Monitoring cost limitations

Providers must compete for limited places in a subsidy scheme. This scenario goes a step beyond accreditation, effectively introducing an additional competitive process. Limiting places in a subsidy scheme limits choice for patients, but in many cases it lowers administrative and monitoring costs. This form of competitive subsidy may be used to avoid duplication in the supply of services that require high initial investments and services for which the number of potential beneficiaries is relatively low. Like accreditation, competition for limited places in a subsidy scheme can be used to improve quality in areas that patients are unable to perceive. It can also drive down costs. With supply-side subsidies, there is probably a stronger incentive to compete for places in the scheme than with demand-side subsidies, because once selected the provider is sure that it will receive the subsidy (with demand-side sub-... 

The setup of the monitoring strategy includes decisions on sample matrix, sampling locations, frequencies and methods. This selection depends on the purpose of monitoring and usually represents a compromise between a sufficient coverage of samples in time and space and limiting the monitoring costs. 

What are the advantages and limitations of continuous and periodic monitoring Continuous monitoring requires a relatively large initial expenditure. But once installed, cost of operation is quite low. Periodic monitoring has a low initial cost, but is manpower intensive and therefore has a relatively high continuing cost. 

Detailed sampling can include, but is not limited to, the installation of monitoring well networks. After the wells have been installed, aquifer tests are typically performed. Once the aquifer tests are performed and the aquifer characteristics are determined, time series sampling for a given contaminant, or a surrogate, is undertaken. The combined results of these efforts provide the basis for development of a treatment strategy. Modeling can be used as part of this effort to help determine the best technical and most cost-effective techniques to be used at a site. 

Process inefficiencies, like the example, are often the most serious limiting factor in a plant. Their negative impact on plant productivity and profitability is often greater than the total cost of the maintenance operation. However, without regular monitoring of process parameters, many plants do not recognize this unfortunate fact. 

Most plants can be cost-effectively monitored using a microprocessor-based system designed to use vibration, process parameters, visual inspection and limited infrared temperature monitoring. 

A factor which previously limited installation of automatic corrosion monitoring systems was the cost of cabling between sensors and control room instrumentation-this was particularly relevant to the electrical resistance (ER) systems. Developments to overcome this have included transmitter units at the probe location providing the standard 4-20 mA output (allowing use of standard cable) for onward transmission to data systems or the use of radio linkage which has been successfully used for other process-plant instrumentation. 

The workhorses in national monitoring programs are multi-residue methods. Any official method collection of any EU Member State contains at least one multi-residue method. For multi-analyte and/or multi-matrix methods, it is likely to be impractical to validate a method for all possible combinations of analyte, concentration and type of sample matrix that may be encountered in subsequent use of the method. Therefore, initial validation should incorporate as many of the target analytes and matrices as practicable. For practical reasons this validation and the evaluation of other methods with limited scope often cannot be conducted in inter-laboratory studies. Other concepts based on independent laboratory validation or validation in a single laboratory have been developed and can provide a practical and cost-effective alternative (or intermediate) approach. 

With a 13C label at the methide center, the presence of reactive methide intermediate can be verified and complex reaction products can be inventoried and eventually identified. The only limitations are the synthesis and cost involved in incorporation of the 13C label. As a rule we, only use 13C-labeled dimethylformamide and NaCN as starting materials because of their low cost and availability. Another limitation of enriched 13C-NMR monitoring is dilution of the enriched label to natural abundance levels. Currently, we are developing isotope-editing techniques that utilize unnatural 13C double labels to solve this problem. 

The version 1.0 bDNA assay was compared with the Monitor and NASB A HIV-1 RNA assays in three clinical evaluations (Coste et al., 1996 Revets et al., 1996 Schuurman et al., 1996). Coste et al. (1996) found that the sensitivity of the bDNA assay was lower (68.3%) than that of both the Monitor (93.3%) and NASBA (100%) assays for detection of HTV-1 RNA among 60 plasma specimens. When results with specimens for which the RNA levels were higher than the lower quantitation limit of each method were analyzed, the mean levels by Monitor, bDNA, and NASBA were 5.38 0.52,5.03 0.55, and 5.39 0.53 log10 copies/ml, re-... 

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