Cost of nursing turnover in a Teaching Hospital

Abstract OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.

Logging residues from regeneration fellings for biofuel production - a GIS-based availability and supply cost analysis

Finland has large forest fuel resources. However, the use of forest fuels for energy production has been low, except for small-scale use in heating. According to national action plans and programs related to wood energy promotion, the utilization of such resources will be multiplied over the next few years. The most significant part of this growth will be based on the utilization of forest fuels, produced from logging residues of regeneration fellings, in industrial and municipal power and heating plants. Availability of logging residues was analyzed by means of resource and demand approaches in order to identify the most suitable regions with focus on increasing the forest fuel usage. The analysis included availability and supply cost comparisons between power plant sites and resource allocation in a least cost manner, and between a predefined power plant structure under demand and supply constraints. Spatial analysis of worksite factors and regional geographies were carried out using the GIS-model environment via geoprocessing and cartographic modeling tools. According to the results of analyses, the cost competitiveness of forest fuel supply should be improved in order to achieve the designed objectives in the near future. Availability and supply costs of forest fuels varied spatially and were very sensitive to worksite factors and transport distances. According to the site-specific analysis the supply potential between differentlocations can be multifold. However, due to technical and economical reasons ofthe fuel supply and dense power plant infrastructure, the supply potential is limited at plant level. Therefore, the potential and supply cost calculations aredepending on site-specific matters, where regional characteristics of resourcesand infrastructure should be taken into consideration, for example by using a GIS-modeling approach constructed in this study.

GIS-based approach for optimization of onshore wind park infrastructure alignment in Finland

Wind power is a rapidly developing, low-emission form of energy production. In Fin-land, the official objective is to increase wind power capacity from the current 1 005 MW up to 3 500–4 000 MW by 2025. By the end of April 2015, the total capacity of all wind power project being planned in Finland had surpassed 11 000 MW. As the amount of projects in Finland is record high, an increasing amount of infrastructure is also being planned and constructed. Traditionally, these planning operations are conducted using manual and labor-intensive work methods that are prone to subjectivity. This study introduces a GIS-based methodology for determining optimal paths to sup-port the planning of onshore wind park infrastructure alignment in Nordanå-Lövböle wind park located on the island of Kemiönsaari in Southwest Finland. The presented methodology utilizes a least-cost path (LCP) algorithm for searching of optimal paths within a high resolution real-world terrain dataset derived from airborne lidar scannings. In addition, planning data is used to provide a realistic planning framework for the anal-ysis. In order to produce realistic results, the physiographic and planning datasets are standardized and weighted according to qualitative suitability assessments by utilizing methods and practices offered by multi-criteria evaluation (MCE). The results are pre-sented as scenarios to correspond various different planning objectives. Finally, the methodology is documented by using tools of Business Process Management (BPM). The results show that the presented methodology can be effectively used to search and identify extensive, 20 to 35 kilometers long networks of paths that correspond to certain optimization objectives in the study area. The utilization of high-resolution terrain data produces a more objective and more detailed path alignment plan. This study demon-strates that the presented methodology can be practically applied to support a wind power infrastructure alignment planning process. The six-phase structure of the method-ology allows straightforward incorporation of different optimization objectives. The methodology responds well to combining quantitative and qualitative data. Additional-ly, the careful documentation presents an example of how the methodology can be eval-uated and developed as a business process. This thesis also shows that more emphasis on the research of algorithm-based, more objective methods for the planning of infrastruc-ture alignment is desirable, as technological development has only recently started to realize the potential of these computational methods.

Análisis económico de las vacunas 10-valente y 13-valente contra neumococo: revisión sistemática

Introducción: Las vacunas clásicamente han representado un método económico y eficaz para el control y prevención de múltiples enfermedades infecciosas. En los últimos años se han introducido nuevas vacunas contra neumococo a precios elevados, y los diferentes análisis económicos a nivel mundial de estas vacunas no muestran tendencias. El objetivo de este trabajo era resumir la evidencia existente a través de los diferentes estudios económicos evaluando las dos vacunas de segunda generación contra neumococo en la población a riesgo. Metodología: En este trabajo se realizo una revisión sistemática de la literatura en 8 bases de datos localizadas en diferentes partes del mundo y también que tuvieran literatura gris. Los artículos fueron inicialmente evaluados acorde a su titulo y resumen, posteriormente los elegidos se analizaron en su totalidad. Resultados: Se encontraron 404 artículos, de los cuales 20 fueron incluidos en el análisis final. Se encontró que la mayoría de los estudios se realizaron en áreas donde la enfermedad tiene una carga baja, como es Norte América y Europa, mientras que en los lugares del mundo donde la carga es mas alta, se realizaron pocos estudios. De igual manera se observo que la mayoría de los estudios mostraron por los menos ser costo efectivos respecto a la no vacunación, y en su totalidad las dos vacunas de segunda generación mostraron costo efectividad respecto a la vacunación con PCV-7. Los resultados de los estudios son muy heterogéneos, hasta dentro del mismo país, señalando la necesidad de guías para la conducción de este tipo de estudios. De igual manera, la mayoría de los estudios fueron financiados por farmacéuticas, mientras en un numero muy reducido por entes gubernamentales. Conclusiones: La mayoría de los estudios económicos sobre las vacunas de segunda generación contra neumococo han sido realizados en países con un alto índice de desarrollo económico y patrocinados por farmacéuticas. Dado que la mayoría de la carga de la enfermedad se encuentran en regiones con un menor nivel de desarrollo económico se deberían realizar mas en estas zonas. De igual manera, al ser la vacunación un asunto de salud publica y con un importante impacto económico los gobiernos deberían estar mas involucrados en los mismos.

Standard cost model: three different paths and their common problems

Red tape is not desirable as it impedes business growth. Relief from the administrative burdens that businesses face due to legislation can benefit the whole economy, especially at times of recession. However, recent governmental initiatives aimed at reducing administrative burdens have encountered some success, but also failures. This article compares three national initiatives - in the Netherlands, UK and Italy - aimed at cutting red tape by using the Standard Cost Model. Findings highlight the factors affecting the outcomes of measurement and reduction plans and ways to improve the Standard Cost Model methodology.

Four year multitrophic food web: source food web description, methodology accuracy and species diversity

Food webs have been used in order to understand the trophic relationship among organisms within an ecosystem, however the extension by which sampling efficiency could affect food web responses remain poorly understood. Still, there is a lack of long-term sampling data for many insect groups, mainly related to the interactions between herbivores and their host plants. In the first chapter, I describe a source food web based on the Senegalia tenuifolia plant by identifying the associated insect species and the interactions among them and with this host plant. Furthermore, I check for the data robustness from each trophic level and propose a cost-efficiently methodology. The results from this chapter show that the collected dataset and the methodology presented are a good tool for sample most insect richness of a source food web. In total the food web comprises 27 species belonging to four trophic levels. In the second chapter, I demonstrate the temporal variation in the species richness and abundance from each trophic level, as well as the relationship among distinct trophic levels. Moreover, I investigate the diversity patterns of the second and third trophic level by assessing the contribution of alfa and beta-diversity components along the years. This chapter shows that in our system the parasitoid abundance is regulated by the herbivore abundances. Besides, the species richness and abundances of the trophic levels vary temporally. It also shows that alfa-diversity was the diversity component that most contribute to the herbivore species diversity (2nd trophic level), while the contribution of alfa- and beta-diversity changed along the years for parasitoid diversity (3rd level). Overall, this dissertation describes a source food web and bring insights into some food web challenges related to the sampling effort to gather enough species from all trophic levels. It also discuss the relation among communities associated with distinct trophic levels and their temporal variation and diversity patterns. Finally, this dissertation contributes for the world food web database and in understanding the interactions among its trophic levels and each trophic level pattern along time and space

Ecologia da paisagem para avaliação da idoneidade de redes ecológicas, como subsídio para o planejamento territorial

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Cost-effectiveness of intensified interventions to control healthcare-associated MRSA infections -- A systematic literature review

Methicillin Resistant Staphylococcus aureus healthcare-associated infections (MRSA HAIs) are a major cause of morbidity in hospitalized patients. They pose great economic burden to hospitals caring for these patients. Intensified Interventions aim to control MRSA HAIs. Cost-effectiveness of Intensified Interventions is largely unclear. We performed a review of cost-effectiveness literature on Intensified Interventions , and provide a summary of study findings, the status of economic research in the area, and information that will help decision-makers at regional level and guide future research.^ We conducted literature search using electronic database PubMed, EBSCO, and The Cochrane Library. We limited our search to English articles published after 1999. We reviewed a total of 1,356 titles, and after applying our inclusion and exclusion criteria selected seven articles for our final review. We modified the Economic Evaluation Abstraction Form provided by CDC, and used this form to abstract data from studies.^ Of the seven selected articles two were cohort studies and the remaining five were modeling studies. They were done in various countries, in different study settings, and with different variations of the Intensified Intervention . Overall, six of the seven studies reported that Intensified Interventions were dominant or at least cost-effective in their study setting. This effect persisted on sensitivity testing.^ We identified many gaps in research in this field. The cost-effectiveness research in the field is mostly composed of modeling studies. The studies do not always clearly describe the intervention. The intervention and infection costs and the sources for these costs are not always explicit or are missing. In modeling studies, there is uncertainty associated with some key model inputs, but these inputs are not always identified. The models utilized in the modeling studies are not always tested for internal consistency or validity. Studies usually test the short term cost-effectiveness of Intensified Interventions but not the long results.^ Our study limitation was the inability to adjust for differences in study settings, intervention costs, disease costs, or effectiveness measures. Our study strength is the presentation of a focused literature review of Intensified Interventions in hospital settings. Through this study we provide information that will help decision makers at regional level, help guide future research, and might change clinical care and policies. ^

Analytic hierarchy process helps evaluate projects in Indian oil pipeline industry

Conventionally, oil pipeline projects are evaluated thoroughly by the owner before investment decision is made using market, technical and financial analysis sequentially. The market analysis determines pipelines throughput and supply and demand points. Subsequent, technical analysis identifies technological options and economic and financial analysis then derives the least cost option among all technically feasible options. The subsequent impact assessment tries to justify the selected option by addressing environmental and social issues. The impact assessment often suggests alternative sites, technologies, and/or implementation methodology, necessitating revision of technical and financial analysis. This study addresses these issues via an integrated project evaluation and selection model. The model uses analytic hierarchy process, a multiple-attribute decision-making technique. The effectiveness of the model has been demonstrated through a case application on cross-country petroleum pipeline project in India.

Project risk management in analytic framework

Risks and uncertainties are part and parcel of any project as projects are planned with many assumptions. Therefore, managing those risks is the key to project success. Although risk is present in all most all projects, large-scale construction projects are most vulnerable. Risk is by nature subjective. However, managing risk subjectively posses the danger of non-achievement of project goals. This study introduces an analytical framework for managing risk in projects. All the risk factors are identified, their effects are analyzed, and alternative responses are derived with cost implication for mitigating the identified risks. A decision-making framework is then formulated using decision tree. The expected monetary values are derived for each alternative. The responses, which require least cost is selected. The entire methodology has been explained through a case study of an oil pipeline project in India and its effectiveness in managing projects has been demonstrated. © INTERNATIONAL JOURNAL OF INDUSTRIAL ENGINEERING.

Integrated approach to project feasibility analysis:a case study

Feasibility studies of industrial projects consist of multiple analyses carried out sequentially. This is time consuming and each analysis screens out alternatives based solely on the merits of that analysis. In cross-country petroleum pipeline project selection, market analysis determines throughput requirement and supply and demand points. Technical analysis identifies technological options and alternatives for pipe-line routes. Economic and financial analysis derive the least-cost option. The impact assessment addresses environmental issues. The impact assessment often suggests alternative sites, routes, technologies, and/or implementation methodology, necessitating revision of technical and financial analysis. This report suggests an integrated approach to feasibility analysis presented as a case application of a cross-country petroleum pipeline project in India.

Application of Volterra Equations to Solve Unit Commitment Problem of Optimised Energy Storage and Generation

Development of reliable methods for optimised energy storage and generation is one of the most imminent challenges in modern power systems. In this paper an adaptive approach to load leveling problem using novel dynamic models based on the Volterra integral equations of the first kind with piecewise continuous kernels. These integral equations efficiently solve such inverse problem taking into account both the time dependent efficiencies and the availability of generation/storage of each energy storage technology. In this analysis a direct numerical method is employed to find the least-cost dispatch of available storages. The proposed collocation type numerical method has second order accuracy and enjoys self-regularization properties, which is associated with confidence levels of system demand. This adaptive approach is suitable for energy storage optimisation in real time. The efficiency of the proposed methodology is demonstrated on the Single Electricity Market of Republic of Ireland and Northern Ireland.

Process Selection Using Variation and Cost Relations

Variations are inherent in all manufacturing processes and can significantly affect the quality of a final assembly, particularly in multistage assembly systems. Existing research in variation management has primarily focused on incorporating GD&T factors into variation propagation models in order to predict product quality and allocate tolerances. However, process induced variation, which has a key influence on process planning, has not been fully studied. Furthermore, the link between variation and cost has not been well established, in particular the effect that assembly process selection has on the final quality and cost of a product. To overcome these barriers, this paper proposes a novel method utilizing process capabilities to establish the relationship between variation and cost. The methodology is discussed using a real industrial case study. The benefits include determining the optimum configuration of an assembly system and facilitating rapid introduction of novel assembly techniques to achieve a competitive edge.

A Cost Analysis Of Carbon Dioxide Emission Reduction Strategies For New Plants In Michigan's Electric Power Sector

This thesis attempts to find the least-cost strategy to reduce CO2 emission by replacing coal by other energy sources for electricity generation in the context of the proposed EPA’s regulation on CO2 emissions from existing coal-fired power plants. An ARIMA model is built to forecast coal consumption for electricity generation and its CO2 emissions in Michigan from 2016 to 2020. CO2 emission reduction costs are calculated under three emission reduction scenarios- reduction to 17%, 30% and 50% below the 2005 emission level. The impacts of Production Tax Credit (PTC) and the intermittency of renewable energy are also discussed. The results indicate that in most cases natural gas will be the best alternative to coal for electricity generation to realize CO2 reduction goals; if the PTC for wind power will continue after 2015, a natural gas and wind combination approach could be the best strategy based on the least-cost criterion.

Digestibility of plant protein-based diets by largemouth bass Micropterus salmoides

Commercial farming of carnivorous fish demands the reduction of environmental impact of feeds; that requires minimal use of dietary animal protein. This study investigated the digestibility of diets formulated exclusively out of plant protein, added feed attractants, by the carnivore largemouth bass, Micropterus salmoides. Juvenile largemouth bass (14.0 +/- 1.0 cm) conditioned to accept artificial, dry feed were confined in polypropylene cages and fed ad libitum in three daily meals, seven experimental diets containing varying levels of vegetable and animal protein sources, added of different feed stimulants. After last daily meal, cages were transferred to cylindrical-conical-bottomed, 200-L aquaria, where faeces were collected by sedimentation into refrigerated containers, preserved and later analysed for chemical composition. Soybean meal can be used as partial substitute of animal protein in diets for largemouth bass; the poultry by-product meal shows as a good option as animal protein source in these rations. Control treatment - 50PP : 50AP - yielded best performances; the need for the use of fish meal in the formulation for carnivorous diets is, at least, questionable. Results of the digestibility trials demonstrated the importance of determining the diet digestibility, if precision in the formulation of least-cost feeds for carnivorous fish is the ultimate goal.