Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized th...Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.展开更多
Background:As well as imposing an economic burden on affected households,the high costs related to tuberculosis(TB)can create access and adherence barriers.This highlights the particular urgency of achieving one of th...Background:As well as imposing an economic burden on affected households,the high costs related to tuberculosis(TB)can create access and adherence barriers.This highlights the particular urgency of achieving one of the End TB Strategy’s targets:that no TB-affected households have to face catastrophic costs by 2020.In Indonesia,as elsewhere,there is also an emerging need to provide social protection by implementing universal health coverage(UHC).We therefore assessed the incidence of catastrophic total costs due to TB,and their determinants since the implementation of UHC.Methods:We interviewed adult TB and multidrug-resistant TB(MDR-TB)patients in urban,suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier.Following the WHO recommendation,we assessed the incidence of catastrophic total costs due to TB.We also analyzed the sensitivity of incidence relative to several thresholds,and measured differences between poor and non-poor households in the incidence of catastrophic costs.Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs.Results:We analyzed 282 TB and 64 MDR-TB patients.For TB-related services,the median(interquartile range)of total costs incurred by households was 133 USD(55-576);for MDR-TB-related services,it was 2804 USD(1008-4325).The incidence of catastrophic total costs in all TB-affected households was 36%(43%in poor households and 25%in non-poor households).For MDR-TB-affected households,the incidence was 83%(83%and 83%).In TB-affected households,the determinants of catastrophic total costs were poor households(adjusted odds ratio[aOR]=3.7,95%confidence interval[CI]:1.7-7.8);being a breadwinner(aOR=2.9,95%CI:1.3-6.6);job loss(aOR=21.2;95%CI:8.3-53.9);and previous TB treatment(aOR=2.9;95%CI:1.4-6.1).In MDR-TB-affected households,having an income-earning job before diagnosis was the only determinant of catastrophic total costs(aOR=8.7;95%CI:1.8-41.7).Conclusions:Despite the implementation of UHC,TB-affected households still risk catastrophic total costs and further impoverishment.As well as ensuring access to healthcare,a cost-mitigation policy and additional financial protection should be provided to protect the poor and relieve income losses.展开更多
Widespread adoption of electric vehicles(EVs)is a common and critical component of international strategies to mitigate environmental pollution,climate change and oil dependency.The ability of consumers to assess the ...Widespread adoption of electric vehicles(EVs)is a common and critical component of international strategies to mitigate environmental pollution,climate change and oil dependency.The ability of consumers to assess the total cost of ownership(TCO)of EVs relative to internal combustion engine vehicles(ICEVs)remains an important factor for EV uptake.The TCO of vehicles is not universal across different car segments and user profiles.We analyse and compare the TCO of ICEVs and EVs from 17 car segments across short-and long-term ownership periods,and further advance existing TCO approaches by integrating detailed activity-based driving profiles,taxation,grant structures and pricing.Results show that EV options in the most popular Irish car segments have existing battery EV options with a TCO averaging respectively 26% and 42% less than their equivalent petrol and diesel ICEV options over a 4-year ownership term when the current grant is included.This integrated method for granular TCO evaluation offers important insights for this market and affords scope to investigate how changes in travel patterns,car-segment pricing,taxation,grant policy,fuel costs,and carbon pricing and other transport policies can all affect TCO values over time across a broad range of market offerings.展开更多
The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question t...The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question that whether lower length of stay and higher utilization of post-op facilities would be helpful to control the overall costs. Using the National Hospital Discharge Survey (NHDS) database and cost data from Blue Cross Blue shield, this study seeks to identify which U.S. region renders the highest quality patient care during a three-year span of 2008-2010. Using length of stay and discharge disposition (2010) as input factors, and regional TKA costs (2013) as output factors, Data Envelopment Analysis (DEA), a non-parametric method, illustrated the efficiency ranking of four regions in the US on TKA expenditures. The result shows the West is the most efficient region on controlling the overall cost by shrinking the length of stay and increasing the utilization of short-term/long-term care facilities.展开更多
商用车碳减排已经成为我国道路交通减碳的关键瓶颈,新能源商用车被视作重型商用车减碳的重要途径,但是新能源商用车的市场渗透率远低于其他车辆部门;但与此同时,现阶段新能源零碳商用车的发展还存在着应用场景复杂、技术路径多样化、同...商用车碳减排已经成为我国道路交通减碳的关键瓶颈,新能源商用车被视作重型商用车减碳的重要途径,但是新能源商用车的市场渗透率远低于其他车辆部门;但与此同时,现阶段新能源零碳商用车的发展还存在着应用场景复杂、技术路径多样化、同时成本较高的显著的瓶颈。本研究构建了基于新能源汽车总拥有成本(total cost of ownership,TCO)、使用便利性等因素的多元Logit离散选择模型——零碳商用车市场演进模型(discrete choice-based market evolution of green truck model,DC-MEGT),使用自下向上的方法计算TCO,并将车辆使用便利性使用补能时间成本进行货币化量化,构建综合效用函数对纯电动车、燃料电池汽车及零碳燃料等不同动力类型从目前到2060年的市场渗透率演进情况进行预测分析。研究以重型长途牵引场景为例进行分析,结果表明2060年主要的技术路径包括燃料电池汽车、纯电动车、天然气及柴油车,占比分别为48%、28%、12%和10%。政策推广、技术进步、商业模式等因素的不确定性会引发纯电动车和燃料电池汽车2060年市场份额17%~19%的波动。展开更多
文摘Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.
基金This study was funded by Indonesian Endowment Fund for Education(Lembaga Pengelola Dana Pendidikan,LPDP),Indonesia.
文摘Background:As well as imposing an economic burden on affected households,the high costs related to tuberculosis(TB)can create access and adherence barriers.This highlights the particular urgency of achieving one of the End TB Strategy’s targets:that no TB-affected households have to face catastrophic costs by 2020.In Indonesia,as elsewhere,there is also an emerging need to provide social protection by implementing universal health coverage(UHC).We therefore assessed the incidence of catastrophic total costs due to TB,and their determinants since the implementation of UHC.Methods:We interviewed adult TB and multidrug-resistant TB(MDR-TB)patients in urban,suburban and rural areas of Indonesia who had been treated for at least one month or had finished treatment no more than one month earlier.Following the WHO recommendation,we assessed the incidence of catastrophic total costs due to TB.We also analyzed the sensitivity of incidence relative to several thresholds,and measured differences between poor and non-poor households in the incidence of catastrophic costs.Generalized linear mixed-model analysis was used to identify determinants of the catastrophic total costs.Results:We analyzed 282 TB and 64 MDR-TB patients.For TB-related services,the median(interquartile range)of total costs incurred by households was 133 USD(55-576);for MDR-TB-related services,it was 2804 USD(1008-4325).The incidence of catastrophic total costs in all TB-affected households was 36%(43%in poor households and 25%in non-poor households).For MDR-TB-affected households,the incidence was 83%(83%and 83%).In TB-affected households,the determinants of catastrophic total costs were poor households(adjusted odds ratio[aOR]=3.7,95%confidence interval[CI]:1.7-7.8);being a breadwinner(aOR=2.9,95%CI:1.3-6.6);job loss(aOR=21.2;95%CI:8.3-53.9);and previous TB treatment(aOR=2.9;95%CI:1.4-6.1).In MDR-TB-affected households,having an income-earning job before diagnosis was the only determinant of catastrophic total costs(aOR=8.7;95%CI:1.8-41.7).Conclusions:Despite the implementation of UHC,TB-affected households still risk catastrophic total costs and further impoverishment.As well as ensuring access to healthcare,a cost-mitigation policy and additional financial protection should be provided to protect the poor and relieve income losses.
基金supported by the China Scholarship Council(CSC)(Grant No.201708300027)the Environmental Protection Agency of Ireland.
文摘Widespread adoption of electric vehicles(EVs)is a common and critical component of international strategies to mitigate environmental pollution,climate change and oil dependency.The ability of consumers to assess the total cost of ownership(TCO)of EVs relative to internal combustion engine vehicles(ICEVs)remains an important factor for EV uptake.The TCO of vehicles is not universal across different car segments and user profiles.We analyse and compare the TCO of ICEVs and EVs from 17 car segments across short-and long-term ownership periods,and further advance existing TCO approaches by integrating detailed activity-based driving profiles,taxation,grant structures and pricing.Results show that EV options in the most popular Irish car segments have existing battery EV options with a TCO averaging respectively 26% and 42% less than their equivalent petrol and diesel ICEV options over a 4-year ownership term when the current grant is included.This integrated method for granular TCO evaluation offers important insights for this market and affords scope to investigate how changes in travel patterns,car-segment pricing,taxation,grant policy,fuel costs,and carbon pricing and other transport policies can all affect TCO values over time across a broad range of market offerings.
文摘The purpose of this research is to evaluate clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States between 2010 and 2013. We tried to answer the question that whether lower length of stay and higher utilization of post-op facilities would be helpful to control the overall costs. Using the National Hospital Discharge Survey (NHDS) database and cost data from Blue Cross Blue shield, this study seeks to identify which U.S. region renders the highest quality patient care during a three-year span of 2008-2010. Using length of stay and discharge disposition (2010) as input factors, and regional TKA costs (2013) as output factors, Data Envelopment Analysis (DEA), a non-parametric method, illustrated the efficiency ranking of four regions in the US on TKA expenditures. The result shows the West is the most efficient region on controlling the overall cost by shrinking the length of stay and increasing the utilization of short-term/long-term care facilities.
文摘商用车碳减排已经成为我国道路交通减碳的关键瓶颈,新能源商用车被视作重型商用车减碳的重要途径,但是新能源商用车的市场渗透率远低于其他车辆部门;但与此同时,现阶段新能源零碳商用车的发展还存在着应用场景复杂、技术路径多样化、同时成本较高的显著的瓶颈。本研究构建了基于新能源汽车总拥有成本(total cost of ownership,TCO)、使用便利性等因素的多元Logit离散选择模型——零碳商用车市场演进模型(discrete choice-based market evolution of green truck model,DC-MEGT),使用自下向上的方法计算TCO,并将车辆使用便利性使用补能时间成本进行货币化量化,构建综合效用函数对纯电动车、燃料电池汽车及零碳燃料等不同动力类型从目前到2060年的市场渗透率演进情况进行预测分析。研究以重型长途牵引场景为例进行分析,结果表明2060年主要的技术路径包括燃料电池汽车、纯电动车、天然气及柴油车,占比分别为48%、28%、12%和10%。政策推广、技术进步、商业模式等因素的不确定性会引发纯电动车和燃料电池汽车2060年市场份额17%~19%的波动。
