Opportunities For Savings Research Articles

ComPreEND: Computation Pruning through Predictive Early Negative Detection for ReLU in a Deep Neural Network Accelerator

A vast amount of activation values of DNNs are zeros due to ReLU (Rectified Linear Unit), which is one of the most common activation functions used in modern neural networks. Since ReLU outputs zero for all negative inputs, the inputs to ReLU do not need to be determined exactly as long as they are negative. However, many accelerators usually do not consider such aspects of DNNs, losing a huge amount of opportunities for speedups and energy savings. To exploit such opportunities, we propose early negative detection (END), a computation pruning technique that detects the negative results at an early stage. The key to the early negative detection is the adoption of inverted two's complement representation for filter parameters. This ensures that as soon as the intermediate results become negative, the final results are guaranteed to be negative. Upon detection, the remaining computation can be skipped and the following ReLU output can be simply set to zero. We also propose a DNN accelerator architecture (ComPreEND) that takes advantage of such skipping. ComPreEND with END significantly improves both the energy efficiency and the performance according to the evaluation. Compared to the baseline, we obtain 20.5 and 29.3 percent speedup with accurate mode and predictive mode, and energy savings by 28.4 and 41.4 percent, respectively.

AUDIT ENERGI DAN MONITORING BERBASIS IOT UNTUK PENINGKATAN EFISIENSI PENGGUNAAN LISTRIK DI ART CENTER DENPASAR

An energy audit is needed to find out energy saving opportunities (PHE) so that it will reduce the amount of electricity bills at the Denpasar Art Center which is used as a cultural performance center in Bali. A more specific location in this research is the Ksirarnawa Art Center Denpasar Building in the lighting section. The energy audit in this study is combined with an IoT-based electrical energy monitoring tool so that electricity usage can be monitored in real time. This IoT-based electrical energy monitoring uses Arduino Nano as a data processor as well as sending data to a site service called Thingspeak to record and display data from sensors. The sensors used are the ZMPT101B voltage sensor and the YHDC SCT 013-000 current sensor which are integrated with the NodeMCU as a module to connect to a wireless network. The results of the energy audit at the Denpasar Art Center got a potential Energy Saving Opportunity (PHE) of 33.6% with suggestions to related parties being to replace lamps using LEDs and to regularly set on/off times.

EE505 Canada's Evolving Market for Biosimilars and What It Means for Payers

Potential savings from biosimilars are a subject of keen interest internationally, with a particular relevance for Canadians. Canada is a relatively high-use and high-price market for biologics and the increased use of biosimilars offers a significant opportunity for cost savings for Canadian payers. Recent policy changes to promote biosimilar switching are expected to result in significant cost reductions for these classes of biologics in Canada, helping to offset the pressure from new higher-cost medicines in coming years. As these initiatives are implemented at the provincial level, Canada offers a unique model to observe the impacts of variations in approach and timing across jurisdictions. The analysis aims to identify potential opportunities in the Canadian biosimilars market in comparison with international practices.

Hospital Characteristics Associated With Heterogeneity in Institutional Postacute Care Spending Reductions Under the Comprehensive Care for Joint Replacement Model

Prior research concluded that institutional postacute care spending decreased under the Comprehensive Care for Joint Replacement (CJR) model. Less is known about how changes in institutional postacute care spending varied across different types of hospitals. To measure hospital-level heterogeneity in the association of the CJR model with changes in institutional postacute care spending and to identify hospital characteristics associated with this variation. Using 100% Medicare claims data, this cross-sectional study assessed institutional postacute care spending from 2016 to 2017 among US hospitals randomly selected to participate in the CJR model and control group hospitals that were eligible but not selected for the participation in the CJR model. A causal forest was used to estimate the treatment effect of the CJR model conditional on hospital characteristics. Analysis was conducted between October 2019 and October 2021. The unit of analysis was each hospital; the outcome was the average per-episode Medicare spending for institutional postacute care within 90 days after hospital discharge for hip or knee joint replacement. This study included 531 CJR participating hospitals and 658 control group hospitals from 2016 to 2017. The CJR model was associated with a $761 reduction in institutional postacute care spending (95% CI, -$1172 to -$351). The reduction in spending under the CJR model did not vary across conditional on hospital characteristics. Limited evidence was found for greater savings among hospitals with higher pre-CJR spending. However, this finding did not hold for hospitals in the highest quintile of pre-CJR spending. In this cross-sectional study of 1189 hospitals, findings did not show strong evidence for significant heterogeneity in how the CJR model was associated with reductions in institutional postacute care spending across a range of hospital characteristics. Savings were not concentrated in hospitals with specific characteristics, such as hospitals with high-volume joint replacement or hospitals serving less medically or socially complex patients. Findings suggest that the CJR model created opportunities for savings across a spectrum of different hospitals.

The green design of high-rise buildings: how is the construction industry evolving

PurposeGreen building, which is also commonly referred to as sustainable building, is focused on the processes implemented that are environmentally efficient and responsible throughout the life cycle of the building. This accounts for the time of manufacturing of materials, to the erection of these materials, on-site, to the operation of the building and how these efficient materials assist in the operation and running of the building daily, all the way through to the demolition. There are many aspects of the building process that can be switched to green. For the construction industry, the change to green design although the complex is nonetheless necessary. This study thus aims to focus on supporting the knowledge surrounding green buildings in high-rise construction. This research will undertake a comparative analysis and review of one case study in Melbourne, Australia.Design/methodology/approachThe direction of this study commences with an introductory section on what it means to build green. This section is further brokendown to evaluate what factors are involved in constructing a green building. The work then shifts towards the green building from a sustainability point of view, touching base with the level of awareness that is surrounding the green building and the level of ignorance that goes with this. Furthermore, the research includes specific pointers which are strategically placed to directly grab the attention of those who lack knowledge in the area of green building by offering a brief, yet in-depth, discussion of possible materials that can be incorporated in the construction phase and will, in turn, create for a more efficient building. As such, life cycle energy is then introduced and calculations are carried out. These calculations offer a more logical form of validation to the previous points and issues raised, with the hope to achieve a more in-depth grasp of the process involved with green building.FindingsThrough comprehensive research, this paper has found the following outcomes. (1) A detailed insight into the contributing factors to green building in high-rise construction and the construction industry in general. (2) An increased understanding of the current status of green buildings within the construction industry. (3) The creation of an effective research methodology plan to implement throughout this research. The appropriate steps and measures, that were required to deliver a successful research piece, included all relevant information. (4) The level of involvement required when calculating the energy levels, including how to perform these calculations when given the correct data, and what these calculations mean concerning what they are defining.Originality/valueThe potential contribution that can be gained from this research is the awareness that is raised in the research and development of green buildings in high-rise construction. This can be achieved by the use of certain materials such as new energy-efficient building materials, recycled materials, etc. Through the incorporation of certain green building methods, an opportunity for cost savings becomes an incentive for the client and builder as the chance for a larger profit margin becomes readily available. In addition to these issues that are anticipated for the potential contribution through this research, the sustainability aspects are also expected to prevail as the construction industry is likely to evolve with changing standards and expectations due to the publicity high-rise buildings achieve, it is more than likely that this research discussion will be adopted willingly and positively promoted for all those involved within the construction industry to get involved. The intention remains that this research paper will be able to contribute a new way of thinking and a new approach to the way of building in the 21st century. As this would be the ideal outcome, the aim remains to portray and deliver information surrounding the views that remain for and against the implementation of green buildings in high-rise construction.

Deadheading minimization of the massive transportation system in the city of Cali Colombia

A model is presented for optimizing the bus allocation to depots or workshop yards (WY), minimizing the total daily fuel consumption of the system during empty runs (non-commercial), and considering the different types of buses, the WY capacities, the demand, and respecting the participation of each WY in the operation. The model is tested in a case study located in Cali and its results reveal significant cost savings opportunities by means of different strategies.

Innovative Lighting Systems: Opportunities for Energy Savings

This paper analyses, from an energy flow perspective, the implementation of smart lighting systems in street lighting, where lights are dimmed to adapt to the flow of objects passing in a street. The research focus on the sustainability perspective of implementing a transition to smart lighting systems when compared to regular LED lighting. To account for externalities, the energy flow was addressed considering the extra electronic devices used in a smart lighting system (controllers, motion sensors, radars, and computers).
 
 To compare both traditional LED street lighting and smart lighting the paper started with a model of a 2.5-kilometre street, scaling up scenarios of the commune Ecublens, in the Swiss canton of Vaud, and then to half and all residential streets of Switzerland were examined to understand if the gains in energy savings are scalable. 
 
 The research shows that, even with the additional electronic devices, the smart lighting system reduces the energy consumption of street lighting, even when considering the production of the extra components used. Financially, the extra costs of implementing smart lighting systems are offset by the savings in electricity consumption. Therefore, smart lighting systems for street lighting can be an environmentally and economically beneficial project to implement.

Variability in pediatric appendectomy: The association between disposable supply cost and procedure duration

BackgroundPediatric appendicitis accounts for a notable proportion of health care use and cost in the United States. To identify opportunities for cost savings during pediatric laparoscopic appendectomy, this study assessed whether surgeons' use of costlier disposable supplies correlated with procedure duration and patient outcomes. MethodsThis retrospective cross-sectional study assessed laparoscopic appendectomy for uncomplicated pediatric appendicitis at 2 tertiary-care academic hospitals. The cost of disposable surgical supplies, procedure duration, and patient outcomes were obtained from medical records. The correlation between average supply cost and procedure duration among surgeons was assessed using Pearson’s correlation coefficient. Associations between use of specific disposable supplies and supply cost or procedure duration were assessed using Student’s t tests. ResultsA total of 380 laparoscopic appendectomies were performed by 11 surgeons. Mean normalized supply cost varied between surgeons (range: 60.6%–151.1%) and was not correlated with procedure duration (R = 0.2951, P = .378). The use of energy-based sealing devices (76.7% increase, P < .001), staplers (38.4% increase, P < .001), endoscopic specimen pouches (45.3% increase, P < .001), and disposable ports (43.6% increase, P < .001) increased overall disposable supply cost. None of the disposable supplies in this analysis were associated with shorter procedures. Based on Medicaid reimbursement, the interquartile range of supply cost was 9.2% and 6.0% of hospital revenue at each site. ConclusionSurgeons varied in their use of disposable supplies for pediatric laparoscopic appendectomy, but the cost of supplies used did not influence outcomes. Incentivizing more judicious supply use may reduce costs related to pediatric appendicitis.

Improving access to medicines by popularising generics: a study of ‘India’s People’s Medicine’ scheme in two districts of Maharashtra

BackgroundIn spite of being the ‘pharmacy of the world’, access to essential medicines for a large majority of Indians is constrained by both physical and financial reasons. According to an estimate, medicines account for 69% of household out-of-pocket spending on health care. To make quality generic medicine affordable, India’s People’s Medicine Scheme (Jan Aushadhi) was launched in 2008 and then revamped and rebranded as Pradhan Mantri Bhartiya Jan Ausadhi Pariyojana (PMBJP) in 2015. The current study focuses on the availability, affordability and acceptability aspects of PMBJP essential medicines.MethodsWe have used a mixed-methods approach, with the survey-based quantitative component supplemented by a qualitative component consisting of in-depth interviews (IDIs). The survey was conducted in 11 PMBJP pharmacies in Mumbai and Palghar. Data were gathered on the availability, stock-outs, price and affordability of 35 essential medicines and 2 consumables.ResultsApart from the limited coverage of essential medicines and the significant presence of Fixed dose combinations (FDCs) in the PMBJP medicine list, the availability of surveyed essential drugs was also found to be low (47%) in PMBJP outlets. Across Mumbai and Palghar districts, around 50% and 42% of medicines were found to be out of stock for the period of 3–6 months respectively. The cost of generic medicines of PMBJP outlets for treating various conditions range from 0.01 days’ wages to 0.47 days’ wages for the lowest paid unskilled worker in Maharashtra.ConclusionsThe study findings show that PMBJP’s unbranded generics offer great opportunities for substantial cost savings. But, in order to fully realise the potential of this scheme, some policy actions are urgently required. First, the PMBJP drug list must include all essential drugs that feature in NLEM. Second, BPPI should procure only those drugs that pass the bioequivalence test. Third, compulsory de-branding of generics should be done in a phased manner. Fourth, PMBJP’s medicine procurement and distribution policies must be reviewed to address the supply chain issues. Moreover, there is a need for major pharmaceutical policy reforms to promote generic medicines in a big way. Regulations to support mandatory generic prescribing and generic substitution by pharmacists are needed.

Managing Perishability in the Fruit and Vegetable Supply Chains

Spoilage reduction in fresh product supply chains is an important challenge and represents great opportunities for cost savings and reduced environmental and social footprints. The purpose of this paper is to identify the drivers of spoilage and to discuss how these insights can be used to reduce spoilage.We use panel data techniques to quantify the drivers of spoilage in the days-fresh category using daily spoilage and supply chain data (457,539 store-SKU level observations) for fresh fruits and vegetables at Switzerland’s largest retailer. We quantify to what extent inventory, promotions, delivery type, commitment changes, order variations, order cycle, and quality issues influence spoilage. We discuss the mechanisms through which inventory age and product standards impact spoilage of days-fresh products. Our novel findings underline the necessity for specialized supply chain processes, tracking inventory age and damage, and collaboration with supply chain partners in the management of this fundamental product category.

Targeted Management of Excess Specialty Spending: The Case of Biologics for Retinal Disease

Summary Injectable biologics used for the treatment of retinal disease offer a strong use case for ACOs, payers, and policy makers as they seek to manage total costs by reducing costly practice variation and avoidable Medicare Part B drug spending. Bevacizumab, which was originally approved by the U.S. FDA in 2004 for the systemic treatment of advanced colon cancer, has seen increased off-label utilization as a vascular endothelial growth factor (VEGF) inhibitor for retinal disease. Three anti-VEGF medications that are commonly used for retinal disease each have similar outcomes in clinical trials but have notably different average costs (in USD) per injection: bevacizumab, $90; ranibizumab, $1,883; and aflibercept, $2,098. Based on these and other factors, leaders at CommonSpirit Health, a large national nonprofit health system operating in 21 states, propose and model a reduction of clinical practice variation to a standard of care for this single indication to represent a $2.3 billion annual savings opportunity for Medicare.

Electricity Consumption using Big Data Analytics

This paper focuses on using big data analytics to analyze the electricity consumption patterns of 500 consumers(residential) in a particular area over 24 months. The data was obtained from MESB and analyzed to understand the trends in consumption better. The analysis was used to create visualizations and graphs that helped to identify the consumption patterns of individual users as well as the overall trends in the area. Using the Power BI tool, a dashboard is created to showcase the results. The dashboard provides valuable information such as the top 10 consumers and average consumption values by user. This information can be used by utility companies to identify areas where consumption is high and to develop strategies to reduce overall electricity consumption. This study demonstrates the value of big data analytics in understanding complex patterns and identifying opportunities for energy savings

Identifying energy savings opportunities in vacant commercial buildings using a semi-supervised sensor fusion model

Recent events have forced building managers to examine energy use during vacant periods and revealed miscellaneous electrical loads (MELs) as an opportunity for savings. This paper addresses a key step in unlocking these savings, specifically the reliable identification of when a building is vacant. A Vacancy Inference Engine (VIE), using sensor fusion, was developed to identify vacant periods based on outputs from common sensors, historical building vacancy patterns, and expert knowledge. The VIE calculates the confidence that a building is vacant, allowing building managers to balance the capture of energy savings with the possibility of complaints due to powering down MELs. The VIE has the advantage over logistic regression and other models in that it does not require a full set of ground truth for the training process.The VIE successfully predicted vacancy in an office building using input data streams of instantaneous electricity demand, indoor carbon dioxide concentrations, and the number of active Wi-Fi connections. The VIE’s ability to predict vacancy was compared to that of logistic regression using a metric based on the Complaint Opportunity Rate and found to be nearly identical (0.94 versus 0.95, respectively).

A decade of hospital costs for firearm injuries in the United States by region, 2005–2015: government healthcare costs and firearm policies

BackgroundFirearm injuries are a costly, national public health emergency, and government-sponsored programs frequently pay these hospital costs. Understanding regional differences in firearm injury burden may be useful for crafting appropriate...

Operational speed strategy opportunities for autonomous trucking on highways

This study examines the potential for cost and carbon emission reduction for autonomous trucks to adopt lower peak speeds than today's human driven trucks, where the hourly cost of the driver remains a significant trade-off. Adopting lower speeds presents an indirect savings opportunity in addition to savings associated with the removal of the driver. Benefits and trade-offs for varying target speed of autonomous trucks on highways were investigated with a parameterised analysis of transport and cargo cost components. A validated fuel consumption model was used to compare fuel consumption for different speed strategies across idealised highway drive-cycles and vehicle scenarios. A volume-limited tractor-trailer (50% cargo mass capacity) could reduce fuel consumption and carbon emissions by 26% when reducing target speed from 90 km/h to 70 km/h. When the trade-offs of driver, vehicle and cargo time are considered for the same 20 km/h target speed reduction, combined costs increase by 3% for the human driver scenario, but decrease by 4% for an autonomous truck (assuming medium cargo time value). Sensitivity to vehicle type, loading, drive-cycle and cargo value was examined. A UK supermarket chain case study was investigated and key differences between a UK and US context were compared. Mandatory rest breaks and Hours-of-Service restrictions were identified as additional barriers for human driven vehicles to adopt slower speed strategies.

Trends and determinants of retail prescription drug costs.

To characterize price trends and variation for US generic and branded drugs at the retail level as they relate to pharmacy acquisition costs and local market factors. Drug pricing data consisting of US pharmacy claims from 2014 to 2019 collected and licensed by GoodRx, an online tool for comparing drug prices. Time trends of median drug prices and coefficients of variation were measured for generic and branded drugs, including subgroups based on clinical condition (i.e., diabetes and cancer). Pharmacy competition was measured using the Herfindahl-Hirschman Index (HHI) at the zip-code level. Multivariable linear regression analysis assessed the impact of local market-level factors on drug prices and variation. US drug pricing data consisting of claims filled through a mix of public and private insurance at 58,332 chain and independent pharmacies across 14,421 zip codes in all 50 states. From 2014 to 2019, pharmacy retail markets trended towards greater competition: average HHI by zip code decreased by 15.0% (p < 0.001). Median cash price increased significantly for both generic (6.58%, p < 0.001) and branded (84.10%, p < 0.001) drugs. When normalized to acquisition costs, cash prices for generic drugs rose 22.03% (p < 0.001) while those of branded drugs decreased by 2.31% (p < 0.001). Diabetes drugs showed higher baseline overall markup of cash prices relative to acquisition costs (10.54, Interquartile range (IQR) 3.28-18.43) than cancer drugs (1.88, IQR 1.36-3.08). Neither local pharmacy competition nor median income significantly predicted drug price or variation. Measures of generic drug price and price variation are high despite decreased costs earlier in the pharmaceutical supply chain, defying expectations of what would happen in a competitive market. Efforts to bypass the pharmacy benefit model for generic drugs may offer consumers an opportunity for substantial savings.

Understanding the Impact of Spot Market Electricity Price on Wastewater Asset Management Strategy

Development of an advanced pumping control scheme is one of the useful methods that can be applied in operational optimisation of wastewater pumps. Optimisation of pumping control can benefit the utility by overall cost saving using different electricity pricing schemes from the energy market. As electricity prices can be varied based on the spot market in some countries such as Australia, the consideration of operating the pumps at the most favourable electricity price, when managed correctly, can offer remarkable savings. This paper provides understanding on the electricity spot price behaviour of South Australia in the National Electricity Market (NEM). Half-hourly electricity spot price data of over 22 years from January 1999 to June 2021 were analysed to investigate the key characteristics of spot prices, including seasonality (intraday, intraweek and seasonal price patterns), spiky behaviour and occurrences of negative prices. In addition, the possible impacts of other factors on electricity spot prices such as electricity demand and weather conditions on pump control were examined. Results indicate a strong relationship between electricity demand and spot price with the Pearson correlation coefficient up to R = 0.95, and extreme high spot prices tended to occur on scorching days with the maximum temperature above 35 °C when air-conditioner usage was high. This paper also explains the importance of electricity spot prices in the wastewater pump on/off operations and analyses opportunities for cost savings by including electricity spot price forecasts as an input of the smart controller to enhance the efficiency of the real-time pumping control.

Reducing milking frequency from twice each day to three times each two days affected protein but not fat yield in a pasture-based dairy system

Milking 3 times in 2 d (3-in-2) could enhance the attractiveness of the dairy workplace relative to twice-a-day milking (TAD) by reducing labor requirements for milking and increasing workforce flexibility. The objective of this study was to quantify the farm system interactions associated with milking 3-in-2 at 3 stages of lactation, with the aim of providing guidance to pasture-based dairy farmers and advisors on the likely consequences of adopting 3-in-2 milking on farm productivity and business performance. Seventy-nine multiparous and 37 primiparous cows were randomly allocated to 4 experimental farms stocked at 3.5 cows/ha. One herd was milked TAD for the whole lactation (August 2019 to May 2020), with the remaining 3 milked 3-in-2 for either the whole lactation, after December 1 when cows were an average of 101 d in milk, or after March 1 when days in milk averaged 189 d. Milking intervals over 48 h were 10-14-10-14 h for TAD and 12-18-18 h for 3-in-2. Animal, pasture, and farm system data were analyzed by linear regression, with the dependent variable being the annualized value of the performance metric of interest, and the number of days in the lactation milked 3-in-2 as the independent variable. For the proportion of the season milked 3-in-2, there was a significant effect on milk (-11%), protein (-8%), and lactose (-12%) yield per cow per year, but no effect of fat. Additionally, there was a positive effect (+6%) on body condition score before dry-off and the energy required for liveweight change (+26%), and a negative effect on the energy required for walking (-30%). There were no differences in estimated feed eaten, or pasture herbage accumulation, composition, or quality. Therefore, pasture management and feed allocation under 3-in-2 should be similar to TAD. On commercial farms, the degree to which reduced milk income can be offset by lower costs will be highly farm-specific, but opportunities for savings were identified in the results. The short walking distances on the research farm and potential to improve farm management using the time saved from fewer milkings suggests better production may be achieved with 3-in-2 milking on a commercial farm.

SWOT Analysis of Chronic Rhinosinusitis Care Anno 2022

Chronic rhinosinusitis (CRS) is a prevalent chronic condition with dynamic developments in diagnostic and therapeutic approaches given the recent updated guidelines and novel therapeutic approaches. A critical reflection on clinical practice of CRS care in 2022 is needed, hence providing hints for better care. This review provides an overall evaluation of the current approach of CRS care, including strengths, weaknesses, opportunities, and threat related to the current care pathways in most regions worldwide. Strengths of current CRS care are mainly related to effective treatment options allowing personalized care, with preventive and curative goals included in the current guidelines. However, a large portion of patients with CRS remain uncontrolled given the multiple weaknesses in CRS care, related to several factors such as underdiagnosis, undertreatment, and suboptimal coordination of care among health care providers. The opportunities for better care are ample given the possibility of implementing optimal care following guidelines, including preventive interdisciplinary strategies and patient-oriented treatment plans. In 2022, CRS represents a chronic condition that is subject to a (r)evolution of care with good opportunities for better outcomes and health economic savings.

Budget Saving Potential of Pegfilgrastim Biosimilar for the Treatment of Chemotherapy-Induced Febrile Neutropenia, in Italy

INTRODUCTION: Current Italian guidelines recommend prophylaxis with granulocyte colony-stimulating factors (G-CSFs) to reduce the risk of chemotherapy-induced febrile neutropenia (FN). The availability of G-CSF biosimilars represents an opportunity for savings in the Italian National Healthcare Service (NHS) delivery of care.OBJECTIVE: To assess the cost saving potential associated with the introduction of pegfilgrastim biosimilars to local formularies, compared to the current G-CSF standard practice in Italy.METHODS: A budget impact model was developed to compare the current standard practice of long-acting (LA) and short-acting (SA) G-CSFs use, with a future scenario in which the market share of LA G-CSFs grows due to the more advantageous administration schedule and price of pegfilgrastim biosimilar. The analysis included G-CSF treatment schedules, drug acquisition costs and costs of patient management including hospitalization and ambulatory care.RESULTS: The introduction of pegfilgrastim biosimilar resulted in cumulative 3-year cost savings of € 59,650 and € 41,539 for FN prophylaxis in a potential cohort of 1000 patients with solid tumors and lymphomas, respectively.CONCLUSIONS: The results indicate that the introduction of pegfilgrastim biosimilar is potentially associated with substantial cost savings for the Italian healthcare system.