Towards Eradication of PPR: Disease Status, Economic Cost and Perception of Veterinarians in Karnataka, India.

In this study, we assessed the PPR disease status, its economic cost, the financial viability of vaccination, and the perspectives of field veterinarians on the PPR vaccination programme implemented in Karnataka state, India. In addition to secondary data, cross-sectional surveys undertaken during 2016-17 (survey I) and 2018-19 (survey II) from 673 sheep and goat flocks and data collected from 62 veterinarians were analysed. The economic costs and perceptions of veterinarians were analysed using deterministic models and the Likert scale, respectively, and the financial viability of vaccination programmes under the best (15%), base (20%), and worst-case (25%) PPR incidence scenarios, considering two different vaccination plans (plan I and plan II), was assessed. The disease incidence in sheep and goats was found to be 9.8% and 4.8% in survey I and survey II, respectively. In consonance with the increased vaccination coverage, the number of reported PPR outbreaks in the state declined significantly. The estimated farm-level loss of PPR varied between the surveyed years. Even under the best-incidence scenario, under vaccination plan-I and plan-II, the estimated benefit-cost ratio (18.4:1; 19.7:1), the net present value (USD 932 million; USD 936 million) and the internal rate of return (412%) implied that the vaccination programmes were financially viable and the benefits outweighed the cost. Though the majority of veterinarians perceived that the control programme was well planned and rolled out in the state, a few of them disagreed or were neutral towards the plan per se, towards the coordination between functionaries, the availability of funding, and the programme acceptance by farmers. Despite many years of vaccination, PPR still persists in the Karnataka state for various reasons and in order to eradicate the disease, a review of the existing control programme with strong facilitation from the federal government is needed.

The Bottom Line: Trauma Center Viability During COVID-19.

INTRODUCTION: The COVID-19 pandemic was a potential threat to the viability of trauma centers and health systems in general. We sought to answer the question of how COVID-19 was associated with patient characteristics as well as trauma center volume, finances, and viability. METHODS: We reviewed 6375 patients admitted to our verified Level 1 trauma center during two time periods: pre-COVID (February 2019-February 2020) and COVID (March 2020-March 2021). Three thousand ninety-nine patients were admitted pre-COVID and 3276 were admitted during COVID. Data including case-mix index (CMI), total contribution margin, insurance status, age, race, gender, ethnicity, and injury mechanism were collected from the trauma registry and finance databases and analyzed. A P < 0.05 was considered significant. RESULTS: Trauma admissions decreased initially during COVID but returned to and ultimately surpassed admission trends pre-COVID. Trauma revenue and patient acuity increased significantly along with a decrease in the number of underinsured patients during COVID. When evaluating all service lines, the trauma center was the highest contributor to overall hospital revenue. CONCLUSIONS: Despite a decrease in admissions for other service lines and a pause in elective surgeries during the pandemic, the trauma center remained unaffected. In addition, trauma was the most significant contributor to the bottom line of the health system. These findings underscore the need to maintain and even increase trauma center resources and staffing to ensure that optimal care is provided to critically ill and injured patients.

Energy and stochastic economic assessment for distributed power generation from Manipueira biogas.

Cassava is a staple food in many countries, and this food source differs from other crops in that its processing generates a highly polluting and toxic residue (manipueira) that requires further treatment. The present study analyzed the economic feasibility of anaerobic digestion of manipueira for producing clean electricity through distributed generation (DG) while simultaneously eliminating toxic compounds. This eliminates the toxic residues. For this, an approach for the sizing of DG plants from manipueira biogas was presented, a non-trivial task which is not widespread in the literature. For two plants with different capacities, a deterministic economic analysis was carried out based on the criteria of Net Present Value, Internal Rate of Return, and Discounted Payback. Finally, the project risk was assessed through a sensitivity and stochastic analysis using Monte Carlo Simulation. The empirical verification was done on Brazilian data. When considering the NPV criterion, the results indicate a feasibility probability of 9.25% and 81.21% for scenarios 01 and 02, respectively. The results show that scale gains were important in reducing the impact of the investment and, at the same time, the larger scale of the project makes the cost of capital more relevant to the result. These findings show the need for subsidies for the investment, in addition to the promotion of specific credit lines that enable small-scale generation, or that can improve results in greater capacity.

Financial viability of a community-based health insurance scheme in two districts of northeast Ethiopia: a mixed methods study.

BACKGROUND: Community-based health insurance initiatives in low- and middle-income countries encountered a number of sustainability challenges due to their voluntary nature, small risk pools, and low revenue. In Ethiopia, the schemes' financial viability has not been well investigated so far. This study examined the scheme's financial viability and explored underlying challenges from the perspectives of various key stakeholders. METHODS: This study employed a mixed methods case study in two purposively selected districts of northeast Ethiopia. By reviewing financial reports of health insurance schemes, quantitative data were collected over a seven years period from 2014 to 2020 to examine trends in financial status. Trends for each financial indicator were analyzed descriptively for the period under review. Interviews were conducted face-to-face with nine community members and 19 key informants. We used the maximum variation technique to select the study participants. Interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was applied with both inductive and deductive coding methods. RESULTS: Both schemes experienced excess claims costs and negative net income in almost all the study period. Even after government subsidies, the scheme's net income remained negative for some reporting periods. The challenges contributing to the observed level of financial performance have been summarized under five main themes, which include adverse selection, moral hazard behaviors, stockout of medicines, delays in claims settlement for service providers, and low insurance premiums. CONCLUSIONS: The health insurance scheme in both districts spent more than it received for claims settlement in almost all the period under the study, and experienced heavy losses in these periods, implying that it is not financially viable for the period in question. The scheme is also unable to fulfill its purpose of protecting members against out-of-pocket expenses at the point of health care. Interventions should target on the highlighted challenges to restore financial balance and enhance the scheme's viability.

A system-based operational assessment of external beam radiotherapy.

PURPOSE: Advanced technologies have led to improvements in modern radiotherapy over the years. However, adoption of advanced technologies can present challenges to existing clinical operations and negatively impact safety. The purpose of this work is to perform an assessment of modern radiotherapy for the operational objectives of safety, efficiency, and financial viability. METHODS: This work focuses on external beam radiotherapy (EBRT). The operational assessment included department management, treatment planning, treatment delivery, and associated workflows for three equipment configurations of Ethos, Halcyon, and TrueBeam with the ARIA information system, Eclipse treatment planning, and IDENTIFY surface guidance. Systems-theoretic process analysis (STPA) was used to analyze the related workflows. Control actions, unsafe contexts of those control actions, and associated causal scenarios that can lead to unsafe radiation and non-radiation physical injury (safety objective), reduced treatment capacity (efficiency objective), and costs that exceed budget (financial viability objective) were identified. RESULTS: The number of control actions (and causal scenarios) were 18 (254), 18 (267), and 20 (267) for the equipment configurations of Halcyon, TrueBeam, and Ethos, respectively. The extent that safety, efficiency, and financial viability were impacted is similar across the different equipment configurations, but there were some noteworthy differences related to information transfer and workflow bottlenecks potentially impacting access to care. Seventy-five percent of the scenarios across all three configurations were related to safety. Overall, 29% of the scenarios impacted more than one operational objective and 48% were related to human decisions during the process of care. Planned or unplanned process changes were responsible for 8% of the causal scenarios. CONCLUSIONS: Broad-based clinical improvements may be realized by addressing causal scenarios that impact multiple objectives. Redesigning the roles and responsibilities of the clinical team and some aspects of the radiotherapy workflow may be helpful to fully realize the benefits of advanced technologies. Radiotherapy may benefit from additional tools to improve the consistency between decisions and actions when system or process changes occur.

Independent restaurant operator perspectives in the wake of the COVID-19 pandemic.

The purpose of this study was to assess the perceptions and attitudes of South Carolina independent full-service restaurant operators in relation to the operational and economic effects of the COVID-19 pandemic. The study utilized a mixed-methods approach that first partnered with local administrative and governmental bodies to disseminate a short survey. The survey was open to respondents for a 5-week period, beginning May 4th, 2020, which was when restaurants were permitted to reopen indoor dining, but with seating capacity restrictions to ensure social distancing. The second qualitative stage employed semi-structured post-survey interviews with selected independent restaurant operators from across the state. The results indicated that 25% of the restaurants polled did not survive the nearly two-month closure. Less than a quarter of respondents were unable to bring back their company's employees to pre-pandemic levels. The CARES Act financial relief programs were favored by most (81%) of the surveyed restaurant operators. Approximately 65% of the respondents did not feel they could keep their restaurants open if the pandemic restrictions remained in place until 2021. The respondents were split as to the future viability of the hospitality and tourism industry. The study offers guidance and managerial strategies for other independent full-service restaurant operators, as the COVID-19 pandemic continues to evolve.

Varying Trends In The Financial Viability Of US Rural Hospitals, 2011-17.

The financial viability of rural hospitals has been a matter of serious concern, with ongoing closures affecting rural residents' access to medical services. We examined the financial viability of 1,004 US rural hospitals that had consistent rural status in 2011-17. The median overall profit margin improved for nonprofit critical access hospitals (from 2.5 percent to 3.2 percent) but declined for other hospitals (from 3.0 percent to 2.6 percent for nonprofit non-critical access hospitals, from 3.2 percent to 0.4 percent for for-profit critical access hospitals, and from 5.7 percent to 1.6 percent for for-profit non-critical access hospitals). Occupancy rate and charge markup were positively associated with overall margins: In 2017 hospitals with low versus high occupancy rates had median overall profit margins of 0.1 percent versus 4.7 percent, and hospitals with low versus high charge markups had median overall margins of 1.8 percent versus 3.5 percent. Rural hospital financial viability deteriorated in states that did not expand eligibility for Medicaid and was lower in the South. Rural hospitals that closed during the study period had a median overall profit margin of -3.2 percent in their final year before closure. Policy makers should compare the incremental cost of providing essential services between hospitals and other settings to balance access and efficiency.

Modelo de avaliação da viabilidade econômico-financeira da implantação de usinas de reciclagem de resíduos da construção civil em municípios brasileiros / Economic and financial viability evaluation model for the implementation of waste recycling plants construction in Brazilian municipalities

RESUMO Este trabalho teve como objetivo geral desenvolver um modelo de avaliação da viabilidade econômico-financeira da implantação de usinas de reciclagem de resíduos da construção civil e demolição (URRCD) em municípios brasileiros. O modelo de avaliação proposto para cada projeto de investimento (PI) em estudo uniu o modelo de negócio Canvas, o plano de negócios, a metodologia multi-índice proposta por Souza e Clemente (2009) e ampliada por Lima et al. (2015) por meio do aplicativo web $AVEPI. Também foi realizada uma análise de sensibilidade por meio de limites de elasticidade e valores-limite, bem como uma análise estocástica utilizando a simulação de Monte Carlo (SMC). Com base na proposição desse modelo, este foi aplicado em um estudo de caso no município de Pato Branco (PR). Os resultados mostram que há viabilidade econômico-financeira na implantação desse PI, uma vez que o valor presente líquido médio é de aproximadamente R$ 583.919,87, e a recuperação do investimento se concretizará em 12 anos (payback). Por meio da SMC, visualizou-se que há alta probabilidade (99,78%) de que o investimento na URRCD de Pato Branco seja rentável. Entretanto, os índices de elasticidade mostraram que é preciso monitorar as receitas esperadas e os custos estimados com mais atenção. Assim, será preciso um trabalho, por parte dos gestores da URRCD, em prol de sempre estarem buscando aumentar a demanda pelos agregados reciclados, como maneira de aumentar a receita da usina, desde que se respeite a sua capacidade de produção.

ABSTRACT This work had as main objective to develop an evaluation model for analyzing the economic and financial feasibility of implementing Construction and Demolition Waste Recycling Plants (URRCD) in Brazilian municipalities. The evaluation model proposed for the Investment Project (IP) under study was performed using the business model Canvas, the business plan, the multi-index method proposed by Souza and Clemente (2009) and expanded by Lima et al. (2015) through the $AVEPI Web app. Also, a sensitivity analysis was performed, through the elasticity limits and limit values as well as a stochastic analysis using the Monte Carlo Simulation (MCS). From the proposition of this model, it was applied in a case study in Pato Branco, Paraná. The results showed that there is economic and financial viability in the implementation of this IP, since the average Net Present Value (NPV) is about R$ 583,919.87 and the investment recovery will materialize in 12 years (Payback). Through MCS, it was observed that there is a high probability (99.78%) that the investment in the URRCD of Pato Branco, Paraná, be profitable. However, the elasticity indices showed that it is necessary to monitor the expected revenues and the estimated costs with more attention. Thus, it will require a work by the managers of the URRCD, in favor of always seeking to increase the demand for recycled aggregates, as a way to increase the revenue of the plant, as long as it does not exceed its production capacity.

Gene Therapy for Cancer - A New Dimension and Challenge for Insurers.

Due to an increasingly better understanding of the human genome, the number of potential molecular targets, and therefore, potential applications by gene therapies is also increasing. After almost two decades of basic research, the first gene therapeutics are now entering the market. They are among the most expensive types of treatment in medicine. Over the next 10 years, the number and volume of their applications will increase significantly. So, our healthcare systems and inherently health insurance companies will face considerable challenges that will require new approaches to financial solutions. This article first describes the mode of action of the first gene therapies of cancer and their by now known side effects. Subsequently, the cost problems are dealt with and possible financing options are pointed out.

Estudo de viabilidade econômica da implantação de uma usina de reciclagem de resíduos da construção civil no município de Pato Branco (PR), utilizando a metodologia multi-índice ampliada / Economic feasibility study of the implementation of a waste recycling plant construction in Pato Branco city, Paraná, using the multi-index methodology extended

RESUMO Este artigo analisou a viabilidade econômica da instalação de uma usina de reciclagem de resíduos da construção civil, por meio das expectativas de retorno e risco associadas à sua implantação. A análise do investimento em estudo foi realizada utilizando-se a metodologia multi-índice por meio do sistema Web $LV€P. Também foi realizada uma análise estocástica utilizando a Simulação de Monte Carlo como forma de melhor analisar os riscos envolvidos no projeto. Os resultados mostraram que há viabilidade econômica e baixo risco na implantação dessa usina, pois a probabilidade de o valor presente líquido (VPL) ser menor que zero é de 0,22%. A análise preliminar realizada mostrou que a decisão de investir nesse empreendimento se apresenta como uma boa opção de investimento, sendo recomendada a sua implementação por ser um projeto com possibilidades de bom retorno financeiro.

ABSTRACT This paper analyzed the economic feasibility of installing a construction waste recycling plant, through the return expectations and risks associated with its implementation. The investment analysis study was performed using multi-index methodology via the web system $LV€P. A stochastic analysis also was performed using the Monte Carlo simulation, in order to further analyze the risks involved in the project. The results showed that there is low risk and economic feasibility in implementation of this plant, because the probability of the Net Present Value NPV to be zero is less than 0.22%. The performed preliminary analysis showed that the decision to invest in this project is presented as a good investment option, and its implementation is recommended because it is a project with the possibility of a good financial return.

E-prescription as a tool for improving services and the financial viability of healthcare systems: the case of the Greek national e-prescription system.

E-prescription systems can help improve patient service, safety and quality of care. They can also help achieve better compliance for the patients and better alignment with the guidelines for the practitioners. The recently implemented national e-prescription system in Greece already covers approximately 85% of all prescriptions prescribed in Greece today (approximately 5.5 million per month). The system has not only contributed already in significant changes towards improving services and better monitoring and planning of public health, but also substantially helped to contain unnecessary expenditure related to medication use and improve transparency and administrative control. Such issues have gained increasing importance not only for Greece but also for many other national healthcare systems that have to cope with the continuous rise of medication expenditure. Our implementation has, therefore, shown that besides their importance for improving services, national e-prescription systems can also provide a valuable tool for better utilisation of resources and for containing unnecessary healthcare costs, thus contributing to the improvement of the financial stability and viability of the overall healthcare system.

Viabilidade financeira da utilização de quatro ordenhas nos primeiros 21 dias da lactação em vacas mestiças F1 Holandês/Zebu / Financial viability analyses of four milkings in the first 21 days of lactation in F1 crossbred Holstein-Zebu cows

Avaliou-se financeiramente o efeito de quatro ordenhas diárias nos primeiros 21 dias da lactação, seguidas de duas ordenhas diárias, com ou sem a sucção de leite pelo bezerro em um dos tetos durante a ordenha. Foram utilizadas 53 vacas F1 Holandês/Zebu multíparas. A produção e a composição do leite foram mensuradas a cada quatro dias até o 33º dia da lactação e, posteriormente, a cada 15 dias. Como indicador do desempenho financeiro dos diferentes grupos, foi utilizada a margem bruta. O experimento foi desenvolvido em delineamento inteiramente ao acaso, em arranjo fatorial 2x2. As produções médias de leite foram 16,7, 17,2, 19,0 e 18,9kg/d (PÂ0,01) para vacas ordenhadas duas e quatro vezes por dia, com ou sem a sucção do leite pelo bezerro durante a ordenha, respectivamente. O aumento da frequência de ordenhas nos primeiros 21 dias da lactação proporcionou incremento na produção de dois litros/dia e 17,3 por cento na margem bruta estimada com a venda de leite.

Fifty-three F1 crossbred Holstein-Zebu cows were used to evaluate financially the effects of four daily milkings until lactation day 21, and after this day two milkings, with or without suckling by the calf in one teat during milking. Milk production and composition were measured each four days until lactation day 33, and then each 15 days until the end of lactation. The experiment followed a completely randomized design in a 2x2 factorial. To analyze the financial viability of the different groups, the gross margin was used, as financial indicator. Milk productions were 16.7, 17.2, 19.0, and 18.9kg/day (PÂ0.01) for cows milked twice or four times a day with or without suckling by the calf, respectively. The rise of milking frequency increased milk production in two liters per day, and in 17.3 percent of estimated gross margin from the sale of milk.