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PubMed1990

Managing operating room budget variances.

Credibility, power, and the ability to obtain greater departmental resources are three benefits of managing the operating room (OR) department's operating budget effectively. Still, few resources exist to help novice as well as seasoned OR directors grapple with the practicalities of maintaining their budget after the annual budget process is completed. The authors examine how astutely controlling personnel, materials, and services budget variances will result in hospital administrators "hearing" and approving an OR director's requests for resources more readily, staff and physicians who enjoy the benefits of better-staffed services and new technology, and an OR director with a reputation as an effective department head among peers in the hospital.

Administrative Personnel↗
PubMedDate not supplied

Microsurgical instrument handling systems. A new approach to instrument budget control.

1. Large portion of a hospital's supply budget is allocated for repair and replacement of surgical instruments. Microsurgical instrumentation can account for 18% or more of a total OR budget. 2. Managing the surgical instrument repair and replacement budgets with greater emphasis on accountability can help demonstrate effective cost containment. Cost savings may be experienced through appropriate use of surgical instrument management systems for handling, sterilization, and storage of microsurgical instruments. 3. Many facilities are implementing quality control programs to minimize replacement and repair costs, to ensure surgical instrument integrity, and to extend the life of their investment. Education, management information systems, improved communication, and appropriate use of instrument handling systems are some components of budget accountability in the operating room.

Budgets↗
PubMed1996

Global physician budgets as common-property resources: some implications for physicians and medical associations.

Since 1990 payment for physician services in the fee-for-service sector has shifted from an open-ended system to fixed global budgets. This shift has created a new economic context for practising medicine in Canada. A global cap creates a conflict between physicians' individual economic self-interest and their collective interest in constraining total billings within the capped budget. These types of incentive problems occur in managing what are known in economics as "common-property resources." Analysts studying common-property resources have documented several management principles associated with successful, long-run use of such resources in the face of these conflicting incentives. These management principles include early defining the boundaries of the common-property resource, explicitly specifying rules for using the resource, developing collective decision-making arrangements and monitoring mechanisms, and creating low-cost conflict-resolution mechanisms. The authors argue that global physician budgets can usefully be viewed as common-property-resources. They describe some of the key management principles and note some implications for physicians and the provincial and territorial medical associations as they adapt to global budgets.

Budgets↗
PubMed1993

A weighted time budget approach for the assessment of cognitive and social activities.

An instrument designed to assess potentially challenging cognitive and social activities in a wide range of both psychiatric and normal study populations is described in this paper. The technique used combines traditional time budget approaches with an additional, significant component, i.e. a rating indicating the amount of challenge for each activity that is sampled. Separate ratings reflecting the subject's and the interviewer's perspective are generated. Along with a detailed description of this weighted time budget instrument, preliminary data regarding practicality, reliability and validity are reported. An analysis based on time budget interviews with 30 schizophrenic patients showed overall interrater agreement to average 84% (kappa = 0.72). In a study with a possible bearing on the concurrent validity of the instrument, relapsing schizophrenics significantly differed from stable subjects in weighted time budget indices.

Activities of Daily Living↗
PubMed2001

An investigation of relationships between climate and dengue using a water budgeting technique.

Climatic water budget indicators were used to assess intra- and interannual variations in dengue incidence for San Juan, Puerto Rico. Multivariate stochastic relationships between dengue and the water budget were developed to (1) determine and quantify the particular climatic measures and their associated lag periods related to dengue variations, and (2) assess their use for dengue prediction and initiation of emergency response procedures. Such a predictive model would be advantageous because it is based on reliable, easily obtained, and low-cost weather observations. Daily running averages of water budget variables over an 8-week period were related to daily running averages of unconfirmed dengue totals (1988-1993). Resultant models show that a variety of water budget and traditional climate measures over the full 8-week period are associated with dengue. The mean seasonal variation in dengue is highly related (R2=88.1%) to the mean seasonal climate variation, with those thermal and energy variables immediately preceding the dengue response showing the strongest relationships. However, moisture variables, predominantly in the form of surplus, are more influential many weeks in advance. For the interannual model (R2=44.1%), energy change, thermal change, and moisture variables are significant across the 8-week period, with moisture variables playing a stronger role than in the intraannual model. Standardisation substantially changes the importance and timing of the variables, and suggests that dengue during this period is more associated with the mean annual variation of climate than deviations from mean conditions. A dengue early-warning model (based on 5 weeks of climate data) was also developed to predict dengue incidence 3 weeks later. While this predictive model is not reliable as a sole predictor of dengue in San Juan, it may be useful as part of a multifaceted watch/warning system.

Animals↗
PubMed1986

The energy budget of Tetrahymena and the material fluxes into and out of the adenylate pool.

The material budget of the adenylate pool deals with all processes which physically establish and maintain this pool, while the energy budget is concerned with the intracompartmental ATP recycling. Both budgets were analysed in Tetrahymena thermophila exposed to various energy and material demands. Some of the general conclusions are: at a maximum growth rate the overall ATP consumption during one cell cycle is 10(-10) mol ATP; the contribution of osmoregulation and ciliary motion to the budget is about 1% each; at zero net growth, energy is consumed because of a continuous recycling of matter between the monomer and the polymer compartment. The rate of ATP production is about 1000-fold greater than the rate of adenylate monomer influx. The residence time of adenylate monomers within the pool is about 30 min, but for ATP molecules it is only 2 sec.

Adenosine Diphosphate↗
PubMed1994

The carbon budget of Canadian forests: a sensitivity analysis of changes in disturbance regimes, growth rates, and decomposition rates.

Ecosystem responses to climate changes will affect the exchange of carbon (C) with the atmosphere, thus providing feedback for future climate response. We have developed a C budget model of Canadian forests and forest sector activities and used sensitivity analysis runs with changes in productivity, decomposition, and disturbance regimes to assess the sensitivity of the Canadian forest sector C budget over the next century. The model operates on data derived from Canada's National Forest Biomass Inventory, from the Oak Ridge National Laboratory global soil C data base, and from Canadian data bases that document areas annually disturbed by fire, insects, and harvesting. It simulates the dynamics of biomass and soil C pools (including detritus and coarse woody debris) as they are affected by growth, decomposition, and disturbances. For the reference run of the model, we assumed unchanging climate and disturbance regimes. Under these conditions, total ecosystem C increased by 2 Gt C (2.3%) over the 100-year simulation period. In the sensitivity analysis, we explored the effects of changes in the area annually disturbed by fire and insect-induced stand mortality (-60 to +300%), growth rates (-10 to +20%), decomposition rates (-10 to +25%), and combined changes in growth and decomposition rates. In every model run, the change of total ecosystem C relative to the reference run was less than 10%. Combined changes to growth and decomposition rates yielded very small deviations from the results of the reference run (-0.8 to +1.2%). Because disturbance regime changes affect forest age-class structure as well as forest dynamics, they are expected to affect C budgets strongly. Total ecosystem C, however, is slightly more sensitive to changes in growth and decomposition parameters than to changes in disturbance regimes. Although the sensitivity analysis results suggest that C budgets are little affected by the range of parameter changes implemented here, we must emphasize that our sensitivity analyses do not account for potentially important processes, such as regeneration failure or the shifts in forest distribution.

Journal Article↗
PubMed2006

Influence of budget and reinforcement location on risk-sensitive preference.

Little is known about the effect that procedural variables have on risk-sensitive preference. This study assessed the effect of procedural variables on pigeons' choice between a fixed and variable amount of reinforcement (amount risk) and, in a separate condition, between a fixed and variable delay until reinforcement (delay risk). Experiment 1 investigated the impact of water reinforcement and risk dimension when pigeons were in a restrictive budget, where access to water was less than that necessary to maintain current body weight, and a condition where the pigeons had ample access to water. Pigeons exhibited a greater tendency to prefer the variable alternative for delay risk than for amount risk in both restrictive and ample budgets. Varying water budget had no effect on risk preference. Experiment 2 investigated the influence of water reinforcer location while in a restrictive budget, in which reinforcers were delivered to a single location, two distinct locations, or a randomly selected location. With amount risk, pigeons were risk averse when reinforcers were delivered in separate or random locations and were indifferent to risk when delivered to a single location. With delay risk, pigeons were generally risk prone with no effect from reinforcement location. The finding that pigeons were risk averse when reinforcers were delivered to separate locations and were indifferent to risk when delivered to a single location offers a methodological explanation to the inconsistent findings in the literature with amount risk.

Animals↗
PubMed2006

Energy budget of juvenile fat snook Centropomus parallelus fed live food.

The fat snook Centropomus parallelus is a tropical estuarine species with importance for recreational and commercial fisheries and further aquaculture potential. Considering ingested energy (C) is channeled into growth (P), metabolic expenditure (R), excretion (U) and feces (F), a balanced energy budget was established for isolated and grouped juvenile C. parallelus (5.18 to 10.25 g wet mass) by experimental quantification of each of these parameters. Fish were fed live prawn (Macrobrachium sp.) at 25 degrees C and 20 per thousand for 19 days and daily energy budgets could be calculated. Energy content of food (live prawn), fish whole body and feces were 17.7, 14.5 and 6.1 KJ g(-1) dry mass (DW), respectively. Mass-specific rates of oxygen consumption and ammonia-N excretion were 0.271 and 0.0082 mg of O(2) or NH(3)-N g(-1) wet mass (WW) h(-1), respectively, resulting in O:N=23.4. Daily ingestion (C) was dependent on the amount of food offered and ranged between 4.9% to 7.4% of initial wet weight. Growth (P) was positively correlated with initial mass varying from 0.008 to 0.104 g day(-1). Feces release also correlated to fish mass and averaged 9.53 mg dry mass day(-1). The components of energy budget showed mean values of 2.39 (C), 0.24 (P), 1.96 (R), 0.11 (U) and 0.06 (F) KJ ind(-1) day(-1). As percentage of ingested energy, C. parallelus channeled 10% in growth (P), 82% in metabolism (R), 4.6% in excretion (U) and 2.5% in feces (F). Gross (K(1)) and net (K(2)) growth efficiencies were 9.2% and 9.9%, respectively. On the course of this period of juvenile development, K(1) and K(2) increased significantly. Partitioning of ingested energy in P, R, U and F was significantly different in individually and group maintained fish (P<0.05). Energy budget of C. parallelus fed a highly digestible diet (live prawn) revealed poor growth and growth efficiencies (K(1) and K(2)) possibly associated with an elevated metabolic demand and a high channeling of metabolized energy (P+R) into metabolism (R) in both isolated and grouped fish. Data can be applied to ecosystem modeling and may contribute to identify species potential to aquaculture.

Animal Feed↗
PubMed2005

Nitrogen and phosphorus budget in coastal and marine cage aquaculture and impacts of effluent loading on ecosystem: review and analysis towards model development.

Being an essentially open system, cages are usually characterized by a high degree of interaction with environment and cage systems are highly likely to produce large bulk of wastes that are released directly into the environment. Therefore, large-scale cage aquaculture development has been put into question and concerns have been raised that cage aquaculture produces large bulk of wastes that are rich in organic matter and nutrients and are released into coastal and nearshore environment. Recent information on cage aquaculture nutrient budget is scarce and most published reports are dated. This paper reviews cage aquaculture nutrient budget and nutrient loadings and propose a model for nutrient (nitrogen, N and phosphorus, P) budget in a hypothetical cage aquaculture farm with values of feed loss, FCR (feed conversion ratio) and nutrient contents in feed and fish taken from published literature in order to calculate the amount (kg) of N and P produced and released to the environment for each ton of fish produced. The paper proposes, in addition, a critically analyzed nutrient budget based on the dry matter conversion rate instead of the usual feed conversion rate. The conceptual model shows that 132.5 kg N and 25.0 kg P are released to the environment for each ton of fish produced; these values are as high as 462.5 kg N and 80.0 kg P when calculated on the basis of dry matter conversion rate instead of usual feed conversion rate. Thus, the annual global N and P loadings from cage aquaculture (10,000 tons fish and 3000 tons dry matter) are 1325 tons N and 250 tons P and 1387.5 tons N and 240.0 tons P based on usual feed conversion rate and dry matter conversion rate respectively. The paper also proposes, by analyzing the existing data, an FCR-based regression model for predicting nutrient loadings for a given diet. Finally, attempt was made to calculate the annual global loading and release of N and P from cage aquaculture to the coastal and marine environment, the potential impacts of nutrient loading on the ecosystem were discussed and critical points to be considered for minimizing nutrient output in cage aquaculture were suggested.

Animal Feed↗
PubMed2001

Changes in soil organic carbon storage under grassland as evidenced by changes in sulphur input-output budgets.

Information about temporal changes in soil organic carbon (C) pools may be obtained indirectly from changes in input-output budgets of organically combined nutrients such as sulphur (S). Sulphur budgets were therefore evaluated for Northern Ireland (NI) for the period 1940-1990, inclusive. These budgets indicated that the land or soil had acted first as a sink but then as a source for S, and that reserves of soil S built up between 1940 and 1965 were totally depleted by the mid-1980s. Pooled data from six long-term soil-monitoring sites on undisturbed grassland suggested that negative S budgets from the late-1970s onwards had been due to the net mineralization of soil organic matter and thus were indicative of net losses of organic C from surface soil horizons. There was some evidence that the decline in rainfall and fertiliser S inputs from the mid-1960s may have precipitated the breakdown of soil organic matter.

Animal Feed↗
PubMedDate not supplied

Estimates of maximum limits of food colours use in Brazil through the Danish Budget Method and the Bär and Würtzen-modified method.

The establishment of the permissible levels for the use of additives in foods must be based on the Acceptable Daily Intake (ADI). A method that may be applied for this purpose is the Danish Budget Method which estimates the maximum amount of the additive that may be added to the food based on the functional properties of the additive, and on the categories of the food in which the additive will be used. Based on the latest information Bär and Würtzen propose some modifications to the original Budget Method, one of which is the addition of a correction factor which takes into account the competition between different food additives with the same functional properties. In the present paper, both the Budget Method and the Bär and Würtzen-modified method were applied to evaluate whether the maximum levels of food colours use exceeded their ADI or not. Applying the original Budget Method, the results showed that the colours Sunset Yellow, Amaranth, Erythrosine, Ponceau 4R and Cochineal possibly exceeded the ADI; while applying the modified method only the colours Erythrosine and Cochineal would exceed the ADI. Brazilian regulatory authorities should be advised to establish maximum limits of use for the following categories of colours: Caramel, Inorganic, Natural and Artificial Colours Identical to the Natural Ones, where ADIs have been evaluated by JECFA.

Brazil↗
PubMed2004

An uncertainty budget for the measurement of ethanol in blood by headspace gas chromatography.

An uncertainty budget was constructed for the measurement of ethanol in blood by headspace gas chromatography. The uncertainty budget, covering the analytical range of ethanol concentrations up to 3.00 g/kg, included analytical uncertainty components, traceability uncertainty components, and effects caused by interindividual variation in blood water content. The analytical combined standard uncertainty was estimated from duplicate measurements of real samples and included contributions from headspace recovery, variation between columns, injection, repeatability of analytical signals, and statistical uncertainty of the calibration function. The traceability uncertainty was estimated in a sub-budget based on information about the calibrator and about the preparation of the aqueous standards. Two uncertainty components depended on the interindividual variation in blood water content. First, it caused uncertainty on the density of the blood, and second, it had an effect on the gas phase concentration of ethanol when doing the headspace sampling. These effects as well as their covariance were included in the uncertainty budget. For fresh blood samples, the analytical uncertainty was the dominating uncertainty component, accounting for approximately 90% of the variance. For blood samples collected 100 h postmortem, the interindividual variation in blood water content was the largest uncertainty component. It was demonstrated that subtracting a "safety margin" of 0.1 g/kg from the results was sufficient to keep the risk of committing a type 1 error below 0.1% in ethanol concentrations ranging up to 2 g/kg for fresh blood samples. This risk was higher for postmortem blood samples because of the higher uncertainty of measurement, but still less than approximately 1.4%.

Algorithms↗
PubMed2002

Evidence for large decadal variability in the tropical mean radiative energy budget.

It is widely assumed that variations in Earth's radiative energy budget at large time and space scales are small. We present new evidence from a compilation of over two decades of accurate satellite data that the top-of-atmosphere (TOA) tropical radiative energy budget is much more dynamic and variable than previously thought. Results indicate that the radiation budget changes are caused by changes in tropical mean cloudiness. The results of several current climate model simulations fail to predict this large observed variation in tropical energy budget. The missing variability in the models highlights the critical need to improve cloud modeling in the tropics so that prediction of tropical climate on interannual and decadal time scales can be improved.

Journal Article↗
PubMed2002

A dynamic mass budget for toxaphene in North America.

A continental-scale dynamic mass budget for toxaphene in North America is presented, based on available information on physicochemical properties, usage patterns, and reported environmental concentrations and using the Berkeley-Trent North American mass balance contaminant fate model (BETR North America). The model describes contaminant fate in 24 ecological regions of North America, including advective transport between regions in the atmosphere, freshwater, and near-shore coastal water. The dynamic mass budget accounts for environmental partitioning, transport, and degradation of the estimated 534 million kg of toxaphene that were used in North America as an insecticide and piscicide between 1945 and 2000. Satisfactory agreement exists between model results and current and historically reported concentrations of toxaphene in air, water, soil, and sediments throughout North America. An estimated 15 million kg of toxaphene are believed to remain in active circulation in the North American environment in the year 2000, with the majority in soils in the southern United States and Mexico, where historic usage was highest. Approximately 70% of total toxaphene deposition from the atmosphere to the Great Lakes is attributed to sources outside the Great Lakes Basin, and an estimated total of 3.9 million kg of toxaphene have been transported to this region from other parts of the continent. The toxaphene mass budget presented here is believed to be the first reported continental-scale multimedia mass budget for any contaminant.

Agriculture↗
PubMed2002

[The budget control function of the Drug Reimbursement System].

We now have 10 years of experience with the Dutch Price Reference System (Dutch acronym GVS), which was instituted in order to reduce the growth of extramural pharmaceutical costs to 4.1% annually, assuming no loss of medical quality. The system focussed mainly on budget control rather than on increasing cost-effectiveness by substitution. The budget-control aims were not achieved. As epidemiological and demographic developments would account for about 3% annual budget growth given an unchanged individual consumption of pharmaceuticals, the 4.1% criterion left only 1% room for autonomous growth (price, volume). The current 8% average annual growth rate indicates 5% autonomous growth. This rate is low, however, compared to other European countries, where a number of autonomous growth factors are not systematically counterbalanced at the product level by substitution incentives and control over prices and indication by health-care authorities and health-insurance companies. The GVS and related administrative measures have therefore most likely exerted a significant budget-controlling influence. The current policy of the Dutch Ministry of Health, Welfare and Sports in terms of goals, actors' roles and incentives fits well with the GVS, which should therefore be continued.

Cost Control↗
PubMed2005

Mass budget of perfluorooctane surfactants in Lake Ontario.

Perfluorooctane surfactants have been reported in biota, water, and air samples worldwide. Despite these reports, the main environmental sources of these compounds remain undefined. To address this gap in knowledge, an annual lake-wide mass budget of eight perfluorooctane surfactants was developed for Lake Ontario. To determine the atmospheric contribution to the mass budget, over-the-lake gas-phase air concentrations for N-EtFOSE and N-EtFOSA and particulate-phase air concentrations for PFOS in any air sample are reported for the first time, with mean concentrations when present of 0.5+/-0.32 (N-EtFOSE gas-phase), 1.1+/-0.9 (N-EtFOSA gas-phase), and 6.4+/-3.3 (PFOS particulate-phase) pg/m3. The mass budget finds inflow from Lake Erie (14 361+/-4489 kg sigma perfluorooctane surfactants) and wastewater discharge (1762+/-2697 kg sigma perfluorooctane surfactants) to be the major sources, while outflow through the St. Lawrence River is the dominant loss mechanism (22,727+/-7060 kg/year sigma perfluorooctane surfactants). Using the mass budget data, the steady state and measured mean concentrations in the lake water are the same at the 95% confidence level.

Environmental Monitoring↗
PubMed1988

Impact of home infusion therapy on the Colorado Medicaid program budget.

The impact of home infusion therapies on the pharmaceutical services drug budget of the Colorado Medicaid program was evaluated retrospectively. Pharmacy billing claims and prior authorization forms for home infusion therapies submitted to the Colorado Department of Social Services during a 26-month period were reviewed to determine the costs of the drug or hydration solutions and ancillary products necessary for the preparation and administration of the solutions. A dispensing fee of +3.40 per dose was figured into calculations of total costs of home infusion therapies, and an estimated cost of +100-+150 per day for follow-up care was added. Equivalent costs of hospitalization were calculated using an average per diem charge of +315. A total of 61 patients received 1361 days of home infusion therapy during the study period. The majority of patients received home antimicrobial therapy; 752 days of hospitalization theoretically were avoided because of home administration of antimicrobial agents, which translates into a cost savings of +76,716-+114,316. Patients also received home parenteral nutrition therapy, analgesic therapy, and rehydration therapy that yielded cost savings of +48,374-+78,824 but in some cases resulted in higher costs than hospitalization would have. Home infusion therapies increased pharmaceutical services costs by +99,475, representing an important shift of costs from the hospital services budget to the pharmaceutical services budget. Home infusion therapies generally incur lower costs than would be incurred during an equivalent hospital stay. The Colorado Medicaid budget should be adjusted to compensate for the shift of costs from hospital to pharmaceutical services.

Anti-Infective Agents↗