These differences were partly due to differences in how long it takes to recoup the total upfront investment (training, home adaptations, and the costs of the dialysis machine for centres which make an outright purchase rather than lease).
The business model for the China train-the-trainer program is to reuse existing open educational resources and make little to no upfront investment in training materials.
Such a transformation would require upfront financing for training, data processing and the like, but the investment should rapidly pay off in reduced costs.
While some authors [ 1, 6, 12] acknowledge that there will be greater upfront costs and training for patients/professionals to use technology, electronic formats are still more economical both in terms of time and resources [ 3, 4, 6- 8, 12, 15].
Similar to continuous quality initiatives which become more difficult and less economically feasible in a centre with a small number of patients on peritoneal dialysis, NCHD requires infrastructure and upfront costs and patient training may not be possible in centres with small amounts of ESRD patients.
Yet, unlike CEOs, principals often do not get the upfront -- and ongoing -- training they need to be successful.
Word of the deal was greeted with relief in many circles in Philadelphia, where officials had made Edison's assignment contingent on raising the cash it needs to buy new computers and textbooks, and train teachers -- upfront expenses that Edison must try to recoup from its revenues from the district.
When considering the staffing hours that are saved by using an automated liquid handler, the upfront resource requirements (instrument acquisition and training) can be properly accounted for.
