Carbon footprint of the RSNA annual meeting.

PURPOSE: To determine the airplane travel-related carbon footprint of the Radiological Society of North America (RSNA) annual meeting, the associated health burden, and the costs to offset these greenhouse gas emissions (i.e. compensation of emissions by funding an equivalent CO2 saving elsewhere). METHODS: The RSNA's website was used to determine the reported country of origin of attendees to the 2017 meeting that took place in Chicago from November 26 to December 1. It was assumed that attendees had traveled from the airport nearest to the largest city in their country or state to Chicago's O'Hare international airport. The total amount of air travel-related CO2-equivalent emission (based on round-trip economy class travel), the imposed health burden in terms of disability-adjusted life years (DALYs) in the global population, the total CO2 offsets costs, and the CO2 offsets costs per DALY were calculated. RESULTS: The calculated airplane travel-related CO2-equivalent emissions of 11,223 attendees from the United States and 10,684 attendees from other countries were 7,067,618 kg and 32,438,420 kg, totaling 39,506,038 kg. This caused an estimated 51.4-79.0 DALYs. The calculated amount of Total CO2 offset costs were calculated to be $474,072, which corresponds to $6,001-9,223 per DALY averted. CONCLUSIONS: The airplane travel-related carbon footprint of the RSNA annual meeting and the associated disease burden are relevant, and potential attendees and organizers should take measures to overcome this undesired side effect. Offsetting this carbon footprint is cost-effective and this initiative should be taken by the radiological community.

Development of interval-valued fuzzy GRA with SERVPERF based on subjective and objective weights for evaluation of airline service quality: A case study of Korea low-cost carriers.

As the airline industry has become ever-more competitive and profitability more tenuous, airline service quality management has grown more important to airlines. Although many studies have focused on the evaluation of airline service quality, some common limitations need to be noted. First, traditional fuzzy logics were utilized to present linguistic variables as fuzzy numbers. However, precise quantification of lower and upper bounds with a single number is often difficult; thus, interval-valued fuzzy sets that represent the lower and upper bounds in the fuzzy number as an interval form should be applied instead. Second, while some studies have applied various multiple-criteria decision-making method [MCDM] and the service quality (SERVQUAL) method for evaluation of airline service quality, few have utilized grey relational analysis (GRA, a simple and data-driven MCDM method applicable to environments with incomplete information) and the service performance (SERVPERF), a performance-based measure that can resolve the ambiguity issue of the expectations construct in SERVQUAL. Third, extant studies dealing with the issue of weighting criteria in the evaluation of airline service quality have focused only on either subjective or objective weights, though weighting criteria based on a combined objective/subjective approach would be much better than those just considering the subjective approach. The present study endeavored to fill these literature gaps by developing, for evaluation of airline service quality, interval-valued fuzzy GRA with SERVPERF based on both subjective and objective weights. It contributes to the field by incorporating the 22 criteria from SERVPERF to effectively account for the various characteristics of airline service. Additionally, it is the first study to utilize interval-valued fuzzy GRA together with a novel technique that combines a subjective/objective weighting method for integration of objective decision-matrix-derived information with subjective decision-maker preferences. The supplemental empirical case study of airline service evaluation, further, provides researchers and practitioners with a means of better understanding the proposed approach in the practical perspectives.

Return on Investment Analysis of Health Experts onLine at Portsmouth: A 2-Year Review of the Navy's Newest Teleconsultation System.

BACKGROUND: Health Experts onLine at Portsmouth (HELP) is a web-based teleconsultation system launched in June 2014 to facilitate communication between specialists at Naval Medical Center Portsmouth and providers assigned to both the fleet forces and primary care clinics across the eastern United States, Europe, and the Middle East. Specialist consultations through the HELP system purport to improve access to care for patients who otherwise might be referred to the civilian network or medically evacuated (MEDEVACed) to Naval Medical Center Portsmouth for specialized care. If HELP-facilitated communications help avoid civilian referrals or MEDEVACs, the associated costs of that care should be reduced. METHODS: We evaluated cost savings associated with prevented MEDEVACs by analyzing both tangible savings (prevented costs of flights, per diems, and consults) and intangible savings (reduced lost productivity time). We compared these savings to the costs of maintaining and utilizing the HELP system: startup costs, administrative costs, and provider time costs. We used patient and provider data from the HELP database to evaluate clinical consult cases. Before this analysis, a panel of 3 physicians associated with HELP reviewed each consult to determine whether a case qualified as a prevented MEDEVAC. Data from the Military Health System (MHS) Management and Analysis Reporting Tool and the MHS Data Repository were used to estimate costs associated with provider time, patient time, and direct care medical encounters. FINDINGS: The HELP program delivered measurable, positive returns on investment (ROIs) between June 2014 and December 2015. In that time frame, 559 consult cases occurred in the HELP system. Of the 559 total consult cases, 50 consults prevented MEDEVACs. Incorporating only tangible savings, HELP produced an 80% ROI on the basis of prevented medical evacuations; the addition of intangible savings such as reduced lost productivity increased the ROI to 250%. The dollar values of these savings were $693,461 and $1,337,628, respectively. IMPACT: The HELP program produces considerable savings (both tangible and intangible) to the Military Healthcare System for small costs. It does this both by increasing access to care at previously inaccessibly remote medical treatment facilities and by consequently decreasing the forward provider's reliance on medical evacuation in questionable cases. This positive ROI was potentially underestimated as this analysis did not account for recapture of care that would otherwise have been sent to the civilian market. On the basis of this analysis, a low bandwidth, asynchronous, and internet accessible teleconsultation system is both a feasible and effective means of projecting quality care forward into the deployed setting. Future implementation of similar initiatives throughout the MHS can be expected, and will likely draw from the lessons learned during the successful implementation and execution of the HELP system.