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
Demand for plug-in hybrid electric vehicles(PHEVs)in China’s automotive industry has soared,leading to a rise in the number of automakers crafting PHEVs with various ranges to cater to the expanding market needs.A cr...Demand for plug-in hybrid electric vehicles(PHEVs)in China’s automotive industry has soared,leading to a rise in the number of automakers crafting PHEVs with various ranges to cater to the expanding market needs.A critical question for both manufacturers and consumers is how to select the ideal all-electric range(AER)of PHEVs.Previous studies have focused on the total cost of ownership(TCO)of PHEVs compared to other powertrains without optimizing their AER.Therefore,this paper innovatively constructs a technically rich TCO model for PHEVs that includes vehicle technical attributes,considers battery degradation,and integrates consumer travel characteristics.This model enables the design of the AER of PHEVs and provides an in-depth analysis of its influencing factors.The results reveal that the key factors influencing the TCO of PHEVs are annual travel mileage,battery cycle life,and battery unit cost,while battery energy density,fuel price,and electricity price play a minor role.Under current vehicle parameters,battery parameters,economic parameters,and driving characteristics,the ideal AER for PHEVs is 50 km.A sensitivity analysis of the key factors shows that if the values of the key factors fluctuate by 20%,neither battery energy density,battery unit cost,fuel price,nor electricity price will change the optimal range for PHEVs.However,further reductions in battery unit costs may increase the ideal range.Battery cycle life and annual travel mileage can change the ideal range of PHEVs,with an increase in battery cycle life or a decrease in annual travel mileage,changing the ideal AER to 75 km.Battery cycle life is the most significant factor affecting the ideal AER of PHEVs.If battery technology advances to the point where the cycle life covers the lifetime of the PHEV,then the ideal range based on TCO would be 50 km.In the future,automotive manufacturers will need to prioritize the improvement of battery cycle life in PHEVs.By doing so,they can reduce the TCO without developing PHEVs with longer ranges.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
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
本研究旨在基于全生命周期成本(Total cost of ownership,TCO)框架,定量评估燃料电池卡车(Fuel cell trucks,FCT)与纯电动卡车(Battery electric trucks,BET)在中国典型货运场景中的经济性差异。研究构建了覆盖车辆购置、能源补给、运...本研究旨在基于全生命周期成本(Total cost of ownership,TCO)框架,定量评估燃料电池卡车(Fuel cell trucks,FCT)与纯电动卡车(Battery electric trucks,BET)在中国典型货运场景中的经济性差异。研究构建了覆盖车辆购置、能源补给、运维及残值回收的TCO模型,选取冷链物流、城市短途、封闭场景、短倒运输和长途干线运输作为代表性应用场景,并将政策补贴、氢气价格、电价等关键参数纳入敏感性分析。结果显示,在当前成本结构下,除封闭场景外,燃料电池卡车的TCO均高于纯电动卡车,氢气价格和系统成本是影响其经济性的主导因素。在未来成本下降路径的预测下,当氢气价格降至31.4元/kg时,燃料电池重卡在封闭场景与短倒运输中呈现明显的成本优势;至2040年,若氢气制备与储运成本进一步下降并实现规模化应用,当氢气价格降至10.1元/kg时,其在长途重载运输场景中的TCO有望与纯电动卡车形成竞争。研究结论可为氢能交通领域的政策制定提供定量依据,并为产业界在车辆技术路线选择、补能基础设施规划及市场应用定位方面提供参考。展开更多
According to the Total Cost of Ownership concept (TOCO), the selection criterion of international procurement suppliers can be classified into two levels, namely Macroeconomic decision-making level and Microeconomic d...According to the Total Cost of Ownership concept (TOCO), the selection criterion of international procurement suppliers can be classified into two levels, namely Macroeconomic decision-making level and Microeconomic decision-making level. In this paper, a new quantitative method is put forward to accomplish the task of total assessment on the Microeconomic level which analyses all of the quantitative and qualitative factors with regard to the supplier selection. A Microsoft Excel based new application kit named TOCO Total Assessment Tool is introduced. It can calculate the direct cost and the indirect cost conveniently and can help to evaluate the performance of candidate suppliers. To use the tool, the first module called Total Cost Analysis Module is introduced to calculate the total cost of supplier selection, and then the second module named Supplier Evaluation Module is used to evaluate the performance of each supplier. Finally, the results from these two modules are transferred to the Final Comparison Module to get the final decision-making results. In this paper, the supplier selection related factors are discussed; the method of using the tool is illustrated in detail. It is shown that scientific usage of the TOCO Total Assessment Tool can make the decision-making processes of supplier selection in international procurement transparent, easily calculated, and objective. At the end, a practical case is given to clarify the procedure of using the tool.展开更多
目的分析某军队医院按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费模式下产生高倍率病例的原因,并提出改进措施,旨在减少医院经济损失,并提升医疗质量。方法选取2023年5月—12月期间的426例高倍率病例作为研究对象,采用回顾性...目的分析某军队医院按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费模式下产生高倍率病例的原因,并提出改进措施,旨在减少医院经济损失,并提升医疗质量。方法选取2023年5月—12月期间的426例高倍率病例作为研究对象,采用回顾性调查方法,对病案首页填写质量、药占比、耗占比及住院天数进行统计分析。结果因首页填写不规范导致DRG入组错误的病例共87例,占比20.42%;耗占比超过30%的病例156例,占比36.62%;药占比超过30%的病例255例,累计占比59.86%;住院天数超过10 d的病例391例,占比91.78%。高倍率病例的产生与病案首页填写错误、药品和耗材占比过高、住院天数过长等医疗质量指标密切相关。结论加强病案首页质量控制与住院时间管理,实施药品、耗材精细化管理和深化DRG组内诊疗同质化管理,是减少高倍率病例的有效措施。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
We consider a replacement policy for a multiple-component cold-standbysystem, and after we analyze this policy, we want to get the mean total cost rate and the preventivepolicy to make it the lowest. In this system, t...We consider a replacement policy for a multiple-component cold-standbysystem, and after we analyze this policy, we want to get the mean total cost rate and the preventivepolicy to make it the lowest. In this system, the failure rate of the component in operation isconstant, and the inspection will control all the processes of the operation. The system isinspected at random points over time to determine whether it is to be replaced. During the process,the replacement decision is based on the number of failed components at the time of inspection.展开更多
Project cost management should not only adjust the personnel, material and fund structure, but also based on the overall situation, from the perspective of economy and benefit, dynamic and refined project cost managem...Project cost management should not only adjust the personnel, material and fund structure, but also based on the overall situation, from the perspective of economy and benefit, dynamic and refined project cost management operation. For some engineering projects, the cost is usually constantly changing within the prescribed area, so actively carrying out the research work of the project budget and cost can escort the normal construction of construction projects, achieve the optimization of comprehensive economic benefits, and promote the steady growth of the construction industry and the whole construction industry.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sponsored by the National Natural Science Foundation of China(52272371)Natural Science Foundation of Beijing Municipality(9232011).
文摘Demand for plug-in hybrid electric vehicles(PHEVs)in China’s automotive industry has soared,leading to a rise in the number of automakers crafting PHEVs with various ranges to cater to the expanding market needs.A critical question for both manufacturers and consumers is how to select the ideal all-electric range(AER)of PHEVs.Previous studies have focused on the total cost of ownership(TCO)of PHEVs compared to other powertrains without optimizing their AER.Therefore,this paper innovatively constructs a technically rich TCO model for PHEVs that includes vehicle technical attributes,considers battery degradation,and integrates consumer travel characteristics.This model enables the design of the AER of PHEVs and provides an in-depth analysis of its influencing factors.The results reveal that the key factors influencing the TCO of PHEVs are annual travel mileage,battery cycle life,and battery unit cost,while battery energy density,fuel price,and electricity price play a minor role.Under current vehicle parameters,battery parameters,economic parameters,and driving characteristics,the ideal AER for PHEVs is 50 km.A sensitivity analysis of the key factors shows that if the values of the key factors fluctuate by 20%,neither battery energy density,battery unit cost,fuel price,nor electricity price will change the optimal range for PHEVs.However,further reductions in battery unit costs may increase the ideal range.Battery cycle life and annual travel mileage can change the ideal range of PHEVs,with an increase in battery cycle life or a decrease in annual travel mileage,changing the ideal AER to 75 km.Battery cycle life is the most significant factor affecting the ideal AER of PHEVs.If battery technology advances to the point where the cycle life covers the lifetime of the PHEV,then the ideal range based on TCO would be 50 km.In the future,automotive manufacturers will need to prioritize the improvement of battery cycle life in PHEVs.By doing so,they can reduce the TCO without developing PHEVs with longer ranges.
基金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.
文摘本研究旨在基于全生命周期成本(Total cost of ownership,TCO)框架,定量评估燃料电池卡车(Fuel cell trucks,FCT)与纯电动卡车(Battery electric trucks,BET)在中国典型货运场景中的经济性差异。研究构建了覆盖车辆购置、能源补给、运维及残值回收的TCO模型,选取冷链物流、城市短途、封闭场景、短倒运输和长途干线运输作为代表性应用场景,并将政策补贴、氢气价格、电价等关键参数纳入敏感性分析。结果显示,在当前成本结构下,除封闭场景外,燃料电池卡车的TCO均高于纯电动卡车,氢气价格和系统成本是影响其经济性的主导因素。在未来成本下降路径的预测下,当氢气价格降至31.4元/kg时,燃料电池重卡在封闭场景与短倒运输中呈现明显的成本优势;至2040年,若氢气制备与储运成本进一步下降并实现规模化应用,当氢气价格降至10.1元/kg时,其在长途重载运输场景中的TCO有望与纯电动卡车形成竞争。研究结论可为氢能交通领域的政策制定提供定量依据,并为产业界在车辆技术路线选择、补能基础设施规划及市场应用定位方面提供参考。
文摘According to the Total Cost of Ownership concept (TOCO), the selection criterion of international procurement suppliers can be classified into two levels, namely Macroeconomic decision-making level and Microeconomic decision-making level. In this paper, a new quantitative method is put forward to accomplish the task of total assessment on the Microeconomic level which analyses all of the quantitative and qualitative factors with regard to the supplier selection. A Microsoft Excel based new application kit named TOCO Total Assessment Tool is introduced. It can calculate the direct cost and the indirect cost conveniently and can help to evaluate the performance of candidate suppliers. To use the tool, the first module called Total Cost Analysis Module is introduced to calculate the total cost of supplier selection, and then the second module named Supplier Evaluation Module is used to evaluate the performance of each supplier. Finally, the results from these two modules are transferred to the Final Comparison Module to get the final decision-making results. In this paper, the supplier selection related factors are discussed; the method of using the tool is illustrated in detail. It is shown that scientific usage of the TOCO Total Assessment Tool can make the decision-making processes of supplier selection in international procurement transparent, easily calculated, and objective. At the end, a practical case is given to clarify the procedure of using the tool.
文摘目的分析某军队医院按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费模式下产生高倍率病例的原因,并提出改进措施,旨在减少医院经济损失,并提升医疗质量。方法选取2023年5月—12月期间的426例高倍率病例作为研究对象,采用回顾性调查方法,对病案首页填写质量、药占比、耗占比及住院天数进行统计分析。结果因首页填写不规范导致DRG入组错误的病例共87例,占比20.42%;耗占比超过30%的病例156例,占比36.62%;药占比超过30%的病例255例,累计占比59.86%;住院天数超过10 d的病例391例,占比91.78%。高倍率病例的产生与病案首页填写错误、药品和耗材占比过高、住院天数过长等医疗质量指标密切相关。结论加强病案首页质量控制与住院时间管理,实施药品、耗材精细化管理和深化DRG组内诊疗同质化管理,是减少高倍率病例的有效措施。
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We consider a replacement policy for a multiple-component cold-standbysystem, and after we analyze this policy, we want to get the mean total cost rate and the preventivepolicy to make it the lowest. In this system, the failure rate of the component in operation isconstant, and the inspection will control all the processes of the operation. The system isinspected at random points over time to determine whether it is to be replaced. During the process,the replacement decision is based on the number of failed components at the time of inspection.
文摘Project cost management should not only adjust the personnel, material and fund structure, but also based on the overall situation, from the perspective of economy and benefit, dynamic and refined project cost management operation. For some engineering projects, the cost is usually constantly changing within the prescribed area, so actively carrying out the research work of the project budget and cost can escort the normal construction of construction projects, achieve the optimization of comprehensive economic benefits, and promote the steady growth of the construction industry and the whole construction industry.
