RESUMO
OBJECTIVE: This study tests the impacts of Digital Elevation Model (DEM) data on an exposure assessment methodology developed to quantify flooding of coastal infrastructure from storms and sea level rise on a regional scale. The approach is piloted on the United States Virgin Islands (USVI) for a one-hundred-year storm event in 2050 under the IPCC's 8.5 emission scenario (RCP 8,5). METHOD: Flooding of individual infrastructure was tested against three different digital elevation models using a GIS-based coastal infrastructure database created specifically for the project using aerial images. Inundation for extreme sea levels is based on dynamic simulations using Lisflood-ACC (LFP). RESULTS: The model indicates transport and utility infrastructure in the USVI are considerably exposed to sea level rise and modeled storm impacts from climate change. Prediction of flood extent was improved with a neural network processed SRTM, versus publicly available SRTM (~30â¯m) seamless C-band DEM but both SRTM based models underestimate flooding compared to LIDAR DEM. The modeled scenario, although conservative, showed significant flood exposure to a large number of access roads to facilities, 113/176 transportation related buildings, and 29/66 electric utility and water treatment buildings including six electric power transformers and six waste water treatment clarifiers. CONCLUSION: The method bridges a gap between large-scale non-specific flood assessments and single-facility detailed assessments and can be used to efficiently quantify and prioritize parcels and large structures in need of further assessment for regions that lack detailed data to assess climate exposure to sea level rise and flooding caused by waves. The method should prove particularly useful for assessment of Small Island Developing State regions that lack LIDAR data, such as the Caribbean.
RESUMO
PURPOSE: To quantify the monetary and time costs associated with oral contrast administration in the emergency department (ED) for patients with nontraumatic abdominal pain and to evaluate the cost savings associated with an institutional policy change in the criteria for oral contrast administration. METHODS: A HIPAA-complaint, institutional review board-approved time-driven activity-based costing analysis was performed using both prospective time studies and retrospective data obtained from a quaternary care center. Retrospective data spanned a 1-year period (January 1, 2016, to December 31, 2016). A process map was generated. Examination volume-related data, labor costs, and material costs were determined and applied to a base-case model. Univariate and multivariate sensitivity analyses were conducted. Multivariate analysis was used to estimate the cost savings associated with a policy change eliminating oral contrast for patients with body mass index ≥ 25 kg/m2, no prior abdominal surgery within 30 days preceding CT, and no inflammatory bowel disease. RESULTS: The baseline oral contrast utilization rate was 86% (4,541 of 5,263). The annual base-case cost estimate for oral contrast administration was $82,552. In multivariate analyses, this ranged from $13,685 to $315,393. The model was most sensitive to the volume of CTs requiring oral contrast. Applying parameters from the new policy change reduced the annual cost by 52% (cost saving: $35,836.57). Impact of oral contrast on time to discharge was highly variable and dependent on the contrast agent utilized. CONCLUSION: Costs associated with oral contrast in the ED are modest and should be balanced with its potential diagnostic benefits. Our criteria reduced oral contrast utilization by 52%.
