Tangible Costs Research Articles

Postoperative pain management among surgically treated patients in an Ethiopian hospital.

BackgroundIncidence of postoperative pain has been reported to be between 47–100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia.Methods and FindingsA prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach’s α coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients’ charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar’s; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r = 0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status.ConclusionDespite patients’ paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management.

Social Cost of Substance Abuse in Russia

ObjectiveTo summarize results of studies that estimate the social costs of alcohol, tobacco, and illicit drug abuse in Russia. The purpose of these studies was to inform policymakers about the real economic burden of risky behaviors and to provide conditions for evidence-based and well-informed decision making in this area. MethodsThe cost-of-illness method was applied to estimate the social cost of substance abuse. The intangible cost was not included in estimation. A prevalence-based approach was applied to estimate the tangible cost. For the estimation of direct costs, a top-down method was used. Indirect costs were estimated using two methods: the human capital and the friction cost. ResultsIn 2008, the social cost of substance abuse in Russia comprised 677.2 billion rubles if the friction cost method is applied and 1965.9 billion rubles if the human capital method is used. The social cost of substance abuse is defined to the greatest extent by alcohol consumption, comprising about 45% of the economic burden. Illicit drug use comprises about 30% of the economic burden and tobacco consumption 25%. ConclusionsThe results of economic studies demonstrated that psychoactive substances impose a considerable economic burden on society. Analysis of the substance abuse social cost pattern shows that the main losses that society bears because of these behavioral risk factors fall outside the health care system and lay in other sectors of the economy such as social care, law enforcement, and productivity losses.

CP-082 Cost benefit analisys of a computerised physician order entry project: a method of benefit evaluation based on error analysis

BackgroundThe computerised physician order entry (CPOE) system is considered the single most effective technological solution for reducing medical errors, but high costs and limited data on its financial benefits are...

Regulation in the Pulp and Paper: Costs and Consequences

The paper and pulp industry is one of the most heavily regulated industries in the United States. This working paper investigates the extent to which environmental and workplace regulations affect the industry and evaluate the impact of these regulations on the industry, its customers, its employees and society in general. A review of literature on this topic reveals that numerous scholars have attempted to discern the effects of specific regulations on the industry or attempted to place a dollar value on what pollution abatement costs paper manufacturers. In this paper, we will take their findings into account, identify which regulations affect the industry, and describe the total cost these regulations impose on society. We investigate the tangible and direct costs of regulation, meaning the amount that regulation actually costs companies within the industry in dollar terms, as well as the less-visible, non-monetary costs resulting from regulation. Regulation also inevitably creates unforeseen costs that neither the regulators nor participants in the market could have anticipated, and those unanticipated consequences of regulation often create the very types of problems the regulators intended to reduce or eliminate. Although the paper and pulp industry incurs a relatively high regulatory burden, firms in the industry also tend to be quite large, which gives them the advantage of being able to disperse the costs of regulation over more units. It therefore remains unclear whether regulation affects firms in this industry to a greater or lesser extent than the average firm in the United States in absolute terms, but the industry nonetheless serves as an example of the costs and consequences of government regulation.

Organizational socialization in the first three years of nursing profession: strategies to decrease turnover intention

In the first years of nursing profession, new-graduate nurses' turnover intention is a relevant issue due to both the tangible and intangible costs it generates to health care organizations, such as selection and recruitment costs, ward team burden in the onboarding process and the possibility to enhance ward team stability in order to provide an effective and safe nusing care. Organizational socialization is the main factor involved in these dynamics of turnover intention in the first years of nursing profession. This study aims to identify the main factors involved in the organizational socialization process to reduce turnover intention in the first 3 years of nursing profession. 101 new-graduate nurses have been enrolled within the first three years of nursing profession. They have been stratified looking at tenure and years in nursing. Organizational Socialization Inventory scale has been used to assess the onboarding process and 4 items to assess turnover intention. Turnover intention is of 23% in the first year in nursing, and it's over the 26% starting from the second year. The onboarding process explains over the 26% of the variance in turnover intention, and over the 36% in the sub-sample with a stable tenure. Unstable tenured nurses prefer to acquire those competences useful to perform their work, while stable tenure nurses aim to search for professional growth opportunities and integration in the ward-team, in order to reduce turnover intention. Turnover intention is relevant in the first three years of nursing profession. According to the different tenure, different strategies are necessary to plan an effective onboarding process and enhance nursing retention.

The cost of harmful alcohol use in South Africa.

The economic, social and health costs associated with alcohol-related harms are important measures with which to inform alcohol management policies and laws. This analysis builds on previous cost estimates for South Africa. We reviewed existing international best-practice costing frameworks to provide the costing definitions and dimensions. We sourced data from South African costing literature or, if unavailable, estimated costs using socio-economic and health data from secondary sources. Care was taken to avoid possible causes of cost overestimation, in particular double counting and, as far as possible, second-round effects of alcohol abuse. The combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 - 12% of the 2009 gross domestic product (GDP). The tangible financial cost of harmful alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP. The costs of alcohol-related harms provide a substantial counterbalance to the economic benefits highlighted by the alcohol industry to counter stricter regulation. Curtailing these costs by regulatory and policy interventions contributes directly and indirectly to social well-being and the economy. CONCLUSIONS; Existing frameworks that guide the regulation and distribution of alcohol frequently focus on maximising the contribution of the alcohol sector to the economy, but should also take into account the associated economic, social and health costs. Current interventions do not systematically address the most important causes of harm from alcohol, and need to be informed by reliable evidence of the ongoing costs of alcohol-related harms.

Religion and Intergroup Conflict

How might religion shape intergroup conflict? We tested whether religious infusion—the extent to which religious rituals and discourse permeate the everyday activities of groups and their members—moderated the effects of two factors known to increase intergroup conflict: competition for limited resources and incompatibility of values held by potentially conflicting groups. We used data from the Global Group Relations Project to investigate 194 groups (e.g., ethnic, religious, national) at 97 sites around the world. When religion was infused in group life, groups were especially prejudiced against those groups that held incompatible values, and they were likely to discriminate against such groups. Moreover, whereas disadvantaged groups with low levels of religious infusion typically avoided directing aggression against their resource-rich and powerful counterparts, disadvantaged groups with high levels of religious infusion directed significant aggression against them—despite the significant tangible costs to the disadvantaged groups potentially posed by enacting such aggression. This research suggests mechanisms through which religion may increase intergroup conflict and introduces an innovative method for performing nuanced, cross-societal research.

The Economics of Hydro-Meteorological Disasters: Approaching the Estimation of the Total Costs

Hydro-meteorological disasters have caused increasing losses in recent years. Efficient risk reduction policies require accurate assessment approaches, with careful consideration of costs, beyond direct tangible costs, which are commonly used in practice. Faced with possible risk reduction scenarios, limited financial resources require an improvement in the quality of cost estimation, thereby contributing to an efficient allocation of resources. This paper focuses on the concept of total costs of hydro-meteorological disasters, based on direct and indirect as well as tangible and intangible cost categories. These categories are defined and explained, supported by a comprehensive review of economic valuation methods. Based on this information, practice relevant suggestions are made concerning the most appropriate methods for different cases in terms of scale, availability of data and of technical resources. Our survey also provides critical insights to drawbacks of flood risk estimation, which need to be addressed and carefully dealt with in any future research in this area.

Cloudy with a Chance of Cost Savings

Cloud-based hosting is claimed to possess many advantages over traditional in-house (on-premise) hosting such as better scalability, ease of management, and cost savings. It is not difficult to understand how cloud-based hosting can be used to address some of the existing limitations and extend the capabilities of many types of applications. However, one of the most important questions is whether cloud-based hosting will be economically feasible for my application if migrated into the cloud. It is not straightforward to answer this question because it is not clear how my application will benefit from the claimed advantages, and, in turn, be able to convert them into tangible cost savings. Within cloud-based hosting offerings, there is a wide range of hosting options one can choose from, each impacting the cost in a different way. Answering these questions requires an in-depth understanding of the cost implications of all the possible choices specific to my circumstances. In this study, we identify a diverse set of key factors affecting the costs of deployment choices. Using benchmarks representing two different applications (TPC-W and TPC-E) we investigate the evolution of costs for different deployment choices. We consider important application characteristics such as workload intensity, growth rate, traffic size, storage, and software license to understand their impact on the overall costs. We also discuss the impact of workload variance and cloud elasticity, and certain cost factors that are subjective in nature.

International experiences of promoting generics use and its implications to China

To summarize international experiences in promoting use of generics and to extract essence for China's reference. This is a commentary of two systematic reviews about policies to promote use of generics and its implications to China. Price, reimbursement, and generic substitution policies in European countries, and approaches in low and middle income countries in promoting market competition, appropriate intellectual property right protection strategy, and necessary demand side incentives, are all meaningful for China to contain soaring pharmaceutical expenditures, and to maintain the achievements and outcomes of the national health system reform. Effective promotion of generics use must be practice based on the real situation. Tailor-made and comprehensive measures are needed to address both demand and supply sides barriers before achieving tangible cost containment effect without unexpected side effects.

Integrated Assessment of Natural Hazards and Climate Change Adaptation: I - The KULTURisk Methodological Framework

A conceptual framework integrating different disciplines has been developed to comprehensively evaluate the benefits of risk prevention. Three main innovations are proposed with regards to the state of the art: (1) to include the social capacities of reducing risk, (2) to go beyond the estimation of direct tangible costs, and (3) to provide an operational solution to assess risks, impacts and the benefits of plausible risk reduction measures. The traditional risk metric in the physical sciences is the expected damage (direct tangible costs), which is defined as a function of hazard, vulnerability (physical) and exposure. The last element, exposure, provides the information to convert results intomonetary terms. In the development of the KULTURisk Framework (KR-FWK), we considered several different pre-existing proposals, and we designed a new one as a conceptual model and also a flow chart for the elaboration of information. The proposed KR-FWK is thus expected to provide: 1) an operational basis for multidisciplinary integration; 2) a flexible reference to deal with heterogeneous case studies and potentially various types of hazards; and 3) a means to support the assessment of alternative risk prevention measures including consideration of social and cultural dimensions. The project case studies of the process are expected to provide a quite diversified set of situations, allowing to consolidate the framework itself and to develop ad hoc tailored solutions for most common implementation cases.

Household costs of seeking outpatient care in Egyptian children with diarrhea: a cross-sectional study

IntroductionAddressing difficulties of seeking and getting health care would lower the burden of diarrhea among ill children from developing countries as Egypt. The purpose of the study is to evaluate the economic burden of diarrhea associated with outpatient visits of children in Egypt by identifying the different types of related costs.MethodsThis cross-sectional clinic-based survey was done by interviewing parents of 763 children presenting with diarrhea to the outpatient clinics of Pediatric Hospital of Cairo University. Estimated costs included tangible costs (direct, indirect) and intangible costs (forms of suffering). Insurance status of the children was also described. Descriptive statistics were presented in frequency tables, median, minimum, maximum, interquartile range, mean and standard deviation, whenever appropriate.ResultsIt was found that 90. 7% of the studied children were of low and middle socioeconomic standard with a median monthly family income of US$83 and a median monthly expenditure of LE US$79. The average direct and indirect costs of acute diarrhea per case were US$13.2±19.5 and US$11.3±93.1 respectively. The mean cost per diarrheal episode is US$24.5 which almost consumes 29.5% of the mean monthly income. About 61% of cases sought medical care before visiting our hospital, 43.6% of them visited more than one provider. Awareness about health insurance was found in 72.7% and coverage by a health insurance system in 33%. Of insured patients only 41.4% utilized the insurance services.ConclusionDiarrhea causes great socio-economic burden for families in Egypt, which could result in significant delay in seeking health care.

Digital subcarrier optical networks and cross-connects

This paper describes a rate flexible network transport solution to achieve sub-wavelength circuit provisioning between edge node pairs. Sub-wavelength circuits are obtained by concatenating spectrally efficient digital subcarrier channels along the network path, with each subcarrier frequency carrying only a fraction of the wavelength bandwidth. By reserving one or more such subcarrier frequencies along a path connecting two edge nodes, a dedicated end-to-end sub-wavelength circuit is provisioned. At an intermediate node, incoming frequencies are switched to outgoing frequencies via a cross-bar electronic circuit switch or cross-connect. By performing digital subcarrier multiplexing DSCM using CMOS based advanced digital signal processing DSP algorithms, spectral guard-bands between adjacent channels are not necessary, thus yielding good bandwidth efficiency when multiplexing multiple subcarrier channels onto the same wavelength.Compared to current TDM based transport network solutions, e.g., OTN/SONET/SDH, the described solution offers the unique advantage of implementing two key transport functionalities in the same DSP system, which is capable of 1 performing compensation of fiber transmission impairments in the electronic domain to ensure good signal integrity, and 2 multiplexing demultiplexing subcarrier channels after before add/drop and switching circuit operations. Because of this design advantage, system complexity and fabrication of the network equipment are ameliorated, possibly leading to tangible cost and electric power consumption reductions.

A randomised trial comparing the cost effectiveness of different emergency department healthcare professionals in soft tissue injury management

ObjectivesTo evaluate the cost effectiveness of soft tissue injury management by emergency nurse practitioners (ENPs) and extended scope physiotherapists (ESPs) compared with the routine care provided by doctors in an...

Location-Specific Technoeconomic Evaluation of a Novel Amine Technology

A novel amine capture technology for CO2 emissions has been developed by Huaneng/Xi’an Thermal Power Research Institute. Lawrence Livermore National Laboratory (LLNL), on behalf of the U.S.-China Clean Energy Research Center, has evaluated the technology using location-specific economic parameters to reflect power generation loss from a coal-fired power generation plant due to amine regeneration, the necessary utility constraints and investment, and the constraints of the location.The conceptual design used for cost estimates consists of a pre-absorption cooler (cooling by injection of water directly into the flue gas was not feasible because of 100% flue gas humidity post-flue gas desulfurizer), an absorber with a spray stage to minimize evaporative amine losses; an economizing heat exchanger and trim heaters and coolers: a stripper with a reboiler and condenser to recover absorbed CO2; a five-stage CO2 compression train with intercooling and water removal; and an ion exchange process to control build-up of heat-stable salts by treating a bleed stream from the lean amine stream.We conclude that Huaneng's novel amine composition, because of the use of hindered and tertiary amines, has a lower heat of regeneration and hence reduces the power generation penalty. Further, we assess that the hindered and tertiary amines are less susceptible to thermal and oxidative degradation, although they are still susceptible to degradation by reaction with CO2. We estimate the reduced power generation penalty and reduced solvent degradation gives a modest but tangible cost advantage relative to 30% MEA.Among the location-specific constraints we have identified are: limited ability to cool incoming flue gas by water injection because of high humidity; and poor soil conditions that would require extensive civil engineering prior to plant construction. These differences we assess will increase the cost of implementing an amine-based capture technology over costs based on assumed greenfield construction.

A Conceptual Framework for Comprehensive Assessment of Risk Prevention Measures: The Kulturisk Framework (KR-FWK)

A conceptual framework integrating different disciplines is described in order to provide the basis for the development of a methodology to comprehensively evaluate the benefits of risk prevention. Two main innovations are proposed with regards to the state of the art: to define a measure of risk that goes beyond the direct tangible costs and to include the social capacities of reducing risk.

Competition in Financial Services: Evidence from British Mutual Funds

This article explores the effects of competition on risk‐taking behavior and firm performance within the financial services industry. It does so by exploiting a regulatory change that allowed new players to enter the British mutual fund industry. Exploiting this regulatory shock, we trace nontrivial linkages among industry competition, risk taking, and performance. Greater competition followed the regulatory liberalization, leading to a significant increase in risk‐taking behavior of funds. Competition generated performance efficiencies, forcing underperforming funds to exit and halting earlier value destruction. Competition, however, did not produce tangible cost savings for consumers of investment services.

Financial frictions and real implications of macroprudential policies

I model a number of imperfections in financial intermediation that have implications for real economic activity in a production economy with technological risk. Partially opaque firms are financed by both debt and insider equity. Banks have market power over borrowers. There can be a prior bias in public beliefs about aggregate productivity (business sentiment). I investigate the dependence of equilibrium on the biased business sentiment and a prudential policy instrument (a convex dependence of bank capital requirements on the quantity of uncollateralized credit). Loss given default can be reduced by both a monetary restriction and a macroprudential restriction. Real implications of both are very similar in the aggregate, but macroprudential policies are more advantageous for bank earnings. On the other hand, the policies considered here are unable to reduce the number of defaulting firms (default frequency). Economic activity is highly sensitive to “leaning against the wind” actions on both fronts, so that using a macroprudential instrument to intervene against an asset price bubble has tangible welfare costs comparable to those of a monetary restriction. The costs can be offset by fine tuning capital charges as a function of corporate governance on the borrower side (specifically, by discouraging limited liability of borrowing firm managers).

The Total Cost of Hydrological Disasters

The rising costs of disasters caused by floods and landslides make it a high priority to improve the quality and the reliability of the assessment exercises, so as to inform risk prevention policies. The concept of total cost is much more ambitious than what has been traditionally provided, because it aims at describing the total burden imposed by a disaster to a socio‐ecosystem. The true costs of disasters include costs (and benefits) which are difficult to identify and quantify. It comprises all direct, indirect, tangible and intangible costs. Apart from direct and tangible costs, the remaining cost elements have been largely neglected in the field of economics of natural disasters. This report builds on these categories of costs presenting specific examples for the hydrological disasters. A brief review of economic valuation methodologies and project appraisal methods is also provided. Given that the full estimation of the total costs might turn challenging and controversial, we propose alternative options to traditional cost‐benefit analysis for processing the retrievable information, including non‐monetary impacts.

"Clearnesses, Clearances": Telegrams and the Formal Economy of The Golden Bowl

"Clearnesses, Clearances":Telegrams and the Formal Economy of The Golden Bowl Jennifer Sorensen Emery-Peck Lydia Touchett, the most famous user of telegrams in Henry James's fiction, is introduced to the reader as a woman who has "thoroughly mastered the art of condensation" required for telegraphic expression and who is continually marked for her "devotion to the electric wire" (67, 220). Mrs. Touchett's style of telegraphic authorship is often transcribed in The Portrait of a Lady (1881), as in the following ambiguous telegram which gives a sense of her flair for the medium: "Changed hotel, very bad, impudent clerk, address here. Taken sister's girl, died last year, go to Europe, two sisters, quite independent" (67). In Portrait, James uses Mrs. Touchett's cryptic style to emphasize the economic constraints on the telegraphic form as Lydia explains her lack of clarity and her eccentric style in telegrams like this one to Ralph with the telling phrase: "clearness is too expensive" (98).1 In Mrs. Touchett's telegrams, her frugal compression breeds ambiguity and generates a coded speech that cannot be easily deciphered; James exploits her ambiguous transatlantic missives to stage scenes of communal reading where other characters puzzle over her potential meanings. The marked publicity of the telegraphic form in Portrait—unlike the letters in the novel which remain private—underscores James's interest in the telegram as a form of mediated and expensive communication that is always already public. In this early novel, James was intrigued by the telegram as a uniquely rich textual form for his fictional projects. Throughout his career, James continually returned to the telegram because this medium provided a material form of communication that generated a cryptic, condensed style tied to the costliness of transmission that often occasioned public consumption and collaborative reading. [End Page 164] In 1898, James signaled his continuing interest in telegraphy as a subject and as a formal problem; in his novella In the Cage, James experimented with what it might mean if an unnamed telegraphist made free with the coded messages that she transmits. In this story, James plays with the perspective of his unnamed telegraphist as an authorial presence and stresses the telegram as a form of modern communication that is crucially shaped by the material conditions of its production in which words can only travel after the exchange of coins. James's telegraphist is elated by her fantasies of special communion with her clientele and yet, despite her imagined connections, the telegrams that she processes continually remind her of the socio-economic gulf between herself and her customers: What twisted the knife in her vitals was the way the profligate rich scattered about them, in extravagant chatter over their extravagant pleasures and sins, an amount of money that would have held the stricken household of her frightened childhood, her poor pinched mother and tormented father and lost brother and starved sister, together for a lifetime. During her first weeks she had often gasped at the sums people were willing to pay for the stuff they transmitted—the "much love"s, the "awful" regrets, the compliments and wonderments and vain vague gestures that cost the price of a new pair of boots. (386-87) In passages like this one, James emphasizes that the telegraphist's occupation as word-counter and change-maker constantly reminds her of the "extravagant" and tangible cost of the telegraphic medium of communication. The telegraphist expresses her disdain for the thoughtless profligacy of her upper-class clientele: she describes one particularly interesting customer as "[belonging] supremely to the class that wired everything, even their expensive feelings (so that, as he evidently never wrote, his correspondence cost him weekly pounds and pounds and he might be in and out five times a day)" (382).2 Here, James marks the crucial difference between letter writing ("as he evidently never wrote") and the expensive, publicly transmitted, medium of telegraphy. In a telegram to Mrs. Hugh Bell, Henry James expresses his own "expensive feelings" and his awareness of their "cost" in an extravagantly cryptic message of his own: "Impossible impossible impossible if you knew what it costs me to say so you can count however at the...