Steel Bridges with Double-Composite Action: Innovative Design

2000 ◽  
Vol 1696 (1) ◽  
pp. 299-309 ◽  
Author(s):  
Steven L. Stroh ◽  
Rajan Sen
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
South Florida ◽  
Steel Bridge ◽  
Innovative Design ◽  
Composite Action ◽  
Design Concepts ◽  
Negative Moment ◽  
Composite Bridge

Bridge engineers are continually faced with the challenge of providing efficient and cost-effective structures. In particular, the Florida Department of Transportation has recognized the need to develop economical bridge configurations in the medium-span range of 200- to 400-ft (60.96-to 121.92-m) spans and authorized a research project at the University of South Florida to identify and develop innovative design concepts within this span range. The study identified the concept of a steel bridge with double-composite action as an innovative bridge concept with the potential for significant cost savings compared with conventional modes of construction. This bridge type has been used with good success in Europe, but to the authors’ knowledge it has not been used in the United States. In addition to a composite concrete top slab, the double-composite bridge concept utilizes a composite concrete bottom slab in the negative moment regions. The result is provision of a design meeting compact requirements throughout, increased stiffness with corresponding decrease in fatigue stress range and deflections, savings in cross frames, and savings in flange material. The design implications of this system are examined, including redistribution effects due to creep and shrinkage, implications of different construction sequences, and strength and serviceability issues. Trial designs are presented, including both plate and box girder type structures, and design considerations are discussed. A prototype structure is identified for further development of the double-composite concept.

scholarly journals Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization

2015 ◽  
Vol 4 (6) ◽  
pp. 82 ◽  
Author(s):  
Julie M. Mhlaba ◽  
Emily W. Stockert ◽  
Martin Coronel ◽  
Alexander J. Langerman
Keyword(s):  
United States ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Waste Reduction ◽  
Significant Cost ◽  
Instrument Type ◽  
Hospital Revenue ◽  
Potential Strategy ◽  
The Cost

Objective: Operating rooms (OR) generate a large portion of hospital revenue and waste. Consequently, improving efficiency and reducing waste is a high priority. Our objective was to quantify waste associated with opened but unused instruments from trays and to compare this with the cost of individually wrapping instruments.Methods: Data was collected from June to November of 2013 in a 550-bed hospital in the United States. We recorded the instrument usage of two commonly-used trays for ten cases each. The time to decontaminate and reassemble instrument trays and peel packs was measured, and the cost to reprocess one instrument was calculated.Results: Average utilization was 14% for the Plastic Soft Tissue Tray and 29% for the Major Laparotomy Tray. Of 98 instruments in the Plastics tray (n = 10), 0% was used in all cases observed and 59% were used in no observed cases. Of 110 instruments in the Major Tray (n = 10), 0% was used in all cases observed and 25% were used in no observed cases. Average cost to reprocess one instrument was $0.34-$0.47 in a tray and $0.81-$0.84 in a peel pack, or individually-wrapped instrument.Conclusions: We estimate that the cost of peel packing an instrument is roughly two times the cost of tray packing. Therefore, it becomes more cost effective from a processing standpoint to package an instrument in a peel pack when there is less than a 42%-56% probability of use depending on instrument type. This study demonstrates an opportunity for reorganization of instrument delivery that could result in a significant cost-savings and waste reduction.

scholarly journals High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System

10.36469/9861 ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 134-150 ◽  
Author(s):  
J. Mark Stephens ◽  
Samuel Brotherton ◽  
Stephan C. Dunning ◽  
Larry C. Emerson ◽  
David T. Gilbertson ◽  
...  
Keyword(s):  
United States ◽  
Public Transportation ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Levels Of Care ◽  
Dialysis Facility ◽  
Effective Delivery ◽  
Stage Renal Disease ◽  
End Stage

Background: The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly. Research has suggested that substantial cost savings could be achieved if medically appropriate transport was made available and covered by Medicare. Objectives: To estimate US dialysis transportation costs from a purchaser’s perspective, and to estimate cost savings that could be achieved if less expensive means of transport were utilized. Methods: Costs were estimated using an actuarial model. Travel distance estimates were calculated using GIS software from patient ZIP codes and dialysis facility addresses. Cost and utilization estimates were derived from fee schedules, government reports, transportation websites and peer-reviewed literature. Results: The estimated annual cost of dialysis transportation in the United States is $3.0 billion, half of which is for ambulances. Most other costs are due to transport via ambulettes, wheelchair vans and taxis. Approximately 5% of costs incurred are for private vehicle or public transportation use. If ambulance use dropped to 1% of trips from the current 5%, costs could be reduced by one-third. Conclusions: Decision-makers should consider policies to reduce ambulance use, while providing appropriate levels of care.

scholarly journals Cost-Effective Use of White Blood Cell Growth Factors in the Veterans Administration

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4761-4761
Author(s):  
Kevin Knopf ◽  
William Hrureshky ◽  
Bryan Love ◽  
Leann Norris ◽  
Charles L. Bennett
Keyword(s):  
United States ◽  
Survey Data ◽  
Conflicts Of Interest ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Convincing Evidence ◽  
Cost Driver ◽  
Veterans Administration ◽  
Va Health Care System

Abstract The use of granulocyte colony-stimulating (G-CSF) factors to avoid chemotherapy induced neutropenia is a major cost driver in clinical oncology. Short acting formulations, while less convenient, are 39% the cost of the longer formulation (Pegfilgrastim). We analyzed the use of G-CSF vs. Neulasta in the Veterans Administration (VA) health care system as currently practiced by clinical judgement and analyzed this economically. A survey of 23 sites within the VA on the relative frequency of use of filgrastim, Tbo-filgrastim, Filgrastim-sndz and Pegfilgrastim was conducted. Cost was estimated using 340B pricing. A maximally cost-effecient strategy of 100% Tbo-filgrastim would result in a cost of $62,336 per 100 patient episodes. Tbo-filgrastim was the preferred treatment in 18 of 23 sites surveyed. Cost results ranged from a minimum of $62,336 (4 of 23 sites) to a maximum of $201,356 (2 of 23 sites) with a mean cost of $99,080. The VA was overall 73% efficient, and therefore highly cost-effective, in minimizing use of Pegfilgrasim. As in Europe cost-efficiency favors the use of Tbo-filgrastim over Pegfilgrastim; further cost-saving opportunities exist with the following strategies : (1) avoid G-CSF use where there is no convincing evidence of efficacy (i.e. low risk patients, treatment of neutropenia rather than prophylaxis) (2) use daily filgrastim in lieu of pegfilgrastim whenever possible (3) use Tbo-filgrastrim rather than filgrastrimn (4) continue to examine strategies using 2 or 4 day courses of G-CSf as opposed to 8 days which would cut cost an additional 50 to 75%. Survey data showed that uptake of biosimilar G-CSF in the VA system has been extremely rapid. All sites are using biosimilar GCSF for all new patients; 6 of 23 sites were comfortable shifting current patients on branded G-CSF to the biosimilar. Survey data shows an overwhelming use of filgrastrim compared to pegfilgrastim in the VA system, in contradistinction to the rest of the United States - resulting in an efficiency of 73% (i.e. only 27% of patients are being given pegfilgrastrim). This represents a great savings to the VA system which can be emulated in other sites in the United States. Switching to a Tbo-filgrastim, although heralded by some as cost savings, only engendered a cost savings of 2.2% - small compared to other clinical changes. Disclosures No relevant conflicts of interest to declare.

S268 – Cost-Effective Balloon Sinuplasty

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P164-P165
Author(s):  
Paul E Lomeo ◽  
Judith Finneman
Keyword(s):  
Frontal Sinus ◽  
Guide Wire ◽  
New Technology ◽  
Balloon Catheter ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Balloon Sinuplasty ◽  
Guide Catheter ◽  
The Cost

Objectives Balloon sinuplasty is a new procedure that is gaining popularity in the United States. However, with all new technology, there is an increase in cost. Balloon sinuplasty increases the overhead for the facility where it is being performed and does not affect reimbursement. To decrease the cost of new technology, the physician, facility, and the company must all think of creative methods to acheive this goal. Methods In our institution, we had 60 patients that had balloon sinuplasties performed, with all of them involving both maxilary and frontal sinus. Re-useable olive-tip cannula was used instead of the company's recommended disposable guide catheter for the frontal and maxillary sinuses. In using the olive-tip as a guide catheter, the guide wire and balloon catheter are easily directed to the opening of both the maxillary and frontal sinus. Results The outcome from all 60 patients was successful, with none returning for revision. In using the olive-tip cannula instead of the disposable catheter guide for the maxillary and frontal sinuses, there was a savings of $37,500 for the institution. Conclusions The use of an olive-tip cannula from the basic FESS set decreases the cost of performing balloon sinuplasty. This suction-tip can replace the catheter guide without compromising the surgical procedure and is easy to use by the experienced sinus surgeon. There was a cost savings of $625 per procedure when using an olive-tip cannula instead of the company's recommended catheter guide.

Health Impact and Cost-Effectiveness of Achieving the National Salt and Sugar Reduction Initiative Voluntary Sugar Reduction Targets in the United States: A Micro-Simulation Study

Circulation ◽  
2021 ◽  
Author(s):  
Siyi Shangguan ◽  
Dariush Mozaffarian ◽  
Stephen Sy ◽  
Yujin Lee ◽  
Junxiu Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Potential Health ◽  
Added Sugar ◽  
Health Gains ◽  
Life Years ◽  
Sugar Reduction

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated microsimulation model, CVD-PREDICT, coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs and cost-effectiveness of the NSSRI policy. The model was run at the individual-level, incorporating the annual probability of each person's transition between health status based on their risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011-2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from healthcare and societal perspectives. Uncertainty was evaluated in a one-way analysis by assuming 50% industry compliance, and probabilistic sensitivity analyses via a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal healthcare cost savings, stratified by age, race, income and education. Results: Achieving the NSSRI sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150K/QALYs) at 6 years, highly cost-effective (< 50K/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a healthcare perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black and Hispanic, lower income, and less educated Americans. Conclusions: Implementing and achieving the NSSRI sugar reformation targets could generate substantial health gains, equity gains and cost-savings.

Reinventing Distribution

2020 ◽  
pp. 64-78
Author(s):  
Lea Shaver
Keyword(s):  
United States ◽  
Developing Countries ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Hard Copy ◽  
Digital Content ◽  
Potential Cost ◽  
Trade Off ◽  
Children’S Homes

This chapter covers the difficulties of distributing books, especially developing countries that contend with limited transportation infrastructure and unreliable postal systems. From Pratham Books' perspective, “Creating access is infinitely harder than creating books,” Suzanne Singh states plainly. It explains how postal systems offer a convenient and cost-effective way to deliver hard-copy books. In the United States, Imagination Library spends pennies per book to ship directly to children's homes. The trade-off, however, is that the recipients have no ability to select particular books of interest. The chapter also explains how digital technology offers to make books “magically appear” in a different way. For charities looking to make their budgets stretch, these potential cost savings are significant and very attractive. For this reason, literacy charities in the developing world are increasingly emphasizing digital content.

Lateral Sliding of Multispan Steel Bridges

1996 ◽  
Vol 1544 (1) ◽  
pp. 57-63
Author(s):  
W. Victor Anderson ◽  
Ferdinand Trenkler
Keyword(s):  
United States ◽  
Urban Infrastructure ◽  
Cost Effective ◽  
The United States ◽  
Steel Bridges ◽  
Steel Bridge ◽  
Effective Manner ◽  
The World ◽  
Computer Controlled ◽  
Complex Computer

As the urban infrastructure in the cities around the world becomes more complex and congested, engineers are more often required to design and construct major structures under severely constrained physical and environmental conditions. To deal with these constraints, an increasing number of projects in recent years have involved the construction and subsequent sliding of bridges, including the lateral sliding of major, multispan steel bridges. Because multispan continuous steel bridges are relatively lightweight, robust, and resistant to any possible inadvertent damage from major sliding operations, they are particularly well-suited to dealing with the constraints in a cost-effective manner. Several such projects have been completed in Europe, the United States, Canada, Japan, and elsewhere in the world. These and other related steel bridge projects are described that have successfully used complex, computer-controlled, multitrack lateral bridge slides.

Abstract P285: Potential Direct Medical Cost-Savings Attributable to Physical Activity in Major Disease Categories

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Zachary Rourk ◽  
Ivo Abraham ◽  
Thomas Olson ◽  
Eric Snyder
Keyword(s):  
Physical Activity ◽  
Direct Medical Cost ◽  
Medical Cost ◽  
Population Attributable Risk ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Medical Intervention ◽  
Physically Active ◽  
Meta Analyses

Introduction: Physical activity (PA) is known to be effective in treating and preventing many lifestyle diseases including CVD, stroke, depression, type II diabetes, Alzheimer’s disease, as well as breast and colon cancer. To date the direct medical cost-savings of PA as a medical intervention are poorly understood. Hypothesis: We hypothesized that a 10% increase in the proportion of US citizens who meet the minimum weekly exercise requirements of 150 minutes per week would lead to savings in direct medical costs (DMC) and cases prevented, as related to the above diseases. Methods: Population Attributable Risk (PAR) was calculated as PAR= (1+Prf x (RR-1))/(Prf x(RR-1)), where Prf is the percentage of the U.S. population not meeting minimum exercise requirements and RR is the relative risk of disease for sedentary versus physically active individuals. Prf and RR data were retrieved from the most recent and comprehensive meta-analyses and systematic reviews. PAR was calculated for each disease under two conditions; first, Prf was equal to the current percent (9.6%) of the population estimated to achieve the minimum weekly PA requirements. Second, Prf was equal to the initial Prf plus 10 percent (19.6%). For each condition the following were calculated: Attributable DMC=(PAR x DMC), preventable cases=(PAR x Prevalence) and Savings=(Condition 2- Condition 1). Results: The Prevalence, RR, PAR and DMC are provided in Table 1. This table also describes the potential savings in DMC and new cases by improving the Prf by 10%. A 10% increase in US citizens who meet the minimum weekly exercise requirements could lead to a total savings of 10.78 billion USD in DMC and 2.1 million cases prevented related to the studied diseases. Conclusion: A healthcare system directed PA intervention that effectively leads to a 10% increase in US citizens that meet minimum weekly exercise requirements and costs less than 10.78 billion dollars has the potential to be cost-effective, and prevent and treat, millions of cases in the United States.

Evaluating Payments for Watershed Services Programs in the United States

2019 ◽  
Vol 05 (04) ◽  
pp. 1950003
Author(s):  
Margaret Walls ◽  
Yusuke Kuwayama
Keyword(s):  
United States ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Program Outcomes ◽  
Marginal Value ◽  
Funding Sources ◽  
Additional Water ◽  
Watershed Services ◽  
Payment Mechanisms

We review 15 forest watershed protection programs in the United States in which a local government agency or water provider collects payments from downstream service beneficiaries, such as water consumers, and pays upstream forest landowners for provision of watershed services. We describe the features of these Payments for Watershed Services (PWS) programs, focusing on funding sources, how the payment mechanisms work, and outcomes achieved. We also assess the extent to which the programs adhere to the economic principles that are associated with efficient or cost effective PWS schemes. In general, we find that payments in the programs do not closely reflect the marginal value of the service provided. Payments received by landowners mainly reflect the landowners’ opportunity costs. Fees paid by water consumers are set to yield revenue targets and/or reflect the avoided cost of additional water filtration and treatment. The programs appear to yield societal benefits, primarily through cost savings, but data from program outcomes is limited and more rigorous analysis of both the benefits and costs would be worthwhile.

scholarly journals TRANSPORTATION ROUTES FOR LATIN AMERICAN PRODUCE IMPORTS INTO THE UNITED STATES

HortScience ◽  
1992 ◽  
Vol 27 (6) ◽  
pp. 609a-609
Author(s):  
David H. Picha ◽  
Roger A. Hinson
Keyword(s):  
Latin American ◽  
Fruits And Vegetables ◽  
Cost Savings ◽  
The United States ◽  
South Florida ◽  
Central American ◽  
South American ◽  
Significant Cost ◽  
Trade Routes ◽  
Transportation Routes

The origin and distribution of counter-seasonal fresh fruit and vegetable imports from Latin America into the U.S. was evaluated. Infrastructure comparisons were made among various U.S. ports of entry capable of receiving perishables. Economic comparisons were made utilizing different transportation routes. Market boundary analyses indicated significant cost savings would result from changing existing transportation routes to certain final U.S. destinations. Currently the port of Philadelphia receives the majority of South American fruit which is mostly shipped break bulk or palletized. South Florida ports (Miami and Port Everglades) receive the majority of Central American and Caribbean fruits and vegetables which are mostly shipped containerized. Interest exists among Latin American exporters to diversify their U.S. ports of entry in order to avoid distribution bottlenecks. Future trade routes will likely see an increased utilization of more economical U.S. Gulf of Mexico ports.

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