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El presente documento pretende definir la incidencia de los planes de desarrollo en el proceso de trasformación de la sociedad, especialmente en el de la ciudad de Santiago de Cali. En este contexto, se pudo identificar que las inversiones que se están realizando en los diferentes programas sociales no necesariamente son pertinentes para las necesidades actuales o futuras, puesto que, por un lado, no hay una coordinación sistemática entre los diferentes planes de acción y, en segundo término, no hay una correlación estrecha entre los diferentes planes y no se evidencia una voluntad propia tendiente a la evaluación y desarrollo de nuevos escenarios para la construcción de ciudad. This document aims to define the incidence of development plans in the process of transformation of society, especially in the city of Santiago de Cali. In this context, it was possible to identify that the investments made in the different social programs are not necessarily relevant to current or future needs, since on the one hand, there is no systematic planning among the different action plans. Secondly, there is no close correlation between the different plans and there is no evidence of a willingness to evaluate and develop new scenarios for the construction of the city.

The paper analyzes the concept and indicator of vertical fiscal imbalance (VFI) and its capability in assessing the creditworthiness (debt sustainability) of Russian regions. It is found that VFI does not replace other indicators of debt and broader fiscal sustainability, but complements them by providing diagnostics of the balance of incoming and outgoing intergovernmental transfers in addition to the balance of expenditures and revenues (budget deficit). Vertical fiscal imbalance has a close inverse pair correlation with the share of own (tax and non-tax) revenues and fiscal capacity, and can therefore reflect creditworthiness (along with the amount of debt and capital expenditures). Technically, it is advisable to carry out an analysis using VFI with a recalculation accounting for subventions. It is concluded that vertical fiscal imbalance is an important element of the methodology of diagnosing fiscal sustainability. Further study of features of the concept, as well as the use of VFI in the analysis and regulation of intergovernmental relations, suggests a promising outlook.

Background We review the impact of the consequences of operating room (OR) management decision making on power analyses for observational studies of surgical site infections (SSIs) among patients receiving care in ORs with interventions versus without interventions involving physical changes to ORs. Examples include ventilation systems, bactericidal lighting, and physical alterations to ORs. Methods We performed a narrative review of operating room management and surgical site infection articles. We used 10-years of operating room data to estimate parameters for use in statistical power analyses. Results Creating pivot tables or monthly control charts of SSI per case by OR and comparing among ORs with or without intervention is not recommended. This approach has low power to detect a difference in SSI rates among the ORs with or without the intervention. The reason is that appropriate OR case scheduling decision making causes risk factors for SSI to differ among ORs, even when stratifying by surgical specialty. Such risk factors include case duration, urgency, and American Society of Anesthesiologists’ Physical Status. Instead, analyze SSI controlling for the OR, where the patient had surgery, and matching patients using these variables is preferable. With α = 0.05, 600 cases per OR, 5 intervention ORs, and 5 or 1 control patients for each intervention patient, reasonable power (≅94% or 78%, respectively) can be achieved to detect reductions (3.6% to 2.4%) in the incidence of SSI between ORs with or without the intervention. Conclusions By using this matched cohort design, the effect of the purchase and installation of capital equipment in ORs on SSI can be evaluated meaningfully.

In this study, the impact of urine diversion on the treatment capacity, treatment process, and capital costs of a decentralised wastewater treatment plant (WWTP) was simulated using BioWin. The data for simulation including for economic analysis were obtained from a real decentralised WWTP at Sydney. Simulation was conducted for two alternative process design scenarios of a WWTP: membrane bioreactor (MBR) without denitrification and anaerobic MBR in place of aerobic MBR and compared to existing process design. The simulation shows that with about 75% urine diversion (through source separation), the treatment capacity of the existing WWTP can be doubled although above 40% urine diversion, the impact appears less rapid. When the urine diversion exceeds 75%, it was found that the anoxic tank for biological denitrification becomes redundant and the current wastewater treatment process could be replaced with a simpler and much less aeration intensive membrane bioreactor (MBR) producing similar effluent quality with a 24% reduction in capital expenditure (footprint) cost. Anaerobic MBR can be a potential alternative to aerobic MBR although pre-treatment becomes essential before reverse osmosis treatment for water reuse applications. Sensitivity analysis has revealed that by operating the bioreactor at higher mixed liquor suspended solids concentrations (9 g/L instead of 5 g/L) could help increase the WWTP treatment capacity by about 3.5 times at 75% urine diversion. Hence, urine diversion (until nitrogen-limiting conditions occur above 75% urine diversion) can increase the treatment capacity of an existing WWTP and reduce the capital expenses due to reduced plant footprint.

Little is known about how firms change energy consumption over time. Yet, to meet global climate change targets, understanding how changes in firm investment impact environmental performance is important for policymakers and firms alike. To investigate the environmental performance of firms, we measure the energy consumption and efficiency of firms in the Netherlands’ manufacturing industries before and after large capital expenditures over the 2000 to 2008 period. Unique to this data set is that firm investment is decomposed into the following three streams: investment in buildings only, investment in equipment only, or a simultaneous investment in both buildings and equipment. We find that firms increase energy consumption when experiencing a simultaneous investment. However, after large capital expenditures, energy efficiency increases. Further decomposition by firm types suggests that the building capital investments of firms active in high-tech, energy-intensive, and low labor-intensive industries do not coincide with energy efficiency improvements while energy efficiency does increase with capital expenditures in equipment. From a policy perspective, it is important for regulators to understand firm investment and production processes, which help regulators understand when and where energy efficiency increases are feasible across firm types and expansionary production strategies. Firms, regulators, and other third parties may work together to develop an energy efficiency plan in line with investment strategies, including enhanced transparency by firms, energy efficiency subsidies, and R&D tax credits, for innovation. Targeted agreements may work to cooperatively improve energy performance.

The UK's 2050 net-zero emission target is one of the most ambitious goals in the world. Organisations should play a vital role by communicating a sufficient level of carbon emission information with the stakeholders. Motivated by the necessity of measuring the level of carbon disclosure, this paper provides a unique carbon emission disclosure measurement based on a sample of UK firms from 2013 to 2019. We apply different methods to assess the validity and reliability of our developed measurement. The results suggest that our measurement captures the actual CO2 emission, including scope 1, scope 2, and also captures the environmental, social and governance (ESG) score. Additionally, we explore the association between capital expenditure, corporate governance and the level of carbon emission disclosure. Further, the results show a positive relationship between capital expenditure and carbon emission disclosure. Also, there is a significant positive relationship between internal governance and carbon emission disclosure. Moreover, the analysis suggests that internal governance strengthen the relationship between capital expenditure and carbon emission disclosure. We also use quantile regression, and the findings show that capital expenditure and internal governance have a positive impact on carbon emission disclosure under all quantiles. Our data suggest that capital expenditure declines within the UK by around 53% over the last six years. Following the reduction in capital expenditure, the results demonstrate 39% decline in the CO2 emission level. The results also indicate that for every $1 million capital expenditure, approximately 2.75 Metric tons of carbon dioxide (MtCO2) emissions increase. Business investment is around 70% of the UK's total investment. Therefore, the reduction in capital expenditure is one of the primary reasons that might explain the decrease in the UK's overall CO2 emission level. The unique findings of this paper are relevant to the government, management and standard-setters.\ud bMahmoudElmarzoukyc

The number of rural hospital mergers has increased substantially in recent years. A commonly reported reason for merging is to increase access to capital. However, no empirical evidence exists to show whether capital expenditures increased at rural hospitals after a merger. We used a difference-in-differences approach to determine whether total capital expenditures changed at rural hospitals after a merger. The comparison group (rural hospitals that did not merge during the 2012 through 2015 study period) was weighted using inverse probability of treatment weights. The key outcome measure was logged total capital expenditures.Merging resulted in a 26% increase in capital expenditures and also was associated with a significant improvement in plant age. The postmerger improvement in plant age may have been partially attributable to merger-related accounting changes and partially attributable to increased capital expenses, possibly on long-term asset renovations and replacement.These findings suggest that through mergers, rural hospital board members and executives who have accepted or are considering a merger may improve a hospital's ability to increase capital expenditures. Further, increased capital investments in rural hospitals may be an important signal to the community that the acquirer intends to keep the rural hospital open and continue providing some volume and level of services within the community. Future research should determine how capital is spent after a merger.

China has suffered from extensive and serious SO

В статье рассматриваются риски сопутствующие деятельности нефтегазовых компаний, которые на данный момент играют важную роль в экономике РФ, обозначены общепризнанные инструменты снижения влияния рисков на ТЭК.

About 60% of the US hospitals are not-for-profit and it is not clear how traditional theories of capital structure should be adapted to understand the borrowing behavior of not-for-profit hospitals. This paper identifies important determinants of capital structure taken from theories describing for-profit firms as well as prior literature on not-for-profit hospitals. We examine the differential effects these factors have on the capital structure of for-profit and not-for-profit hospitals. Specifically, we use a difference-in-differences regression framework to study how differences in leverage between for-profit and not-for-profit hospitals change in response to key explanatory variables (i.e. tax rates and bankruptcy costs). The sample in this study includes most US short-term general acute hospitals from 2000 to 2012. We find that personal and corporate income taxes and bankruptcy costs have significant and distinct effects on the capital structure of for-profit and not-for-profit hospitals. Specifically, relative to not-for-profit hospitals: (1) higher corporate income tax encourages for-profit hospitals to increase their debt usage; (2) higher personal income tax discourages for-profit hospitals to use debt; and (3) higher expected bankruptcy costs lead for-profit hospitals to use less debt. Over the past decade, the capital structure of for-profit hospitals has been more flexible as compared to that of not-for-profit hospitals. This may suggest that not-for-profit hospitals are more constrained by external financing resources. Particularly, our analysis suggests that not-for-profit hospitals operating in states with high corporate taxes but low personal income taxes may face particular challenges of borrowing funds relative to their for-profit competitors.

One possible way to further reduce levelized costs of electricity of concentrated solar thermal energy is to directly use water/steam as the primary heat transfer fluid within a concentrated collector field. This so-called direct steam generation offers the opportunity of higher operating temperatures and better exergy efficiency. A technical challenge of the direct steam generation technology compared to oil-driven power cycles is a competitive storage technology for heat transfer fluids with a phase change. Latent heat thermal energy storages are suitable for storing heat at a constant temperature and can be used for direct steam generation power plants. The calculation of the economic impact of an economically optimized thermal energy storage system, based on a latent heat thermal energy storage system with phase change material, is the main focus of the presented work. To reach that goal, a thermal energy storage system for a direct steam generation power plant with parabolic troughs in the solar field was thermally designed to determine the boundary conditions. This paper discusses the economic impact of the designed thermal energy storage system based on the levelized costs of electricity results, provided via a wide parametric study. A state-of-the-art power cycle with a primary and a secondary heat transfer fluid and a two-tank thermal energy storage is used as a benchmark technology for electricity generation with solar thermal energy. The benchmark and direct steam generation systems are compared to each other, based respectively on their annual electricity yields and their levelized costs of electricity at two different sites. A brief comparison of a passive and an active latent heat storage system is included. Finally, specific target costs for the new direct steam generation thermal energy storage system are determined based on the results of the parametric study.

Understanding the principles behind the time value of money can help individuals succeed in both business and personal long-term planning. The Internal Rate of Return (IRR) method provides a straightforward way to analyze long-term financial decisions. The result, the project's IRR, is a simple percentage that is easy to explain and compare with the results from other projects. When considering multiple investments, it is relatively simple to rank them by their IRRs, make minor adjustments to the list for qualitative issues, and invest down the list until the funds for the year have been spent.

MaKing and justitying capital expenditures can be a difficult part of a supervi- sory or managerial position. Understanding more advanced accounting tools for justifying these expenditures, like Internal Rate of Return (IRR) and Net Present Value (NPV), can improve the chances of receiving necessary funding. NPV avoids the weaknesses of the IRR method by allowing decision makers to specify when cash flows will occur instead of assuming that net cash flows will be equal each year ofa project. Taking the time to learn basic account- ing definitions and tools can improve your ability to manage and provide greater opportunities to help patients, staff, and the community.

The purpose of this work was a cost analysis for the acquisition of two new MRI devices in a university hospital. The costs of a classical exchange (new purchase) were compared to those of a system upgrade. Taking the local circumstances into account, up to $121,000 could be saved with. the system upgrade for one MRI system compared to a classic exchange. Upgrades of the 1.5 and 3 Tesla systems were performed within 15 working days without any problems or restrictions. The number of examinations per day could be increased from 13.4 to 16.2 using the 1.5T system and from 14.1 to 15.9 using the 3T. The upgrade possibility of an old MRI device represents an economically attractive approach, which allows access to the latest state-of-the-art MRI technology while respecting the limited economic resources of the department.

Making and justifying capital expenditures can be a difficult part of a supervisory or managerial position. Understanding some basic tools for making estimates and calculating values can help simplify this process. Breaking down some of the most common accounting methods into a six-step, intuitive process allows everyone, even those with little or no accounting background, to use and understand the results of these tools. Accounting tools can seem complex when they are first used, but after walking through them step-by-step and practicing them, they can become an essential tool in working with executives and other administrators.

Biorefineries offer a promising alternative to fossil‐based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital‐intensive projects that involve state‐of‐the‐art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well‐documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early‐stage capital cost estimation tool suitable for biorefinery processes.

Several surveys have been administered over the last 40 plus years to learn about capital budgeting practices of healthcare organizations. In this report, we analyze and synthesize these surveys in a four-stage framework of the capital budgeting process: identification, development, selections, and post-audit. We examine three issues in particular: (1) efficiency of for-profit hospitals relative to not-for-profit hospitals, (2) capital budgeting practices of the healthcare industry vis-à-vis other industries, and (3) effects of healthcare mergers and acquisitions on capital budgeting decisions. We found indirect evidence that for-profit hospitals exhibited greater efficiency than not-for-profit hospitals in recent years. The acquisition of not-for-profits by for-profits is credited as the primary reason for growth of multihospital systems; these acquisitions may have contributed to the more efficient capital budgeting practices. One unique attribute of healthcare is the dominant role of physicians in almost all aspects of the capital budgeting process. In agreement with some researchers, we conclude that the disproportionate influence of physicians is likely to impede efficient decision making in capital budgeting, especially for nonprofit organizations.

Demands for constant upgrades to already-installed electronic health record systems are slowing investment in other important digital technologies like telehealth, remote patient monitoring and online billing.

Taking stock of the market’s current and recent trends can help owners assess their business strategies.

The existing ProCure21+ (P21+) framework deal for delivering healthcare construction projects for the NHS is due to end this September, and will be replaced by ProCure22, which could see a spend of £2 bn - £5 bn over four years. Against this backdrop, Ian Nunn ICIOB, a senior associate at multidisciplinary design, property, and construction consultancy solutions business, Pellings, reviews the different types of procurement options open to NHS Trusts, and considers their 'pros and cons'.

There is a risk of presupposing that enhancing efficiency will simply improve financial health in local governments. However, there are several reasons to think that the healthy governments could be the least efficient ones. This chapter aims to contribute to this discussion by using a sample of the 132 largest Italian local governments during the period 2005-2014. The results show that the taken-for-granted positive effect of efficiency on financial condition is observable only when efficiency refers to current expenditures, but such a positive effect has not been observed in the case of capital expenditures.

This study illustrates the financial analyses for demonstration and assessment of additionality presented in the project design (PDD) and enclosed documents of the 431 large Clean Development Mechanisms (CDM) classified as the ‘waste handling and disposal sector’ (13) over the past ten years (2004–2014). The expected certified emissions reductions (CER) of these projects total 63.54 million metric tons of CO2eq, where eight countries account for 311 projects and 43.36 million metric tons. All of the projects declare themselves ‘not financially attractive’ without CER with an estimated sum of negative results of approximately a half billion US$. The results indicate that WM benchmarks and indicators are converging and reducing in variance, and the sensitivity analysis reveals that revenues have a greater effect on the financial results. This work concludes that an extensive financial database with simple standards for disclosure would greatly diminish statement problems and make information more comparable, reducing the risk and capital costs of WM projects.

The aim of this study was to determine the influence of Capital Expenditure and Investment, and Employment on economic growth in South Sulawesi. This study uses time series data (time series) in 2001-2013. Data collected through observation and documentation. Data were analyzed using multiple linear regression analysis by the method of ordinary least squares (OLS). The results showed that the variable Capital Expenditures, Investment, and Labour significant effect on economic growth in South Sulawesi. Capital Expenditure Partially variables, and variables of Labor has a significant influence on the economic growth of South Sulawesi. While variable investments significantly negative effect on economic growth in South Sulawesi. Keywords: Capital Expenditures, Investment, Employment, Economic growth.

This work is part of a series of investigations on pyrolysis of lignin. After obtaining the necessary information regarding the quantity and quality of the obtained products, a first step economics evaluation for converting lignin into chemicals was essential. To accomplish this aim, a pyrolysis plant with a 50 t/d capacity was designed, and the total capital investment and operating costs were estimated. Next, the minimal selling price of the obtained dry oil was calculated and the effect of crucial variables on the estimated price was examined. The key result indicates the estimated selling price would not compete with the price of the chemicals that are fossil fuel based, which is primarily due to the high cost of the feedstock. To overcome this challenge, different scenarios for reducing the selling price of the obtained oil, which consequently is helping by taking a place among the fossil fuel based chemicals, were discussed.

The object of this study is a theoretical and practical basis of the state budget expenses’ function as a component of the social and economic policy. The objective of the study is to reveal the social and economic effect of budget expenses and to define specifics of the influence of expenses segregated by current and capital expenditures based on the social and economic development indices. Methods of the study. The following scientific methods were used: system, factor, correlation and regression analyses, comparison, analysis and synthesis that jointly allowed implementing the uniform research concept, determining precise quantitative connections between the studied features, carrying out the comprehensive analysis of the studied object and making scientific conclusions. Work results. As a result the authors have revealed the social and economic effect of budget expenses reflected by the regulation of consumption and stimulation of production output, social security of every citizen, development of the scientific and technical progress and international activity, etc. The correlation and regression analysis allowed us to study the influence of capital and operational expenses at the main indices of the social and economic development, in particular at: the gross domestic product (GDP) output; income, expenses and savings of the population; amounts of wages and social assistance paid (and other current transfers); and also to determine relations between the abovementioned indices. We have substantiated the importance of capital expenses from the national and local budgets, since the capital expenditures are exactly the factor influencing the modernization of production capacities, stimulating business activities of the entities and leading to growth of the employment rate, decrease of the unemployment rate, increase of the labor efficiency rate and social security level, and growth of the national production output, etc. Score of results. Finance. Budget policy. Budget system. Economic analysis. Conclusions. The budget expenses represent a powerful tool for regulation of economic processes and cash flows country-wide. By using the budget revenues and expenses as the financial tools the state authorities are able to change the structure and shares of contribution of the national industrial output, to regulate the level of social standards and financial support of the population, internal and external economic activities and to develop international financial relations. Based on the regression analysis’ results we have proven that any change of the structure and amounts of capital expenditures cause a substantial growth of the major indices of economy and social development; particularly, if the amount of capital expenses increases by UAH 1 bln, in average the following indices grow: GDP by UAH 21.4 bln, people’s expenditures and savings by UAH 14.1 bln, wages by UAH 5.9 bln and social assistance (and other current transfers) by UAH 4.6 bln. Nevertheless, in the period of the study (2007 – 2016) the closest correlation dependence existed between the current expenses and GDP, revenues, expenses and savings of the population, wages and social assistance (and other transfers) making 1.00; 0.98; 0.98 and 0.98 respectively., Предметом дослідження є теоретичні та практичні засади функціонування видатків бюджету як складової механізму соціально-економічної політики. Метою дослідження є розкриття соціально-економічного ефекту видатків бюджету та визначення особливостей впливу видатків, в розрізі поточних та капітальних, на основні індикатори соціально-економічного розвитку. Методи дослідження. У роботі використано наступні наукові методи: системний, факторний, кореляційного та регресійного аналізу, порівняння, аналізу та синтезу, що в сукупності дозволили реалізувати концептуальну єдність дослідження, встановити точні кількісні зв’язки між досліджуваними показниками, всебічно проаналізувати об’єкт дослідження та отримати наукові висновки. Результати роботи. Розкрито соціальний та економічний ефект бюджетних видатків, який відображається у регулюванні споживання та стимулюванні виробництва, соціальному забезпеченні кожного громадянина, розвитку науково-технічного прогресу та міжнародної діяльності тощо. За допомогою кореляційно-регресійного аналізу досліджено вплив капітальних і поточних видатків на основні індикатори соціально-економічного розвитку, зокрема на: обсяг валового внутрішнього продукту; доходи, витрати та заощадження населення; обсяг заробітної плати, а також соціальної допомоги (та інших поточних трансфертів), а також визначено взаємозв’язок між зазначеними показниками. Обґрунтовано необхідність капітальних вкладень з державного та місцевих бюджетів, оскільки саме капіталовкладення сприяють зростанню виробничих потужностей народного господарства, сприяють модернізації діючого виробництва, спонукають до ведення діяльності суб’єктами господарювання, що призводить до підвищення зайнятості населення, зменшення рівня безробіття, підвищення продуктивності праці та рівня соціального забезпечення населення, збільшення обсягів національного виробництва тощо. Галузь застосування результатів. Фінанси. Бюджетна політика. Бюджетна система. Економічний аналіз. Висновки. Бюджетні видатки є вагомим інструментом регулювання економічних процесів та фінансових потоків в країні. Використовуючи доходи і видатки бюджету – як фінансові інструменти – органи влади мають можливість змінювати структуру та пропорції національного виробництва, регулювати рівень соціальних стандартів та фінансового забезпечення населення, регулювати зовнішню та внутрішню економічну діяльність, розвивати міжнародні фінансові взаємовідносини. На основі регресійного аналізу доведено, що зміна структури та обсягів саме капітальних видатків в більшій мірі призводить до зростання основних показників економіки та соціального розвитку; зокрема при збільшенні обсягу капітальних видатків на 1 млрд. грн. в середньому збільшуються значення таких індикаторів: ВВП – на 21,4 млрд. грн., доходи, витрати та заощадження населення – на 14,1 млрд. грн., заробітна плата – на 5,9 млрд. грн., соціальна допомога (та інші поточні трансферти) – на 4,6 млрд. грн. Проте, за досліджуваний період (2007 – 2016 рр.) найбільша щільність кореляційного зв’язку має місце між поточними видатками і обсягом ВВП, доходами, витратами та заощадженнями населення, заробітною платою, соціальною допомогою (та іншими поточними трансфертами) – 1,00; 0,98; 0,98 та 0,98 відповідно.

INTRODUCTION: This study examines the effect of highway capital investments on highway fatalities. METHODS: We used state-level data from the 48 contiguous states in the United States from 1968 through 2010 to estimate the effects on highway fatalities of capital expenditures and highway capital stock. We estimated these effects by controlling for a set of control variables together with state and year dummy variables and state-specific linear time trends. RESULTS: We found that capital expenditures and capital stock had significant and negative effects on highway fatalities. CONCLUSION: States faced with declines in gas tax revenues have already cut back drastically on spending on roads including on maintenance and capital outlay. If this trend continues, it may undermine traffic safety. PRACTICAL APPLICATION: While states and local governments are currently fiscally strained, it is important for them to continue investments in roadways to enhance traffic safety and, more significantly, to save lives. Language: en

The ability to calculate the development costs for specific medicines and vaccines is important to inform investments in innovation. Unfortunately, the literature is predominated by non-reproducible studies only measuring aggregate level drug research and development (RD) costs. We describe methodology that improves the transparency and reproducibility of primary indication expected RD expenditures.We used publically accessible clinical trial data to investigate the fate of all seasonal influenza vaccine candidates that entered clinical development post year 2000. We calculated development times and probabilities of success for these candidates through the various phases of clinical development. Clinical trial cost data obtained from university based clinical researchers were used to estimate the costs of each phase of development. The cost of preclinical development was estimated using published literature.A vaccine candidate entering pre-clinical development in 2011 would be expected to achieve licensure in 2022; all costs are reported in 2022 Canadian dollars (CAD). After applying a 9% cost of capital, the capitalized total RD expenditure amounts to $474.88 million CAD.Clinical development costs for vaccines and drugs can be estimated with increased specificity and transparency using public sources of data. The robustness of these estimates will only increase over time due to public disclosure incentives first introduced in the late 1990s. However, preclinical development costs remain difficult to estimate from public data.

Objectives To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Design Cross-sectional study. Setting Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Participants Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). Measurements A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Results Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. Conclusion In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes.

An industry-supported center claims that it costs companies $2.6 billion to develop a new drug. But we need a broader-based and more transparent reckoning of research-and-development costs to inform discussions about fostering innovation and paying for medications.

The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process.

The authors draw on their experience with the University of California, San Diego Medical Center's successful enterprise-level clinical telemedicine program to present a paradigm for other academic health centers (AHCs) that wish to develop such a program. They detail key telemedicine program elements, or "tele-ments," that they consider essential to the development of a centralized, structured telemedicine program and relevant to the development of smaller programs. These tele-ments include an overall organizational vision, a centralized telemedicine infrastructure, telemedicine-specific policies and procedures, medical record documentation, relationships between the AHC clinical hub and its remote (spoke) partners, identification of and training for specialty providers, a business plan based on service agreements and/or insurance billing, and licensure/privileging. They discuss the importance of delaying equipment purchases until a plan is in place for sustaining the telemedicine enterprise and of establishing measures to define success at the outset of program development. In addition, they detail the benefits and concerns associated with telemedicine, provide a comprehensive listing of the roles and responsibilities of providers and staff involved in all aspects of telemedicine, and share samples of their program's informed consent forms and workflow checklists. Their goal is to offer support and guidance to other AHCs entering the telemedicine arena, enabling them to replicate key elements of a successful, enterprise-wide telemedicine infrastructure.

The present work targeted the understanding of the influence of nine different hardwood species as feedstock on ethanol production yield and costs. It was found that the minimum ethanol revenue (MER) ($ per gallon to the producer) to achieve a 12% internal rate of return (IRR) on invested capital was smaller for low lignin content samples and the influence of species characteristics remained restricted to high residual lignin content. We show that if the pretreatment being applied to the feedstock targets or is limited to low lignin removal, one can expect the species to have a significant impact on overall economics, playing important role to project success. This study also showed a variation of up to 40% in relative MER among hardwood species, where maple, globulus and sweet gum varied the least. Sensitivity analysis showed ethanol yield per ton of feedstock had the largest influence in MER, followed by CAPEX.

This paper provides evidence on the mechanisms influencing the patent output of a sample of small and large, entrepreneurial and established biotechnology firms from the input of indirect knowledge acquired from capital expenditures and direct knowledge from in-house R&D. Statistical models of counts are used to analyse the relationship between patent applications and R&D investment and capital expenditures. It focuses on biotechnology in the period 2002-2007 and is based on a unique data set drawn from various sources including the EU Industrial R&D Investment Scoreboard, the European Patent Office (EPO), the US Patent and Trademark Office (USPTO), and the World Intellectual Property Organisation (WIPO/PCT). The statistical models employed in the paper are Poisson distribution generalisations with the actual distribution of patent counts fitting the negative binomial distribution and gamma distribution very well. Findings support the idea that capital expenditures – taken as equivalent to technical change embodied in new machinery and capital equipment - may also play a crucial role in the development of new patentable items from scientific companies. For EPO patents, this role appears even more important than that played by R&D investment. The overall picture emerging from our analysis of the determinants of patenting in biotechnology is that the innovation process involves a well balanced combination of inputs from both R&D and new machinery and capital equipment.

We examine the utilization of remittances for expenditures associated with development, specifically children's education. We use household-level data from the Nepal Living Standards Survey (NLSS II, 2003-04) to separate remittance effects from general household income effects to demonstrate the migration-development relationship reflected in child schooling investment. We find that family-household remittances are spent on education of children, but the expenditures are disproportionately for boys' schooling. Only when girls are members of higher-income households do greater schooling expenditures go to them. This gender-discriminating pattern at the household level contrasts with the call for universal and gender-equal education. [ABSTRACT FROM AUTHOR]

With the aim of understanding the contribution of enzymes to the cost of lignocellulosic biofuels, we constructed a techno-economic model for the production of fungal cellulases. We found that the cost of producing enzymes was much higher than that commonly assumed in the literature. For example, the cost contribution of enzymes to ethanol produced by the conversion of corn stover was found to be $0.68/gal if the sugars in the biomass could be converted at maximum theoretical yields, and $1.47/gal if the yields were based on saccharification and fermentation yields that have been previously reported in the scientific literature. We performed a sensitivity analysis to study the effect of feedstock prices and fermentation times on the cost contribution of enzymes to ethanol price. We conclude that a significant effort is still required to lower the contribution of enzymes to biofuel production costs.

As part of his or her role in preparing a departmental budget, a manager must often become involved in budgeting for capital expenditures, those purchases that are of a type and sufficient dollar value to be capitalized and depreciated. Depending on the value of a proposed purchase, the department manager may have only a partial voice in the process; some significant purchases will require administrative approval, whereas some major acquisitions will require approval by the board of directors. Planning for possible capital purchases should begin well before the start of the annual budget exercise. Listing a capital item in the department's budget request does not imply approval; often, there are many more "needs" than there are capital funds available. Therefore, there must be a consistent process for identifying the proposed purchases that will be funded, such process necessarily including detailed specification of the need for a particular capital purchase, identification of all reasonable alternatives, consideration of any constraints, detailed financial comparison of alternatives, assessment of intangible factors, and a recommended choice.

From 1997 to 2001, hospitals expanded their capital expenditures by only 1% while future capital investment was expected to grow by 14% (Healthcare Financial Management Association 2004). Analyzing California hospital data from 2002 to 2004 to 2005 to 2007, the author identified and classified capital expenditures into 4 major types. Between the 2 study periods, growth in capital purchases exceeded 23% for medical equipment, expansion, and maintenance types of projects. Large nonprofit hospitals capturing a greater share of the market and serving fewer uninsured and government payers had a greater number of these types of capital purchases.

Este trabalho foi realizado com o objetivo de avançar na pesquisa sobre dificuldades de financiamento da empresa brasileira. Pesquisa-se a existência de tais dificuldades para viabilizar os investimentos em capital físico e também investimentos em inovação. As implicações empíricas são caracterizadas por um modelo de investimento dinâmico, proposto por Bond e Meghir (1994), que assume a presença de custos convexos de ajuste de capital e o objetivo de maximização de valor da empresa. Para uma amostra de empresas não financeiras brasileiras no período 1995-2006 os resultados mostram que a empresa brasileira encara dificuldades de financiamento externo para os investimentos das duas naturezas citadas. This work has been done with the purpose of advancing in the research about financing difficulties of the Brazilian company. Such difficulties are researched for capital expenditures as well as for financing innovation activities. The empirical implications are characterized by a dynamic investment model, as proposed by Bond and Meghir (1994), that assumes the presence of convex costs of adjustment and the objective of firm value maximization. For a sample of non financial Brazilian companies in the period 1995-2006, the results show that the Brazilian firm faces difficulties to finance its capital expenditure as well as innovation with external funds.

Summary Objectives To examine the different methods that can be used in the quantification of the added value of information technologies (IT) in the health care sector. This quantification represents a major issue for decision-makers and health care professionals when they have to plan an IT investment. MethodsArticles were chosen via Medline, internet and the University of Geneva bibliographic portal. Some of the papers were obtained directly from their authors. We examine the most current methods used to evaluate IT return on investment (ROI) in the general business and in the health care sector, drawing attention on methods traditionally used in macro economic studies that could reveal themselves disruptive for IT ROI impact evaluation in hospitals. Results Financial and accounting methods can provide interesting data on a specific IT project but are usually incomplete for revealing the global IT investment influence. Econometric methods tend to demonstrate the positive impact of health care IT (HIT) on hospital production and productivity. Hospitals having higher levels of IT investment tend to deliver a higher level of clinical quality and show improved hospital cost performances. Conclusions Information technologies are so intermingled with people and processes that the identification of specific IT benefit remains questionable. Using macro economic tools could be the best way to analyze and compute IT ROI in health care. Econometric tools take into account all types investments (inputs) and all the returns (outputs) enabling the precise measurement of IT investments impact, breakeven points, and possible threshold levels, thus providing helpful intelligence to reach the higher levels of IT governance in hospitals.

OBJECTIVE: Target 10 of the Millennium Development Goals (MDGs) is to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". Because of its impacts on a range of diseases, it is a health-related MDG target. This study presents cost estimates of attaining MDG target 10. METHODS: We estimate the population to be covered to attain the MDG target using data on household use of improved water and sanitation for 1990 and 2004, and taking into account population growth. We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014. Costs per capita for investment and recurrent costs are applied. Country data is aggregated to 11 WHO developing country subregions and globally. FINDINGS: Estimated spending required in developing countries on new coverage to meet the MDG target is US$ 42 billion for water and US$ 142 billion for sanitation, a combined annual equivalent of US$ 18 billion. The cost of maintaining existing services totals an additional US$ 322 billion for water supply and US $216 billion for sanitation, a combined annual equivalent of US$ 54 billion. Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%). Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation. CONCLUSION: In assessing financing requirements, estimates of cost should include the operation, maintenance and replacement of existing coverage as well as new services and programme costs. Country-level costing studies are needed to guide sector financing.