metal Reactors (LWRs) to provide energy production and to convert reactor fission waste to a more manageable waste product. Each technology contributes to the energy solution. Light Water Reactors For The 1990s And Beyond--The U. S. Program The economic and national security of the United States requires a diversified energy supply base built primarily upon adequate, domestic resources that are relatively free from international pressures. Nuclear energy is a vital component of this supply and is essential to meet current and future national energy demands. It is a safe, economically continues to contribute to national energy stability, and strength. The Light Water Reactor (LWR) has been a major and successful contributor to the electrical generating needs of many nations throughout the world. It is being counted upon in the United States as a key to revitalizing nuclear energy option in the 1990s. In recent years, DOE joined with the industry to ensure the availability and future viability of the LWR option. This national program has the participation of the Nation's utility industry, the Electric Power Research Institute (EPRI), and several of the major reactor manufacturers and architect-engineers. Separate but coordinated parts of this program are managed by EPRI and DOE.

  20. Hybrid Reactor designs in the United States

    International Nuclear Information System (INIS)

    Wolkenhauer, W.C.

    1978-01-01

    This paper reviews the current, active, interrelated Hybrid Reactor development programs in the United States, and offers a probable future course of action for the technology. The Department of Energy (DOE) program primarily emphasizes development of Hybrid Reactors that are optimized for proliferation resistance. The Electric Power Research Institute (EPRI) program concentrates on avenues for Hybrid Reactor commercialization. The history of electrical generation technology has been one of steady movement toward higher power densities and higher quality fuels. An apparent advantage of the Hybrid Reactor option is that it follows this trend

  1. United States Army Weapon Systems 2010

    Science.gov (United States)

    2009-09-18

    equipment, tractor, van, wrecker, 8.8-ton Load Handling System (LHS), 8.8-ton LHS trailer, and 10-ton dump truck models). Three truck variants and...NJ) hydraulic pump and motor: Vickers (Jackson, MS) 131 UnIteD StAteS Army ACqUISItIon phASe InveStment Component High Mobility Engineer Excavator...MEDEVAC and hoist configuration, the UH-72A is also being fielded in a VIP, National Guard Homeland Security (HLS) and a Combined Training Center

  2. Wind Lidar Activities in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, Andrew; Newman, Jennifer; St. Pe, Alexandra; Iungo, G. Valerio; Wharton, Sonia; Herges, Tommy; Filippelli, Matthew; Pontbriand, Philippe; Osler, Evan

    2017-06-28

    IEA Wind Task 32 seeks to identify and mitigate the barriers to the adoption of lidar for wind energy applications. This work is partly achieved by sharing experience across researchers and practitioners in the United States and worldwide. This presentation is a short summary of some wind lidar-related activities taking place in the country, and was presented by Andrew Clifton at the Task 32 meeting in December 2016 in his role as the U.S. Department of Energy-nominated country representative to the task.

  3. Nuclear engineering education in the United States

    International Nuclear Information System (INIS)

    Williamson, T.G.

    1982-01-01

    In discussing nuclear engineering education in the United States it is shown that the most critical issue facing the nuclear engineering education community today is enrolment in a time of increasing demand for graduate engineers. Related to the issue of enrolment is support for graduate students, whether it be fellowships, traineeships, or research assistantships. Other issues are those of maintaining a vital faculty in the face of a competitive job market, of maintaining research facilities and developing new ones, and of determining the directions of educational efforts in the future. (U.K.)

  4. Early uranium mining in the United States

    International Nuclear Information System (INIS)

    Hahne, F.J.

    1990-01-01

    Uranium mining in the United States is closer to 100 years old than to the 200 years since the discovery of the element. Even then, for much of this time the rock was brought out of the ground for reasons other than its uranium content. The history of the US uranium industry is divided into five periods which follow roughly chronologically upon one another, although there is some overlap. The periods cover: uranium use in glass and ceramics; radium extraction; vanadium extraction; government uranium extraction and commercial extraction. (author)

  5. Uranium enrichment services in the United States

    International Nuclear Information System (INIS)

    Jelinek, P.; Lenders, M.

    1994-01-01

    The United States of America is the world's largest market for uranium enrichment services. After the disintegration of the Soviet Union, Russian uranium is entering the world market on an increasing scale. The U.S. tries to protect its market and, in this connection, also the European market from excessive price drops by taking anti-dumping measures. In order to become more competitive, American companies have adapted modern enrichment techniques from Europe. European - U.S. joint ventures are to help, also technically and economically, to integrate military uranium, accumulating as a consequence of worldwide disarmament, into the commercial fuel cycle for the peaceful use of nuclear power. (orig.) [de

  6. States reducing solar's soft costs

    Energy Technology Data Exchange (ETDEWEB)

    Meehan, Chris

    2012-07-01

    In 2012 the costs of modules will drop below the balance of system costs or 'soft costs' of solar in the US. Federal policy that nationalizes permitting processes could reduce some of the soft costs, but is unlikely. That's why states like California, Colorado, Connecticut and Vermont passed own laws to reduce soft costs by speeding solar permitting and reducing fees. (orig.)

  7. 75 FR 31465 - United States, State of Illinois, State of Colorado, and State of Indiana

    Science.gov (United States)

    2010-06-03

    ..., and often offer full-service restaurants or in-service dining. Premiere theatres also differ from... selection is deemed not to be a suitable alternative, the United States shall in its sole discretion select... suitable alternative pursuant to Section VI(A). If AMC's selection is deemed not to be a suitable...

  8. 22 CFR 22.3 - Remittances in the United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Remittances in the United States. 22.3 Section...-DEPARTMENT OF STATE AND FOREIGN SERVICE § 22.3 Remittances in the United States. (a) Type of remittance. Remittances shall be in the form of: (1) Check or bank draft drawn on a bank in the United States; (2) money...

  9. COSTING OF QUALITY IN BUSINESS BASE UNIT SEVERAL PRODUCTIONS, CIENFUEGOS

    Directory of Open Access Journals (Sweden)

    Gómez Alfonso, Elizabeth

    2013-01-01

    Full Text Available The calculation of quality costs as a component of the System of Quality Management, is a must for Cuban business managers, to provide a technique identified as an advanced instrument of management, which will lead to improved competitiveness and serve as an informative source. Identify and calculate the costs of quality, as well as propose measured plans, to promote a decrease in operating expenses, which can be used as a tool to improve processes. The Business Unit of Several Base Productions of Cienfuegos presents the fault to give way to Business Improvement and certification of its Quality Management System, according to the norm ISO 9001:2008 and the decree law 281, so that the objective research was to estimate the costs of quality processes in the company. To achieve this level were used empirical methods and techniques such as direct observation, document review and work in groups, which allowed to calculate the costs of quality in all processes. The results obtained are applicable to companies that operate in the Cuban economy and according to the Cuban economic model implemented from the year 2011.

  10. The value of group purchasing organizations in the United States.

    Science.gov (United States)

    Rooney, Curtis

    2011-01-01

    This article examines the valuable role of group purchasing organizations (GPOs) in hospital purchasing in the United States. For over 100 years old GPOs have helped hospitals and other health care providers realize savings and create contracting efficiencies by aggregating purchasing volume to negotiate discounts with manufacturers, distributors and other vendors. The US has recently enacted a series of healthcare reforms to correct some of the historical concerns regarding cost, quality and access. GPOs are expected to continue to play a critical role in the business of hospital purchasing and may potential export that other countries may wish to examine.

  11. Assisted Reproductive Technology Surveillance - United States, 2015.

    Science.gov (United States)

    Sunderam, Saswati; Kissin, Dmitry M; Crawford, Sara B; Folger, Suzanne G; Boulet, Sheree L; Warner, Lee; Barfield, Wanda D

    2018-02-16

    Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to deliver multiple-birth infants. Multiple births pose substantial risks for both mothers and infants, including obstetric complications, preterm delivery (state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2015 and compares birth outcomes that occurred in 2015 (resulting from ART procedures performed in 2014 and 2015) with outcomes for all infants born in the United States in 2015. 2015. In 1995, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). Data are collected through the National ART Surveillance System, a web-based data collection system developed by CDC. This report includes data from 52 reporting areas (the 50 states, the District of Columbia, and Puerto Rico). In 2015, a total of 182,111 ART procedures (range: 135 in Alaska to 23,198 in California) with the intent to transfer at least one embryo were performed in 464 U.S. fertility clinics and reported to CDC. These procedures resulted in 59,334 live-birth deliveries (range: 55 in Wyoming to 7,802 in California) and 71,152 infants born (range: 68 in Wyoming to 9,176 in California). Nationally, the number of ART procedures performed per 1 million women of reproductive age (15-44 years), a proxy measure of the ART utilization rate, was

  12. Renewable energy atlas of the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J.A.; Hlava, K.Greenwood, H.; Carr, A. (Environmental Science Division)

    2012-05-01

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. It is designed for the U.S. Department of Agriculture Forest Service (USFS) and other federal land management agencies to evaluate existing and proposed renewable energy projects. Much of the content of the Atlas was compiled at Argonne National Laboratory (Argonne) to support recent and current energy-related Environmental Impact Statements and studies, including the following projects: (1) West-wide Energy Corridor Programmatic Environmental Impact Statement (PEIS) (BLM 2008); (2) Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2010); (3) Supplement to the Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2011); (4) Upper Great Plains Wind Energy PEIS (WAPA/USFWS 2012, in progress); and (5) Energy Transport Corridors: The Potential Role of Federal Lands in States Identified by the Energy Policy Act of 2005, Section 368(b) (in progress). This report explains how to add the Atlas to your computer and install the associated software; describes each of the components of the Atlas; lists the Geographic Information System (GIS) database content and sources; and provides a brief introduction to the major renewable energy technologies.

  13. Step-grandparenthood in the United States.

    Science.gov (United States)

    Yahirun, Jenjira J; Park, Sung S; Seltzer, Judith A

    2018-01-18

    This study provides new information about the demography of step-grandparenthood in the United States. Specifically, we examine the prevalence of step-grandparenthood across birth cohorts and for socioeconomic and racial/ethnic groups. We also examine lifetime exposure to the step-grandparent role. Using data from the Panel Study of Income Dynamics and the Health and Retirement Study, we use percentages to provide first estimates of step-grandparenthood and to describe demographic and socioeconomic variation in who is a step-grandparent. We use life tables to estimate the exposure to step-grandparenthood. The share of step-grandparents is increasing across birth cohorts. However, individuals without a college education and non-Whites are more likely to become step-grandparents. Exposure to the step-grandparent role accounts for approximately 15% of total grandparent years at age 65 for women and men. A growing body of research finds that grandparents are increasingly instrumental in the lives of younger generations. However, the majority of this work assumes that these ties are biological, with little attention paid to the role of family complexity across three generations. Understanding the demographics of step-grandparenthood sheds light on the family experiences of an overlooked, but growing segment of the older adult population in the United States. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Zoonotic Leprosy in the Southeastern United States

    Science.gov (United States)

    Sharma, Rahul; Singh, Pushpendra; Loughry, W.J.; Lockhart, J. Mitchell; Inman, W. Barry; Duthie, Malcolm S.; Pena, Maria T.; Marcos, Luis A.; Scollard, David M.; Cole, Stewart T.

    2015-01-01

    Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and have been implicated in zoonotic transmission of leprosy. Early studies found this disease mainly in Texas and Louisiana, but armadillos in the southeastern United States appeared to be free of infection. We screened 645 armadillos from 8 locations in the southeastern United States not known to harbor enzootic leprosy for M. leprae DNA and antibodies. We found M. leprae–infected armadillos at each location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using single-nucleotide polymorphism variable number tandem repeat genotyping/genome sequencing, we detected M. leprae genotype 3I-2-v1 among 35 armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In comparison, 52 human patients from the same region were infected with 31 M. leprae types. However, 42.3% (22/52) of patients were infected with 1 of the 2 M. leprae genotype strains associated with armadillos. The geographic range and complexity of zoonotic leprosy is expanding. PMID:26583204

  15. Regional geologic framework off northeastern United States

    Science.gov (United States)

    Schlee, J.; Behrendt, John C.; Grow, J.A.; Robb, James M.; Mattick, R.; Taylor, P.T.; Lawson, B.J.

    1976-01-01

    Six multichannel seismic-reflection profiles taken across the Atlantic continental margin Previous HitoffTop the northeastern United States show an excess of 14 km of presumed Mesozoic and younger sedimentary rocks in the Baltimore Canyon trough and 8 km in the Georges Bank basin. Beneath the continental rise, the sedimentary prism thickness exceeds 7 km south of New Jersey and Maryland, and it is 4.5 km thick south of Georges Bank. Stratigraphically, the continental slope--outer edge of the continental shelf is a transition zone of high-velocity sedimentary rock, probably carbonate, that covers deeply subsided basement. Acoustically, the sedimentary sequence beneath the shelf is divided into three units which are correlated speculatively with the Cenozoic, the Cretaceous, and the Jurassic-Triassic sections. These units thicken offshore, and some have increased seismic velocities farther offshore. The uppermost unit thickens from a fraction of a kilometer to slightly more than a kilometer in a seaward direction, and velocity values range from 1.7 to 2.2 km/sec. The middle unit thickens from a fraction of a kilometer to as much as 5 km (northern Baltimore Canyon trough), and seismic velocity ranges from 2.2 to 5.4 km/sec. The lowest unit thickens to a maximum of 9 km (northern Baltimore Canyon), and velocities span the 3.9 to 5.9-km/sec interval. The spatial separation of magnetic and gravity anomalies on line 2 (New Jersey) suggests that in the Baltimore Canyon region the magnetic-slope anomaly is due to edge effects and that the previously reported free-air and isostatic gravity anomalies over the outer shelf may be due in part to a lateral increase in sediment density (velocity) near the shelf edge. The East Coast magnetic anomaly and the free-air gravity high both coincide over the outer shelf edge on line 1 (Georges Bank) but are offset by 20 km from the ridge on the reflection profile. Because the magnetic-slope-anomaly wavelength is nearly 50 km across, a

  16. 31 CFR 500.520 - Payments from accounts of United States citizens in employ of United States in foreign countries...

    Science.gov (United States)

    2010-07-01

    ... States citizens in employ of United States in foreign countries and certain other persons. 500.520..., Authorizations and Statements of Licensing Policy § 500.520 Payments from accounts of United States citizens in employ of United States in foreign countries and certain other persons. (a) Banking institutions within...

  17. 31 CFR 515.520 - Payments from accounts of United States citizens in employ of United States in foreign countries...

    Science.gov (United States)

    2010-07-01

    ... States citizens in employ of United States in foreign countries and certain other persons. 515.520..., Authorizations, and Statements of Licensing Policy § 515.520 Payments from accounts of United States citizens in employ of United States in foreign countries and certain other persons. (a) Banking institutions within...

  18. United States of America: health system review.

    Science.gov (United States)

    Rice, Thomas; Rosenau, Pauline; Unruh, Lynn Y; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

    2013-01-01

    This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  19. Terms, Trends, and Insights: PV Project Finance in the United States, 2017

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, David J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Schwabe, Paul D [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-10-23

    This brief is a compilation of data points and market insights that reflect the state of the project finance market for solar photovoltaic (PV) assets in the United States as of the third quarter of 2017. This information can generally be used as a simplified benchmark of the costs associated with securing financing for solar PV as well as the cost of the financing itself (i.e., the cost of capital). This work represents the second DOE sponsored effort to benchmark financing costs across the residential, commercial, and utility-scale PV markets, as part of its larger effort to benchmark the components of PV system costs.

  20. Chinese medicine education and its challenges in the United States.

    Science.gov (United States)

    Kwon, Yihyun

    2014-04-01

    Over the past 4 decades Chinese medicine (CM) has come increasingly into the spotlight in the United States as the clinical effectiveness of CM has been not only empirically well-tested over a long period of time but also proven by recent scientific research. It has proven cost effectiveness, safety, and is authorized for natural and holistic approaches. In consideration, CM is one of the underutilized health care professions in the United States with a promising future. However, CM faces many challenges in its education and system, its niche in the health care system as an independent profession, legal and ethical issues. This paper discusses the confronting issues in the United States: present education, standards of CM education with shifting first professional degree level, new delivery systems of CM education. Development of new research models, training of evidence-based practice, and implementation of integrative medicine into CM education also are the key issues in the current CM profession. This paper also discusses opportunities for the CM profession going beyond the current status, especially with a focus on fusion medicine.

  1. Uber and Metropolitan Traffic Fatalities in the United States.

    Science.gov (United States)

    Brazil, Noli; Kirk, David S

    2016-08-01

    Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Leading Causes of Death in Females United States

    Science.gov (United States)

    ... and Health Issues at Work Health Equity Leading Causes of Death in Females, United States Recommend on Facebook Tweet ... to current and previous listings for the leading causes of death in females in the United States. Please note ...

  3. Arsenic in Ground Water of the United States

    Science.gov (United States)

    ... Team More Information Arsenic in groundwater of the United States Arsenic in groundwater is largely the result of ... Gronberg (2011) for updated arsenic map. Featured publications United States Effects of human-induced alteration of groundwater flow ...

  4. Residency training in the United States: What foreign medical ...

    African Journals Online (AJOL)

    FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past ...

  5. Survey of State-Level Cost and Benefit Estimates of Renewable Portfolio Standards

    Energy Technology Data Exchange (ETDEWEB)

    Heeter, J.; Barbose, G.; Bird, L.; Weaver, S.; Flores-Espino, F.; Kuskova-Burns, K.; Wiser, R.

    2014-05-01

    Most renewable portfolio standards (RPS) have five or more years of implementation experience, enabling an assessment of their costs and benefits. Understanding RPS costs and benefits is essential for policymakers evaluating existing RPS policies, assessing the need for modifications, and considering new policies. This study provides an overview of methods used to estimate RPS compliance costs and benefits, based on available data and estimates issued by utilities and regulators. Over the 2010-2012 period, average incremental RPS compliance costs in the United States were equivalent to 0.8% of retail electricity rates, although substantial variation exists around this average, both from year-to-year and across states. The methods used by utilities and regulators to estimate incremental compliance costs vary considerably from state to state and a number of states are currently engaged in processes to refine and standardize their approaches to RPS cost calculation. The report finds that state assessments of RPS benefits have most commonly attempted to quantitatively assess avoided emissions and human health benefits, economic development impacts, and wholesale electricity price savings. Compared to the summary of RPS costs, the summary of RPS benefits is more limited, as relatively few states have undertaken detailed benefits estimates, and then only for a few types of potential policy impacts. In some cases, the same impacts may be captured in the assessment of incremental costs. For these reasons, and because methodologies and level of rigor vary widely, direct comparisons between the estimates of benefits and costs are challenging.

  6. Study of geothermal prospects in the western United States

    Energy Technology Data Exchange (ETDEWEB)

    1976-08-20

    The commercial development potential of 13 underdeveloped geothermal prospects in the Western United States has been examined and the prospects have been ranked in order of relative potential for development on the basis of investment considerations. The following were considered in the ranking: geotechnical and engineering data, energy market accessibility, administrative constraints, and environmental and socio-economic factors. The primary ranking criterion is the unit cost of energy production expected from each prospect. This criterion is obtained principally from expected reservoir temperatures and depths. Secondary criteria are administrative constraints, environmental factors and the quality of the geotechnical data. The Roosevelt, Utah, prospect ranks first in development potential followed in order by Beowawe, Nevada; Coso Hot Springs, California; Long Valley, California; and Brady's Hot Springs, Nevada.

  7. Study of geothermal prospects in the western United States

    Energy Technology Data Exchange (ETDEWEB)

    1975-01-01

    The commercial development potential of 13 underdeveloped geothermal prospects in the western United States has been examined and the prospects have been ranked in order of relative potential for development on the basis of investment considerations. The following were considered in the ranking: geotechnical and engineering data, energy market accessibility, administrative constraints, and environmental and socio-economic factors. The primary ranking criterion is the unit cost of energy production expected from each prospect. This criterion is obtained principally from expected reservoir temperatures and depths. Secondary criteria are administrative constraints, environmental factors and the quality of the geotechnical data. The Roosevelt, Utah, prospect ranks first in development potential followed in order by Beowawe, Nevada; Coso Hot Springs, California; Long Valley, California; and Brady's Hot Springs, Nevada.

  8. The United States and the Arab Gulf Monarchies

    International Nuclear Information System (INIS)

    Kechichian, J.A.

    1999-01-01

    The United States has enduring strategic interests in the Persian Gulf region. To understand these interests and the Usa policy towards the Arab Gulf Monarchies, the french institute of international relations (IFRI) proposes this document. The following chapters are detailed: the United States and the Arab Gulf Monarchies, overview, Chief Unites States Objective: Access to oil, re-evaluating United States Foreign Policy in the Gulf, the second term (Usa strategy). (A.L.B.)

  9. Market power and state costs of HIV/AIDS drugs.

    Science.gov (United States)

    Leibowitz, Arleen A; Sood, Neeraj

    2007-03-01

    We examine whether U.S. states can use their market power to reduce the costs of supplying prescription drugs to uninsured and underinsured persons with HIV through a public program, the AIDS Drug Assistance Program (ADAP). Among states that purchase drugs from manufacturers and distribute them directly to clients, those that purchase a greater volume pay lower average costs per prescription. Among states depending on retail pharmacies to distribute drugs and then claiming rebates from manufacturers, those that contract with smaller numbers of pharmacy networks have lower average costs. Average costs per prescription do not differ between the two purchase methods.

  10. Air pollution problem in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Heimann, H

    1964-10-01

    Air pollution in the United States as a problem affecting health, as well as man's enjoyment of his property, was first noted in 1912 in the reports of the investigators at the Mellon Institute of the University of Pittsburgh. The Selby copper smelter incident in 1915 was among the first episodic air pollution events documented. The US Public Health Service studied carbon monoxide buildup in vehicular tunnels in 1928 and 1929. the Donora (Pennsylvania) pollution episode, where 17 people died, occurred in 1949. It and the onset of smog conditions in the Los Angeles area really initiated broad public awareness of air pollution as a public health hazard in the USA. The symptoms of air pollution-related injuries are discussed, the role of the US Public Health Service in dealing with air pollution, and the effect of the Clean Air Act of 1963 are discussed. 26 references.

  11. United States Transuranium and Uranium Registries

    International Nuclear Information System (INIS)

    Kathren, R.L.; Filipy, R.E.; Dietert, S.E.

    1991-06-01

    This report summarizes the primary scientific activities of the United States Transuranium and Uranium Registries for the period October 1, 1989 through September 30, 1990. The Registries are parallel human tissue research programs devoted to the study of the actinide elements in humans. To date there have been 261 autopsy or surgical specimen donations, which include 11 whole bodies. The emphasis of the Registry was directed towards quality improvement and the development of a fully computerized data base that would incorporate not only the results of postmortem radiochemical analysis, but also medical and monitoring information obtained during life. Human subjects reviews were also completed. A three compartment biokinetic model for plutonium distribution is proposed. 2 tabs

  12. Licensing of HTGRs in the United States

    International Nuclear Information System (INIS)

    Fisher, C.R.; Orvis, D.D.

    1981-01-01

    The licensing history of the high-temperature gas-cooled reactor (HTGR) in the United States is given historical perspective. The experience began with the licensing of the Peach Bottom Atomic Power Station and extends to the continuing experience at the Fort St. Vrain Nuclear Generating Station. Additional experience was obtained from the licensing reviews in the mid-1970s of the large HTGR plants that were to be built by Philadelphia Electric Company and Delmarva Power and Light. Also, information was provided by the licensing review of the General Atomic standard plant by the U.S. Nuclear Regulatory Commission (NRC) at about the same time. These experiences are summarized in terms of the principal design criteria that were required by the regulatory authority for each project. These criteria include specification of the design basis accidents that were postulated for the plant safety analysis. Several technical issues raised by the NRC during their review of the large HTGR are presented. (author)

  13. Licensing of HTGRs in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Fisher, C. R.; Orvis, D. D. [General Atomic Co., San Diego, CA (USA)

    1981-01-15

    The licensing history of the high-temperature gas-cooled reactor (HTGR) in the United States is given historical perspective. The experience began with the licensing of the Peach Bottom Atomic Power Station and extends to the continuing experience at the Fort St. Vrain Nuclear Generating Station. Additional experience was obtained from the licensing reviews in the mid-1970s of the large HTGR plants that were to be built by Philadelphia Electric Company and Delmarva Power and Light. Also, information was provided by the licensing review of the General Atomic standard plant by the U.S. Nuclear Regulatory Commission (NRC) at about the same time. These experiences are summarized in terms of the principal design criteria that were required by the regulatory authority for each project. These criteria include specification of the design basis accidents that were postulated for the plant safety analysis. Several technical issues raised by the NRC during their review of the large HTGR are presented.

  14. Nuclear material control in the United States

    International Nuclear Information System (INIS)

    Jaeger, C.; Waddoups, I.

    1995-01-01

    The Department of Energy has defined a safeguards system to be an integrated system of physical protection, material accounting and material control subsystems designed to deter, prevent, detect, and respond to unauthorized possession, use, or sabotage of SNM. In practice, safeguards involve the development and application of techniques and procedures dealing with the establishment and continued maintenance of a system of activities. The system must also include administrative controls and surveillance to assure that the procedures and techniques of the system are effective and are being carried out. The control of nuclear material is critical to the safeguarding of nuclear materials within the United States. The U.S. Department of Energy includes as part of material control four functional performance areas. They include access controls, material surveillance, material containment and detection/assessment. This paper will address not only these areas but also the relationship between material control and other safeguards and security functions

  15. Uranium resources in the United States

    International Nuclear Information System (INIS)

    Grenon, Michel.

    1975-01-01

    The United States are certainly the country which is the most concerned by a better evaluation of uranium resources. This is so because of the importance of the American nuclear program and because of a certain number of doubts in their uranium supply. This is probably why studies concerning American uranium resources have been very frequent in recent months. Although, most of these studies are not yet finished it is perhaps possible to draw a few conclusions in order to better see the framework of this important uranium resources problem. This is what this article attempts, using among other studies, the one carried-out for the National Science Foundation which is among the most complete, especially concerning the complete range of resources [fr

  16. China, Southeast Asia, and the United States

    Directory of Open Access Journals (Sweden)

    Lowell Dittmer

    2016-04-01

    Full Text Available Southeast Asia has historically been a meeting point between East Asia and South Asia before Western colonialism opened the region to the West and to the winds of global modernization. Since Japan’s coercive decolonization during the Second World War, the dominant outside influences have come from the United States and from the People’s Republic of China. The post-Cold War era began with a withdrawal of both China’s and US power projection from Southeast Asia, facilitating the configuration of a triangular ménage à trios, with ASEAN expanding to include all of Southeast Asia and introducing a number of extended forums intended to socialize the rest of East Asia into the ASEAN way. The “rise of China” occurred within this friendly context, though beginning around 2010 its strategic implications began to appear more problematic with the mounting dispute over the issue of the South China Sea.

  17. The United States nuclear merchant ship program

    International Nuclear Information System (INIS)

    Maynard, E.V.

    1978-01-01

    The issues of financial protection contemplate appropriate financing to permit construction of the involved vessels. In addition, the licensing process will require a demonstrated ability for financial response in the event of injury to persons or damage to property. Since the thrust in the United States is to use the Price-Anderson framework for Insurance and Indemnity, much attention is devoted to this legislation. The pre-existing regime is related to the distinguishing requirements of the Maritime field with proposals being advanced to more nearly parallel the insurance coverage philosophy of Europe, i.e., to utilize insurance pools for the nuclear risks and utilize the conventional insurance market for non-nuclear risks. Public affairs issues impact heavily on legislation efforts and thusly become significant in developing a program for Financial Protection

  18. Renewable Energy Atlas of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J. [Environmental Science Division; Hlava, K. [Environmental Science Division; Greenwood, H. [Environmentall Science Division; Carr, A. [Environmental Science Division

    2013-12-13

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. This report explains how to add the Atlas to your computer and install the associated software. The report also includes: A description of each of the components of the Atlas; Lists of the Geographic Information System (GIS) database content and sources; and A brief introduction to the major renewable energy technologies. The Atlas includes the following: A GIS database organized as a set of Environmental Systems Research Institute (ESRI) ArcGIS Personal GeoDatabases, and ESRI ArcReader and ArcGIS project files providing an interactive map visualization and analysis interface.

  19. Hantavirus Pulmonary Syndrome in the United States.

    Science.gov (United States)

    Fabbri, Marilyn; Maslow, Melanie J.

    2001-06-01

    Since the first outbreak of hantavirus pulmonary syndrome (HPS) in 1993, understanding of the vast distribution and potential impact of hantaviruses has grown. At least 277 cases of HPS have been documented in the United States. The full clinical spectrum has yet to be elucidated, and one outbreak suggested the possibility of person-to-person transmission. New research has identified the b-3 integrins as cellular receptors for hantaviruses and has determined the pivotal role of the immune system in pathogenesis. Rapid diagnosis has been facilitated by a new immunoblot assay to detect Sin Nombre virus infection. Treatment remains primarily supportive; however, a placebo- controlled trial of ribavirin is ongoing. Extracorporeal membrane oxygenation may be a potential therapy in severe cases; inhaled nitric oxide needs further study. Vaccines developed against hantaviruses associated with hemorrhagic fever and renal syndrome might be effective against HPS-associated strains.

  20. Unplanned pregnancies in the United States.

    Science.gov (United States)

    Grimes, D A

    1986-03-01

    Unplanned pregnancies constitute an epidemic in the United States. Over 3 million unplanned pregnancies occur, and over 1.5 million induced abortions are performed each year. Women of minority races and those with less than 12 years of education are at high risk of having unwanted children. Fear of complications (not the complications themselves) is the most powerful deterrent to women's use of contraception. Much of this fear is due to bad press. Recent good news about contraception, such as protection against ovarian and endometrial cancer, protection against ectopic pregnancy, and absence of teratogenic effects, has not received appropriate media coverage. For healthy women younger than 35 years, failure to use fertility control is more dangerous than use of any method.

  1. Global context for the United States Forest Sector in 2030

    Science.gov (United States)

    James Turner; Joseph Buongiorno; Shushuai Zhu; Jeffrey P. Prestemon

    2005-01-01

    The purpose of this study was to identify markets for, and competitors to, the United States forest industries in the next 30 years. The Global Forest Products Model was used to make predictions of international demand, supply, trade, and prices, conditional on the last RPA Timber Assessment projections for the United States. It was found that the United States, Japan...

  2. 27 CFR 479.89 - Transfers to the United States.

    Science.gov (United States)

    2010-04-01

    ... Transfers to the United States. A firearm may be transferred to the United States or any department... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Transfers to the United States. 479.89 Section 479.89 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO...

  3. 32 CFR 516.54 - Witnesses for the United States.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Witnesses for the United States. 516.54 Section..., Travel, and Expenses of Witnesses § 516.54 Witnesses for the United States. (a) Status of witness. A military member authorized to appear as a witness for the United States, including those authorized to...

  4. 32 CFR 150.21 - Appeals by the United States.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Appeals by the United States. 150.21 Section 150... the United States. (a) Restricted filing. Only a representative of the government designated by the Judge Advocate General of the respective service may file an appeal by the United States under Article...

  5. 78 FR 27857 - United States Standards for Wheat

    Science.gov (United States)

    2013-05-13

    ... RIN 0580-AB12 United States Standards for Wheat AGENCY: Grain Inspection, Packers and Stockyards... (GIPSA) is revising the United States Standards for Wheat under the United States Grain Standards Act (USGSA) to change the definition of Contrasting classes (CCL) in the class Hard White wheat. This change...

  6. 31 CFR 515.334 - United States national.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States national. 515.334 Section 515.334 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... of the United States, and which has its principal place of business in the United States. [61 FR...

  7. United States Domestic Research Reactor Infrastructure - TRIGA Reactor Fuel Support

    International Nuclear Information System (INIS)

    Morrell, Douglas

    2008-01-01

    The purpose of the United State Domestic Research Reactor Infrastructure Program is to provide fresh nuclear reactor fuel to United States universities at no, or low, cost to the university. The title of the fuel remains with the United States government and when universities are finished with the fuel, the fuel is returned to the United States government. The program is funded by the United States Department of Energy - Nuclear Energy division, managed by Department of Energy - Idaho Field Office, and contracted to the Idaho National Laboratory's Management and Operations Contractor - Battelle Energy Alliance. Program has been at Idaho since 1977 and INL subcontracts with 26 United States domestic reactor facilities (13 TRIGA facilities, 9 plate fuel facilities, 2 AGN facilities, 1 Pulstar fuel facility, 1 Critical facility). University has not shipped fuel since 1968 and as such, we have no present procedures for shipping spent fuel. In addition: floor loading rate is unknown, many interferences must be removed to allow direct access to the reactor tank, floor space in the reactor cell is very limited, pavement ends inside our fence; some of the surface is not finished. The whole approach is narrow, curving and downhill. A truck large enough to transport the cask cannot pull into the lot and then back out (nearly impossible / refused by drivers); a large capacity (100 ton), long boom crane would have to be used due to loading dock obstructions. Access to the entrance door is on a sidewalk. The campus uses it as a road for construction equipment, deliveries and security response. Large trees are on both sides of sidewalk. Spent fuel shipments have never been done, no procedures approved or in place, no approved casks, no accident or safety analysis for spent fuel loading. Any cask assembly used in this facility will have to be removed from one crane, moved on the floor and then attached to another crane to get from the staging area to the reactor room. Reactor

  8. Latin America and the United States: What Do United States History Textbooks Tell Us?

    Science.gov (United States)

    Fleming, Dan B.

    1982-01-01

    Evaluates how U.S.-Latin American relations are presented in high school U.S. history textbooks. An examination of 10 textbooks published between 1977-81 revealed inadequate coverage of Latin American cultural diversity and United States foreign policy from the Latin American perspective. (AM)

  9. Short Rotation Crops in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Wright, L L

    1998-06-04

    The report is based primarily on the results of survey questions sent to approximately 60 woody and 20 herbaceous crop researchers in the United States and on information from the U.S. Department of Energy's Bioenergy Feedstock Development Program. Responses were received from 13 individuals involved in woody crops research or industrial commercialization (with 5 of the responses coming from industry). Responses were received from 11 individuals involved in herbaceous crop research. Opinions on market incentives, technical and non-technical barriers, and highest priority research and development areas are summarized in the text. Details on research activities of the survey responders are provided as appendices to the paper. Woody crops grown as single-stem systems (primarily Populus and Eucalyptus species) are perceived to have strong pulp fiber and oriented strand board markets, and the survey responders anticipated that energy will comprise 25% or less of the utilization of single-stem short-rotation woody crops between now and 2010. The only exception was a response from California where a substantial biomass energy market does currently exist. Willows (Salix species) are only being developed for energy and only in one part of the United States at present. Responses from herbaceous crop researchers suggested frustration that markets (including biomass energy markets) do not currently exist for the crop, and it was the perception of many that federal incentives will be needed to create such markets. In all crops, responses indicate that a wide variety of research and development activities are needed to enhance the yields and profitability of the crops. Ongoing research activities funded by the U.S. Department of Energy's Bioenergy Feedstock Development Program are described in an appendix to the paper.

  10. Fires Across the Western United States

    Science.gov (United States)

    2007-01-01

    Days of record heat made the western United States tinder dry in early July 2007. Numerous wildfires raced across the dry terrain during the weekend of July 7. From Washington to Arizona, firefighters were battling fast-moving wildfires that threatened residences, businesses, gas wells, coal mines, communications equipment, and municipal watersheds. This image of the West was captured by the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite on Sunday, July 8. Places where MODIS detected actively burning fires are marked in red. Some of the largest blazes are labeled. Utah's Milford Flat was the largest; according to the July 9 morning report from the National Interagency Fire Center, the blaze was more than 280,000 acres, having grown more than 124,000 acres in the previous 24 hours. The fires have destroyed homes, forced evacuations, shut down trains and highways, and killed several people. Weather conditions were not expected to improve significantly across much of the area for several days, with hot temperatures and dry thunderstorms (lightning and winds, but little rain) likely in many places. Nearly the entire western United States was experiencing some level of drought as of July 3, according to the U.S. Drought Monitor. The drought had reached the 'extreme' category in southern California and western Arizona, and ranged from moderate to severe across most of the rest of the Southwest and Great Basin. The large image provided above has a spatial resolution (level of detail) of 500 meters per pixel. The MODIS Rapid Response Team provides twice-daily images of the region in additional resolutions and formats, including an infrared-enhanced version that makes burned terrain appear brick red. NASA image courtesy the MODIS Rapid Response Team, Goddard Space Flight Center

  11. The United States: breakthroughs and waste.

    Science.gov (United States)

    Reinhardt, U E

    1992-01-01

    The health system of the United States is in a paradoxical position. At its best, the system is a magnet for those seeking the latest technical breakthroughs. It can offer that excellence because there have never been effective financial constraints on the imagination; the system has become a major economic frontier, at which professional and other entrepreneurs successfully seek their fortune. At the same time, the system is leaving increasing numbers of Americans frustrated and disillusioned. It is beset by excess capacity in many areas, is needlessly expensive, and often bestows unnecessary health services. Yet only the experts are aware of these flaws; most Americans still express high satisfaction with the quality of the services they receive from their doctors and hospitals. The public's major misgivings arise over the awkward and inequitable way in which American health care is financed. The typical private health insurance policy, for example, is tied to a particular job. If the job is lost, so is the health insurance. Furthermore, these policies are priced on actuarially "fair" principles, so sick individuals are forced to pay higher insurance premiums than relatively healthy ones and chronically ill persons often cannot obtain health insurance coverage at any price. Although there are public programs to catch many persons not privately insured, the coverage tends to be insufficiently extensive and deep. Some 35 million Americans, mostly poor, have no health insurance whatsoever. Unfortunately, at this time there is no political force in the United States strong enough to reform the American health system toward greater social equity and economic efficiency, whereas there are numerous groups powerful enough to block whatever reform might harm their own narrow economic interests. Other nations can learn from America's clinical and organizational innovations in health care delivery. They can also learn what not to do by studying the unseemly way in which

  12. Inpatient Financial Burden of Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2017-01-01

    Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all...... hospitalizations in the United States. Hospitalization rates for AD or eczema were highest in the northeast during the winter and south during the summer. Geometric mean cost of care (95% confidence interval) was lower for a primary diagnosis of AD or eczema versus no AD or eczema in adults ($3,502 [$3......,360-$3,651] vs. $6,849 [$6,775-$6,925]; P = 0.0004) and children ($2,716 [$2,542-$2,903] vs. $4,488 [$4,302-$4,682]; P = 0.0004). However, the high prevalence of hospitalization resulted in total inpatient costs of $8,288,083 per year for adults and $3,333,868 per year for children. In conclusion...

  13. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health

  14. Abortion surveillance--United States, 1991.

    Science.gov (United States)

    Koonin, L M; Smith, J C; Ramick, M

    1995-05-05

    From 1980 through 1991, the number of legal induced abortions reported to CDC remained stable, varying each year by 1969, CDC has compiled abortion data received from 52 reporting areas: 50 states, the District of Columbia, and New York City. In 1991, 1,388,937 abortions were reported--a 2.8% decrease from 1990. The abortion ratio was 339 legal induced abortions per 1,000 live births, and the abortion rate was 24 per 1,000 women 15-44 years of age. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most had had no previous live births and had been obtaining an abortion for the first time. More than half (52%) of all abortions were performed at or before the 8th week of gestation, and 88% were before the 13th week. Younger women (i.e., women may partially account for this decline. An accurate assessment of the number and characteristics of women who obtain abortions in the United States is necessary both to monitor efforts to prevent unintended pregnancy and to identify and reduce preventable causes of morbidity and mortality associated with abortions.

  15. The cost of failing states and the limits to sovereignty

    OpenAIRE

    Chauvet, Lisa; Collier, Paul; Hoeffler, Anke

    2007-01-01

    In this paper, we estimate the costs of state failure, both for the failing state itself and for its neighbours. In our analysis, the cost of failure arises from two distinct sources: organized violence due to the incapacity of the state to ensure its own citizens’ security and low quality of regulation and public goods due to poor governance. To estimate the cost of failure, we proceed in two steps. First we estimate the annual loss of growth induced by state failure. Then we cumulate this l...

  16. Brackish groundwater in the United States

    Science.gov (United States)

    Stanton, Jennifer S.; Anning, David W.; Brown, Craig J.; Moore, Richard B.; McGuire, Virginia L.; Qi, Sharon L.; Harris, Alta C.; Dennehy, Kevin F.; McMahon, Peter B.; Degnan, James R.; Böhlke, John Karl

    2017-04-05

    For some parts of the Nation, large-scale development of groundwater has caused decreases in the amount of groundwater that is present in aquifer storage and that discharges to surface-water bodies. Water supply in some areas, particularly in arid and semiarid regions, is not adequate to meet demand, and severe drought is affecting large parts of the United States. Future water demand is projected to heighten the current stress on groundwater resources. This combination of factors has led to concerns about the availability of freshwater to meet domestic, agricultural, industrial, mining, and environmental needs. To ensure the water security of the Nation, currently [2016] untapped water sources may need to be developed.Brackish groundwater is an unconventional water source that may offer a partial solution to current and future water demands. In support of the national census of water resources, the U.S. Geological Survey completed the national brackish groundwater assessment to better understand the occurrence and characteristics of brackish groundwater in the United States as a potential water resource. Analyses completed as part of this assessment relied on previously collected data from multiple sources; no new data were collected. Compiled data included readily available information about groundwater chemistry, horizontal and vertical extents and hydrogeologic characteristics of principal aquifers (regionally extensive aquifers or aquifer systems that have the potential to be used as a source of potable water), and groundwater use. Although these data were obtained from a wide variety of sources, the compiled data are biased toward shallow and fresh groundwater resources; data representing groundwater that is at great depths and is saline were not as readily available.One of the most important contributions of this assessment is the creation of a database containing chemical characteristics and aquifer information for the known areas with brackish groundwater

  17. [Unit cost variation in a social security company in Querétaro, México].

    Science.gov (United States)

    Villarreal-Ríos, Enrique; Campos-Esparza, Maribel; Garza-Elizondo, María E; Martínez-González, Lidia; Núñez-Rocha, Georgina M; Romero-Islas, Nestor R

    2006-01-01

    Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. Unit cost variation was more important in the emergency room and the dental service.

  18. 78 FR 70274 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-11-25

    ... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade... the schedule and agenda for an open meeting of the United States Travel and Tourism Advisory Board...

  19. 78 FR 3398 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-01-16

    ... DEPARTMENT OF COMMERCE International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade... the schedule and agenda for an open meeting of the United States Travel and Tourism Advisory Board...

  20. Baumol's Cost Disease and the Sustainability of the Welfare State

    DEFF Research Database (Denmark)

    Andersen, Torben M.; Kreiner, Claus T.

    2017-01-01

    If productivity increases more slowly for services than for manufactured goods, then services suffer from Baumol's cost disease and tend to become relatively more costly over time. Since the welfare state in all countries is an important supplier of tax financed services, this translates into a f......If productivity increases more slowly for services than for manufactured goods, then services suffer from Baumol's cost disease and tend to become relatively more costly over time. Since the welfare state in all countries is an important supplier of tax financed services, this translates...