• International Journal of Highway Engineering
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• v.17 no.6
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• pp.97-104
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• 2015

PURPOSES : Expressways experience chronic and recurring congestion, especially during weekends and holidays, because of the increased demands for leisure-related travel. The alternatives to solve chronic and recurring congestion may be three-fold: (1) physical expansion of expressway capacities, (2) road pricing, and (3) temporal and spatial distribution of traffic demands. Among these, the third alternative may be the most cost-effective method for the Korea Expressway Corporation (KEC) that can be achieved by using the existing ITS infrastructure. METHODS : KEC initiated a pilot study in which the traffic on congested expressways was managed by providing traffic condition information (i.e., travel times) of neighboring national highways for taking detours via variable message signs (VMS). This study aimed to estimate the detour rate, and the two pilot studies on Seohaean and Yeongdong expressways yielded many benefits. RESULTS : It was revealed that the total length of congestion segments decreased by 7.8 km, and the average travel speed increased by 5.3 km/h. CONCLUSIONS : Based on these findings, it was concluded that the propagation of detour information via VMSs during congestion hours can help reduce congestion on expressways and increase the benefits of the entire network.

• Archives of Plastic Surgery
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• v.41 no.3
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• pp.218-224
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• 2014

Plastic surgery training worldwide has seen a thorough restructuring over the past decade, with the introduction of formal training curricula and work-based assessment tools. Part of this process has been the introduction of revalidation and a greater use of simulation in training delivery. Simulation is an increasingly important tool for educators because it provides a way to reduce risks to both trainees and patients, whilst facilitating improved technical proficiency. Current microsurgery training interventions are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess the potential benefits of alternative models, particularly cross-training, a model now widely used in non-medical areas with significant benefits. Furthermore, with the proliferation of microsurgery training interventions and therefore diversity in length, cost, content and models used, appropriate standardisation will be an important factor to ensure that courses deliver consistent and effective training that achieves appropriate levels of competency. Key research requirements should be gathered and used in directing further research in these areas to achieve on-going improvement of microsurgery training.

• International Journal of Railway
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• v.2 no.1
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• pp.1-7
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• 2009

The development of structural solutions for high-speed or very high-speed tracks that minimize total life cycle costs of the system is a key issue to improve the operational profitability of new investments. In opposition to conventional ballasted tracks, slab track solutions can be a cost-effective solution, but only in the cases where the benefits due to the increase in track availability and the reduction of track maintenance offsets its much higher construction costs. In the cases where such investment is not feasible, it is worth to evaluate possible structural improvements to ballasted track that allow reducing its maintenance needs without increasing too much its construction costs. This paper evaluates the design requirements and the impact of improving conventional high-speed ballasted tracks by using a bituminous subballast layer. It is divided into two main parts: first the design requirements of the structural solutions with bituminous subballast and its possible benefits on high-speed track deterioration, and secondly the evaluation of the economic impact, in terms of construction costs, of using this structural solution material in future Spanish high-speed lines.

• Journal of the Korean Society for Aeronautical & Space Sciences
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• v.43 no.4
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• pp.334-340
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• 2015

Engine derating is often considered for reliability benefits because lower power operation reduces its failure probability. To be derated during operation, however, the engine must be initially overdesigned. The engine overdesign is cost effective only if reliability increased from derating is enough to offset the initial increase in the development cost caused from the overdesign. The purpose of this paper is to provide an analytical model to consider a trade-off between the engine overdesign and derating. We use a logistic regression model to explain reliability growth in the number of hot firing tests for a fixed power level. Using the Transcost model with the reliability growth model, we show that 10% overdesign of Titan rocket engine decreases its development cost by about 9% and 23% depending on the reliability requirement. We also point out that such a cost reduction depends on the fuel type a rocket uses.

• YAKHAK HOEJI
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• v.51 no.5
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• pp.327-335
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• 2007

This study was to evaluate economic impact of a comprehensive pharmaceutical care intervention provided by community pharmacists on drug-related morbidity and mortality in the elderly population, in a societal perspective. Clinical outcomes of pharmaceutical care included compliance increase, inappropriate medication discontinuation, and subsequent drug-related morbidity and mortality reduction. Economic outcomes included cost savings from direct medical costs reduction such as medication and healthcare resource utilization. Input costs for pharmaceutical care included pharmacist time and computerized prescription review supporting program costs. Model parameters of outcomes were derived from published literatures, and costs were from literatures and health insurance statistical data in Korea. Annual costs and benefits were estimated in the year 2005. Current usual care and standardized pharmaceutical care required 0.3 and 2.0 hours per year respectively, for elderly outpatient using average 4.4 prescription drugs per visit and average annual frequency of 17.8 pharmacy visits. Comprehensive pharmaceutical care provided to overall elderly outpatients at community pharmacies would have cost of \74,994 mil. and benefit of \357,002 mil. per year. Benefit:cost ratio was 4.8:1 and net benefit was \282,008 mil/year. It was corresponded to net benefit of \73,816/year for individual elderly patient. In addition, pharmaceutical care was estimated to reduce 1,531 drug-related deaths/year. Conclusively this study, a first attempt in Korea to evaluate an economic value of pharmaceutical care at community pharmacies, proved that it was a cost-effective intervention having significant economic benefit.

• Imaging Science in Dentistry
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• v.35 no.4
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• pp.185-190
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• 2005

Purpose: Once the decision has been made to adopt an integrated medical information system (IMIS), there are a number of issues to overcome. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. The purpose of this study is to investigate the benefits and unexpected problems encountered in the implementation of IMIS and to determine a useful framework for IMIS. Materials and Methods: The Yonsei University Dental Hospital is steadily constructing an IMIS. The vendor's PACS software, Piview STAR, supports transactions between workstations that are approved to integrating the healthcare enterprise (IHE) with security function. It is necessary to develop an excellent framework that is good for the patient, healthcare provider and information system vendors, in an expert, efficient, and cost-effective manner. Results : The problems encountered with IMIS implementation were high initial investments, delay of EMR enforcement, underdevelopment of digital radiographic appliances and software and insufficient educational training for users. Conclusions: The clinical environments of dental IMIS is some different from the medical situation. The best way to overcome these differences is to establish a gold standard of dental IMIS integration, which estimates the cost payback. The IHE and its technical framework are good for the patient, the health care provider and all information systems vendors.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.531-537
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• 2022

Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.799-805
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• 2016

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

• Journal of the Korean Institute of Gas
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• v.15 no.2
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• pp.40-46
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• 2011

The purpose of CBA(cost-benefit analysis) in risk assessment is to show whether the benefits of implementing additional risk reduction methods(RRMs) derived through risk assessment outweigh its costs and it is proper to implement the methods. In this paper CBA has been conducted in order to select the most effective and reasonable RRM as implementing the RRM derived after QRA for the high pressure urban gas pipelines. As conducting QRA again by applying the derived RRMs, No. 10 measure which includes pipeline corrosion monitoring, MOV(motor operated valve) installation and the method to protect pipeline damage caused by third-party mechanical interference has showed the highest risk reduction effect. Also it has been considered to be reasonably practicable by conducting CBA and then is selected as the most effective and reasonable RRM on the objects of this paper.

• Culinary science and hospitality research
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• v.14 no.4
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• pp.339-356
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• 2008

The purpose of this study is to provide the developmental basic data of a change in shift work types by making a self-administered survey of the effect of commitment by shift work and the open kitchen system on job satisfaction and job stress, and mutual relation between variables on 287 cooks in luxury hotels. Analysis showed that the operation of the shift work system was effective in reducing the internal stress of the cooks, their external stress, or their self-uncertainty on the job, and the business by the open kitchen system was effective in raising self-esteem. In addition, job commitment by shift work and the open kitchen system were effective in promoting the job satisfaction of employees, interpersonal relations, promotion, benefits and wages. Consequently, the decrease of external and internal stress or self-uncertainty and the improvement of job satisfaction can be connected with the increase of productivity or cost reduction. Therefore, the open kitchen system should be properly applied to the shift work system, along with sanitation, safety and the periodic checkup of kitchen.