Telemedical emergency services: central or decentral coordination?

Abstract Background and objective Teleemergency doctors support ambulance cars at the emergency site by means of telemedicine. Currently, each district has its own teleemergency doctor office (decentralized solution). This paper analyses the advantages and disadvantages of a centralized solution where several teleemergency doctors work in parallel in one office to support the ambulances in more districts. Methods The service of incoming calls from ambulances to the teleemergency doctor office can be modelled as a queuing system. Based on the data of the district of Vorpommern-Greifswald in the Northeast of Germany, we assume that arrivals and services are Markov chains. The model has parallel channels proportionate to the number of teleemergency doctors working simultaneously and the number of calls which one doctor can handle in parallel. We develop a cost function with variable, fixed and step-fixed costs. Results For the district of Greifswald, the likelihood that an incoming call has to be put on hold because the teleemergency doctor is already fully occupied is negligible. Centralization of several districts with a higher number of ambulances in one teleemergency doctor office will increase the likelihood of overburdening and require more doctors working simultaneously. The cost of the teleemergency doctor office per ambulance serviced strongly declines with the number of districts cooperating. Discussion The calculations indicate that centralization is feasible and cost-effective. Other advantages (e.g. improved quality, higher flexibility) and disadvantages (lack of knowledge of the location and infrastructure) of centralization are discussed. Conclusions We recommend centralization of telemedical emergency services. However, the number of districts cooperating in one teleemergency doctor office should not be too high and the distance between the ambulance station and the telemedical station should not be too large.

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The costs of icebreaking services: an estimation based on Swedish data

WMU Journal of Maritime Affairs ◽

10.1007/s13437-019-00191-x ◽

2020 ◽

Vol 19 (1) ◽

pp. 125-142 ◽

Cited By ~ 1

Author(s):

Eva Lindborg ◽

Peter Andersson

Keyword(s):

Marginal Cost ◽

Fixed Costs ◽

External Effects ◽

Marginal Costs ◽

Advantages And Disadvantages ◽

The Social ◽

The Usa ◽

The Cost ◽

Pricing Schemes ◽

Swedish Data

AbstractIn winter, the sea around Sweden and Finland as well as parts of the waters around Canada, Russia and the USA become ice covered, and ships may require assistance from icebreakers to proceed to their destinations. This paper accordingly analyses the cost structure and estimates the cost of icebreaking operations at sea, including the costs of external effects of the icebreakers’ emissions, and analyses the consequences of different pricing schemes for financing icebreaking services. A regression analysis was carried out based on data from icebreaking services in Sweden over 14 winters from 2001/2002 to 2015/2016. The social marginal cost of an average assistance operation (which may involve more than one ship) is estimated at EUR 6476 and for each assisted ship EUR 5304. The same cost is EUR 907 per running hour for the icebreakers and EUR 1990 per hour a ship is assisted. Each additional nautical mile sailed by an icebreaker costs society EUR 141 and each assisted nautical mile EUR 234. The marginal cost is found not to be related to winter severity. Despite the significant social marginal costs, not including large fixed costs, icebreaking in Sweden and Finland is free of charge. The advantages and disadvantages of four pricing models that can be applied to cover at least parts of the costs to society are discussed. All models could create new distortions, but a price per assisted hour may be worth applying in practice.

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Strategic Capacity Management With Modular Manufacturing And Outsourcing: A Case Study

Journal of Business & Economics Research (JBER) ◽

10.19030/jber.v4i4.2658 ◽

2011 ◽

Vol 4 (4) ◽

Cited By ~ 1

Author(s):

Ignacio Garcia ◽

Ray Venkataraman

Keyword(s):

Business Strategy ◽

Net Present Value ◽

Cost Model ◽

Flow Analysis ◽

Cost Effective ◽

Product Line ◽

Fixed Costs ◽

Course Of Action ◽

The Cost

This paper proposes that downsizing an industrial manufacturer’s capacity is a cost-effective strategy to reduce the cost of conversion while ensuring that adequate capacity is available to meet its business strategy requirements. A case study of a U.S. manufacturer of motors and other mechanical drive systems illustrates a proposed reduction in capacity that utilizes the development and implementation of a cost model to determine the best alternatives for a company whose capacity is not synchronized with its business strategy. The cost model for each alternative is investigated and compared against the ‘Do nothing’ alternative, using net present value and cash flow analysis to build a case for the most effective course of action. The findings show the benefits of merging manufacturing by separating people, non-people, and fixed costs by facility, product line and product. In addition, the paper also illustrates the benefits of modular manufacturing and outsourcing as a way to further improve costs after the reduction of capacity.

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COMPARATIVE EVALUATION OF EFFICIENCY OF METHODS OF SULFITATION AND ACIDIFICATION WITH SULFURIC ACID IN THE PROCESSING OF THE EXTRACTING BEET SUGAR PRODUCTION

Известия вузов. Пищевая технология ◽

10.26297/0579-3009.2019.2-3.15 ◽

2019 ◽

Author(s):

С.О. СЕМЕНИХИН ◽

В.О. ГОРОДЕЦКИЙ ◽

Н.М. ДАИШЕВА ◽

Н.И. КОТЛЯРЕВСКАЯ

Keyword(s):

Sulfuric Acid ◽

Sulfur Dioxide ◽

Production Capacity ◽

Cost Effective ◽

Total Cost ◽

Advantages And Disadvantages ◽

Negative Effect ◽

Design Characteristics ◽

Equipment And Pipelines ◽

The Cost

Проведено сравнение технических преимуществ и недостатков способов сульфитации и подкисления серной кислотой при обработке экстрагента свеклосахарного производства. Рассчитана стоимость основного оборудования и материалов для каждой схемы обработки экстрагента с целью выявления наиболее экономически эффективного способа. Расчет проведен для сахарного завода, имеющего производственную мощность 5000 т свеклы в сутки. Установлено, что способ подкисления серной кислотой имеет одно техническое преимущество – простоту дозирования серной кислоты, но уступает способу сульфитации по суммарным затратам на оборудование и трубопроводы, составившим около 10 млн р. Способ сульфитации также имеет недостатки технического характера – зависимость абсорбции экстрагентом сернистого ангидрида от конструктивных характеристик сульфитационных установок и равномерности технологического потока, негативное влияние которых можно снизить путем применения современных сульфитаторов жидкостно-струйного типа, обеспечивающих стопроцентную утилизацию сернистого ангидрида в диапазоне от 50 до 120% от их расчетной производительности. Суммарные затраты на оборудование и трубопроводы при схеме сульфитационной обработки экстрагента составили около 7,7 млн р. Таким образом, реализация схемы сульфитации в 1,25 раза дешевле, чем схемы подкисления экстрагента серной кислотой. По стоимости реагента сульфитационная обработка примерно в 13 раз выгоднее по сравнению со схемой подкисления серной кислотой. Comparison of technical advantages and disadvantages of sulfitation and acidification methods by sulfuric acid in the treatment of extracting of sugar beet production was carried out. The cost of the main equipment and materials for each treatment scheme of the extracting is calculated in order to identify the most cost-effective way. The calculation was carried out for a sugar factory with a production capacity of 5000 tons of beets per day. It is established that the method of acidification with sulfuric acid has one technical advantage-the simplicity of dosing sulfuric acid, but is inferior to the method of sulfitation for the total cost of equipment and pipelines, amounting to about 10 million rubles. The sulfitation method also has technical disadvantages-the dependence of the absorption of sulfur dioxide by the extracting on the design characteristics of the sulfitation plants used and the uniformity of the process flow, the negative effect of which can be reduced by the use of modern liquid-jet sulfitators, providing 100% utilization of sulfur dioxide in the range from 50 to 120% of their design capacity. The total cost of equipment and pipelines in the scheme of sulfitation treatment of the extracting will be about 7,7 million rubles. Thus, the implementation of the sulfitation scheme is 1,25 times cheaper than the scheme of acidification of the extracting with sulfuric acid. Sulfitation treatment at the cost of the reagent is about 13 times more profitable compared to the scheme of acidification with sulfuric acid.

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Total Cost of Pre-Hospital Emergency Missions based on the Activity-based Costing Model and its Comparison with the Cost of Private Emergency Pre-Hospital Emergency Services in Mashhad in 2016

Quarterly Journal of Management Strategies in Health System ◽

10.18502/mshsj.v4i2.1405 ◽

2019 ◽

Author(s):

Hossein Ebrahimi Pour ◽

Elahe Pourahmadi ◽

Reza Vafayinezhad ◽

Shapour Badie Aval ◽

Ahra Keyvanlou ◽

...

Keyword(s):

Emergency Services ◽

Human Life ◽

Cost Effective ◽

Cross Sectional Study ◽

Activity Based Costing ◽

Hospital Emergency ◽

Cross Sectional ◽

Public And Private ◽

The Public ◽

The Cost

Background: Pre-hospital care plays an important role in managing patients who require emergency services and preserving human life. The aim of this study was to evaluate the cost of completed public pre-hospital emergency missions according to the activity-based costing model and to compare it with the cost of private pre-hospital emergency services in Mashhad in 2016. Methods: In this applied and descriptive cross-sectional study, the data were collected using a researcher-made form 4 major groups of costs were identified to estimate the total costs: 1- Personnel salaries, 2- Current expenses 3- Medical consumables 4- Depreciation. The cost of providing pre-hospital services was calculated based on the activity-based costing. Eventually, the cost of pre-hospital emergency services was compared between the public and private sectors. To investigate the cost-effective factors for missions, multiple regression analysis, Breusch-Pagan, Ramsey RESET, Swilk, and Linktest diagnostic tests were used by Stata 11.0 software. Results: The average cost of each mission was equal to 2114337 ± 217786 thousand Rials in 58 emergency medical centers of Mashhad in 2016. Of this cost, 78.51 %, (1660129 ± 1578445 Rials) was related to employees' salaries, 19.24 % (406842 ± 375083 Rials) was related to the current costs of each center, 0.23 % (4796 ± 4476 Rials) was related to depreciation, and 2/02 % (42761 ± 42822 Rials) was related to medical consumables in each pre-hospital emergency mission. The value of contract with an emergency pre-hospital emergency was 1104000 Rials for each mission in 2016, which is almost half of the cost related to the public pre-hospital. Results of the regression model estimation also showed that among the variables of the model, the fuel cost variable was identified as an effective variable on the cost of each mission (p = 0.0001). Conclusion: The private sector provides pre-hospital emergency services at a lower cost. Moreover, before establishing a pre-hospital pre-service center, the cost-effectiveness of establishing a center in each region should be checked.

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Modelling the cost-effectiveness of wallaby control in New Zealand

Wildlife Research ◽

10.1071/wr05008 ◽

2006 ◽

Vol 33 (2) ◽

pp. 77 ◽

Cited By ~ 3

Author(s):

David Choquenot ◽

Bruce Warburton

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Rate Of Change ◽

Variable Cost ◽

Fixed Costs ◽

Instantaneous Rate ◽

Control Techniques ◽

Positive Effects ◽

Unit Reduction ◽

The Cost

Bennett’s wallaby (Macropus rufogriseus rugogriseus) was introduced to South Canterbury in New Zealand’s South Island in 1874. The species rapidly established populations throughout the region, and by the 1940s had increased to levels where it had become a significant agricultural pest. Potential wallaby-control techniques include the use of shooting teams with dogs and deployment of 1080 either from the air or as gel applied to foliage. For livestock graziers, shooting teams are probably the least cost-effective of these techniques (i.e. highest cost per unit reduction in average wallaby density), but are preferred to either form of 1080 poisoning because the latter require stock to be withheld from treated areas. In this study, we combine a simple model of wallaby population dynamics with empirically derived estimates of the density-dependent variation in wallaby-control costs to contrast the relative cost-effectiveness of these control techniques. Variation in wallaby density was predicted from a logistic population model modified for the positive effects of rainfall on rates of change in wallaby abundance. The model was fitted to estimates of density- and rainfall-dependent variation in the instantaneous rate of change in wallaby abundance (r), derived from catch–effort data recorded by shooting teams. Comparison of the control techniques demonstrated that the cost-effectiveness of hunting with dogs was lower than that achieved by either poisoning technique, and increased exponentially as progressively lower wallaby densities were targeted. This increase reflected the higher variable cost of locating wallabies to shoot as their density declined. In contrast, because 1080 poisoning is dominated by the fixed costs of bait or gel deployment, overall costs increased linearly as lower wallaby densities were targeted, and the frequency of poisoning was increased. Of the two 1080 poisoning methods considered, deployment using gel applied to foliage was always more cost effective than aerial distribution of bait.

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Cost functions for the line intersect method of sampling forest residue in the Pacific Northwest

Canadian Journal of Forest Research ◽

10.1139/x84-012 ◽

1984 ◽

Vol 14 (1) ◽

pp. 57-62 ◽

Cited By ~ 2

Author(s):

John W. Hazard ◽

Stewart G. Pickford

Keyword(s):

Cost Function ◽

Pacific Northwest ◽

Sampling Time ◽

Cost Functions ◽

Fixed Costs ◽

Total Cost ◽

Forest Residue ◽

The Pacific ◽

The Cost ◽

Northwest Region

Cost functions were developed for estimating the cost of inventorying forest residue in the Pacific Northwest region by line intersect sampling. Time was accurately recorded for individual tasks of measuring forest residue on three widely varying clear cuttings. The model developed relates the total cost of completing an inventory to fixed costs associated with the entire unit and each sample line, and variable costs of residue loading, fine fuel loadings, number of lines, and length of lines. The slope of the inventory unit was not found to be significantly (P ≤ 0.05) related to the cost, however, the residue loading was significant. Several simplified versions of the cost function are provided which are applicable under certain assumptions and conditions.

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Discrete homing problems

Archives of Control Sciences ◽

10.2478/v10170-011-0039-6 ◽

2013 ◽

Vol 23 (1) ◽

pp. 5-18

Author(s):

Mario Lefebvre ◽

Moussa Kounta

Keyword(s):

Optimal Control ◽

Markov Chain ◽

Markov Chains ◽

Cost Function ◽

Discrete Time ◽

Value Function ◽

The Cost ◽

The Value Function

Abstract We consider the so-called homing problem for discrete-time Markov chains. The aim is to optimally control the Markov chain until it hits a given boundary. Depending on a parameter in the cost function, the optimizer either wants to maximize or minimize the time spent by the controlled process in the continuation region. Particular problems are considered and solved explicitly. Both the optimal control and the value function are obtained

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Bertrand Competition in Markets with Fixed Costs

The B E Journal of Theoretical Economics ◽

10.2202/1935-1704.1634 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 10

Author(s):

Alejandro Saporiti ◽

Germán Coloma

Keyword(s):

Cost Function ◽

Price Competition ◽

Pure Strategy ◽

Sufficient Conditions ◽

Natural Monopoly ◽

Bertrand Competition ◽

Fixed Costs ◽

Bertrand Equilibrium ◽

Pure Strategies ◽

The Cost

This paper provides necessary and sufficient conditions for the existence of a pure strategy Bertrand equilibrium in a model of price competition with fixed costs. It unveils an interesting and unexplored relationship between Bertrand competition and natural monopoly. That relationship points out that the non-subadditivity of the cost function at the output level corresponding to the oligopoly break-even price, denoted by D(pL(n)), is sufficient to guarantee that the market sustains a (not necessarily symmetric) Bertrand equilibrium in pure strategies with two or more firms supplying at least D(pL(n)). Conversely, the existence of a pure strategy equilibrium ensures that the cost function is not subadditive at every output greater than or equal to D(pL(n)).

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The IBM-PC in electron microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100165525 ◽

1996 ◽

Vol 54 ◽

pp. 612-613

Author(s):

James F. Mancuso

Keyword(s):

Head Start ◽

Image Acquisition ◽

Cost Effective ◽

Financial Applications ◽

Number Of Factors ◽

Instrument Control ◽

The Cost ◽

Training And Support ◽

Control Image ◽

Ibm Pc

IBM PC compatible computers are widely used in microscopy for applications ranging from control to image acquisition and analysis. The choice of IBM-PC based systems over competing computer platforms can be based on technical merit alone or on a number of factors relating to economics, availability of peripherals, management dictum, or simple personal preference.IBM-PC got a strong “head start” by first dominating clerical, document processing and financial applications. The use of these computers spilled into the laboratory where the DOS based IBM-PC replaced mini-computers. Compared to minicomputer, the PC provided a more for cost-effective platform for applications in numerical analysis, engineering and design, instrument control, image acquisition and image processing. In addition, the sitewide use of a common PC platform could reduce the cost of training and support services relative to cases where many different computer platforms were used. This could be especially true for the microscopists who must use computers in both the laboratory and the office.

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Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽

10.1055/s-0037-1622198 ◽

2007 ◽

Vol 36 (06) ◽

pp. 309-312 ◽

Cited By ~ 11

Author(s):

T. Schulz ◽

M. Jünger ◽

M. Hahn

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Stage ◽

Clinical Signs ◽

Cost Effective ◽

Duplex Sonography ◽

Foam Sclerotherapy ◽

Average Loss ◽

One Year ◽

The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

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