Differences In Resource Consumption Research Articles

Assessment of circularity potential in façades of high-rise buildings in Belgrade

A growing trend in the construction of high-rise buildings is currently prevalent in Belgrade, where more high-rise buildings have been built in the last decade than in the previous 50 years. However, these buildings have a significant negative impact on the environment, as their sophisticated construction technologies demand substantial resources and energy consumption. The aim of this research is to assess the possibility of reducing the resource consumption of these buildings, focusing on the circularity potential of their fa?ades. The research is conducted on typical fa?ades of high-rise buildings in Belgrade. The applied methodology for assessing the circular potential of fa?ades relies on numerical calculations of material circularity indicators and CO2 emissions. Research findings draw conclusions about the circular potential at the beginning and end of the fa?ade's lifecycle, covering the production, dismantling and disposal phases of integrated components. The study highlights differences in resource consumption based on the architectural characteristics of the examined fa?ades and provides insights for their improvement through the implementation of materials with higher circularity potential and optimized impacts on the environment.

Decoupling Economic Growth from Embodied Water–Energy–Food Consumption Based on a Modified MRIO Model: A Case Study of the Yangtze River Delta Region in China

Water, energy, and food are indispensable resources for socioeconomic development, and are highly interwoven in urban activities. Clarifying spatial differences in resource consumption is of great significance for coordinated management. However, there is still a lack of a unified assessment for water–energy–food (WEF) nexus flow analysis. This study proposes a comprehensive framework to investigate WEF utilization based on a modified multi-regional input–output (MRIO) analysis. Taking the case of the Yangtze River Delta region, we first inventoried embodied water–energy–food consumption from 2012 to 2017. Then, decoupling analysis and the Logarithmic Mean Divisia Index (LMDI) method were applied to explore decoupling states and identify driving factors. The results show that overall embodied WEF consumption experienced a downward trend from 2012 to 2017, and different provinces varied significantly. Jiangsu had the largest consumption of water and energy, while Anhui contributed a big chunk to food consumption. The manufacturing sector heavily relied on WEF resources and had a great impact on the ecological environment. The decoupling performance indicated a general trend of weak decoupling and strong decoupling in most provinces, with the mining, electricity, and gas supply sectors contributing most to positive decoupling, and the service sectors devoting the most to negative decoupling. As for resource type, water ecological footprint decoupled more than energy and food ecological footprints. Technology level and industrial structure had a major effect on the realization of decoupling, while economic output and population scale were the main restraining factors. Finally, we provide some differentiated policy recommendations for coordinated resource management.

MT40 Comparing Resource Consumption from an Economic Evaluation of Gore® Viatorr® Tips Endoprosthesis Versus Large Volume Paracentesis in the Spanish and U.K. Healthcare Systems

The GORE® VIATORR® TIPS Endoprosthesis is widely used in patients for the treatment of portal hypertension and its complications such as refractory ascites in Spain and the U.K. Two key economic evaluations have demonstrated how the GORE® VIATORR® TIPS Endoprosthesis is cost-saving. However, limited information is known about the resource consumption in both nations. The aim of this analysis was to highlight similarities and differences in resource consumption when using the GORE® VIATORR® TIPS Endoprosthesis in the two major European countries, Spain and the U.K.

PCN104 - ECONOMIC ANALYSIS OF COSTS AND RESOURCE CONSUMPTION OF IXAZOMIB IN PATIENTS WITH RELAPSED / REFRACTORY MULTIPLE MYELOMA IN AUSTRIA

Multiple myeloma (MM) is a progressive, fatal cancer that affects the plasma cells. It accounts for 1% of all malignancies and 10% of all hematological cancers. In Austria, nearly 350 people are newly diagnosed every year. The nationwide, age-standardized incidence of MM for 2015 is 4.9 per 100,000 inhabitants. The aim of this cost comparison is to analyze differences in resource consumption and costs of treatment alternatives administered in different settings. Oral Ixazomib was compared with infusable Carfilzomib, Elotuzumab and Daratumumab, all in combination with Lenalidomide and Dexamethasone. Daratumumab requires premedication. A costing model with a six month time horizon was developed from the payer’s perspective in 2017 Euros. The main objective of the model was to assess differences in resource consumption (medication, personal, material, monitoring and day clinic) and related costs. In order to conduct the analysis a bottom-up micro-costing approach was carried out. Personal, material and monitoring costs were calculated based on a resource utilization survey via questionnaire. Total treatment costs for Ixazomib+Lenalidomide+Dexamethasone (IxLenDex) amount to 94,000 € over a time horizon of 6 months. Carfilzomib+Lenalidomide+Dexamethasone (CarLenDex) is associated with 107,762 € and costs for Elotuzumab+Lenalidomide+Dexamethasone (EloLenDex) amount to 137,166 €; Daratumumab+Lenalidomide+Dexamethasone (DarLenDex) accounts for 155,494 € within the same period. Treatment costs for IxLenDex are 65% below DarLenDex costs, 46% lower compared to EloLenDex and 15% under CarLenDex. The lower costs of IxLenDex are partly due to the lack of personal and material costs in the hospital setting as well as costs for the day clinic, as IxLenDex is administered orally compared to CarLenDex, EloLenDex and DarLenDex. Lowest medication costs of CarLenDex were offset by higher drug administration costs. The economic-analysis shows that the use of IxLenDex is associated with cost-savings. Oral administration saves resources and relieves the inpatient sector.

Amino acid composition reveals functional diversity of zooplankton in tropical lakes related to geography, taxonomy and productivity.

Variation in resource use among species determines their potential for competition and co-existence, as well as their impact on ecosystem processes. Planktonic crustaceans consume a range of micro-organisms that vary among habitats and species, but these differences in resource consumption are difficult to characterize due to the small size of the organisms. Consumers acquire amino acids from their diet, and the composition of tissues reflects both the use of different resources and their assimilation in proteins. We examined the amino acid composition of common crustacean zooplankton from 14 tropical lakes in Colombia in three regions (the Amazon floodplain, the eastern range of the Andes, and the Caribbean coast). Amino acid composition varied significantly among taxonomic groups and the three regions. Functional richness in amino acid space was greatest in the Amazon, the most productive region, and tended to be positively related to lake trophic status, suggesting the niche breadth of the community could increase with ecosystem productivity. Functional evenness increased with lake trophic status, indicating that species were more regularly distributed within community-wide niche space in more productive lakes. These results show that zooplankton resource use in tropical lakes varies with both habitat and taxonomy, and that lake productivity may affect community functional diversity and the distribution of species within niche space.

Trait selection and co-existence of phytoplankton in partially mixed systems: Trait based modelling and potential of an aggregated approach.

Trait selection and co-existence in phytoplankton communities in partially mixed water columns is investigated using trait based modelling. In the models employed, trait selection results from phytoplankton competition for two limiting resources, light and nutrients. The study employs spatially resolved models, in which the phytoplankton community is represented as a large number of trait-groups characterized by fixed trait combinations (trade-offs). Results from the trait-group resolving model (RM) are compared to results from an aggregated trait based model with adaptive traits (AM). Differences in specific production resulting from a trade-off between the half saturation constants of light and nutrients are sufficient to support evolutionary stable co-existence confirming that co-existence does not require differences in resource consumption. If abiotic conditions lead to the selection of a single trait group in RM, AM provides excellent approximations of the development of total biomass, average community trait and trait variance in the phytoplankton community. However, if selection leads to bimodal trait distributions, e.g. to co-existence of two trait groups (or species), functionally important properties of the phytoplankton community cannot be adequately represented by the aggregated information provided by AM. Because the increase in variance due to the development of bimodal trait distributions cannot be distinguished from an increase in variance due to an increase in trait diversity, the development of trait variance in AM models is not a reliable measure of trait diversity. Furthermore, AM may not provide reliable simulations of trophic interactions if the performance of the consumers depends on the traits of their resources. However, AM may support exploration of the consequences of environmental conditions and of the parameterization of species for co-existence within communities.

Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: critical health and economic issues.

BackgroundDifferent inhalation devices are characterized by different techniques of use. The untrained switching of device in chronic obstructive pulmonary disease (COPD) and asthma patients may be associated with inadequate inhalation technique and, consequently, could lead to a reduction in adherence to treatment and limit control of the disease. The aim of this analysis was to estimate the potential economic impact related to errors in inhalation in patients switching device without adequate training.MethodsAn Italian real-practice study conducted in patients affected by COPD and asthma has shown an increase in health care resource consumption associated with misuse of inhalers. Particularly, significantly higher rates of hospitalizations, emergency room visits (ER), and pharmacological treatments (steroids and antimicrobials) were observed. In this analysis, those differences in resource consumption were monetized considering the Italian National Health Service (INHS) perspective.ResultsComparing a hypothetical cohort of 100 COPD patients with at least a critical error in inhalation vs 100 COPD patients without errors in inhalation, a yearly excess of 11.5 hospitalizations, 13 ER visits, 19.5 antimicrobial courses, and 47 corticosteroid courses for the first population were revealed. In the same way, considering 100 asthma patients with at least a critical error in inhalation vs 100 asthma patients without errors in inhalation, the first population is associated with a yearly excess of 19 hospitalizations, 26.5 ER visits, 4.5 antimicrobial courses, and 21.5 corticosteroid courses. These differences in resource consumption could be associated with an increase in health care expenditure for INHS, due to inhalation errors, of €23,444/yr in COPD and €44,104/yr in asthma for the considered cohorts of 100 patients.ConclusionThis evaluation highlights that misuse of inhaler devices, due to inadequate training or nonconsented switch of inhaled medications, is associated with a decrease in disease control and an increase in health care resource consumption and costs.

Economic Performance of Oblique Lateral Lumbar Interbody Fusion (OLLIF) with a Focus on Hospital Throughput Efficiency.

Oblique lateral lumbar interbody fusion (OLLIF) is a minimally invasive lumbar surgery. Differences in resource consumption between open spinal surgeries, transformational lumbar interbody fusions (TLIF) and OLLIF, are not documented. We monetize quantifiable differences in resource utilization between the two procedures. A retrospective review of 124 surgeries was performed (OLLIF=69, TLIF=55). Standard conversion factors were used and values reported based on the levels (1-4) addressed at surgery. One level surgery time (OLLIF 62.9 vs. TLIF 134.9 minutes) and surgical expense (OLLIF $5,253 vs. TLIF $11,264) were reduced in the OLLIF population. Inpatient costs (OLLIF $5,712 vs. TLIF $9,271) and length of stay (LOS) were also reduced (OLLIF 2.6 vs. TLIF 4.2 days). Per case, reduced resource consumption suggests lower total hospital costs. Reduced surgical time and LOS can result in greater patient throughput per operating room and patient bed for OLLIF patients in hospitals that have resourced constrained environments.

Diet quality and prey selectivity correlate with life histories and predation regime in Trinidadian guppies

Summary 1. Life histories evolve as a response to multiple agents of selection, such as age-specific mortality, resource availability or environmental fluctuations. Predators can affect life-history evolution directly, by increasing the mortality of prey, and indirectly, by modifying prey density and resources available to the survivors. Increasing survivor densities can intensify intraspecific competition and cause evolutionary changes in their selectivity, also affecting nutrient acquisition. 2. Here, we show that different life-history traits in guppies (Poecilia reticulata) are correlated with differences in resource consumption and prey selectivity. We examined differences in wildcaught guppy diet among stream types with high (HP) and low predation (LP) pressure and how they are related to benthic invertebrate biomass. Fish and invertebrate samples were collected from two HP and two LP reaches of two distinct study rivers in Trinidad. 3. Our results reveal a strong association between life history and diet. Guppies from HP environments mature earlier and have higher fecundity and reproductive allotment than those from LP environments. Prior work revealed that their population densities are lower and that they grow faster than their LP counterparts. Here, we show that these life-history differences are repeated and that HP guppies feed primarily on invertebrates. In contrast, guppies from LP sites feed primarily on detritus and algae, which are a poorer quality food. LP guppies fed on invertebrates according to their availability, while HP guppies were selective towards those invertebrates with the lower carbon ⁄ nitrogen body ratio and thus with higher nutritional value. 4. Our study suggests that as predators shape the life histories of their prey and alter prey population densities, they can also indirectly shape their prey’s foraging and diet selectivity. This is, to our knowledge, the first report on how intraspecific differences in life-history traits are correlated with prey selectivity, where prey stoichiometry is included. Although there are clear limitations of association data, our study suggests that the patterns of resource use and life history evolve in concert with one another. However, further research is needed to investigate the possible causal links between risk of predation, the indirect effects of predators on guppy population density, the evolution of life-history traits and nutrient acquisition.

Database as an evidence based lessons learned from terror related injuries in Israeli Civilians

IntroductionTerror-related injuries have become a threat for populations all over the world. A lot of theories and papers were published as principles for MCI management. We decided to take some...

Economic analysis based on multinational studies: methods for adapting findings to national contexts

Health economic parameters are increasingly considered as variables in health care decisions, but decision makers are interested in country-specific evaluations. However, a large number of studies are performed in foreign countries or in a multinational setting, which limits the transferability to a single nation’s context. The present analysis summarises several of the most common international methods for generating health economic analyses based on clinical studies from different settings. A narrative literature review was performed to identify potential reasons for limited transferability of health economic evaluation results from one country to another. Based on these results, we searched the methodological literature for analytic approaches to handle the restrictions. Additionally we describe the possibility of transferring foreign economic study results to the country of interest by matching trial data with routine data of national databases. The main factors for limited transferability of health economic findings were found in country-specific differences in resource consumption and the resulting costs. These differences are affected by a number of influencing cofactors (demography, epidemiology and individual patient’s factors) and the overall health care system structures (e.g. payment systems, health provider incentives). However, despite the limitations country-specific health economic assessments could be realised using the pooled/split analyses approach, some statistical approaches and modelling approaches. A variety of methods for identifying and adjusting country-specific differences in costs, effects and cost-effectiveness was established during the past decades. Multinational studies will continue to play a crucial role in the evaluation of cost-effectiveness at national levels. It seems likely that the growing interest in multinational studies will lead to continued developments in adaptation methods.

Seasonal polyphenism and developmental trade-offs between flight ability and egg laying in a pierid butterfly

Butterflies have competing demands for flight ability depending on, for example, mating system, predation pressure, the localization of host plants and dispersal needs. The flight apparatus, however, is costly to manufacture and therefore trade-offs are expected since resources are limited and must be allocated between flight ability and other functions, such as reproduction. Trade-offs between flight and reproduction may be difficult to reveal since they interact with other factors and can be confounded by differences in resource consumption. Previous studies have shown that adults of the summer generation of Pieris napi have relatively larger thoraxes compared with the spring generation. To study whether difference in thorax size results in a trade-off between flight ability and reproduction among the two generations, we conducted a split-brood experiment under common garden conditions. Our results show that summer generation adults have a higher dispersal capacity measured as flight duration in five different temperatures. Reproductive output differed between the two developmental pathways; spring generation females had a significantly higher output of eggs compared with summer generation females. We suggest that this is a consequence of a resource-allocation trade-off made during pupal development implemented by different demands for flight between the spring and summer generations. The significance of this finding is discussed in relation to reproduction and mobility in butterflies.

Prospective Payments in a Regional Trauma Center: The Case for Recognition of the Transfer Patient in Diagnostic Related Groups

Transfer patients (TP) differ from patients transported directly from the field (DP) by virtue of their complexity and delays to definitive care, factors that might impact on costs and resource utilization and aggravate the adverse selection that already threatens TC reimbursement. This is a retrospective cohort study where patients admitted to a Level I trauma center were classified as a TP or DP. Crude and adjusted total costs, complications, length of stay, and proportion of DRG outliers were compared across the two cohorts. Among 8,665 patients, 40% were transferred. TP were more likely to be DRG outliers (15% versus 10%, p < 0.001). Costs in 65% of the DRGs were higher in the TP. Rates of complications and length of stay were significantly greater in the TP. There are systematic differences in resource consumption between transferred patients and patients transported directly from the field. These differences render conventional DRG-based mechanisms of reimbursement inadequate, suggesting a need for recognition of the transfer patient as a distinct entity by payers.

Variaciones del consumo de recursos ambulatorios en la atención especializada de salud mental a niños y adolescentes

Objectives To assess possible variability in the therapeutic approaches provided to patients aged less than 18 years old in community mental health centres (CMHC) in terms of the number of visits and length of treatment. Method An observational, analytical, prospective, longitudinal study was performed in a clinical cohort of 298 subjects attending the CMHC of Leganés and Fuenlabrada (Madrid) for the first time. Results The median number of visits per patient was six in Leganés and three in Fuenlabrada (p < 0.001). The mean length of treatment was more than twice as long in Leganés (276 days) than in Fuenlabrada (119 days) (p < 0.001). Stratified analysis showed that the treatments provided in Fuenlabrada involved fewer visits, irrespective of the health professional in charge (psychiatrist or psychologist), the treatment modality prescribed (individual psychotherapy, other psychotherapies or no explicit treatment prescribed), or whether the patient abandoned treatment or the discharge was agreed. Similar results were found for the length of treatment. Conclusions The different clinical styles illustrate the difficulty of developing useful risk adjustment systems in mental health. The differences in resource consumption and costs cannot easily be attributed to patient-related variables, but are due rather to the intervention provided, which depends on the staff.

Variability in outpatient resource use in mental health services for children and adolescents

OBJECTIVES To assess possible variability in the therapeutic approaches provided to patients aged less than 18 years old in community mental health centres (CMHC) in terms of the number of visits and length of treatment. METHOD An observational, analytical, prospective, longitudinal study was performed in a clinical cohort of 298 subjects attending the CMHC of Leganes and Fuenlabrada (Madrid) for the first time. RESULTS The median number of visits per patient was six in Leganes and three in Fuenlabrada (p < 0.001). The mean length of treatment was more than twice as long in Leganes (276 days) than in Fuenlabrada (119 days) (p < 0.001). Stratified analysis showed that the treatments provided in Fuenlabrada involved fewer visits, irrespective of the health professional in charge (psychiatrist or psychologist), the treatment modality prescribed (individual psychotherapy, other psychotherapies or no explicit treatment prescribed), or whether the patient abandoned treatment or the discharge was agreed. Similar results were found for the length of treatment. CONCLUSIONS The different clinical styles illustrate the difficulty of developing useful risk adjustment systems in mental health. The differences in resource consumption and costs cannot easily be attributed to patient-related variables, but are due rather to the intervention provided, which depends on the staff.

The cost of providing intensive care to Diagnosis Related Groups

The precise contribution of intensive care to total hospital cost remains incompletely characterized. The goal of this study was to observe the cost of providing intensive care to those Diagnosis Related Groups (DRG) that most frequently require intensive care unit (ICU) admission at this hospital. We used the cost accounting system at our hospital to observe differences in resource consumption between patients who required intensive care and those who did not experience ICU admission within the same assigned DRG. We observed that the 22% of the study population who required intensive care consumed one half (14.2 million U.S. dollars) of the total resources consumed during care of all patients in the study. Furthermore, we observed that two thirds of this 14.2 million dollars was attributed to resources consumed during the ICU stay. We also observed significant variation in the relative contribution of six major support departments to the cost of caring for ICU patients across DRG groups. These data docum...

Resource Intensity Weights™ and Canadian Hospital Costs: Some Preliminary Data

Different types of inpatients "consume" differing amounts of hospital resources, and it is important to be able to measure these differences in resource consumption. An equitable methodology for funding hospitals must take into account differences in case mix between facilities. An ability to examine these differences in case mix and resource utilization allows hospitals to focus efforts to improve efficiency. A standardized methodology for measuring resource consumption is critical to funding and resource allocation both at a global and organizational level. This study was undertaken to determine whether or not the Canadian system for measuring resource consumption, Canadian Institute for Health Information (CIHI) RIWs, was reflective of the relative cost differences between inpatient cases at the Greater Victoria Hospital Society (GVHS) and to identify RIWs with a significant difference in comparison to GVHS cost weights. A regression analysis was performed on the more than 30,000 inpatient cost profile records from the GVHS 1995-96 cost and patient activity data. The scope of the analysis was restricted to the 424 Case Mix Groups (CMGs) that had a minimum composition of five patient profiles. Comparisons of GVHS cost weights to CIHI RIWs yielded mostly positive results. With the noted exception of about 20 CMGs, there was a high correlation between the CIHI RIW and the GVHS actual cost weights. Hence, the GVHS cost weights can be viewed with confidence as representative of the relative cost differences between typical RIW value CMGs and actual costs.

Cost analysis of fracture of the neck of femur.

A detailed cost analysis of fractures of the neck of femur in elderly patients has been conducted at Aberdeen Royal Infirmary. The aims of this study were as follows: (1) to show that the use of average orthopaedic bed day costs can lead to an overestimation of costs; (2) to identify the key explanatory variables of hip fracture costs; and (3) to identify differences in resource consumption between patient groups. The care of 50 first and ten second (contralateral) hip fracture patients admitted to Aberdeen Royal Infirmary in 1993 was costed in considerable detail. Acute care, convalescence, rehabilitation and operations accounted for more than 90% of total costs in both groups. It was found that patients who were admitted from their own homes cost significantly more than patients who were admitted from long-term care (4018 pounds vs. 2069 pounds; p < 0.001). In order to validate the costed samples, additional data were collected on all hip fracture patients admitted to Aberdeen Royal Infirmary in 1993. The main factors in explaining cost variation were the number of days spent in acute care and convalescence or rehabilitation [r2 = 0.62; logcost = (0.009 x acute days) + (0.01 x rehabilitation days) + 3.213]. Age and place of residence prior to admission explained a further 2.8% of total costs but neither variable was statistically significant. When costing fractures of the neck of femur, we recommend the collection of a minimum data set of these four variables which account for 65% of the variation in total costs.

Economic Evaluation of A Support Program for Caregivers of Demented Elderly

An economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.