Annual Running Costs Research Articles

Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis

ContextThere is a substantial lack of inter-facility referral systems for emergency obstetrical and neonatal care in rural areas of sub-Saharan Africa. Data on the costs and cost-effectiveness of such systems...

Energy consumption and feasibility study of a hybrid desiccant dehumidification air conditioning system in Beirut

In this work, the transient performance of a hybrid desiccant vapor compression air conditioning system is numerically simulated for the ambient conditions of Beirut. The main feature of this hybrid system is that the regenerative heat needed by the desiccant wheel is partly supplied by the condenser dissipated heat while the rest is supplied by an auxiliary gas heater. The hybrid air conditioning system of the present study replaces a 23 kW vapor compression unit for a typical office in Beirut characterized by a high latent load. The vapor compression subsystem size in the hybrid air conditioning system is reduced to 15 kW at the peak load when the regeneration temperature was fixed at 75 °C. Also the sensible heat ratio of the combined hybrid system increased from 0.47 to 0.73. Based on hour by hour simulation studies for a wide range of recorded ambient conditions of Beirut city, this paper predicts the annual energy consumption of the hybrid system in comparison with the conventional vapor compression system for the entire cooling season. The annual running costs savings for the hybrid system is 418.39 USD for a gas cost price of 0.141 USD/kg. The pay back period of the hybrid system is less than 5 years when the initial cost of the hybrid air conditioning system priced an additional 1712.00 USD. Hence, for a 20-year life cycle, the life cycle savings of the hybrid air conditioning system are 4295.19 USD.

The public health sector supply chain costs in Tanzania.

Tanzania's supply chain system is a complicated web of integrated and vertical systems, covering essential and vertical programs health commodities, laboratory and diagnostics, equipment, and supplies. Despite significant improvement in the supply chain over the decades, the availability of medicines has remained uneven. Therefore, identifying the cost of operating the supply chain is vital to facilitate allocation of adequate finances to run the supply chain. We adopted a three-step approach to costing, which included i) identification, ii) measurement, and (iii) valuation of the resource use. Two levels of the Tanzanian supply chain system were examined to determine the cost of running the supply chain by function. These included first the Medical Stores Department (MSD) central and zonal level, secondly the health service delivery level that include National, Zonal and regional hospitals and the Primary Health Care (District Hospital, health center and Dispensary). The review adopted the health system perspective, whereby all resources consumed in delivering health commodities were considered, resource use was then classified as financial and economic costs. The costing period was an average of two financial years, 2015/16 and 2016/17. The cost data were exchanged from Tanzania Shillings to 2017 US$ and then adjusted for inflation to 2020 US$. The study used the total sales reported in audited financial accounts for throughput value. The average annual costs of running the supply chain at the central MSD was estimated at USD$ 15.5 million and US$ 4.1 million at the four sampled MSD Zonal branches. There is a wide variation in annual running costs among MSD zonal branches; the supply chain's unit cost was highest in the Dodoma zone and lowest in the Mwanza zone at 26% and 8%, respectively. When examined on a cost-per-unit basis, supply chain systems operate at sub-optimal levels at health facilities at a unit cost of 37% per unit of commodity throughput value. There are inefficiencies in supply chain financing in Tanzania. Storage costs are higher than distribution costs, this may imply some efficiency gains. MSD should employ a "just in time" inventory model, reducing the inventory holding costs, including the high-expired commodities holding charge, this could be improved by increasing the order fill rate.

Heat requirement in an indoor recirculating aquaculture system

Due to the benefits of the recirculating aquaculture system (RAS), many fish farmers are choosing this system. Some farmers chose indoor RAS, where fish tanks are kept inside buildings or greenhouses. Heating the buildings and the makeup water requires a substantial amount of energy since optimum growth temperatures exceed the normal temperature of supply water. In this paper three different heating systems are analyzed: ground source heat pump, natural gas boiler and wood pellet boiler. The annual running cost of the water heating system in both cases (with heat recovery and no heat recovery) is the lowest for the ground source heat pump, followed by the wood pellet boiler and the natural gas boiler.

Enhancing Existing Formal Home Care to Improve and Maintain Functional Status in Older Adults: Results of a Feasibility Study on the Implementation of Care to Move (CTM) in an Irish Healthcare Setting.

Background: Care to Move (CTM) provides a series of consistent ‘movement prompts’ to embed into existing movements of daily living. We explored the feasibility of incorporating CTM approaches in home care settings. Methods: Feasibility study of the CTM approach in older adults receiving home care. Recruitment, retention and attrition (three time points), adherence, costs to deliver and data loss analyzed and differentiated pre and post the COVID-19 pandemic. Secondary outcomes, including functional status, physical activity, balance confidence, quality of life, cost to implement CTM. Results: Fifty-five home care clients (69.6% of eligible sample) participated. Twenty were unable to start due to COVID-19 disruptions and health issues, leaving 35 clients recruited, mostly women (85.7%), mean age 82.8 years. COVID-19 disruption impacted on the study, there was 60% retention to T2 assessments (8-weeks) and 13 of 35 (37.1%) completed T3 assessments (6-months). There were improvements with small to medium effect sizes in quality of life, physical function, balance confidence and self-efficacy. Managers were supportive of the roll-out of CTM. The implementation cost was estimated at EUR 280 per carer and annual running costs at EUR 75 per carer. Conclusion: Embedding CTM within home support services is acceptable and feasible. Data gathered can power a definitive trial.

Hospital Cost Savings for Sequential COPD Patients Receiving Domiciliary Nasal High Flow Therapy.

PurposeTo estimate the 5-year budget impact to Aotearoa New Zealand (NZ) hospitals of domiciliary nasal high flow (NHF) therapy to patients with chronic obstructive pulmonary disease (COPD) who require long term oxygen therapy.MethodsHospital admission counts along with length of stay were obtained from hospital records of 200 COPD patients enrolled in a 12-month randomized clinical trial of NHF in Denmark, both over a 12-month baseline and then in the study period while on randomized treatment (control or NHF). NZ costings from similar COPD patients were estimated using data from Middlemore Hospital, Auckland and were applied to the Danish trial. The budget impact of NHF was estimated over the predicted 5-year lifetime of the device when used by patients sequentially.ResultsFifty-five of 100 patients in the NHF group and 44 of 100 patients in the control group were admitted to hospital with a respiratory diagnosis during the baseline year. They had 108 admissions in the treatment group vs 89 in the control group, with 632 vs 438 days in hospital, and modeled annual costs of $9443 vs $6512 per patient, respectively. During the study period there were 38 vs 44 patients with 67 vs 80 admissions and 302 vs 526 days in hospital, at a modeled annual cost of $6961 vs $9565 per patient respectively. Taking into account capital expenditure and running costs, this resulted in cost savings of $5535 per patient-year (95% CI, -$36 to -$11,034). With 90% usage over the estimated five-year lifetime of the NHF device, amortized capital costs of $594 per year and annual running costs of $662, we estimate a 5-year undiscounted cost saving per NHF device of $18,626 ($16,934 when discounted to net present value at 5% per annum). There would still be annual cost savings over a wide range of assumptions.ConclusionDomiciliary NHF therapy for patients with severe COPD has the potential to provide substantial hospital cost savings over the five-year lifetime of the NHF device.

Investigation of enhancement in the thermal response of phase change materials through nano powders

A major problem faced by Phase Change Materials (PCM) based latent heat thermal energy storage systems is the slow thermal response. In this study, the feasibility of nano phase change materials composites is investigated experimentally by using various types of nanoparticles in PCM, to improve thermal response by increasing the thermal conductivity. Heat transfer enhancement of PCM composites (RT26 and coconut oil) is achieved by acquiring better thermophysical properties through seeding nanoparticles in PCM. RT26 and coconut oil are beneficial due to the absence of corrosion to metallic containers. A thermal response investigation is conducted with a flat slab type latent heat thermal energy storage unit. It was observed that the increase in thermal conductivity of PCM by seeding nanoparticles is useful for the improvement of heat transfer. Carbon nanotubes have shown better performance as compared to Al2O3 and Fe3O4 nanoparticles. It was further analyzed that at a 1 wt percent concentration of nanoparticles, the maximum heat transfer enhancement in RT26 caused by Fe3O4, Al2O3 and carbon nanotubes nanocomposites is up to 20.01, 36.68 and 64.21% respectively. The maximum heat transfer enhancement in coconut oil caused by Fe3O4, Al2O3 and carbon nanotubes nanocomposites is up to 8.83, 14.84 and 33.38% respectively. Therefore, it is revealed that RT26 has more potential for heat transfer enhancement as compared to coconut oil. This is due to the percentage improvement in the thermophysical response of RT26 as compared to coconut oil. The economic and environmental analysis was conducted to compare the performance of latent heat thermal energy storage unit with and without the application of nanoparticles in PCM, to estimate the most viable candidate among various nano composites. The economic analysis presented the lowest annual energy running cost and Net Present Value(NPV) for nanocomposite of carbon nanotubes in RT26 is Rs.-4381 and RS.-36375 respectively. Whereas the maximum annual energy cost and NPV for pure RT26 are Rs.-12240 and Rs. -75548 respectively. The NPV for Fe3O4 and Al2O3 is Rs.-62207 and Rs.-53062 respectively. The cost and NPV were Rs.-6646 and Rs.-55226 in the case of carbon nanotubes in coconut oil. It shows that the trend is the same in the case of Fe3O4 and Al2O3 nanoparticles in both RT26 and coconut oil, unlike of carbon nanotubes. The environmental analysis shows that the maximum and minimum payments of carbon dioxide by carbon nanotubes and Fe3O4 nano composites respectively in RT26, are Rs.7000 and Rs.2176. While the corresponding values are Rs.2975 and Rs.798 in the case of coconut oil. Hence, carbon nanotubes in RT26 have the highest economic and environmental viability. Accordingly, the enhancement in heat transfer using these nanoparticles will be helpful in air conditioning applications like animal houses.

Experimental investigation of occupants’ thermal sensation under a personalized ventilation system

By considering the importance of providing proper indoor environment conditions for occupants and also due to energy costs, one of the solutions for indoor local air-conditioning is Personalized Ventilation System (PVS). In this paper, the occupants’ thermal sensation was experimentally studied for body segments that are mostly affected by the PVS. The local sensation of head, chest, arm, and hand at two supply air temperatures of 16 and 32°C were investigated. Eight volunteer subjects participated in this survey. The subjects reported the most thermal satisfaction on their hands. Also, the arms were the segments with the coolest thermal sensation (-1.28, between slightly cool and cold). Results indicate that the head’s thermal sensation at both supply air temperatures was neutral and the hand was the only body part that experienced warm thermal sensation during the test. Also, by increasing the supply air temperature to 32°C whole body thermal sensation changed from -0.46 to -0.09 on the seven-point scale, which means that the cooling system worked properly for occupants’ cooling. In this system, cooling occurred at 32°C instead of the common 16°C supply air temperature, which results in energy-saving and decreases annual running costs.

Domestic Retrofit Assessment of the Heat Pump System Considering the Impact of Heat Supply Temperature and Operating Mode of Control—A Case Study

In this study, performance assessment of the variable speed compressor-based air source heat pump (ASHP) system as a domestic retrofit technology instead of fossil fuel-based heating technologies for the 1900s Mid terraced house is investigated. The assessment was conducted considering operating mode of control and heat supply temperature impact of the system. In the literature, ASHP system experimental development with variable speed mode (VSM) of control in comparison to fixed speed mode (FSM) of control at low to medium and high heat supply temperature in the context of UK was found with very limited number of studies, but without considering retrofit application. The focus of the earlier studies was on the individual components and performance improvement. The designed heat pump (HP), developed, and tested at constant heat load, simulating the real domestic heat demand under the controlled laboratory conditions and numerical modeling is utilized for the analysis purposes. The HP performance, energy demand, carbon emissions, and cost varies significantly due to changing heat supply temperature (35 °C, 45 °C, and 55 °C), control mode and accordingly the carbon emission and cost savings are achieved. The oil and gas boilers ranges from conventional to highly efficient type and evaluated in terms of annual running cost, energy consumptions, and carbon emissions in comparison with the HP system. Additionally, a comparative study with the existing retrofitted very high temperature ASHP inside the house is conducted. The developed HP at 55 °C could not defeat the very high heat supply temperature HP system (75 °C supply temperature) in performance and cost savings but become attractive at low supply temperature (35 °C). The HP system in VSM at low heat supply temperature instead of gas boiler (90% efficiency) could cut the annual carbon emissions by 59% but with additional 6% running cost for the Mid terraced test house in Belfast climatic conditions.

Why do we need the ISS? [Space Innovation

In November 2020, the International Space Station celebrated 20 years of its permanent human habitation. A major milestone for the world of astronautics and, as the world's space agencies say, for humanity itself. The assembly of the station began in late 1998 with the launch of the Russian-built module Zarya and the American Unity. It was completed in the early 2010s after the arrival of Tranquility with its trademark Earth-facing viewing platform Cupola. Consisting of 16 pressurised modules and a lot of supporting hardware, the station covers the size of a football pitch. Its construction stretched the technical as well as political skills of the partnering space agencies. With a construction cost of nearly £90bn and an annual running cost of nearly £3bn, it also stretched their budgets. This paper gives a brief overview of some of the most interesting or promising studies that have come out of the orbiting laboratory. These include: drug development and smart delivery, water recycling and air purification, artificial organs' growth, robotics, and combustion.

Impact of Legionella regulation on a 4th generation district heating substation energy use and cost: the case of a Swiss single-family household

4th Generation District Heating (4GDH) systems can have a supply temperature lower than 50 °C to decrease losses and to favour the integration of renewable and waste heat. As the temperature requirement for space heating in new and retrofitted buildings is around 35 °C or lower, they would be suitable for 4GDH. However, Domestic Hot Water (DHW) is a significant barrier in district heating, because the temperature needs to be maintained above the standard Legionella growing range (25 °C–55 °C), even if 45 °C would be sufficient for comfort. Nonetheless, current regulations vary widely across countries in Europe, especially for small buildings. This paper aims to study the effect of different Legionella regulations on the DHW energy use, and on the substation cost of a Swiss single-family household connected to a 4GDH network. The Swiss standard is confronted with the requirements of the Danish regulation and the German “3-litre rule”. Results demonstrated that a relaxation of the current Swiss regulation could present energy and economic savings. The “3-litre rule” resulted in an annual heat consumption reduction of 13% while the Danish standard achieved the lowest annual running cost and annualized total cost.

Essential services provided and costs of facility-based maternity waiting homes in Ethiopia.

Introductionthe objective was to describe establishment cost, essential services provided and operating costs of maternity waiting homes (MWH) in Ethiopia.Methodsa cross-sectional study was carried out from December 2017 to June 2018 in eight health facilities with maternity waiting homes (MWH) in the Gurage Zone of Ethiopia. MWH users exit interviews and observational checklists were used to collect data on essential services provided. Cost-related data were retrieved from relevant records in the health facilities.Resultsmost clinical services and basic amenities were available and provided for MWH users. The average capital costs of a MWH were $2,245 US with fixed costs of $1,476 US per year. The personnel cost for a MWH was $1,439 US per year. The average annual running cost of a MWH was $1,303 US per year. The average estimated MWH utilization and delivery costs was $16.9 US per woman.Conclusionmost MWHs provided essential clinical services and basic amenities. The majority of the cost of a MWH was attributed to building construction costs. If building cost is annualized, the unit cost of a MWH service is in an acceptable range which encourage government considering expansion of the service in rural area.

Optimization of a Hybrid Solar PV and Gas Turbine Generator System Using the Loss of Load Probability Index

In this paper, an optimization approach for designing a hybrid renewable energy system with zero load rejection is presented for a specific location in Malaysia. The proposed renewble energy system includes photovoltaic system, gas turbine generator and battery bank. The aim of the optimization process is to design the system with a loss of load probability that is less than 1%. An improved numerical algorithm is proposed in this paper. Moreover, a comparison between electrification options, including the existing gas-turbine-based generator (existing system), electricity grid and the proposed system, is presented in terms of the annualized total life-cycle cost. The results show that the proposed system can reduce the annual running cost by USD 2.1 million, while the electricity grid connection option can reduce the annual cost by USD 1.16 million as compared to the existing gas-turbine-based generator. In addition to this, the proposed optimization algorithm provides a reliable power system with zero load rejection based on simulation results.

87 Effects of Community Falls Prevention Service Closure on ICD-10 Coded Fracture Rates in Older People: An Interrupted Time Series Approach

Abstract Introduction Guidelines on falls prevention recommend case ascertainment based on opportunistic case ascertainment and referral in those who have fallen. In October 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service with enhanced case-ascertainment through proactive, primary care-based screening for associated risk factors. In addition to comprehensive geriatric assessment, 25% of 4032 service participants underwent strength and balance training. The baseline outcomes have been previously reported.1 Funding was withdrawn, and the service closed on 31/01/2014. We examined the effect of service-closure on fractures presenting to secondary care with and without the service running. Methods An interrupted time series method was used. ICD-10 coded fracture numbers attending secondary care were determined (Hospital Episode Statistics from 01/02/2012-31/05/2017) for all North Tyneside residents ≥60 years at the time of service closure, including 25-months with, and 40-months without, service provision. Results There was a 0.9% (p=0.018) monthly reduction in falls over 25-months of service provision which increased during the winter months of a 9.8% (p=0.015) increase. In the month following the service closure there was an initial increase in fractures of 8.5% (p=0.231), followed by an increase in the monthly time trend of 1% (p=0.018). This resulted in a post-service monthly increase in fractures of 0.1%, an estimated extra 625 fractures over the 40-month post-service cessation period. At an average £8600 per fracture, the estimated cost may have been £5,375,000. Conclusions In this naturalistic experiment, following an initial drop in fractures, disinvestment in this service resulted in a rise in elders’ fractures presenting to secondary care. The closure of the service may have had a large unintended cost, averaging £1.5 million annually, versus annual running costs of £220,000. Further research is needed to control for patient-level characteristics and to establish the cost-effectiveness of the service.

Geothermal storage integration into a supermarket's CO2 refrigeration system

This paper investigates the integration of geothermal storage into state-of-the-art CO2 trans-critical booster systems. The objective is to evaluate the impact of this integration on energy efficiency. Three scenarios of integration are studied including stand-alone and integrated supermarket building systems.The results show that for a stand-alone average size supermarket, heat recovery from the CO2 system should be prioritized over a separate ground source heat pump. Extracting heat from the ground by an extra evaporator in the CO2 system has also little impact on this supermarket annual energy use. However, in the case of supermarket integration with a neighboring building where the supermarket provides heat to the neighbor, geothermal storage integration can reduce the total annual running cost of the two non-integrated buildings by 20–30% with a payback time of less than 3.5 years. The results also show there is no need for a separate ground source heat pump.

Micro-multigeneration prospects for residential applications in Italy

The development of multigeneration systems is evolving in different directions. One of the main directions is the extended application of the technologies at smaller sizes. Micro-multigeneration solutions aim at becoming competitive at the size of the residential users. The cost of the technologies, in particular the cost of the cogenerator, is a major limitation to the diffusion of micro-multigeneration, especially in countries (e.g., Italy) where residential customers have a limited usage of electricity to supply their facilities. This paper discusses the prospects for the application of micro-multigeneration in Italy. The modelling and analysis of a residential micro-multigeneration system are developed from the energy efficiency and economic assessment viewpoints. The analysis is carried out on a typical system composed of a natural gas internal combustion engine, a small-scale photovoltaic plant, a backup boiler, thermal energy storage and electrical energy storage. A specific analysis tool has been implemented to address the operational planning of this system during a time period of one year. The whole model has been constructed from real data of thermal and electrical demand in a housing complex in Italy. The annual running cost and the primary energy savings occurring to serve the multi-energy demand have been considered in the operational assessment. From an economical viewpoint, the model considers the price of natural gas related to the cogeneration system, the electricity prices and all the tax breaks allowed in Italy. In this way, different scenarios have been constructed and assessed. The results indicate the impact of providing incentives on the purchase cost of the technologies, leading to increase the diffusion of micro-multigeneration solutions for the residential sector in the next years.

Feasibility of a real-time hand hygiene notification machine learning system in outpatient clinics

Various technologies have been developed to improve hand hygiene (HH) compliance in inpatient settings; however, little is known about the feasibility of machine learning technology for this purpose in outpatient clinics. To assess the effectiveness, user experiences, and costs of implementing a real-time HH notification machine learning system in outpatient clinics. In our mixed methods study, a multi-disciplinary team co-created an infrared guided sensor system to automatically notify clinicians to perform HH just before first patient contact. Notification technology effects were measured by comparing HH compliance at baseline (without notifications) with real-time auditory notifications that continued till HH was performed (intervention I) or notifications lasting 15s (intervention II). User experiences were collected during daily briefings and semi-structured interviews. Costs of implementation of the system were calculated and compared to the current observational auditing programme. Average baseline HH performance before first patient contact was 53.8%. With real-time auditory notifications that continued till HH was performed, overall HH performance increased to 100% (P<0.001). With auditory notifications of a maximum duration of 15s, HH performance was 80.4% (P<0.001). Users emphasized the relevance of real-time notification and contributed to technical feasibility improvements that were implemented in the prototype. Annual running costs for the machine learning system were estimated to be 46% lower than the observational auditing programme. Machine learning technology that enables real-time HH notification provides a promising cost-effective approach to both improving and monitoring HH, and deserves further development in outpatient settings.

Cost-benefit analysis of water source improvements through borehole drilling or rehabilitation: an empirical study based on a cluster randomized controlled trial in the Volta Region, Ghana

ABSTRACTBackground: Despite remarkable progress in water coverage improvements, diseases associated with poor water remain a considerable public health problem in many developing countries.Objective: We aimed to estimate the costs and benefits of drilling or rehabilitating boreholes with handpumps in resource-poor settings and hard-to-reach areas.Methods: Diarrheal reduction in the population was predicted on the basis of the empirical findings from a cluster randomized controlled trial. The full investment and estimated annual running costs were used to calculate the intervention costs. Direct economic benefits of avoiding child diarrheal disease, indirect economic benefits related to health improvements, and non-health benefits related to water improvement were estimated. One-way and multi-way sensitivity analyses were performed to determine the robustness of the findings.Results: Our analysis found that the return on a US$ 1 investment was US$ 9.4 for borehole drilling and US$ 14.1 for borehole rehabilitation. Time savings were the main contributor, accounting for 68% of the benefits, followed by the economic benefits of averted child deaths, which contributed to 15% of the benefits. The sensitivity analyses suggested that improving water sources yields high returns under all circumstances, and that borehole rehabilitation is more efficient than borehole drilling.Conclusion: This study explicitly justifies increased investment in water improvement in rural areas and demonstrates the high returns of rehabilitating boreholes. We hope that this study will be used as evidence for informing the policy decisions of governments or international agencies regarding further investments in improved water coverage in rural areas and the selection of appropriately designed interventions.

Waste heat recovery from industrial baking ovens

Under this work, a system level energy model of an industrial-scale baking oven with an integrated waste heat recovery unit is developed using experimentally determined inputs to estimate the potential benefits of a gas-to-gas heat recovery system. This work has demonstrated that at least 4% savings in the oven fuel consumption can be achieved, reducing the annual running costs by £4,207. An environmental assessment indicates reduction of circa 43 tonnes in CO2 emissions per annum. The study also provides a systematic methodology to test low temperature gas-to-gas heat recovery technology for food manufacturing process.

Techno-economic analysis of air source heat pump applied for space heating in northern China

To meet the demand of clean heating in cold regions of northern China, high efficiency and environment-friendly low temperature air source heat pump heating system has been proposed and applied. In this paper, the technical feasibility and economical applicability of low temperature air source heat pump heating mode were studied and compared with conventional heating systems. A mathematical model of technical and economic analysis of different heating modes was established. With the mathematical model, different heating systems were compared with their primary energy consumption, pollution emissions, initial investment and annual running cost. The results showed that the low temperature air source heat pump heating system can stably and reliably meet the demand of space heating in residential buildings when outdoor air temperature is −15°C. In terms of energy efficiency, the primary energy consumption of low temperature air source heat pump heating mode is lower than coal-fired boiler, gas boiler, direct electric heating mode, but higher than combined heat and power generation. Comparing the pollution emissions, low temperature air source heat pump heating mode move the pollution source from residential areas to power plant, and has the relative low dioxide pollution emissions. Comparison results also show that the low temperature air source heat pump heating system is the most economical way among the candidates.