By comparing the related total cost before and after the formation of purchasing consortia, the impetus of formation is analyzed. Moreover, pointed to different transportation and storage policies, the formation impet...By comparing the related total cost before and after the formation of purchasing consortia, the impetus of formation is analyzed. Moreover, pointed to different transportation and storage policies, the formation impetus is studied in detail and some conclusions are arrived at. Finally the research orientation of the formation impetus of purchasing consortia is exploratory presented under more complicated conditions, and purchasing consortia in more cross-zones and multi-segment will occur in China.展开更多
Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized th...Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.展开更多
Background:As well as imposing an economic burden on affected households,the high costs related to tuberculosis(TB)can create access and adherence barriers.This highlights the particular urgency of achieving one of th...Background:As well as imposing an economic burden on affected households,the high costs related to tuberculosis(TB)can create access and adherence barriers.This highlights the particular urgency of achieving one of the End TB Strategy’s targets:that no TB-affected households have to face catastrophic costs by 2020.In Indonesia,as elsewhere,there is also an emerging need to provide social protection by implementing universal health coverage(UHC).We therefore assessed the incidence of catastrophic total costs due to TB,and their determinants since the implementation of UHC.Methods:We interviewed adult TB and multidrug-resistant TB(MDR-TB)patients in urban,suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier.Following the WHO recommendation,we assessed the incidence of catastrophic total costs due to TB.We also analyzed the sensitivity of incidence relative to several thresholds,and measured differences between poor and non-poor households in the incidence of catastrophic costs.Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs.Results:We analyzed 282 TB and 64 MDR-TB patients.For TB-related services,the median(interquartile range)of total costs incurred by households was 133 USD(55-576);for MDR-TB-related services,it was 2804 USD(1008-4325).The incidence of catastrophic total costs in all TB-affected households was 36%(43%in poor households and 25%in non-poor households).For MDR-TB-affected households,the incidence was 83%(83%and 83%).In TB-affected households,the determinants of catastrophic total costs were poor households(adjusted odds ratio[aOR]=3.7,95%confidence interval[CI]:1.7-7.8);being a breadwinner(aOR=2.9,95%CI:1.3-6.6);job loss(aOR=21.2;95%CI:8.3-53.9);and previous TB treatment(aOR=2.9;95%CI:1.4-6.1).In MDR-TB-affected households,having an income-earning job before diagnosis was the only determinant of catastrophic total costs(aOR=8.7;95%CI:1.8-41.7).Conclusions:Despite the implementation of UHC,TB-affected households still risk catastrophic total costs and further impoverishment.As well as ensuring access to healthcare,a cost-mitigation policy and additional financial protection should be provided to protect the poor and relieve income losses.展开更多
Widespread adoption of electric vehicles(EVs)is a common and critical component of international strategies to mitigate environmental pollution,climate change and oil dependency.The ability of consumers to assess the ...Widespread adoption of electric vehicles(EVs)is a common and critical component of international strategies to mitigate environmental pollution,climate change and oil dependency.The ability of consumers to assess the total cost of ownership(TCO)of EVs relative to internal combustion engine vehicles(ICEVs)remains an important factor for EV uptake.The TCO of vehicles is not universal across different car segments and user profiles.We analyse and compare the TCO of ICEVs and EVs from 17 car segments across short-and long-term ownership periods,and further advance existing TCO approaches by integrating detailed activity-based driving profiles,taxation,grant structures and pricing.Results show that EV options in the most popular Irish car segments have existing battery EV options with a TCO averaging respectively 26% and 42% less than their equivalent petrol and diesel ICEV options over a 4-year ownership term when the current grant is included.This integrated method for granular TCO evaluation offers important insights for this market and affords scope to investigate how changes in travel patterns,car-segment pricing,taxation,grant policy,fuel costs,and carbon pricing and other transport policies can all affect TCO values over time across a broad range of market offerings.展开更多
This paper reaches a recommendation for the 10-year e-bus transition roadmap for New York City. The lifecycle model of emission reduction demonstrates the ecological and financial impacts of a complete transition from...This paper reaches a recommendation for the 10-year e-bus transition roadmap for New York City. The lifecycle model of emission reduction demonstrates the ecological and financial impacts of a complete transition from the current diesel bus fleet to an all-electric bus fleet in New York City by 2033. This study focuses on the NOx pollution, which is the highest among all major cities by Environmental Protection Agency (EPA) and greenhouse gases (GHG) with annual emissions of over five million tons. Our model predicts that switching to an all-electric bus fleet will cut GHG emissions by over 390,000 tons and NOx emissions by over 1300 tons annually, in addition to other pollutants such as VOCs and PM 2.5. yielding an annual economic benefit of over 75.94 million USD. This aligns with the city mayor office’s initiative of achieving total carbon neutrality. We further model an optimized transition roadmap that balances ecological and long-term benefits against the costs of the transition, emphasizing feasibility and alignment with the natural replacement cycle of existing buses, ensuring a steady budgeting pattern to minimize interruptions and resistance. Finally, we advocate for collaboration between government agencies, public transportation authorities, and private sectors, including electric buses and charging facility manufacturers, which is essential for fostering innovation and reducing the costs associated with the transition to e-buses.展开更多
订单审核与投放(Order Review and Release,ORR)是一种适用于面向订单制造(Make to Order,MTO)企业的生产控制技术。生产部门接收到顾客订单后,采用ORR确定所需物料投放到车间的时间,以使订单能够按时完工。另外ORR还对车间和机器的负...订单审核与投放(Order Review and Release,ORR)是一种适用于面向订单制造(Make to Order,MTO)企业的生产控制技术。生产部门接收到顾客订单后,采用ORR确定所需物料投放到车间的时间,以使订单能够按时完工。另外ORR还对车间和机器的负荷进行限制,以降低车间库存和订单在车间内的加工时间。由此ORR考虑的是一个多目标优化问题。以往的研究中一般选取多个评价指标,分别分析后再对ORR做出一个综合定性判断,导致很难定量、客观的评价不同ORR。基于此,这里提出一个总成本公式,综合考虑了按时完工和降低车间生产时间两类目标的信息,可以对不同ORR进行全面的量化分析。在实验设计的基础上,采用总成本指标对常见ORR的实际效果进行了比较,分析结论对ORR的选择有一定的借鉴意义。展开更多
The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question t...The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question that whether lower length of stay and higher utilization of post-op facilities would be helpful to control the overall costs. Using the National Hospital Discharge Survey (NHDS) database and cost data from Blue Cross Blue shield, this study seeks to identify which U.S. region renders the highest quality patient care during a three-year span of 2008-2010. Using length of stay and discharge disposition (2010) as input factors, and regional TKA costs (2013) as output factors, Data Envelopment Analysis (DEA), a non-parametric method, illustrated the efficiency ranking of four regions in the US on TKA expenditures. The result shows the West is the most efficient region on controlling the overall cost by shrinking the length of stay and increasing the utilization of short-term/long-term care facilities.展开更多
文摘By comparing the related total cost before and after the formation of purchasing consortia, the impetus of formation is analyzed. Moreover, pointed to different transportation and storage policies, the formation impetus is studied in detail and some conclusions are arrived at. Finally the research orientation of the formation impetus of purchasing consortia is exploratory presented under more complicated conditions, and purchasing consortia in more cross-zones and multi-segment will occur in China.
文摘Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.
基金This study was funded by Indonesian Endowment Fund for Education(Lembaga Pengelola Dana Pendidikan,LPDP),Indonesia.
文摘Background:As well as imposing an economic burden on affected households,the high costs related to tuberculosis(TB)can create access and adherence barriers.This highlights the particular urgency of achieving one of the End TB Strategy’s targets:that no TB-affected households have to face catastrophic costs by 2020.In Indonesia,as elsewhere,there is also an emerging need to provide social protection by implementing universal health coverage(UHC).We therefore assessed the incidence of catastrophic total costs due to TB,and their determinants since the implementation of UHC.Methods:We interviewed adult TB and multidrug-resistant TB(MDR-TB)patients in urban,suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier.Following the WHO recommendation,we assessed the incidence of catastrophic total costs due to TB.We also analyzed the sensitivity of incidence relative to several thresholds,and measured differences between poor and non-poor households in the incidence of catastrophic costs.Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs.Results:We analyzed 282 TB and 64 MDR-TB patients.For TB-related services,the median(interquartile range)of total costs incurred by households was 133 USD(55-576);for MDR-TB-related services,it was 2804 USD(1008-4325).The incidence of catastrophic total costs in all TB-affected households was 36%(43%in poor households and 25%in non-poor households).For MDR-TB-affected households,the incidence was 83%(83%and 83%).In TB-affected households,the determinants of catastrophic total costs were poor households(adjusted odds ratio[aOR]=3.7,95%confidence interval[CI]:1.7-7.8);being a breadwinner(aOR=2.9,95%CI:1.3-6.6);job loss(aOR=21.2;95%CI:8.3-53.9);and previous TB treatment(aOR=2.9;95%CI:1.4-6.1).In MDR-TB-affected households,having an income-earning job before diagnosis was the only determinant of catastrophic total costs(aOR=8.7;95%CI:1.8-41.7).Conclusions:Despite the implementation of UHC,TB-affected households still risk catastrophic total costs and further impoverishment.As well as ensuring access to healthcare,a cost-mitigation policy and additional financial protection should be provided to protect the poor and relieve income losses.
基金supported by the China Scholarship Council(CSC)(Grant No.201708300027)the Environmental Protection Agency of Ireland.
文摘Widespread adoption of electric vehicles(EVs)is a common and critical component of international strategies to mitigate environmental pollution,climate change and oil dependency.The ability of consumers to assess the total cost of ownership(TCO)of EVs relative to internal combustion engine vehicles(ICEVs)remains an important factor for EV uptake.The TCO of vehicles is not universal across different car segments and user profiles.We analyse and compare the TCO of ICEVs and EVs from 17 car segments across short-and long-term ownership periods,and further advance existing TCO approaches by integrating detailed activity-based driving profiles,taxation,grant structures and pricing.Results show that EV options in the most popular Irish car segments have existing battery EV options with a TCO averaging respectively 26% and 42% less than their equivalent petrol and diesel ICEV options over a 4-year ownership term when the current grant is included.This integrated method for granular TCO evaluation offers important insights for this market and affords scope to investigate how changes in travel patterns,car-segment pricing,taxation,grant policy,fuel costs,and carbon pricing and other transport policies can all affect TCO values over time across a broad range of market offerings.
文摘This paper reaches a recommendation for the 10-year e-bus transition roadmap for New York City. The lifecycle model of emission reduction demonstrates the ecological and financial impacts of a complete transition from the current diesel bus fleet to an all-electric bus fleet in New York City by 2033. This study focuses on the NOx pollution, which is the highest among all major cities by Environmental Protection Agency (EPA) and greenhouse gases (GHG) with annual emissions of over five million tons. Our model predicts that switching to an all-electric bus fleet will cut GHG emissions by over 390,000 tons and NOx emissions by over 1300 tons annually, in addition to other pollutants such as VOCs and PM 2.5. yielding an annual economic benefit of over 75.94 million USD. This aligns with the city mayor office’s initiative of achieving total carbon neutrality. We further model an optimized transition roadmap that balances ecological and long-term benefits against the costs of the transition, emphasizing feasibility and alignment with the natural replacement cycle of existing buses, ensuring a steady budgeting pattern to minimize interruptions and resistance. Finally, we advocate for collaboration between government agencies, public transportation authorities, and private sectors, including electric buses and charging facility manufacturers, which is essential for fostering innovation and reducing the costs associated with the transition to e-buses.
文摘订单审核与投放(Order Review and Release,ORR)是一种适用于面向订单制造(Make to Order,MTO)企业的生产控制技术。生产部门接收到顾客订单后,采用ORR确定所需物料投放到车间的时间,以使订单能够按时完工。另外ORR还对车间和机器的负荷进行限制,以降低车间库存和订单在车间内的加工时间。由此ORR考虑的是一个多目标优化问题。以往的研究中一般选取多个评价指标,分别分析后再对ORR做出一个综合定性判断,导致很难定量、客观的评价不同ORR。基于此,这里提出一个总成本公式,综合考虑了按时完工和降低车间生产时间两类目标的信息,可以对不同ORR进行全面的量化分析。在实验设计的基础上,采用总成本指标对常见ORR的实际效果进行了比较,分析结论对ORR的选择有一定的借鉴意义。
文摘The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question that whether lower length of stay and higher utilization of post-op facilities would be helpful to control the overall costs. Using the National Hospital Discharge Survey (NHDS) database and cost data from Blue Cross Blue shield, this study seeks to identify which U.S. region renders the highest quality patient care during a three-year span of 2008-2010. Using length of stay and discharge disposition (2010) as input factors, and regional TKA costs (2013) as output factors, Data Envelopment Analysis (DEA), a non-parametric method, illustrated the efficiency ranking of four regions in the US on TKA expenditures. The result shows the West is the most efficient region on controlling the overall cost by shrinking the length of stay and increasing the utilization of short-term/long-term care facilities.
