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Cost Implications (cost + implication)
Selected AbstractsIndustry responses to EU WEEE and ROHS Directives: perspectives from ChinaCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 5 2006Jieqiong Yu Abstract The electrical and electronics (EE) industry has come under increasing pressure to adopt extended producer responsibility (EPR) policies through the introduction of the European Union's Directives on Waste Electrical and Electronic Equipment (WEEE) and the Restriction of Use of Certain Hazardous Substances (ROHS). Based on the findings of 50 questionnaires and in-depth interviews with China's EE manufacturers, this paper investigates the perception of and readiness of companies for implementation of WEEE and ROHS in China. It identifies key difficulties encountered by manufacturers in fulfilling the requirements and evaluates the effectiveness of these two directives in promoting environmental reform. The findings indicate that the extent of companies' responses largely depends on their market structure and client requirements. Supply chain management, raw material testing and cost implications appear to be key challenges in addressing issues surrounding the directives. There is little evidence to suggest that these directives have effectively driven China's EE manufacturers towards systematic eco-design. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] The Impact of Forecast Errors on Early Order Commitment in a Supply Chain,DECISION SCIENCES, Issue 2 2002Xiande Zhao ABSTRACT Supply chain partnership involves mutual commitments among participating firms. One example is early order commitment, wherein a retailer commits to purchase a fixed-order quantity and delivery time from a supplier before the real need takes place. This paper explores the value of practicing early order commitment in the supply chain. We investigate the complex interactions between early order commitment and forecast errors by simulating a supply chain with one capacitated supplier and multiple retailers under demand uncertainty. We found that practicing early order commitment can generate significant savings in the supply chain, but the benefits are only valid within a range of order commitment periods. Different components of forecast errors have different cost implications to the supplier and the retailers. The presence of trend in the demand increases the total supply chain cost, but makes early order commitment more appealing. The more retailers sharing the same supplier, the more valuable for the supply chain to practice early order commitment. Except in cases where little capacity cushion is available, our findings are relatively consistent in the environments where cost structure, number of retailers, capacity utilization, and capacity policy are varied. [source] Interventions for treating traumatized necrotic immature permanent anterior teeth: inducing a calcific barrier & root strengtheningDENTAL TRAUMATOLOGY, Issue 4 2009Mohammad A. D. Al Ansary This systematic review attempts to establish where the effects of interventions using multi-visit apexification, single visit apical plug techniques and root strengthening procedures are consistent and where they may vary significantly. Objectives:, To evaluate the relative effectiveness of apexification and apical plug techniques as well as root strengthening procedures for treating traumatized necrotic immature permanent anterior teeth through a systematic review of randomized controlled trials. Reported immediate and/or long-term adverse events and effects of the materials and techniques are also evaluated. Search strategy & selection criteria:, Structured electronic and hand search was performed with no restriction on the language of publication. Only randomized controlled trials comparing different apical barrier formation techniques and root strengthening procedures in traumatized necrotic immature anterior teeth were assessed. Results:, Two hundred studies were identified but only two were suitable for inclusion. Included studies investigated multi-visit apexification techniques using calcium hydroxide and tricalcium phosphate. There were no eligible studies investigating root strengthening procedures or any other intervention for apical barrier formation in necrotic immature anterior teeth. No reliable information was available on long-term adverse effects of the reported interventions or cost implications. Conclusions:, Based on two included studies, there is weak evidence supporting the use of either calcium hydroxide or tricalcium phosphate for apical barrier formation in necrotic immature anterior teeth employing multi-visit apexification techniques. The evidence is insufficient to provide guidelines for practice. There was no reliable evidence on adverse events or long-term effects after the use of calcium hydroxide or tricalcium phosphate justifying caution in their use in apical barrier formation techniques. [source] Small and Medium-Sized Congenital Nevi in Children: A Comparison of the Costs of Excision and Long-Term Follow-UpDERMATOLOGIC SURGERY, Issue 12 2009FERNANDO ALFAGEME ROLDÁN MD BACKGROUND Clinical decisions on whether to follow up or remove small and medium congenital melanocytic nevi (SMCMN) in children have cost implications that have not been studied. OBJECTIVES To compare the costs of excision of SMCMN in children with lifelong follow-up in a tertiary center. METHODS AND MATERIALS We elaborated models for the evaluation of the costs of excision and long-term follow-up. We retrospectively collected data on 113 consecutive excised SMCMN (105 single-step interventions and 8 multiple-step interventions) from the medical records of our pediatric dermatology unit from 2001 to 2007 and calculated and compared the costs (direct and indirect) of surgery and follow-up. RESULTS The mean ± standard deviation and total cohort costs for single-step interventions were ,1,504.73 ± 198.33 and 157,996.20, respectively. Median and cohort lifelong follow-up costs were similar if performed every 4 years (1,482.66 ± 34.98 and 156,679.63). For multiple-step interventions (3 or 4 steps), surgery costs were similar to those of annual lifelong follow-up. In the case of two-step surgery, costs were similar to lifelong follow-up every 2 years. CONCLUSIONS An analysis of the costs of surgery and long-term follow-up in children with SMCMN is possible. Although the clinical judgment of the dermatologist and parental opinion are the main determinants in the management of SMCMN, costs should also be taken into account. [source] Diabetes control and complications: the role of glycated haemoglobin, 25 years onDIABETIC MEDICINE, Issue 7 2004S. L. Jeffcoate Abstract The long-term complications of diabetes have major consequences for individual subjects and growing healthcare delivery and cost implications for society. Evidence for the benefits of good glycaemic control, as monitored by glycated haemoglobin measurements, has been developed in the 25 years since they were introduced to the point where HbA1c assays play central roles in patient management, clinical guidance and audit, and clinical trial design. In this review this evidence is examined and three classes of uncertainty identified that diminish confidence in the effectiveness of these roles for HbA1c. 1Analytical variability between different methods for HbA1c has restricted the application of clinical targets and this problem has recently been addressed by reference method standardization. There are two approaches to this which result in different HbA1c values and this discrepancy needs to be resolved. 2Biological variability in HbA1c values between individuals also restricts its predictive role when applied to populations. The correlations between HbA1c measurements and various components of glycaemia (overall, fasting, postprandial) are still uncertain and differences in protein glycation and de-glycation are greater between subjects than often thought. The influence of variability in erythrocyte life span is an area where research is needed, especially in diabetic subjects. 3Clinical variability is the most important and complex area of uncertainty. A predictive link between HbA1c and clinical outcomes is not as clear-cut as often stated. The correlation with the development of microvascular disease is well established in Type 1 diabetes, but in Type 2 subjects (90% of those with diabetes) the evidence that HbA1c monitoring is of value in predicting or preventing macrovascular disease is not strong, although it is the major cause of morbidity and early death in this group. It is recommended that, as a matter of urgency, these issues be examined, particularly within the context of self-care in diabetes. Diabet. Med. **, ***,*** (2003) [source] Disease burden of chronic lymphocytic leukaemia within the European UnionEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2008Louise Watson Abstract Objective:, Whilst Chronic lymphocytic leukaemia (CLL) is considered a rare disease, to our knowledge, the current prevalence of CLL within the European Union (EU) member states is not published. Understanding the number of individuals with CLL is vital to assess disease burden within the wider population. Methods:, Using 2002 data from the International Agency for Research on Cancer, we estimated the number of individuals with CLL (ICD-10 C91.1) from those reported for all leukaemias (C91,95) and extrapolated the figures by the population increase within the EU between 2002 and 2006, the last year with fully updated community population estimates. One- and 5-yr partial prevalence estimates are reported (i.e. the number of individuals still living 1,5 yr post-diagnosis). We then applied proportional estimates from the literature to assess those requiring immediate treatment, those under observation and their likely progression rates. Results:, We found that within the 27 EU states plus Iceland, Norway and Lichtenstein, 1- and 5-yr CLL partial prevalence estimates totalled approximately 13 952 and 46 633 individuals respectively in 2006. By applying Binet staging to the 1-yr estimate, 40% of patients will be stage B/C and require immediate treatment. Thus, 5581 individuals may be treated within the first year of diagnosis. Of the 60% (8371) under observation, by 5 yr up to 33% (2763) may have more advanced disease with increased risk of mortality. Conclusion:, Whilst CLL is a rare disease, the number of individuals burdened by the disease within the EU is considerable and thousands of patients require treatment and physician care, which has cost implications for member states. [source] In situ methods of measurement,an important line of evidence in the environmental risk frameworkINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 2 2007Jim Wharfe Abstract A tiered framework provides a structured approach to assess and manage risk and underpins much of the legislation concerning chemicals and environmental management. Management decisions regarding appropriate controls can have high cost implications to the regulated community. The risk framework provides an evidence-based approach to reduce uncertainty in decision making. Traditional assessment is heavily dependent on laboratory-generated toxicity test data and estimations of exposure and effect. Despite many well documented demonstrations of in situ methodologies, they are rarely used by regulators to help improve assessment or to validate risk. Emerging legislation puts greater emphasis on environmental outcomes and represents a significant shift from the reliance on chemical measures alone toward biological responses that improve assessment and demonstrate ecological benefit. Diagnostic methods, that could include in situ-based measures, will help assess and manage environments failing to achieve good status and it is likely that a weight of evidence approach will be needed to help inform management decisions. The potential application of such measures in the risk framework is reviewed in the context of current and emerging legislation concerning chemicals. Effect measures on the basis of in situ methods provide an alternative line of evidence and can help reduce uncertainty in decision making. Criteria are presented to help select appropriate methods in a multiple-line, weight of evidence approach. [source] Screening for High- and Moderate-Risk Drinking During Pregnancy: A Comparison of Several TWEAK-Based ScreenersALCOHOLISM, Issue 9 2001Deborah A. Dawson Purpose: This study investigated the use of the TWEAK and nine alternative screeners for predicting high-risk and moderate-risk drinking during pregnancy. Method: The analysis was based on self-reports from 404 lifetime drinkers who presented for an initial visit at nine prenatal clinics in Washington, DC. Data were collected anonymously by having women directly enter their responses onto an audio, computer-assisted interview that was programmed onto a laptop computer. Pregnancy risk drinking status was based on both average daily volume of intake and frequency of drinking 3+ drinks in a day. Each of the alternative screeners was constructed by adding one additional risk indicator to the TWEAK, and three different scoring options were explored. Results: Using thresholds of 2 points for high-risk drinking and 1 point for moderate-risk drinking, the TWEAK demonstrated a sensitivity and specificity of 70.6% and 73.2% for high-risk drinking and a sensitivity and specificity of 65.6% and 63.7% for any (high- or moderate-) risk drinking during pregnancy. None of the alternative screeners resulted in significant improvement, but the addition of current smoking status showed enough promise to warrant further testing in larger samples. Conclusions: Despite some loss in sensitivity and specificity, the TWEAK, in its original or a modified form, can be extended to measures of high-risk drinking that incorporate infrequent heavy intake and can be used to test for moderate- as well as high-risk drinking. Because identification of moderate-risk drinkers substantially increases the pool of women targeted for intervention, cost implications must be considered in designing appropriate interventions. [source] A short history of muddy floodsLAND DEGRADATION AND DEVELOPMENT, Issue 4 2010J. Boardman Abstract The term ,muddy flood' has been used widely in the lowland, arable areas of western and central Europe to describe muddy runoff from arable fields that causes damage to property. There is some evidence that muddy floods are much more frequent in the last two decades than previously. It is clear though that there is very substantial under-reporting of the phenomena even in areas where they have been recognised for 20 years e.g. UK and France. Reconstructions based on questionnaires, news media and local authority records have had some success in historical analysis of muddy flood frequency but there is still a huge data deficiency. Records from some countries are woefully lacking e.g. Germany, Spain and Italy. Costs of muddy flooding are substantial especially in the loess belt of Belgium. The number of properties flooded in France suggests also that costs are high; similarly in England (UK) where costs for case studies are known but not for the country as a whole. There are two quite different solutions to the problem of muddy flooding. Protection can be provided by engineering devices: retention ponds, dams, trenches. This is an ,end of pipe' solution with severe cost implications and risks with regard to the design return period. Alternatively, land use change on relatively small areas of catchments, can be shown to be effective at reducing flood-risk hazard. A combination of the two has proved most effective at several sites in Europe. Copyright © 2010 John Wiley & Sons, Ltd. [source] Chronic constipation: overview and challengesNEUROGASTROENTEROLOGY & MOTILITY, Issue 2009I. J. Cook Abstract, Despite its high prevalence and cost implications, our understanding of the pathophysiology of constipation remains primitive, and available therapies have limited efficacy. The purpose of this supplement is to address critically the reasons for the current lack of understanding and to propose avenues of future research to address these deficiencies. [source] Management of red cell alloimmunisation in pregnancy: the non-invasive monitoring of the diseasePRENATAL DIAGNOSIS, Issue 7 2010Sebastian Illanes Abstract Haemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization was a significant cause of fetal and neonatal morbidity and mortality until the introduction of anti-D immunoglobulin, which has dramatically changed the incidence of the disease. However, it is still a major problem in affected pregnancies. The emphasis of current clinical management has shifted from an invasive approach to non-invasive monitoring of the disease. The key elements of the modern management are determining which fetuses are at risk of HDFN with the use of cell-free fetal DNA in maternal plasma (fetal RHD genotype) and the follow-up of antigen positive fetuses by Doppler ultrasonography to detect anaemia severe enough to need treatment. When anaemia is suspected, an invasive approach is still required in a timely manner for confirmation of the degree of anaemia and to administer blood transfusions. This non-invasive approach prevents unnecessary administration of human-derived blood products, with the consequent ethical and cost implications and most importantly avoids iatrogenic conversion of mild to severe disease by avoiding need for techniques such as amniocentesis. The potential problem of the non-invasive approach is the reduction in the total number of invasive procedures, with the subsequent difficulty of maintaining the skills required to perform them. Copyright © 2010 John Wiley & Sons, Ltd. [source] What role for betahistine in the treatment of Méniére's disease?PRESCRIBER, Issue 2 2009John Phillips BSc The authors discuss the diagnostic criteria for Méniére's disease and the evidence base and cost implications for initiating betahistine, a potentially life-long treatment. Copyright © 2009 Wiley Interface Ltd [source] Increased maternal BMI is associated with an increased risk of minor complications during pregnancy with consequent cost implicationsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2009FC Denison Objective, To investigate the effect of maternal body mass index (BMI) on minor complications, associated additional medication use during pregnancy and the consequent cost implications. Design, Retrospective analysis of case notes. Setting, Labour wards, tertiary referral hospital, Royal Infirmary Edinburgh, UK. Population, Six hundred and fifty-one women with a singleton pregnancy over four separate time periods in 2007 and 2008. Methods, Descriptive statistics, univariate and multivariate logistic regression analysis and cost analysis using standard techniques and inflation indices. Main outcome measures, Minor complications, use of medications during pregnancy and consequent incremental costs from the perspective of the National Health Service (NHS). Results, 42.4% of women were overweight or obese (BMI , 25 kg/m2). Higher BMI during the first trimester (BMI , 30 kg/m2 compared with BMI < 25 kg/m2) was associated with an increased risk of minor complications including symphysis pubis dysfunction (OR 3.97; 95% CI 2.19,7.18), heartburn (OR 2.65; 95% CI 1.42,4.94) and chest infection (OR 8.71; 95% 2.20,34.44) and with drugs used to treat these complications including Gaviscon (OR 3.52; 95% CI 1.78,6.96). The mean incremental (additional) NHS costs per woman for treating minor complications increased with maternal BMI were £15.45/woman, £17.64/woman and £48.66/woman for BMI < 25 kg/m2, BMI , 25 to <30 kg/m2 and BMI , 30 kg/m2 respectively. Conclusions, Increased maternal BMI is associated with increased risk of developing minor complications during pregnancy; use of medications associated with treating these conditions and has significant NHS costs. [source] Can the levonorgestrel intrauterine system replace surgical treatment for the management of menorrhagia?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2002Rani Nagrani Menorrhagia is a common gynaecological condition for which medical treatment is often ineffective and a large number of women undergo major surgery. Previous short term studies have shown a significant number of women with menstrual problems may avoid surgery if a levonorgestrel intrauterine system (LNG-IUS) is fitted but no long term studies exist to ascertain if this benefit is sustained. This four to five year long term follow up study showed 50% of women continued to use the device and 67.4% avoided surgery. The LNG-IUS is well accepted and effective in the management of menorrhagia and has major cost implications to the National Health Service. [source] Nocturnal polyuria in community-dwelling womenBJU INTERNATIONAL, Issue 4 2004L.V. Swithinbank In this section there are papers describing studies into nocturnal polyuria, the overactive bladder in Asian men and the use of extracorporeal magnetic stimulation for female urinary incontinence. There are also papers which evaluate the cost implications of microwave thermotherapy, the accumulation of proteoglycans in prostatic hyperplasia, and the presentation and management of urethral calculi. The last two papers in this section have nothing directly to do with the lower urinary tract. Indeed, they do not fit into any of the groups of papers in the journal but I felt that they were of general interest to the readership of the BJU International, and so felt they could really be put into any section! OBJECTIVE To determine the age prevalence of nocturnal polyuria among older women in the community, and to investigate the relationship between nocturnal polyuria and nocturia. PATIENTS AND METHODS In all, 1183 women aged ,,50 years, who were registered with a family doctor practice and who had taken part in a prevalence study, were sent brief questionnaires and a frequency/volume chart (FVC) to complete. RESULTS There were 227 FVCs with adequate data and 264 completed questionnaires available for analysis. The prevalence of nocturnal polyuria increased disproportionately with age. There was no clear relationship between nocturia or nocturnal polyuria and daytime frequency, nor was there a clear relationship between diuretic use and nocturnal polyuria. CONCLUSION Nocturnal polyuria is common among women in the community and not obviously related to daytime frequency. Night-time symptoms are common in women as well as men, and are troublesome to them. [source] Buying into our future: sustainability initiatives in local government procurementBUSINESS STRATEGY AND THE ENVIRONMENT, Issue 5 2007Lutz Preuss Abstract Local government in the United Kingdom is well placed to make a contribution to sustainable development in its area. Although only enjoying partial autonomy from central government without its own constitutional basis, its aggregate purchasing expenditure dwarfs that of central government. Case study research into procurement by local authorities in England reveals a wide range of activities aimed at addressing the challenges of sustainable development, covering environmental and social as well as economic development aspects. However, these initiatives are still of a patchy nature, in terms of both differences between aspects of sustainability and variation between local authorities. Many sustainability initiatives also have cost implications for local government, which may clash with other priorities. To overcome such barriers, local authorities could cooperate with other public sector organizations in the United Kingdom and beyond, as well as with the private sector, to learn from the sustainability experience elsewhere. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source] Cladistic coding of genomic mapsCLADISTICS, Issue 5 2002Cyril Gallut A new method of genomic maps analysis is described. The purpose of the method is to reconstruct phylogenetic relationships from the genomic organization of taxa. Our approach is based on gene order coding. This coding allows the description of genome topology without a prior hypothesis about evolutionary events and phylogenetic relationships. Different characters are used for each gene: (1) presence/absence, (2) orientation, and (3) relative position. The relative position of a particular gene inside the genome is the pair of genes surrounding it. The relative position character represents all the positions of a gene in the sampled genomes. It is coded as a multistate character. Our coding method has a priori variable cost implications on operators such as inversion, transposition, and gene loss/gain, which we discuss. The overall approach best fits the "duplication, random loss" evolutionary model. The coding method allows the reconstitution of a possible hypothetical common ancestor genome at each node of the tree. This reconstitution is based on the character states' optimization; it comes down to choosing, among all possible optimizations, the optimization compatible with a complete genome topology at each internal node. The multistate coding of gene relative position, which is an undeniable advantage of this method, permits this reconstitution. [source] Combination therapy for postmenopausal osteoporosisCLINICAL ENDOCRINOLOGY, Issue 5 2002Juliet E. Compston Summary A number of agents have been shown to reduce the risk of fractures in patients with postmenopausal osteoporosis. However, the additional benefits of combination therapy as opposed to monotherapy are uncertain. We performed a MEDLINE search and reviewed the published randomized trials of agents used in combination. Combination therapy results in greater gains in bone mineral density than monotherapy and possibly greater effects on bone turnover. However, none of these studies are large enough or of sufficient duration to determine whether a greater reduction in fracture is achieved. Combination therapy has important cost implications and is likely to be associated with an increased prevalence of adverse events, reduced tolerability and a reduction in adherence. Furthermore, over-suppression of bone turnover as a result of combination antiresorptive therapy might have adverse effects on bone strength, particularly with long-term treatment. Thus, the use of combination therapy for treatment of osteoporosis cannot be recommended on the basis of currently available evidence. [source] Knowledge Accession and Knowledge Acquisition in Strategic Alliances: The Impact of Supplementary and Complementary DimensionsBRITISH JOURNAL OF MANAGEMENT, Issue 4 2009Peter J. Buckley This paper advances the concepts of knowledge accession and knowledge acquisition in strategic alliances by identifying supplementary and complementary dimensions to these knowledge transfer modes. Complementary knowledge transfer reflects the similarity of knowledge that the partners have and is conducted in pursuit of higher efficiency and productivity to enhance partner firms' existing competitiveness. Supplementary knowledge transfer occurs when partners each possess distinctive core competences and the information that is acquired or accessed increases the business scope of partners. As knowledge accession entails knowledge amalgamation that does not involve organizational learning, costs associated with the transfer process are lower and trust is easier to establish than in the case of knowledge acquisition. The paper reviews the implications of these transfer modes on trust building in alliances and their costs implications and presents a number of propositions for further exploration. [source] | ||||||||||||||||||||||