WorldWideScience

Sample records for cost generic alternatives

  1. Potential cost savings from generic medicines – protecting the ...

    African Journals Online (AJOL)

    Results: Three of the algorithms (diabetes insipidus, haemophilia and hypothyroidism) list medicines for which no generic equivalent was available at the time of the study. The median cost differential between brand and generic equivalents for the remaining 22 chronic conditions ranged from 19.5%. (for type 1 diabetes ...

  2. Cost effectiveness of venlafaxine compared with generic fluoxetine or generic amitriptyline in major depressive disorder in the UK.

    Science.gov (United States)

    Lenox-Smith, Alan; Greenstreet, Liz; Burslem, Kate; Knight, Chris

    2009-01-01

    To estimate the cost effectiveness of venlafaxine compared with generic fluoxetine and generic amitriptyline used in major depressive disorder in primary care in the UK. A decision-tree model for the treatment of major depressive disorder was constructed using a Delphi panel. The tree was populated with clinical success rates from a pooled analysis of fluoxetine compared with venlafaxine and a clinical trial of amitriptyline compared with venlafaxine using remission as the key endpoint. Where there was insufficient data from clinical trials, the Delphi panel was used. Costs within the tree were taken from contemporary UK sources. Six-monthly costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were then estimated. Treatment costs for 6 months were pound1530 for venlafaxine, pound1539 for fluoxetine and pound1558 for amitriptyline (year of costing 2006). Cost effectiveness as assessed by incremental cost per QALY ratio at 8 weeks was pound20 600 for venlafaxine compared with fluoxetine, with fluoxetine dominating (being less costly and more effective than) amitriptyline. To test the robustness of the model a Rank Order Stability Assessment was performed that showed that even if fluoxetine and/or amitriptyline were given away free, a scenario starting with venlafaxine would still be the least costly treatment over a 6-month period. In this model, venlafaxine was shown to be a cost-effective alternative to generic fluoxetine and amitriptyline when used as a first-line therapy. Thus, cost of therapy should not be a barrier to use of venlafaxine as a first-line option in treating major depressive disorder in primary care in the UK.

  3. Potential cost savings from generic medicines – protecting the ...

    African Journals Online (AJOL)

    One way to do this would be to limit the costs of medicines provided for the management of chronic conditions listed in the PMBs. This study assessed the potential savings that would be achievable by substituting generics for brand name (originator) medicines listed in the chronic disease algorithms set out by the CMS.

  4. The costs of alternative policies

    OpenAIRE

    Bruvoll, Annegrete

    1998-01-01

    After decades with landfill and incineration as the most common waste treatment methods, the current main waste policy strategy has changed toward recycling. Also, most governments declare that source reduction, to reduce the generation of waste, is the best choice, while in practice few steps have been taken in this direction. In order to improve the understanding of optimal policies for paper and plastic waste reductions we compare the costs of the four alternatives recycling, i...

  5. Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis.

    Science.gov (United States)

    Hill, Andrew; Redd, Christopher; Gotham, Dzintars; Erbacher, Isabelle; Meldrum, Jonathan; Harada, Ryo

    2017-01-20

    The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs. This research was carried out in a non-clinical research setting using secondary data. There were no human participants in the study. Four drugs were selected for the study: bortezomib, dasatinib, everolimus and gefitinib. These medications were selected according to their clinical importance, novel pharmaceutical actions and the availability of generic price data. Target costs for treatment were to be generated for each indication for each treatment. The primary outcome measure was the target cost according to a production cost calculation algorithm. The secondary outcome measure was the target cost as the lowest available generic price; this was necessary where export data were not available to generate an estimate from our cost calculation algorithm. Other outcomes included patent expiry dates and total eligible treatment populations. Target prices were £411 per cycle for bortezomib, £9 per month for dasatinib, £852 per month for everolimus and £10 per month for gefitinib. Compared with current list prices in England, these target prices would represent reductions of 74-99.6%. Patent expiry dates were bortezomib 2014-22, dasatinib 2020-26, everolimus 2019-25 and gefitinib 2017. The total global eligible treatment population in 1 year is 769 736. Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Costs and cost- effectiveness of alternative tuberculosis ...

    African Journals Online (AJOL)

    tuberculosis management strategy in Hlabisa with three alternative strategies ... directly observed therapy for tuberculosis, a strategy that is cheap and ..... Historical Perspec;tive and Critical Evaluation of Current Information. Pretoria: Medical ...

  7. Potential Cost Savings from Generic Medicines - Protecting the ...

    African Journals Online (AJOL)

    Background: South Africa has followed a pro-generic policy since the introduction of the National Drug Policy in 1996. ... This study assessed the potential savings that would be achievable by substituting generics for brand name (originator) medicines listed in the chronic disease algorithms set out by the Council for ...

  8. Generic Drugs - Decreasing Costs and Room for Increased Number of Kidney Transplantations.

    Science.gov (United States)

    Spasovski, Goce

    2015-01-01

    Kidney transplantation is the best treatment option in comparison to dialysis, although patients are obliged to receive life-long medical treatment with immunosuppressive drugs (ISDs) for prevention of the graft rejection. Such immunosuppressive treatment may be costly and associated with multiple adverse effects. Since costs are viewed as one of the major constraints for the increasing number of transplantation, the use of generic ISDs may decrease the overall cost of transplantation and raise the possibility for its further development. An ideal ISD should have the security margin between toxic and therapeutic dose, and prevent development of acute or chronic rejection of the transplanted kidney. This is particularly important for drugs with a "narrow therapeutical index" (NTI), where small differences in dose or concentration lead to dose and concentration-dependent, serious therapeutic failures and/or adverse drug reactions. The NTI generic drug is approved if within 90%-112% of the area under the curve of the original product the pharmacokinetics fulfills the strict criteria of pharmaceutical equivalence and bioequivalence. Every generic has to be proven to be bioequivalent to the innovator product, and not to other generic products because of the possible generic "drift". Thus, the generic ISDs may be economically attractive, but theoretically, they may pose a risk to transplant patients. Such risks may be reduced if a long-term clinical studies showing cost-effectiveness of generic ISDs in de novo and prevalent transplant patients for every new generic ISD are performed. In conclusion, the increased number of solid organ transplantation goes in line with the increased health care expenditure for ISDs. The generic immunosuppressants could be a possible solution if safely substituted for innovator products or other generic drug of choice. The substantial cost reduction needs to be redirected into organ donation initiatives so that more patients can benefit

  9. A comparison of the cost of generic and branded food products in Australian supermarkets.

    Science.gov (United States)

    Chapman, Kathryn; Innes-Hughes, Christine; Goldsbury, David; Kelly, Bridget; Bauman, Adrian; Allman-Farinelli, Margaret

    2013-05-01

    Food cost is an important factor influencing the consumption of nutritious foods and subsequent chronic disease risk. The present study compared the cost of branded food products with their generic equivalents across a range of food categories. The survey was conducted within two major supermarket chains across six locations in Sydney, Australia (n 12). Price differences were calculated for 'core' (nutrient dense and low in energy) and 'extra' (high in undesirable nutrients and/or energy) packaged foods (n 22) between generic and branded items. A cost saving of 44 % was found by purchasing generic over branded products across all food categories. The most significant savings were for core foods, such as bread and cereals, and the smallest cost savings were seen for fruit products. There was little variation in cost saving between branded and generic products by socio-economic status of the supermarket location. The large price differential between branded and generic food products implies that consumers, particularly those on lower incomes, could benefit financially from purchasing generic items. The promotion of core generic products may be an effective strategy to assist people on lower incomes to meet dietary guidelines.

  10. The risks and costs of multiple-generic substitution of topiramate.

    Science.gov (United States)

    Duh, M S; Paradis, P E; Latrémouille-Viau, D; Greenberg, P E; Lee, S P; Durkin, M B; Wan, G J; Rupnow, M F T; LeLorier, J

    2009-06-16

    To investigate clinical and economic consequences following generic substitution of one vs multiple generics of topiramate (Topamax; Ortho-McNeil Neurologics, Titusville, NJ). Medical and pharmacy claims data of Régie de l'Assurance-Maladie du Québec from January 2006 to October 2007 were used. Patients with epilepsy treated with topiramate were selected. An open-cohort design was used to classify the observation period into periods of brand, single-generic, and multiple-generic use. One-year generic-switch and switchback-to-brand rates were estimated using Kaplan-Meier methodology. Medical resource utilization and costs were compared among the three periods using multivariate regression analysis. In total, 948 patients were observed during 1,105 person-years of brand use, 233 person-years of single-generic use, and 92 person-years of multiple-generic use. A total of 23% of generic users received at least two different generic versions. Compared to brand use, multiple-generic use was associated with higher utilization of other prescription drugs (incidence rate ratio [IRR] = 1.27, 95% confidence interval [CI] = 1.24-1.31), higher hospitalization rates (0.48 vs 0.83 visit/person-year, IRR = 1.65, 95% CI = 1.28-2.13), and longer hospital stays (2.6 vs 3.9 days/person-year, IRR = 1.43, 95% CI = 1.27-1.60), but the effect was less pronounced in single-generic use (hospitalization: IRR = 1.08, 95% CI = 0.88-1.34, length of stay: IRR = 1.12, 95% CI = 1.03-1.23). The risk of head injury or fracture was nearly three times higher (hazard ratio = 2.84, 95% CI = 1.24-6.48) following a generic-to-generic switch compared to brand use. The total annualized health care cost per patient was higher in the multiple-generic than brand periods by C$1,716 (cost ratio = 1.21, p = 0.0420). Multiple-generic substitution of topiramate was significantly associated with negative outcomes, such as hospitalizations and injuries, and increased health care costs.

  11. A generic tool for cost estimating in aircraft design

    NARCIS (Netherlands)

    Castagne, S.; Curran, R.; Rothwell, A.; Price, M.; Benard, E.; Raghunathan, S.

    2008-01-01

    A methodology to estimate the cost implications of design decisions by integrating cost as a design parameter at an early design stage is presented. The model is developed on a hierarchical basis, the manufacturing cost of aircraft fuselage panels being analysed in this paper. The manufacturing cost

  12. Low-cost generic drugs under the President's Emergency Plan for AIDS Relief drove down treatment cost; more are needed.

    Science.gov (United States)

    Venkatesh, Kartik K; Mayer, Kenneth H; Carpenter, Charles C J

    2012-07-01

    The President's Emergency Plan for AIDS Relief (PEPFAR) was originally authorized in 2003 with the goal of supporting HIV prevention, treatment, and care within fifteen focus countries in the developing world. By September 2011 nearly 13 million people around the world were receiving HIV/AIDS-related care through PEPFAR, and 3.9 million were receiving antiretroviral treatment. However, in the early years of the program, access to antiretroviral drugs was hampered by the lack of a licensing process that the US government recognized for generic versions of these medications. Ultimately, the obstacle to approval of generic antiretroviral drugs was removed, which led to PEPFAR's considerable success at making these treatments widely available. This article outlines PEPFAR's evolving use of generic antiretroviral drugs to treat HIV in the developing world, highlights ongoing initiatives to increase access to generic antiretrovirals, and points to the need for mechanisms that will speed up the approval of new generic drugs. The striking decline in antiretroviral treatment costs, from $1,100 per person annually in 2004 to $335 per person annually in 2012, is due to the availability of effective generic antiretrovirals. Given growing resistance to existing drugs and the planned expansion of treatment to millions more people, access to newer generations of generic antiretrovirals will have to be expedited.

  13. When is a "generic" medication not really a generic?

    Science.gov (United States)

    Howland, Robert H

    2010-02-01

    The distinction between pharmaceutical equivalent and pharmaceutical alternative drug products can lead to considerable confusion, especially with the proliferation of various branded, alternative, and generic medications that contain the same active ingredient. To illustrate this problem, four examples of medication products containing the active ingredients paroxetine, venlafaxine, bupropion, and valproate will be described. Understanding these differences is important for nurses providing patient care. Only generic drugs can be freely substituted for a brand-name product. Switching to a pharmaceutical alternative requires a change in prescription. Finally, the use, labeling, and cost of branded, alternative, and generic medications may be different.

  14. The impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic medication in Finland.

    Science.gov (United States)

    Koskinen, Hanna; Ahola, Elina; Saastamoinen, Leena K; Mikkola, Hennamari; Martikainen, Jaana E

    2014-12-01

    To assess the impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic drugs in Finland during the first year after its launch. Furthermore, the additional impact of reference pricing on prior implemented generic substitution is assessed. A retrospective analysis was performed between 2006 and 2010. A segmented linear regression analysis of interrupted time series was used to estimate changes in the levels and trends in the cost of one day of treatment. Of the study drugs, clozapine belonged to generic substitution already at the start of the study period while olanzapine and quetiapine were included in generic substitution alongside with reference pricing in 2009. Risperidone was included in generic substitution in 2008, before reference pricing. A substantial decrease in the daily cost of all four antipsychotic substances was seen after one year of the implementation of reference pricing and the extension of generic substitution. The impact ranged from -29.9% to -66.3%, and it was most substantial on the daily cost of olanzapine. Also in the daily cost of risperidone a substantial decrease of -43.3% was observed. However, most of these savings, -32.6%, were generated by generic substitution which had been adopted prior. Reference pricing and the extension of generic substitution produced substantial savings on antipsychotic medication costs during the first year after its launch, but the intensity of the impact differed between active substances. Furthermore, our results suggest that the additional cost savings from reference pricing after prior implemented generic substitution, are comparatively low.

  15. A generic framework for cost estimation and cost control in product design

    NARCIS (Netherlands)

    Lutters-Weustink, Ilanit F.; ten Brinke, E.; Streppel, A.H.; Kals, H.J.J.

    2000-01-01

    Traditionally, cost estimation was performed after the design process, though most opportunities of cost reduction have already passed. Therefore, it is advantageous to be able to estimate the product costs early in the product development cycle. By changing the way cost estimation is dealt with, it

  16. The cost of generic clinical mastitis in dairy cows as estimated by using dynamic programming.

    Science.gov (United States)

    Bar, D; Tauer, L W; Bennett, G; González, R N; Hertl, J A; Schukken, Y H; Schulte, H F; Welcome, F L; Gröhn, Y T

    2008-06-01

    The objective of this study was to estimate the cost of generic clinical mastitis (CM) in high-yielding dairy cows given optimal decisions concerning handling of CM cases. A specially structured optimization and simulation model that included a detailed representation of repeated episodes of CM was used to study the effects of various factors on the cost of CM. The basic scenario was based on data from 5 large herds in New York State. In the basic scenario, 92% of the CM cases were recommended to be treated. The average cost of CM per cow and year in these herds was $71. The average cost of a CM case was $179. It was composed of $115 because of milk yield losses, $14 because of increased mortality, and $50 because of treatment-associated costs. The estimated cost of CM was highly dependent on cow traits: it was highest ($403) in cows with high expected future net returns (e.g., young, high-milk-yielding cows), and was lowest ($3) in cows that were recommended to be culled for reasons other than mastitis. The cost per case of CM was 18% higher with a 20% increase in milk price and 17% lower with a 20% decrease in milk price. The cost per case of CM was affected little by a 20% change in replacement cost or pregnancy rate. Changes in CM incidence, however, resulted from changes in these factors, thus affecting whole-farm profitability. The detailed results obtained from this insemination and replacement optimization model can assist farmers in making CM treatment decisions.

  17. Cost Effectiveness of Alternative Route Special Education Teacher Preparation

    Science.gov (United States)

    Sindelar, Paul T.; Dewey, James F.; Rosenberg, Michael S.; Corbett, Nancy L.; Denslow, David; Lotfinia, Babik

    2012-01-01

    In this study, the authors estimated costs of alternative route preparation to provide states a basis for allocating training funds to maximize production. Thirty-one special education alternative route program directors were interviewed and completed cost tables. Two hundred and twenty-four program graduates were also surveyed. The authors…

  18. [It is not only about cost ... when it comes to generic medication].

    Science.gov (United States)

    Piguet, Valérie; D'Incau, Stéphanie; Besson, Marie; Desmeules, Jules; Cedraschi, Christine

    2016-06-22

    The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Patients' representations suggest that they might be confident in taking a generic medication: when the generic medication is prescribed by the physician and each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Economic arguments are not sufficient to accept substitution. Negative representations require attention and need be considered.

  19. The cost of ethanol production from lignocellulosic biomass -- A comparison of selected alternative processes. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Grethlein, H.E.; Dill, T.

    1993-04-30

    The purpose of this report is to compare the cost of selected alternative processes for the conversion of lignocellulosic biomass to ethanol. In turn, this information will be used by the ARS/USDA to guide the management of research and development programs in biomass conversion. The report will identify where the cost leverages are for the selected alternatives and what performance parameters need to be achieved to improve the economics. The process alternatives considered here are not exhaustive, but are selected on the basis of having a reasonable potential in improving the economics of producing ethanol from biomass. When other alternatives come under consideration, they should be evaluated by the same methodology used in this report to give fair comparisons of opportunities. A generic plant design is developed for an annual production of 25 million gallons of anhydrous ethanol using corn stover as the model substrate at $30/dry ton. Standard chemical engineering techniques are used to give first order estimates of the capital and operating costs. Following the format of the corn to ethanol plant, there are nine sections to the plant; feed preparation, pretreatment, hydrolysis, fermentation, distillation and dehydration, stillage evaporation, storage and denaturation, utilities, and enzyme production. There are three pretreatment alternatives considered: the AFEX process, the modified AFEX process (which is abbreviated as MAFEX), and the STAKETECH process. These all use enzymatic hydrolysis and so an enzyme production section is included in the plant. The STAKETECH is the only commercially available process among the alternative processes.

  20. Statistical Cost Estimation in Higher Education: Some Alternatives.

    Science.gov (United States)

    Brinkman, Paul T.; Niwa, Shelley

    Recent developments in econometrics that are relevant to the task of estimating costs in higher education are reviewed. The relative effectiveness of alternative statistical procedures for estimating costs are also tested. Statistical cost estimation involves three basic parts: a model, a data set, and an estimation procedure. Actual data are used…

  1. A generic interface to reduce the efficiency-stability-cost gap of perovskite solar cells

    Science.gov (United States)

    Hou, Yi; Du, Xiaoyan; Scheiner, Simon; McMeekin, David P.; Wang, Zhiping; Li, Ning; Killian, Manuela S.; Chen, Haiwei; Richter, Moses; Levchuk, Ievgen; Schrenker, Nadine; Spiecker, Erdmann; Stubhan, Tobias; Luechinger, Norman A.; Hirsch, Andreas; Schmuki, Patrik; Steinrück, Hans-Peter; Fink, Rainer H.; Halik, Marcus; Snaith, Henry J.; Brabec, Christoph J.

    2017-12-01

    A major bottleneck delaying the further commercialization of thin-film solar cells based on hybrid organohalide lead perovskites is interface loss in state-of-the-art devices. We present a generic interface architecture that combines solution-processed, reliable, and cost-efficient hole-transporting materials without compromising efficiency, stability, or scalability of perovskite solar cells. Tantalum-doped tungsten oxide (Ta-WOx)/conjugated polymer multilayers offer a surprisingly small interface barrier and form quasi-ohmic contacts universally with various scalable conjugated polymers. In a simple device with regular planar architecture and a self-assembled monolayer, Ta-WOx–doped interface–based perovskite solar cells achieve maximum efficiencies of 21.2% and offer more than 1000 hours of light stability. By eliminating additional ionic dopants, these findings open up the entire class of organics as scalable hole-transporting materials for perovskite solar cells.

  2. Comparative life-cycle cost analysis for low-level mixed waste remediation alternatives

    Energy Technology Data Exchange (ETDEWEB)

    Jackson, J.A.; White, T.P.; Kloeber, J.M.; Toland, R.J.; Cain, J.P.; Buitrago, D.Y.

    1995-03-01

    The purpose of this study is two-fold: (1) to develop a generic, life-cycle cost model for evaluating low-level, mixed waste remediation alternatives, and (2) to apply the model specifically, to estimate remediation costs for a site similar to the Fernald Environmental Management Project near Cincinnati, OH. Life-cycle costs for vitrification, cementation, and dry removal process technologies are estimated. Since vitrification is in a conceptual phase, computer simulation is used to help characterize the support infrastructure of a large scale vitrification plant. Cost estimating relationships obtained from the simulation data, previous cost estimates, available process data, engineering judgment, and expert opinion all provide input to an Excel based spreadsheet for generating cash flow streams. Crystal Ball, an Excel add-on, was used for discounting cash flows for net present value analysis. The resulting LCC data was then analyzed using multi-attribute decision analysis techniques with cost and remediation time as criteria. The analytical framework presented allows alternatives to be evaluated in the context of budgetary, social, and political considerations. In general, the longer the remediation takes, the lower the net present value of the process. This is true because of the time value of money and large percentage of the costs attributed to storage or disposal.

  3. Emission Control Cost-Effectiveness of Alternative-Fuel Vehicles

    OpenAIRE

    Wang, Quanlu; Sperling, Daniel; Olmstead, Janis

    1993-01-01

    Although various legislation and regulations have been adopted to promote the use of alternative-fuel vehicles for curbing urban air pollution problems, there is a lack of systematic comparisons of emission control cost-effectiveness among various alternative-fuel vehicle types. In this paper, life-cycle emission reductions and life-cycle costs were estimated for passenger cars fueled with methanol, ethanol, liquified petroleum gas, compressed natural gas, and electricity. Vehicle emission es...

  4. Cost allocation policy review: options and preferred alternatives

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-10-15

    This policy review of the consultation process on the electricity cost allocation issue is presented with specific cost allocation policy issues addressed herein, such as: the new microFIT rate, accounting changes and the transition to IFRS, and review of allocating costs to load displacement generation. This report gave the current situation for all these issues, previous work, issues, viable options for dealing with these issues and the preferred alternatives.

  5. Pros, Cons, and Alternatives to Weight Based Cost Estimating

    Science.gov (United States)

    Joyner, Claude R.; Lauriem, Jonathan R.; Levack, Daniel H.; Zapata, Edgar

    2011-01-01

    Many cost estimating tools use weight as a major parameter in projecting the cost. This is often combined with modifying factors such as complexity, technical maturity of design, environment of operation, etc. to increase the fidelity of the estimate. For a set of conceptual designs, all meeting the same requirements, increased weight can be a major driver in increased cost. However, once a design is fixed, increased weight generally decreases cost, while decreased weight generally increases cost - and the relationship is not linear. Alternative approaches to estimating cost without using weight (except perhaps for materials costs) have been attempted to try to produce a tool usable throughout the design process - from concept studies through development. This paper will address the pros and cons of using weight based models for cost estimating, using liquid rocket engines as the example. It will then examine approaches that minimize the impct of weight based cost estimating. The Rocket Engine- Cost Model (RECM) is an attribute based model developed internally by Pratt & Whitney Rocketdyne for NASA. RECM will be presented primarily to show a successful method to use design and programmatic parameters instead of weight to estimate both design and development costs and production costs. An operations model developed by KSC, the Launch and Landing Effects Ground Operations model (LLEGO), will also be discussed.

  6. Generics and cost-effective prescribing in Belgium: does bioequivalence always translate in therapeutic equivalence?

    Science.gov (United States)

    Dupont, A G; Heller, F

    2009-01-01

    As many other countries, Belgium has a policy to promote the use of generic pharmaceutical products. In order to protect consumers, these generic products must be demonstrated to be essentially similar to the previously approved product, typically an innovator product. The therapeutic equivalence of a generic and an innovator product is most commonly based on the demonstration of bioequivalence, i.e. clinically insignificant differences in the rate and extent of drug absorption usually assessed from pharmacokinetic measurements, in a normal and healthy population. This article reviews the bioequivalence requirements for generic products and examines whether bioequivalence always adequately substantiates therapeutic equivalence and interchangeability. Clinical practice has identified a number of drug classes for which generic substitution should be approached with caution. Current bioequivalence requirements are based on a measure of average bioequivalence. There are fears that use of this measure may be inappropriate in the case of a drug with a narrow therapeutic range or high intrasubject or intersubject variability. Under these circumstances, measures of individual and population bioequivalence are proposed to be more accurate than measures of average bioequivalence. Bioequivalence issues are discussed together more general concerns about generic drug substitution, such as differences in product and packaging appearance and differences in excipients.

  7. 42 CFR 447.70 - General alternative cost sharing protections.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false General alternative cost sharing protections. 447.70 Section 447.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... the Bright Futures guidelines issued by the American Academy of Pediatrics. (3) Services furnished to...

  8. An alternative safer and cost effective surface sterilization method for ...

    African Journals Online (AJOL)

    user

    2013-10-30

    Oct 30, 2013 ... surface sterilization method for sugarcane. (Saccharum officinarum L.) explants ... alternative safer and cost effective sterilization method to substitute mercury chloride. In the study, sugarcane shoot tip blocks were ... Sahoo, 2009; Kanwar, 2009; Lal et al., 2009). However, mercuric chloride (HgCl2) is ...

  9. An alternative safer and cost effective surface sterilization method for ...

    African Journals Online (AJOL)

    Regardless of its serious health effect, mercury chloride is frequently utilized for surface sterilization to mitigate microbial contamination in sugarcane tissue culture. The current study aimed at finding an alternative safer and cost effective sterilization method to substitute mercury chloride. In the study, sugarcane shoot tip ...

  10. Costs and returns analysis of improved and alternative cassava ...

    African Journals Online (AJOL)

    Costs and returns analysis of improved and alternative cassava production technologies in Enugu State, Nigeria. ... There has been scientific research into new technologies. Increased Agricultural Productivity depends on the acceptability of the innovations and the willingness to invest on them. For farmers to adopt and ...

  11. Use and cost of branded and generic drugs in patients with coronary heart disease--results from a prospective survey of 1008 patients in two London hospitals.

    Science.gov (United States)

    Corp, E V; Antoniou, S; Wright, P G; Khachi, H; Vercaeren, S; Wald, D S

    2009-12-01

    Combination therapy with three classes of drug, antiplatelet, cholesterol and blood pressure lowering treatment markedly reduce the risk of recurrent cardiovascular events in patients with coronary heart disease (CHD). Within each class, generic and branded (patented) drugs are available which have similar efficacy but differ in cost. (i) To assess the extent to which preventive medical drugs are prescribed in patients with CHD and to examine the reasons for drug omissions and (ii) to assess the relative use of branded and generic drugs and the reasons for drug selection. The medication charts and hospital notes of consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) at a large cardiothoracic centre were reviewed over a 3-month period. Interviews with patients, attending cardiologists and general practitioners were undertaken to establish why drugs were and were not prescribed. Among 1008 patients (755 who had PCI and 253 who had CABG) the use of aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), beta blockers and calcium channel blockers were, respectively, 97, 98, 81, 76 and 18%. The combination of any 4 classes of drug were used in 65% of patients. Almost all patients who did not receive aspirin or a statin had clinical contraindications and were on alternative drugs. In about 12% of patients without an ACE inhibitor (or ARB) and 7% of patients without a beta blocker, no reason to withhold such treatment was identified. Branded drugs were used in 52% of patients; the most commonly prescribed being atorvastatin in 33%. Clinical reasons for using branded rather than generic drugs were identified in 13% of cases. Our results show a high rate of use of secondary preventive cardiac medications in patients undergoing coronary revascularization procedures, but the use of ACE inhibitors or beta blockers is still overlooked in about 1 in 10 patients

  12. Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Wisløff Torbjørn

    2012-04-01

    Full Text Available Abstract Background Hypertension is one of the leading causes of cardiovascular disease (CVD. A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease. Methods We used the Norwegian Cardiovascular Disease model (NorCaD to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources. Results In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs. Conclusions Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.

  13. Costs and effectiveness of treatment alternatives for proximal caries lesions.

    Directory of Open Access Journals (Sweden)

    Falk Schwendicke

    Full Text Available OBJECTIVES: Invasive therapy of proximal caries lesions initiates a cascade of re-treatment cycles with increasing loss of dental hard tissue. Non- and micro-invasive treatment aim at delaying this cascade and may thus reduce both the health and economic burden of such lesions. This study compared the costs and effectiveness of alternative treatments of proximal caries lesions. METHODS: A Markov-process model was used to simulate the events following the treatment of a proximal posterior lesion (E2/D1 in a 20-year-old patient in Germany. We compared three interventions (non-invasive; micro-invasive using resin infiltration; invasive using composite restoration. We calculated the risk of complications of initial and possible follow-up treatments and modelled time-dependent non-linear transition probabilities. Costs were calculated based on item-fee catalogues in Germany. Monte-Carlo-microsimulations were performed to compare cost-effectiveness of non- versus micro-invasive treatment and to analyse lifetime costs of all three treatments. RESULTS: Micro-invasive treatment was both more costly and more effective than non-invasive therapy, with ceiling-value-thresholds for willingness-to-pay between 16.73 € for E2 and 1.57 € for D1 lesions. Invasive treatment was the most costly strategy. Calculated costs and effectiveness were sensitive to lesion stage, patient's age, discounting rate and assumed initial treatment costs. CONCLUSIONS: Non- and micro-invasive treatments have lower long-term costs than invasive therapy of proximal lesions. Micro-invasive therapy had the highest cost-effectiveness for treating D1 lesions in young patients. Decision makers with a willingness-to-pay over 16.73 € and 1.57 € for E2 and D1 lesions, respectively, will find micro-invasive treatment more cost-effective than non-invasive therapy.

  14. Costs and effectiveness of treatment alternatives for proximal caries lesions.

    Science.gov (United States)

    Schwendicke, Falk; Meyer-Lueckel, Hendrik; Stolpe, Michael; Dörfer, Christof Edmund; Paris, Sebastian

    2014-01-01

    Invasive therapy of proximal caries lesions initiates a cascade of re-treatment cycles with increasing loss of dental hard tissue. Non- and micro-invasive treatment aim at delaying this cascade and may thus reduce both the health and economic burden of such lesions. This study compared the costs and effectiveness of alternative treatments of proximal caries lesions. A Markov-process model was used to simulate the events following the treatment of a proximal posterior lesion (E2/D1) in a 20-year-old patient in Germany. We compared three interventions (non-invasive; micro-invasive using resin infiltration; invasive using composite restoration). We calculated the risk of complications of initial and possible follow-up treatments and modelled time-dependent non-linear transition probabilities. Costs were calculated based on item-fee catalogues in Germany. Monte-Carlo-microsimulations were performed to compare cost-effectiveness of non- versus micro-invasive treatment and to analyse lifetime costs of all three treatments. Micro-invasive treatment was both more costly and more effective than non-invasive therapy, with ceiling-value-thresholds for willingness-to-pay between 16.73 € for E2 and 1.57 € for D1 lesions. Invasive treatment was the most costly strategy. Calculated costs and effectiveness were sensitive to lesion stage, patient's age, discounting rate and assumed initial treatment costs. Non- and micro-invasive treatments have lower long-term costs than invasive therapy of proximal lesions. Micro-invasive therapy had the highest cost-effectiveness for treating D1 lesions in young patients. Decision makers with a willingness-to-pay over 16.73 € and 1.57 € for E2 and D1 lesions, respectively, will find micro-invasive treatment more cost-effective than non-invasive therapy.

  15. Comparative analysis of the cost and effectiveness of generic and brand-name antibiotics: the case of uncomplicated urinary tract infection.

    Science.gov (United States)

    Lin, Yu-Shiuan; Jan, I-Shiow; Cheng, Shou-Hsia

    2017-03-01

    Generic medications used for chronic diseases are beneficial in containing healthcare costs and improving drug accessibility. However, the effects of generic drugs in acute and severe illness remain controversial. This study aims to investigate treatment costs and outcomes of generic antibiotics prescribed for adults with a urinary tract infection in outpatient settings. The data source was the Longitudinal Health Insurance Database of Taiwan. We included outpatients aged 20 years and above with a urinary tract infection who required one oral antibiotic for which brand-name and generic products were simultaneously available. Drug cost and overall healthcare expense of the index consultation, healthcare cost during a 42-day follow-up period, and treatment failure rates were the main dependent variables. Data were compared between brand-name and generic users from the entire cohort and a propensity score-matched samples. Results from the entire cohort and propensity score-matched samples were similar. Daily antibiotic cost was significantly lower among generic users than brand-name users. Significant lower total drug claims of the index consultation only existed in patients receiving the investigated antibiotics, while the drug price between brand-name and generic versions were relatively large (e.g., >50%). The overall healthcare cost of the index consultation, healthcare expenditure during a 42-day follow-up period, and treatment failure rates were similar between the two groups. Compared with those treated with brand-name antibiotics, outpatients who received generic antibiotics had equivalent treatment outcomes with lower drug costs. Generic antibiotics are effective and worthy of adoption among outpatients with simple infections indicating oral antibiotic treatment. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Power generation costs for alternate reactor fuel cycles

    Energy Technology Data Exchange (ETDEWEB)

    Smolen, G.R.; Delene, J.G.

    1980-09-01

    The total electric generating costs at the power plant busbar are estimated for various nuclear reactor fuel cycles which may be considered for power generation in the future. The reactor systems include pressurized water reactors (PWR), heavy-water reactors (HWR), high-temperature gas cooled reactors (HTGR), liquid-metal fast breeder reactors (LMFBR), light-water pre-breeder and breeder reactors (LWPR, LWBR), and a fast mixed spectrum reactor (FMSR). Fuel cycles include once-through, uranium-only recycle, and full recycle of the uranium and plutonium in the spent fuel assemblies. The U/sub 3/O/sub 8/ price for economic transition from once-through LWR fuel cycles to both PWR recycle and LMFBR systems is estimated. Electric power generation costs were determined both for a reference set of unit cost parameters and for a range of uncertainty in these parameters. In addition, cost sensitivity parameters are provided so that independent estimations can be made for alternate cost assumptions.

  17. Buying Health: The Costs of Commercialization and an Alternative Philosophy

    Directory of Open Access Journals (Sweden)

    Larry Churchill

    2013-01-01

    Full Text Available This paper argues that commercial forces have steadily encroached into our understanding of medicine and health in modern industrial societies. The impact on the delivery of personal medical services and on common ideas about food and nutrition is profound and largely deleterious to public health. A key component of commercialization is reductionism of medical services, health products and nutritional components into small, marketable units. This reductive force makes both medical services and nutritional components more costly and is corrosive to more holistic concepts of health. We compare commercial and holistic approaches to nutrition in detail and offer an alternative philosophy. Adopting this alternative will require sound public policies that rely less on marketing as a distribution system and that enfranchise individuals to be reflective on their use of medical services, their food and nutrition choices, and their larger health needs.

  18. Cost analysis of Navy acquisition alternatives for the NAVSTAR Global Positioning System

    Science.gov (United States)

    Darcy, T. F.; Smith, G. P.

    1982-12-01

    This research analyzes the life cycle cost (LCC) of the Navy's current and two hypothetical procurement alternatives for NAVSTAR Global Positioning System (GPS) user equipment. Costs are derived by the ARINC Research Corporation ACBEN cost estimating system. Data presentation is in a comparative format describing individual alternative LCC and differential costs between alternatives. Sensitivity analysis explores the impact receiver-processor unit (RPU) first unit production cost has on individual alternative LCC, as well as cost differentials between each alternative. Several benefits are discussed that might provide sufficient cost savings and/or system effectiveness improvements to warrant a procurement strategy other than the existing proposal.

  19. Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China.

    Directory of Open Access Journals (Sweden)

    Mehlika Toy

    Full Text Available Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15-25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs, incremental cost-effectiveness ratios (ICERs, and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293 per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10-19.02 for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32-75 (195-460 RMB per month, highly cost-effective at $62-110 (379-670 RMB per month and cost-effective at $63-120 (384-734 RMB per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.

  20. Consumers' perception of generic substitution in Iran.

    Science.gov (United States)

    Yousefi, Nazila; Mehralian, Gholamhossein; Peiravian, Farzad; NourMohammadi, Samaneh

    2015-06-01

    The growth of pharmaceutical expenditure and patients' out of pocket has motivated policy makers to encourage patients to substitution of brands medicines with their generic alternatives called generic substitution. As the patients are final decision makers to accept generic substitution, the aim of this study is to evaluate the patient perception about generic medicines and underlying factors which can promote the generic acceptance. The study was done in community pharmacies in Tehran, the capital city of Iran. A cross-sectional descriptive study inviting people purchasing their drug at community pharmacies were per-formed using a self-administrated anonymous questionnaire (N=1309). Besides the demographic section, 16 items of developed questionnaire were categorized to five main factors including: patients' perception about efficiency, safety and cost of generic medicines, patient trust on physicians and pharmacists' advice. Findings of completed questionnaires showed among the aforementioned factors the physician has the first priority to encourage patients to use of generics medicines which followed respectively by pharmacist's role, cost of medicines, efficacy, and safety concerns. In conclusion, the trust of Iranian's society on the physicians and pharmacists advice would create a credible opportunity to reduce pharmaceutical expenditures as well as patients' out of pocket by promotion of generic substitution.

  1. Extensions of intellectual property rights and delayed adoption of generic drugs: effects on medicaid spending.

    Science.gov (United States)

    Kesselheim, Aaron S; Fischer, Michael A; Avorn, Jerry

    2006-01-01

    Rising prescription drug costs present a critical policy issue for Medicaid. Generic substitution can reduce costs, but the effects are undercut by extensions of intellectual property (IP) protection, elevated generic prices, and low substitution rates. Using Medicaid prescription data for amoxicillin/clavulanate, metformin, and omeprazole, we calculated the savings that could have been realized if generic drugs had been available and fully substituted at their lowest cost when IP protection first expired (an average delay of twenty-six months). The delay in availability, elevated prices, and slow uptake of generic alternatives for these three drugs alone cost Medicaid 1.5 billion dollars in 2000-2004.

  2. The High Cost of Epinephrine Autoinjectors and Possible Alternatives.

    Science.gov (United States)

    Pepper, Amber N; Westermann-Clark, Emma; Lockey, Richard F

    Epinephrine autoinjectors provide potentially life-saving therapy for pediatric and adult subjects with systemic allergic reactions, including anaphylaxis. However, the cost of these devices, specifically the EpiPen (Mylan, Canonsburg, Pa), is increasing exponentially. Epinephrine autoinjectors are commonly prescribed in the United States but are not readily available worldwide. Alternatives for the self-administration of epinephrine exist and should be considered for patients who cannot afford or do not have access to these devices. The epinephrine prefilled syringe, stored in an eyeglass or pencil case, is a safe and viable option for the self-administration of epinephrine. Epinephrine prefilled syringes may not be as ideal as using autoinjectors but are superior to patients living without access to this medication. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  3. Cost-Effectiveness of Single- Versus Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the United States.

    Directory of Open Access Journals (Sweden)

    Donna E Sweet

    Full Text Available The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs, may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings.A comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years--QALYs and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs. The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz.Life expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61 with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained.STRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S.

  4. Variation in Number of Doses, Bottle Volume, and Calculated Yearly Cost of Generic and Branded Latanoprost for Glaucoma.

    Science.gov (United States)

    Queen, Joanna H; Feldman, Robert M; Lee, David A

    2016-03-01

    To evaluate discrepancies in doses per bottle, bottle fill volume, and cost among branded and generic formulations of latanoprost. Comparative economic analysis. This study was conducted at the Ruiz Department of Ophthalmology and Visual Science at The University of Texas Health Science Center at Houston (UTHealth). Four regionally available latanoprost formulations were measured. Number of drops per bottle and actual bottle fill volume were measured for a calculated sample size (10 bottles). Annual cost (using average wholesale price), days use per bottle, drops per milliliter, and number of bottles used per year were calculated. Data were summarized using mean and standard deviation; 1-way analysis of variance and post hoc Tukey's studentized range test were used for comparing means among manufacturers. Pfizer's branded lantanoprost, Xalatan (New York, New York, USA), had the largest fill volume (P Levene 0.14). Annual cost and number of doses per bottle, factors important to patients, vary significantly depending on the manufacturer of latanoprost. Practitioners can better advise patients by being aware of these differences. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Generic Drugs: Questions and Answers

    Science.gov (United States)

    ... about generic medicines? What are generic drugs? A generic drug is a medication created to be the same as an already ... at lower cost, allowing for increased access to medications by the ... Process for Generic Drugs? Detailed information on the critical factors the ...

  6. Comparative effectiveness and costs of generic and brand-name gabapentin and venlafaxine in patients with neuropathic pain or generalized anxiety disorder in Spain

    Directory of Open Access Journals (Sweden)

    Sicras-Mainar A

    2015-06-01

    Full Text Available Antoni Sicras-Mainar,1 Javier Rejas-Gutiérrez,2 Ruth Navarro-Artieda3 1Planning Directorate, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain; 2Department of Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain; 3Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To explore adherence/persistence with generic gabapentin/venlafaxine versus brand-name gabapentin/venlafaxine (Neurontin®/Vandral® in peripheral neuropathic pain (pNP or generalized anxiety disorder (GAD, respectively, and whether it is translated into different costs and patient outcomes in routine medical practice. Methods: A retrospective, new-user cohort study was designed. Electronic medical records (EMR of patients included in the health plan of Badalona Serveis Assistencials SA, Barcelona, Spain were exhaustively extracted for analysis. Participants were beneficiaries aged 18+ years, followed between 2008 and 2012, with a pNP/GAD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM code, who initiated treatment with generic or brand-name gabapentin or venlafaxine. Assessments included 1-year treatment persistence and adherence (medication possession ratio, health care costs, and reduction in severity of pain and anxiety symptoms. Results: A total of 2,210 EMR were analyzed; 1,369 on gabapentin (brand 400; generic 969 and 841 on venlafaxine (brand 370 and generic 471. Brand-name gabapentin and venlafaxine were both significantly associated with longer persistence than generic: 7.3 versus 6.3 months, P<0.001; and 8.8 versus 8.1 months, P<0.05, respectively. Brand-name was associated with higher adherence: 86.5% versus 81.3%, P<0.001; and 82.1% versus 79.0%, P<0.05, respectively. Adjusted average costs were higher with generic compared with brand: €1,277 versus €1,057 (difference of €220 per patient; P<0.001 for gabapentin; and €1,110 versus €928

  7. School District Program Cost Accounting: An Alternative Approach

    Science.gov (United States)

    Hentschke, Guilbert C.

    1975-01-01

    Discusses the value for school districts of a program cost accounting system and examines different approaches to generating program cost data, with particular emphasis on the "cost allocation to program system" (CAPS) and the traditional "transaction-based system." (JG)

  8. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis

    National Research Council Canada - National Science Library

    Goldie, Sue J; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-01-01

    .... Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve...

  9. The National Shipbuilding Research Program: Producibility Cost Reductions through Alternative Materials and Processes

    National Research Council Canada - National Science Library

    Horsmon, Jr., Albert W; Johnson, Karl; Gans-Devney, Barbara

    1999-01-01

    This report describes research into the use of alternative materials and processes to reduce material and labor costs while also looking at the influence of these choices on the life cycle costs of the vessel...

  10. AX Tank Farm waste retrieval alternatives cost estimates

    Energy Technology Data Exchange (ETDEWEB)

    Krieg, S.A.

    1998-07-21

    This report presents the estimated costs associated with retrieval of the wastes from the four tanks in AX Tank Farm. The engineering cost estimates developed for this report are based on previous cost data prepared for Project W-320 and the HTI 241-C-106 Heel Retrieval System. The costs presented in this report address only the retrieval of the wastes from the four AX Farm tanks. This includes costs for equipment procurement, fabrication, installation, and operation to retrieve the wastes. The costs to modify the existing plant equipment and systems to support the retrieval equipment are also included. The estimates do not include operational costs associated with pumping the waste out of the waste receiver tank (241-AY-102) between AX Farm retrieval campaigns or transportation, processing, and disposal of the retrieved waste.

  11. Cost reduction strategies used by elderly patients with chronic obstructive pulmonary disease to cope with a generic-only pharmacy benefit.

    Science.gov (United States)

    Spence, Michele M; Hui, Rita; Chan, James

    2006-06-01

    Generic-only pharmacy benefits may present more of a burden to patients with chronic disease conditions such as chronic obstructive pulmonary disease (COPD), where generic drug therapy choices are more limited. To evaluate the strategies that elderly patients with COPD use to manage their out-of-pocket (OOP) prescription expenses in a generic-only pharmacy benefit compared with similar patients with a single-tier copayment or a 2-tier pharmacy benefit with coverage of brand formulary drugs. Surveys were mailed to a sample of 3,000 Kaiser Permanente (California) patients (aged > or = 65 years) who had a diagnosis for COPD and received at least 1 prescription for a COPD-related medication during 2003. The sample was stratified by type of pharmacy benefit: generic-only, single copayment tier, and 2 copayment tiers. The survey contained questions about strategies used to reduce OOP prescription expenses, such as stop taking a prescribed medication, purchase prescriptions out of the country, or discuss OOP prescription expenses with a physician. The likelihood of using specific strategies to reduce OOP prescription expenses was modeled using logistic regression. Covariates included social support, quality of life, smoking status, socioeconomic status, total prescription costs, and demographics. A total of 1,624 surveys were returned, for a 54% response rate. Results from logistic regressions indicate that COPD patients with a generic-only benefit are significantly more likely to report that they discussed their OOP costs with their physician (odds ratio [OR]=9.02; 95% confidence interval [CI], 6.15- 13.22), purchased their medications from another country (OR=6.70; 95% CI, 3.17-14.16) and reduced spending on food and clothing (OR=4.06; 95% CI, 2.70-6.12). They are also more likely to report that they had taken less than the prescribed amount of a regular medication (OR=1.70; 95% CI, 1.25-2.31) and that they stopped taking one or more of their regular medications (OR=1

  12. Cost-Benefit Analysis For Alternative Low-Emission Surface Preparation/ Depainting Technologies for Structural Steel

    Science.gov (United States)

    Lewis, Pattie

    2007-01-01

    Stennis Space Center (SSC), Kennedy Space Center (KSC) and Air Force Space Command (AFSPC) identified particulate emissions and waste generated from the depainting process of steel structures as hazardous materials to be eliminated or reduced. A Potential Alternatives Report, Potential Alternatives Report for Validation of Alternative Low Emission Surface Preparation/Depainting Technologies for Structural Steel, provided a technical analyses of identified alternatives to the current coating removal processes, criteria used to select alternatives for further analysis, and a list of those alternatives recommended for testing. The initial coating removal alternatives list was compiled using literature searches and stakeholder recommendations. The involved project participants initially considered approximately 13 alternatives. In late 2003, core project members selected the following depainting processes to be further evaluated: (1) Plastic Blast Media-Quickstrip(R)-A. (2) Hard Abrasive-Steel-Magic(R). (3) Sponge Blasting-Sponge-Jet(R). (4) Liquid Nitrogen-NItroJet(R). (5) Mechanical Removal with Vacuum Attachment-DESCO and OCM Clean-Air (6) Laser Coating Removal Alternatives were tested in accordance with the Joint Test Protocol for Validation of Alternative Low-Emission Surface Preparation/Depainting Technologies for Structural Steel, and the Field Evaluation Test Plan for Validation of Alternative Low-Emission Surface Preparation/Depainting Technologies for Structural Steel. Results of the testing are documented in the Joint Test Report. This Cost-Benefit Analysis (CBA) focuses on the three alternatives (Quickstrip(R)-A, SteelMagic (R), and Sponge-Jet(R)) that were considered viable alternatives for large area operations based on the results of the field demonstration and lab testing. This CBA was created to help participants determine if implementation of the candidate alternatives is economically justified. Each of the alternatives examined reduced Environmental

  13. Low-cost rural surface alternatives : literature review and recommendations.

    Science.gov (United States)

    2013-12-01

    Freezing and thawing action induces damage to unbound gravel roads in Iowa resulting in maintenance costs for secondary road departments. Some approaches currently used by County Engineers to deal with this problem include temporarily spreading rock ...

  14. The Costs and Potential Benefits of Alternative Scholarly Publishing Models

    Science.gov (United States)

    Houghton, John W.

    2011-01-01

    Introduction: This paper reports on a study undertaken for the UK Joint Information Systems Committee (JISC), which explored the economic implications of alternative scholarly publishing models. Rather than simply summarising the study's findings, this paper focuses on the approach and presents a step-by-step account of the research process,…

  15. Comparative Cost/Benefit of Alternative/Conventional Feedstuff in ...

    African Journals Online (AJOL)

    /benefit of the use of conventional (corn/soya bean based) and alternative (less of corn and soya bean substituted with agro-allied and industrial by-products) feedstuffs. Completely randomized design was used and the experiment conducted for a period of eight (8) weeks. Feed intake and weight gain were different for the ...

  16. A cost-risk comparison of DOE FUSRAP remediation alternatives

    Energy Technology Data Exchange (ETDEWEB)

    Waddell, J.D.; Patterson, T.M. [Science Applications International Corp., Oak Ridge, TN (United States)

    1994-12-31

    The Formerly Utilized Sites Remedial Action Program was initiated in 1974 under the Atomic Energy Act to identify and clean up contaminated sites used in the early years of the nation`s atomic energy program. Other sites were added in later years by specific legislation enacted by Congress. This report lists remediation alternatives and trade-offs.

  17. Supply Chain Collaboration Alternatives: Understanding the Expected Costs and Benefits.

    Science.gov (United States)

    McLaren, Tim; Head, Milena; Yuan, Yufei

    2002-01-01

    Discusses collaboration as a recent trend in supply chain management (SCM) that focuses on joint planning, coordination, and process integration between suppliers, customers, and other partners in a supply chain. Analyzes alternative information systems approaches for supporting collaborative SCM, including phone, fax, or email systems; Web-based…

  18. Cost-Effectiveness Analysis of Unsafe Abortion and Alternative First ...

    African Journals Online (AJOL)

    To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three ...

  19. Cost analysis of NOx control alternatives for stationary gas turbines

    Energy Technology Data Exchange (ETDEWEB)

    Bill Major

    1999-11-05

    The use of stationary gas turbines for power generation has been growing rapidly with continuing trends predicted well into the future. Factors that are contributing to this growth include advances in turbine technology, operating and siting flexibility and low capital cost. Restructuring of the electric utility industry will provide new opportunities for on-site generation. In a competitive market, it maybe more cost effective to install small distributed generation units (like gas turbines) within the grid rather than constructing large power plants in remote locations with extensive transmission and distribution systems. For the customer, on-site generation will provide added reliability and leverage over the cost of purchased power One of the key issues that is addressed in virtually every gas turbine application is emissions, particularly NO{sub x} emissions. Decades of research and development have significantly reduced the NO{sub x} levels emitted from gas turbines from uncontrolled levels. Emission control technologies are continuing to evolve with older technologies being gradually phased-out while new technologies are being developed and commercialized. The objective of this study is to determine and compare the cost of NO{sub x} control technologies for three size ranges of stationary gas turbines: 5 MW, 25 MW and 150 MW. The purpose of the comparison is to evaluate the cost effectiveness and impact of each control technology as a function of turbine size. The NO{sub x} control technologies evaluated in this study include: Lean premix combustion, also known as dry low NO{sub x} (DLN) combustion; Catalytic combustion; Water/steam injection; Selective catalytic reduction (SCR)--low temperature, conventional, high temperature; and SCONO{sub x}{trademark}.

  20. QUICKTRANS and Alternative Commercial Transportation: A Cost Comparison.

    Science.gov (United States)

    1992-12-01

    88 by 108 inches [Ref. 1: p. 33]. Each commercial air freight forwarder has a different definition of outsized shipments. Danzas Corporation has a...Western Area, Danzas Corporation and Universal Transportation and Services were considered for moving heavy and outsized "𔃺 Over 17 percent of...shipments. Their government tender rates were very close to Federal Express rates. Danzas Corporation was chosen as the most cost effective heavy clean

  1. A Cost-Performance Analysis of Computer Alternatives.

    Science.gov (United States)

    1982-12-01

    States $ivy 4 l.A., University of Coloralo, 1977 Submitted in prilfflmetof the Minn! or SCINC IN INFORMATION SYSTEMS froma the NAVAL POSTGRADUATE...inventory cnr:ol and general ledger, for example; and "vertiral" applications which are directed toward a sia;le industry--job-costing fo_ a building... direct manufacturer sales, compater retailers--and the range of implementations--traditional minicomputer, microcom- puters, networks, distributed

  2. Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data.

    Science.gov (United States)

    Pauly, Nathan J; Talbert, Jeffery C; Brown, Joshua

    2016-06-01

    Administrative claims data are used for a wide variety of research and quality assurance purposes; however, they are prone to medication exposure misclassification if medications are purchased without using an insurance benefit. Low-cost generic drug programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted, and the exposure may go unobserved in claims data. As heavy users of medications, Medicare beneficiaries have much to gain from the affordable medications offered through LCGPs. This use may put them at increased risk of exposure misclassification in claims data. Many high-risk medications (HRMs) and medications tracked for adherence and utilization quality metrics are available through LCGPs, and exposure misclassification of these medications may impact the quality assurance efforts reliant on administrative claims data. Presently, there is little information regarding the use of these programs among a geriatric population. To (a) quantify the prevalence of LCGP users in a nationally representative population of Medicare beneficiaries; (b) compare clinical and demographic characteristics of LCGP users and nonusers; (c) assess determinants of LCGP use and medications acquired through these programs; and (d) analyze patterns of LCGP use during the years 2007-2012. This study relied on data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2012. The first 3 objectives were completed with a cohort of individuals in the most recent MEPS panel, while the fourth objective was completed with a separate cohort composed of individuals who participated in MEPS from 2007 to 2012. Inclusion in either study cohort required that individuals were Medicare beneficiaries aged 65 years or greater, used at least 1 prescription drug during their 2-year panel period, and participated in all 5

  3. The net effect of alternative allocation ratios on recruitment time and trial cost.

    Science.gov (United States)

    Vozdolska, Ralitza; Sano, Mary; Aisen, Paul; Edland, Steven D

    2009-04-01

    Increasing the proportion of subjects allocated to the experimental treatment in controlled clinical trials is often advocated as a method of increasing recruitment rates and improving the performance of trials. The presumption is that the higher likelihood of randomization to the experimental treatment will be perceived by potential study enrollees as an added benefit of participation and will increase recruitment rates and speed the completion of trials. However, studies with alternative allocation ratios require a larger sample size to maintain statistical power, which may result in a net increase in time required to complete recruitment and a net increase in total trial cost. To describe the potential net effect of alternative allocation ratios on recruitment time and trial cost. Models of recruitment time and trial cost were developed and used to compare trials with 1:1 allocation to trials with alternative allocation ratios under a range of per subject costs, per day costs, and enrollment rates. In regard to time required to complete recruitment, alternative allocation ratios are net beneficial if the recruitment rate improves by more than about 4% for trials with a 1.5:1 allocation ratio and 12% for trials with a 2:1 allocation ratio. More substantial improvements in recruitment rate, 13 and 47% respectively for scenarios we considered, are required for alternative allocation to be net beneficial in terms of tangible monetary cost. The cost models were developed expressly for trials comparing proportions or means across treatment groups. Using alternative allocation ratio designs to improve recruitment may or may not be time and cost-effective. Using alternative allocation for this purpose should only be considered for trial contexts where there is both clear evidence that the alternative design does improve recruitment rates and the attained time or cost efficiency justifies the added study subject burden implied by a larger sample size.

  4. An Alternative Method for Computing Unit Costs and Productivity Ratios. AIR 1984 Annual Forum Paper.

    Science.gov (United States)

    Winstead, Wayland H.; And Others

    An alternative measure for evaluating the performance of academic departments was studied. A comparison was made with the traditional manner for computing unit costs and productivity ratios: prorating the salary and effort of each faculty member to each course level based on the personal mix of course taught. The alternative method used averaging…

  5. Enforcement costs: some humanitarian alternatives to stronger patent rights.

    Science.gov (United States)

    Trotter, Andrew

    2012-01-01

    Diseases that cause comparatively few problems in developed countries kill millions of people in the Third World each year. In many cases, people die because they cannot afford the medication needed to save their lives. In others, there are simply no drugs available because there are no wealthy western patients to justify pharmaceutical companies investing in a cure. This reveals a deep-seated problem within the patent system and the pharmaceutical industry that emphasises markets and profits at the expense of health and global welfare. Global efforts have seen substantial improvements in access to medicines in isolated areas, but with international agreements driving towards stronger patent protection and the expiry date for the TRIPS grace period fast approaching, it is time to consider alternatives which will allow the patent system to work for the humanitarian cause rather than against it. This paper considers two such problems in the patent system and pharmaceutical industry - prohibitive pricing and misdirected incentives - to offer a mode of regulation and enforcement that will support both a viable pharmaceutical industry and the human right to health and medication.

  6. The benefits and costs of alternative solid waste management policies

    Energy Technology Data Exchange (ETDEWEB)

    Goddard, Haynes C. [Departamento Academico de Economia, Instituto Tecnologico Autonomo de Mexico, Mexico City, (Mexico)

    1995-06-01

    In the last few years controlling the size and composition of the solid waste flow has moved substantially up the public policy agenda in many countries. With this has come the question of what are the appropriate types of public interventions in the economy to control this flow. The most dramatic of the interventions have involved adoption of high recycling targets for specific fractions of the waste stream and special measures to deal with packaging waste, especially in a number of European countries. Questions are being raised about whether the targets and inventions are warranted on the basis of economic analysis, especially about the costs and benefits of the objectives and the instruments to achieve them. This paper reviews the published and some unpublished literature through the spring of 1993 and generally finds that the conceptual and empirical basis on which to predicate efficient and effective solid waste management policy is still rather incomplete. The only principled basis for public interventions thus far established in the economics literature is that for user fees at the household level. The paper analyzes the role of waste management fees or user charges in rationalizing investment in waste management technology and finds that, while there is wide agreement that the prices are not right in this environmental area, there is little focus on the role that such fees can play in motivation source reduction at the consumer or household level. A number of recommendations are made for using economic instruments for efficient solid waste management

  7. Measuring the costs of children: an alternative approach.

    Science.gov (United States)

    Ray, R

    1983-10-01

    Problems related to the concept of the "cost of a child", more commonly known as the general equivalence scale, are reviewed. The importance of this concept is noted with regard to both theoretical and empirical studies relating to taxation, poverty, income distribution, dietary needs, income maintenance programs, supplementary and child benefits, and other social security payments. "This paper proposes a new methodology for calculating the scale using a framework which is consistent with utility theory and which overcomes the identification problem without having to enforce the arbitrary prior assumptions of recent studies. The proposed method allows easy calculation of not only the basic 'scale' parameter but also how it varies with price and reference utility. [The author illustrates] the usefulness of the procedure by estimating on U.K. budget data at two different levels of aggregation and employing two sets of quite different functional forms. The results are plausible, compare favourably with one another and, hence, confirm the robustness and usefulness of the proposed procedure." excerpt

  8. Brand and Generics Companies Unite to Pressure FDA: They Want the Agency to Drop Its Safety-Label Plan and Adopt Their Alternative.

    Science.gov (United States)

    Barlas, Stephen

    2015-08-01

    Fear of lawsuits and customer confusion have greeted a Food and Drug Administration plan to let generic drug companies change labels quickly, without prior agency approval, when they learn of adverse effects once the generic reaches the market.

  9. Generically speaking.

    Science.gov (United States)

    2009-10-01

    It's best to use the generic name when referring to a medicine. This reduces the likelihood of accidental double prescribing or purchase of a drug, particularly if it has more than one brand name. Prescribing by generic name is also generally cheaper and avoids confusion because the name is internationally recognised. Nevertheless, brand names enjoy undue prominence, even allowing for the clinical situations where it is important to prescribe by brand rather than generic name.

  10. Generic variation?

    DEFF Research Database (Denmark)

    Jensen, Torben Juel

    2009-01-01

    that the increased use of generic du began in Copenhagen and started spreading from Copenhagen to the rest of the country before the time of the old recordings in the 1980s. However, the use of generic du has peaked, or is about to peak, in the Danish speech community seen as a whole, and the developments in the use......In modern Danish, a handful of pronouns may be used to refer to a generic referent. In recent decades, the second person singular pronoun du has gained ground, apparently in parallel to similar recent developments in other languages. Even though generic du may not be as old as the traditional...

  11. Generic Advantages

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Generic Advantages. Scalability an incremental coverage. Standardization. Business Plan Flexibility. Lifecycle Flexibility. Reliability. Service Interoperability. Changed Industry dynamics.

  12. 10 CFR 503.32 - Lack of alternate fuel supply at a cost which does not substantially exceed the cost of using...

    Science.gov (United States)

    2010-01-01

    ... substantially exceed the cost of using imported petroleum. 503.32 Section 503.32 Energy DEPARTMENT OF ENERGY... fuel supply at a cost which does not substantially exceed the cost of using imported petroleum. (a... alternate fuel supply at a cost which does not substantially exceed the cost of using imported petroleum. To...

  13. An Assessment Of The Life Cycle Costs And GHG Emissions For Alternative Generation Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Donnelly, C. Richard; Carias, Anibal; Ali, Mohammad; Wood, Nicholas; Morgenroth, Michael; Bridgeman, Andrew

    2010-09-15

    The best choices for supplying energy in a manner that can reduce emissions at a reasonable cost while still ensuring grid stability and reliability of supply is a matter of some debate. In this paper, a first principles analysis is performed to look at life-cycle costs and emissions as well as the amount of energy that is provided to the system from various low-emission alternatives, including wind, water, solar and nuclear power. These low-emission sources are then benchmarked against coal-fired energy production to establish a normalized assessment of the clean energy alternatives currently available.

  14. Cost Benefit and Alternatives Analysis of Distribution Systems with Energy Storage Systems: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Harris, Tom; Nagarajan, Adarsh; Baggu, Murali; Bialek, Tom

    2017-06-27

    This paper explores monetized and non-monetized benefits from storage interconnected to distribution system through use cases illustrating potential applications for energy storage in California's electric utility system. This work supports SDG&E in its efforts to quantify, summarize, and compare the cost and benefit streams related to implementation and operation of energy storage on its distribution feeders. This effort develops the cost benefit and alternatives analysis platform, integrated with QSTS feeder simulation capability, and analyzed use cases to explore the cost-benefit of implementation and operation of energy storage for feeder support and market participation.

  15. NET 40 Generics Beginner's Guide

    CERN Document Server

    Mukherjee, Sudipta

    2012-01-01

    This is a concise, practical guide that will help you learn Generics in .NET, with lots of real world and fun-to-build examples and clear explanations. It is packed with screenshots to aid your understanding of the process. This book is aimed at beginners in Generics. It assumes some working knowledge of C# , but it isn't mandatory. The following would get the most use out of the book: Newbie C# developers struggling with Generics. Experienced C++ and Java Programmers who are migrating to C# and looking for an alternative to other generic frameworks like STL and JCF would find this book handy.

  16. Corrosion and protection in reinforced concrete : Pulse cathodic protection: an improved cost-effective alternative

    NARCIS (Netherlands)

    Koleva, D.A.

    2007-01-01

    Corrosion and protection in reinforced concrete. Pulse cathodic protection: an improved cost-effective alternative. The aim of the research project was to study the possibilities for establishing a new or improved electrochemical method for corrosion prevention/protection for reinforced concrete.

  17. Neonatal carrier: An easy to make alternative device to costly transport chambers.

    Science.gov (United States)

    Joshi, Milind; Singh, Sangram; Negi, Anupama; Vyas, Tanmay; Chourishi, Vigya; Jain, Anvesh

    2010-10-01

    The transport of sick neonates to the surgical centers or transportation within the center is an essential requirement of neonatal surgery. Neonatal transport incubators are costly, space occupying, and are not available at many places in the developing countries. We report here a cheap yet effective and easy to make, alternate neonatal carrier device.

  18. Neonatal carrier: An easy to make alternative device to costly transport chambers

    Directory of Open Access Journals (Sweden)

    Joshi Milind

    2010-01-01

    Full Text Available The transport of sick neonates to the surgical centers or transportation within the center is an essential requirement of neonatal surgery. Neonatal transport incubators are costly, space occupying, and are not available at many places in the developing countries. We report here a cheap yet effective and easy to make, alternate neonatal carrier device.

  19. Neonatal carrier: An easy to make alternative device to costly transport chambers

    OpenAIRE

    Joshi Milind; Singh Sangram; Negi Anupama; Vyas Tanmay; Chourishi Vigya; Jain Anvesh

    2010-01-01

    The transport of sick neonates to the surgical centers or transportation within the center is an essential requirement of neonatal surgery. Neonatal transport incubators are costly, space occupying, and are not available at many places in the developing countries. We report here a cheap yet effective and easy to make, alternate neonatal carrier device.

  20. Technology alternatives towards low-cost and high-speed interconnect manufacturing

    NARCIS (Netherlands)

    Roozeboom, F.; Kniknie, B.; Lankhorst, A.M.; Winands, G.; Poodt, P.; Dingemans, G.; Keuning, W.; Kessels, W.M.M.; Bullema, J.E.; Bressers, P.M.M.C.; Oosterhuis, G.; Mueller, M.; Huis in 't Veld, Bert

    2012-01-01

    In this work we will review our recent work on novel alternative and disruptive technology concepts with industrial potential for cost-effective and high-speed interconnect manufacturing, in particular on the creation (drilling and filling) of advanced interconnects like TSVs. These technologies are

  1. Physician perceptions about generic drugs.

    Science.gov (United States)

    Shrank, William H; Liberman, Joshua N; Fischer, Michael A; Girdish, Charmaine; Brennan, Troyen A; Choudhry, Niteesh K

    2011-01-01

    With constrained health-care resources, there is a need to understand barriers to cost-effective medication use. To study physician perceptions about generic medications. Physicians used 5-point Likert scales to report perceptions about cost-related medication nonadherence, the efficacy and quality of generic medications, preferences for generic use, and the implications of dispensing medication samples. Descriptive statistics were used to assess physician perceptions and logistic regression models were used to evaluate predictors of physician perceptions. Among the invited sample, 839 (30.4%) responded and 506 (18.3%) were eligible and included in the final study population. Over 23% of physicians surveyed expressed negative perceptions about efficacy of generic drugs, almost 50% reported negative perceptions about quality of generic medications, and more than one quarter do not prefer to use generics as first-line medications for themselves or for their family. Physicians over the age of 55 years were 3.3 times more likely to report negative perceptions about generic quality, 5.8 times more likely to report that they would not use generics themselves, and 7.5 times more likely to state that they would not recommend generics for family members (p generic medication. Almost half of the respondents expressed concern that free samples may adversely affect subsequent affordability, yet two thirds of respondents provide free samples. A meaningful proportion of physicians expressed negative perceptions about generic medications, representing a potential barrier to generic use. Payors and policymakers trying to encourage generic use may consider educational campaigns targeting older physicians.

  2. Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs.

    Science.gov (United States)

    Thokala, Praveen; Baalbaki, Hassan; Brennan, Alan; Pandor, Abdullah; Stevens, John W; Gomersall, Tim; Wang, Jenny; Bakhai, Ameet; Al-Mohammad, Abdallah; Cleland, John; Cowie, Martin R; Wong, Ruth

    2013-09-18

    To estimate the cost-effectiveness of remote monitoring strategies versus usual care for adults recently discharged after a heart failure (HF) exacerbation. Decision analysis modelling of cost-effectiveness using secondary data sources. Acute hospitals in the UK. Patients recently discharged (within 28 days) after a HF exacerbation. Structured telephone support (STS) via human to machine (STS HM) interface, (2) STS via human to human (STS HH) contact and (3) home telemonitoring (TM), compared with (4) usual care. The incremental cost per quality-adjusted life year (QALY) gained by each strategy compared to the next most effective alternative and the probability of each strategy being cost-effective at varying willingness to pay per QALY gained. TM was the most cost-effective strategy in the scenario using these base case costs. Compared with usual care, TM had an estimated incremental cost effectiveness ratio (ICER) of £11 873/QALY, whereas STS HH had an ICER of £228 035/QALY against TM. STS HM was dominated by usual care. Threshold analysis suggested that the monthly cost of TM has to be higher than £390 to have an ICER greater than £20 000/QALY against STS HH. Scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM do not substantially change the conclusions. Cost-effectiveness analyses suggest that TM was an optimal strategy in most scenarios, but there is considerable uncertainty in relation to clear descriptions of the interventions and robust estimation of costs.

  3. Evaluation of solar sludge drying alternatives by costs and area requirements.

    Science.gov (United States)

    Kurt, Mayıs; Aksoy, Ayşegül; Sanin, F Dilek

    2015-10-01

    Thermal drying is a common method to reach above 90% dry solids content (DS) in sludge. However, thermal drying requires high amount of energy and can be expensive. A greenhouse solar dryer (GSD) can be a cost-effective substitute if the drying performance, which is typically 70% DS, can be increased by additional heat. In this study feasibility of GSD supported with solar panels is evaluated as an alternative to thermal dryers to reach 90% DS. Evaluations are based on capital and O&M costs as well as area requirements for 37 wastewater treatment plants (WWTPs) with various sludge production rates. Costs for the supported GSD system are compared to that of conventional and co-generation thermal dryers. To calculate the optimal costs associated with the drying system, an optimization model was developed in which area limitation was a constraint. Results showed that total cost was minimum when the DS in the GSD (DS(m,i)) was equal to the maximum attainable value (70% DS). On average, 58% of the total cost and 38% of total required area were associated with the GSD. Variations in costs for 37 WWTPs were due to differences in initial DS (DS(i,i)) and sludge production rates, indicating the importance of dewatering to lower drying costs. For large plants, GSD supported with solar panels provided savings in total costs especially in long term when compared to conventional and co-generation thermal dryers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    Science.gov (United States)

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value.

  5. A Cost Comparison of Alternative Approaches to Distance Education in Developing Countries

    Science.gov (United States)

    Ventre, Gerard G.; Kalu, Alex

    1996-01-01

    This paper presents a cost comparison of three approaches to two-way interactive distance learning systems for developing countries. Included are costs for distance learning hardware, terrestrial and satellite communication links, and designing instruction for two-way interactive courses. As part of this project, FSEC is developing a 30-hour course in photovoltaic system design that will be used in a variety of experiments using the Advanced Communications Technology Satellite (ACTS). A primary goal of the project is to develop an instructional design and delivery model that can be used for other education and training programs. Over two-thirds of the world photovoltaics market is in developing countries. One of the objectives of this NASA-sponsored project was to develop new and better energy education programs that take advantage of advances in telecommunications and computer technology. The combination of desktop video systems and the sharing of computer applications software is of special interest. Research is being performed to evaluate the effectiveness of some of these technologies as part of this project. The design of the distance learning origination and receive sites discussed in this paper were influenced by the educational community's growing interest in distance education. The following approach was used to develop comparative costs for delivering interactive distance education to developing countries: (1) Representative target locations for receive sites were chosen. The originating site was assumed to be Cocoa, Florida, where FSEC is located; (2) A range of course development costs were determined; (3) The cost of equipment for three alternative two-way interactive distance learning system configurations was determined or estimated. The types of system configurations ranged from a PC-based system that allows instructors to originate instruction from their office using desktop video and shared application software, to a high cost system that uses a

  6. Exploring knowledge, perceptions and attitudes about generic ...

    African Journals Online (AJOL)

    Background. The use of generic medicines to reduce healthcare costs has become a mandated policy in South Africa. An increase in the use of generics can be achieved through improved knowledge, attitudes and perceptions of generic medicine among healthcare professionals. Objective. To explore knowledge, attitudes ...

  7. Life Cycle Costing in Sustainability Assessment—A Case Study of Remanufactured Alternators

    Directory of Open Access Journals (Sweden)

    Annekatrin Lehmann

    2011-11-01

    Full Text Available Sustainability is on the international agenda, and is a driver for industry in international competition. Sustainability encompasses the three pillars: environment, society and economy. To prevent shifting of burden, the whole life cycle needs to be taken into account. For the environmental dimension of sustainability, life cycle assessment (LCA has been practiced for a while and is a standardized method. A life cycle approach for the social and economic pillars of sustainability needs to be further developed. This paper investigates the application of life cycle costing (LCC as part of a wider sustainability assessment where also social life cycle assessment (SLCA and LCA are combined. LCA-type LCC is applied on a case study of remanufactured alternators. Remanufacturing of automobile parts is a fast growing important business with large potential for cost and resource savings. Three design alternatives for the alternator and three locations for the remanufacturing plant are evaluated. The remanufacturer perspective and the user perspective are investigated. The results for the LCA-type LCC show that the largest cost for the remanufacturer is the new parts replacing old warn parts. However, the user cost, and therein especially, cost for fuel used for the alternator’s power production dominates and should be the focus for further improvement. In conducting the case study, it was revealed that the connection between the LCA-type LCC results and the economic dimension of sustainability needs to be further investigated and defined. For this purpose, areas of protection for life cycle sustainability assessment and LCA-type LCC in particular need further development.

  8. Cheese whey: A cost-effective alternative for hyaluronic acid production by Streptococcus zooepidemicus.

    Science.gov (United States)

    Amado, Isabel R; Vázquez, José A; Pastrana, Lorenzo; Teixeira, José A

    2016-05-01

    This study focuses on the optimisation of cheese whey formulated media for the production of hyaluronic acid (HA) by Streptococcus zooepidemicus. Culture media containing whey (W; 2.1g/L) or whey hydrolysate (WH; 2.4 g/L) gave the highest HA productions. Both W and WH produced high yields on protein consumed, suggesting cheese whey is a good nitrogen source for S. zooepidemicus production of HA. Polysaccharide concentrations of 4.0 g/L and 3.2g/L were produced in W and WH in a further scale-up to 5L bioreactors, confirming the suitability of the low-cost nitrogen source. Cheese whey culture media provided high molecular weight (>3000 kDa) HA products. This study revealed replacing the commercial peptone by the low-cost alternative could reduce HA production costs by up to a 70% compared to synthetic media. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Nonruminant Nutrition Symposium: Controlling feed cost by including alternative ingredients into pig diets: a review.

    Science.gov (United States)

    Woyengo, T A; Beltranena, E; Zijlstra, R T

    2014-04-01

    Sustained price increases for traditional cereal grain and protein meal feed commodities have forced the pork industry to consider the dietary inclusion of alternative feedstuffs. Crop seed may serve as feedstuffs but their demand as feedstock for human food, biofuel, and bioindustrial products has increased. Together with these products, coproducts such as distillers dried grains with solubles, wheat millrun, and canola meal are produced. As omnivores, pigs are ideally suited to convert these non-human-edible coproducts into high-quality food animal protein. Therefore, coproducts and other low-cost alternative feedstuffs such as pulses and oilseeds can be included in pig diets to reduce feed cost per metric ton of feed. However, inclusion of alternative feedstuffs in pig diets does not necessarily reduce feed cost per kilogram of gain. Therefore, the use of novel and existing feedstuffs in pig diets must be optimized following their characterization for energy and AA profile. Alternative feedstuffs generally have a high content of at least 1 of the following antinutritional factors (ANF): fiber, tannins, glucosinolates, and heat-labile trypsin inhibitors. Several methods can optimize nutrient use of pigs fed alternative feedstuffs by reducing effects of their ANF. These methods include 1) particle size reduction to increase nutrient digestibility, 2) dehulling or scarification to reduce tannin and fiber content of pulses and oilseeds, 3) air classification to create fractions that have a greater content of nutrients and lower content of ANF than the feedstock, 4) heat treatments such as extrusion, toasting, roasting, and micronization to reduce heat-labile ANF, 5) dietary supplementation with fiber-degrading enzymes or predigestion of fibrous feedstuffs or diets with fiber-degrading enzymes to increase dietary nutrient availability, and 6) formulation of diets based on bioavailable AA coefficients. In conclusion, the feeding of alternative ingredients may reduce

  10. Licensing of Generic Medicines: Are There Any Challenges Left? A Pharmaceutical Regulatory Perspective.

    Science.gov (United States)

    Borg, John Joseph; Tomasi, Paolo; Pani, Luca; Aislaitner, George; Pirozynski, Michal; Leufkens, Hubert; Melchiorri, Daniela

    2014-01-01

    When an innovative product (innovator) is not covered anymore by intellectual property rights, cheaper equivalent medicinal products (generic products) may be marketed and used in clinical practice. The regulation of generic products is well-established, and is primarily based on standard rules for quality, therapeutic equivalence requirements (the latter in most instances proven through a bioequivalence study), and safety data for the innovator. The extensive experience from bringing generic products to the market over the last decades allows the conclusion that they are well-accepted and provide a useful alternative option for cost-effective pharmacotherapy. While supporting this conclusion, there are a number of issues to be considered during the assessment of a generic product application. Six scenarios are described in total, from an efficacy and a safety perspective, where potential concerns with the current regulatory standards could arise in the approval of generic products. We also propose solutions to these scenarios in order to foster debate on these issues.

  11. Cost effectiveness of alternative strategies for incorporating bevacizumab into the primary treatment of ovarian cancer.

    Science.gov (United States)

    Barnett, Jason C; Alvarez Secord, Angeles; Cohn, David E; Leath, Charles A; Myers, Evan R; Havrilesky, Laura J

    2013-10-15

    The objective of this study was to evaluate the comparative effectiveness of strategies that incorporated bevacizumab into the primary platinum-based treatment of ovarian cancer: 1) no bevacizumab; 2) concurrent and maintenance bevacizumab for all; 3) bevacizumab for suboptimally debulked stage III and stage IV disease (high-risk cohort); and the evaluation of an alternative exploratory strategy of 4) directed bevacizumab therapy based on a predictive test for bevacizumab responsiveness. A modified Markov state transition model with a 3-year time horizon that simulated publically available International Collaboration on Ovarian Neoplasms (ICON7) trial outcomes was used to evaluate the cost effectiveness of each strategy. Costs and adverse events were incorporated. An alternative strategy was used to model the impact on overall survival of a genetic-based predictive test. A Monte Carlo simulation simultaneously accounted for uncertainty in key parameters. The incorporation of bevacizumab for high-risk patients had an incremental cost-effectiveness ratio of $168,000 per quality-adjusted life-year (QALY) saved compared with chemotherapy alone and dominated a strategy of giving bevacizumab to all patients with ovarian cancer. Monte Carlo simulation acceptability curves indicated that, at a willingness-to-pay threshold of $200,000 per QALY, the treatment of high-risk women with bevacizumab was the strategy of choice in 84% of simulations. A predictive test had an incremental cost-effectiveness ratio of $129,000 per QALY compared with chemotherapy alone and dominated other bevacizumab treatment strategies. The selective treatment of women with suboptimal and/or stage IV ovarian cancer was a more cost-effective use of bevacizumab than universal treatment but still did not fall within the limits of common willingness-to-pay thresholds. Continued investigation of potentially cost-effective strategies, such as a predictive test, is necessary to optimize the use of this

  12. Efficiency and concordance of alternative methods for minimizing opportunity costs in conservation planning.

    Science.gov (United States)

    Cameron, Susan E; Williams, Kristen J; Mitchell, David K

    2008-08-01

    Scarce resources and competing land-use goals necessitate efficient biodiversity conservation. Combining multicriteria analysis with conservation decision-support tools improves efficiency of conservation planning by maximizing outcomes for biodiversity while minimizing opportunity costs to society. An opportunity cost is the benefit that could have been received by taking an alternative course of action (i.e., costs to society of protecting an area for biodiversity rather than developing it for some other use). Although different ways of integrating multiple opportunity costs into conservation planning have been suggested, there have been no tests as to which method is most efficient. We compared the relative efficiency of 3 such procedures(Faith & Walker [1996], Sarkar et al. [2004], and a procedure of our own design) in a systematic conservation-planning framework for the Milne Bay Province of Papua New Guinea. We devised 14 opportunity costs and assigned these to 3 scenarios representing different conservation planning concerns: food security, macro-economic development, and biodiversity persistence. For each scenario, we compared the efficiency of the 3 methods in terms of amount of biodiversity protected relative to total expenditure for each opportunity cost. All 3 methods captured similar amounts of biodiversity, but differed in total cost. Our method had the least overall cost and was therefore most efficient. Nevertheless, there was a high correlation and geographical concordance among all 3 methods, indicating a high degree of spatial overlap. This suggests that choosing an appropriate approach may often depend on contextual factors related to the design of the planning question, rather than efficiency alone.

  13. Cost and Efficacy Assessment of an Alternative Medication Compliance Urine Drug Testing Strategy.

    Science.gov (United States)

    Doyle, Kelly; Strathmann, Frederick G

    2017-02-01

    This study investigates the frequency at which quantitative results provide additional clinical benefit compared to qualitative results alone. A comparison between alternative urine drug screens and conventional screens including the assessment of cost-to-payer differences, accuracy of prescription compliance or polypharmacy/substance abuse was also included. In a reference laboratory evaluation of urine specimens from across the United States, 213 urine specimens with provided prescription medication information (302 prescriptions) were analyzed by two testing algorithms: 1) conventional immunoassay screen with subsequent reflexive testing of positive results by quantitative mass spectrometry; and 2) a combined immunoassay/qualitative mass-spectrometry screen that substantially reduced the need for subsequent testing. The qualitative screen was superior to immunoassay with reflex to mass spectrometry in confirming compliance per prescription (226/302 vs 205/302), and identifying non-prescription abuse (97 vs 71). Pharmaceutical impurities and inconsistent drug metabolite patterns were detected in only 3.8% of specimens, suggesting that quantitative results have limited benefit. The percentage difference between the conventional testing algorithm and the alternative screen was projected to be 55%, and a 2-year evaluation of test utilization as a measure of test order volume follows an exponential trend for alternative screen test orders over conventional immunoassay screens that require subsequent confirmation testing. Alternative, qualitative urine drug screens provide a less expensive, faster, and more comprehensive evaluation of patient medication compliance and drug abuse. The vast majority of results were interpretable with qualitative results alone indicating a reduced need to automatically reflex to quantitation or provide quantitation for the majority of patients. This strategy highlights a successful approach using an alternative strategy for both the

  14. Comparative effectiveness and cost-effectiveness of screening colonoscopy vs. sigmoidoscopy and alternative strategies.

    Science.gov (United States)

    Sharaf, Ravi N; Ladabaum, Uri

    2013-01-01

    Fecal occult blood testing (FOBT) and sigmoidoscopy are proven to decrease colorectal cancer (CRC) incidence and mortality. Sigmoidoscopy's benefit is limited to the distal colon. Observational data are conflicting regarding the degree to which colonoscopy affords protection against proximal CRC. Our aim was to explore the comparative effectiveness and cost-effectiveness of colonoscopy vs. sigmoidoscopy and alternative CRC screening strategies in light of the latest published data. We performed a contemporary cost-utility analysis using a Markov model validated against data from randomized controlled trials of FOBT and sigmoidoscopy. Persons at average CRC risk within the general US population were modeled. Screening strategies included those recommended by the United States (US) Preventive Services Task Force, including colonoscopy every 10 years (COLO), flexible sigmoidoscopy every 5 years (FS), annual fecal occult blood testing, annual fecal immunochemical testing (FIT), and the combination FS/FIT. The main outcome measures were quality-adjusted life-years (QALYs) and costs. In the base case, FIT dominated other strategies. The advantage of FIT over FS and COLO was contingent on rates of uptake and adherence that are well above current US rates. Compared with FIT, FS and COLO both cost compared with FIT and sigmoidoscopy, depending on the relative rates of screening uptake and adherence and the protective benefit of colonoscopy in the proximal colon. Colonoscopy's cost-effectiveness compared with sigmoidoscopy is contingent on the ability to deliver ~50% protection against CRC in the proximal colon.

  15. Assessing the use of Radio Frequency Identification technologies as an alternative for insurance costs in hospitals.

    Science.gov (United States)

    Asgharzadeh-Karamshahloo, Iraj; Jabbarzadeh, Armin; Shavvalpour, Saeed

    2017-12-15

    This research assesses the use of Radio Frequency Identification (RFID) technologies as an alternative for insurance costs in hospitals. Despite the advantages of RFID, this technology has not been applied in most hospitals due to implementation costs and amortization of RFID. In this paper, we intend to model the total profit of hospitals in three scenarios namely, application of RFID technology in the hospital, without applying RFID technology in the hospital and insuring patients and equipment in the hospital. We analyzed the aforementioned situations over a period of time to find out how they affect the profit of the hospital. Based on this analysis we concluded that if applying RFID technology is costly, it will be feasible for advanced hospitals with more beds. In the scenario of insuring patients and equipment, if insurance organization takes over a small portion of the cost of the mistakes and oversights, insuring patients and equipment will not be feasible for the hospital, and it is better to apply RFID technology Instead. RFID is among the technologies applied to reduce mistakes of the personnel in hospitals. Moreover, applying this technology has led to a decrease in the number of personnel required in hospitals. This study models total profit of hospitals in three aforementioned scenarios. Based on analyzing these models we conclude that if applying RFID technology is costly, it will be feasible for advanced hospitals with more beds.

  16. Effects of alternative promoters of growth on the performance and cost of production of broilers

    Directory of Open Access Journals (Sweden)

    Patrícia Tomazini Medeiros

    2009-09-01

    Full Text Available Probiotics and prebiotics were compared to antimicrobials as alternative growth promoters in male broilers grown from 1 to 42 days of age. Eight treatments were evaluated: a control feed without antimicrobials or alternative growth promoters, a control feed with antimicrobials, a control feed with the antimicrobials colistine and avilamicine, three rations with probiotic Bacillus subtilis in different concentrations and/or under recommended usage, one ration with probiotic Saccharomyces cerevisiae in addition to a mixture of probiotic Bacillus subtilis, Saccharomyces cerevisiae and Aspergillus oryzae, and one ration with mananoligossacarids (MOS plus betaglutanes. Antimicrobials and alternative growth promoters were added to an initial feed and to a growth feed common to all birds. Thirteen to 17 replicates of 50 birds of a Cobb line were utilized per treatment in a completely randomized design. Feed consumption, feed conversion and production costs did not significantly differ among treatments. The weights of 42-day-old birds fed on Bacillus subtilis (1,6 x 109CFU/g or the mixture of probiotics were higher or similar to the weights of birds fed on ration with antimicrobials. It was concluded that probiotics can replace antimicrobials as growth promoters for broilers up to 42 days of age without negative effects on growth performance and production cost.

  17. A cost-benefit analysis of alternative device configurations for aviation-checked baggage security screening.

    Science.gov (United States)

    Jacobson, Sheldon H; Karnani, Tamana; Kobza, John E; Ritchie, Lynsey

    2006-04-01

    The terrorist attacks of September 11, 2001 have resulted in dramatic changes in aviation security. As of early 2003, an estimated 1,100 explosive detection systems (EDS) and 6,000 explosive trace detection machines (ETD) have been deployed to ensure 100% checked baggage screening at all commercial airports throughout the United States. The prohibitive costs associated with deploying and operating such devices is a serious issue for the Transportation Security Administration. This article evaluates the cost effectiveness of the explosive detection technologies currently deployed to screen checked baggage as well as new technologies that could be used in the future. Both single-device and two-device systems are considered. In particular, the expected annual direct cost of using these devices for 100% checked baggage screening under various scenarios is obtained and the tradeoffs between using single- and two-device strategies are studied. The expected number of successful threats under the different checked baggage screening scenarios with 100% checked baggage screening is also obtained. Lastly, a risk-based screening strategy proposed in the literature is analyzed. The results reported suggest that for the existing security setup, with current device costs and probability parameters, single-device systems are less costly and have fewer expected number of successful threats than two-device systems due to the way the second device affects the alarm or clear decision. The risk-based approach is found to have the potential to significantly improve security. The cost model introduced provides an effective tool for the execution of cost-benefit analyses of alternative device configurations for aviation-checked baggage security screening.

  18. Cost of Production of Telenomus remus (Hymenoptera: Platygastridae) Grown in Natural and Alternative Hosts.

    Science.gov (United States)

    Vieira, Natalia F; Pomari-Fernandes, Aline; Lemes, Amanda A F; Vacari, Alessandra M; De Bortoli, Sergio A; de Freitas Bueno, Adeney

    2017-11-01

    The study of the technical and economic aspects of rearing natural enemies is essential for its effective use as a biological control agent in the field. The aim of this study was to determine the cost of production of the parasitoid, Telenomus remus (Nixon; Hymenoptera: Platygastridae), reared in eggs of its natural host, Spodoptera frugiperda (J. E. Smith; Lepidoptera: Noctuidae), and the alternative host, Corcyra cephalonica (Stainton; Lepidoptera: Pyralidae). The insects were reared in accordance with their respective methodologies of laboratory rearing. The cost of production of this biocontrol agent is US$ 0.0004 when reared with S. frugiperda eggs and US$ 0.0002 with C. cephalonica eggs. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

    Science.gov (United States)

    Mcphillamy, Austin; Gurnea, Taylor P; Moody, Alastair E; Kurnik, Christopher G; Lu, Minggen

    2016-12-01

    In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. Retrospective review. Level II Trauma center. 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. Operative treatment with conventional or generic implants. The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. Therapeutic Level III.

  20. Production Costs of Alternative Transportation Fuels. Influence of Crude Oil Price and Technology Maturity

    Energy Technology Data Exchange (ETDEWEB)

    Cazzola, Pierpaolo; Morrison, Geoff; Kaneko, Hiroyuki; Cuenot, Francois; Ghandi, Abbas; Fulton, Lewis

    2013-07-01

    This study examines the production costs of a range of transport fuels and energy carriers under varying crude oil price assumptions and technology market maturation levels. An engineering ''bottom-up'' approach is used to estimate the effect of the input cost of oil and of various technological assumptions on the finished price of these fuels. In total, the production costs of 20 fuels are examined for crude oil prices between USD 60 and USD 150 per barrel. Some fuel pathways can be competitive with oil as their production, transport and storage technology matures, and as oil price increases. Rising oil prices will offer new opportunities to switch to alternative fuels for transport, to diversify the energy mix of the transport sector, and to reduce the exposure of the whole system to price volatility and potential distuption of supply. In a time of uncertainty about the leading vehicle technology to decarbonize the transport sector, looking at the fuel cost brings key information to be considered to keep mobility affordable yet sustainable.

  1. Cost effectiveness of Alternative Helicobacter pylori Eradication Strategies in the Management of Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Bernie O'Brien

    1997-01-01

    Full Text Available Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin are more costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

  2. Family Genericity

    DEFF Research Database (Denmark)

    Ernst, Erik

    2006-01-01

    Type abstraction in object-oriented languages embody two techniques, each with its own strenghts and weaknesses. The first technique is extension, yielding abstraction mechanisms with good support for gradual specification. The prime example is inheritance. The second technique is functional...... abstraction, yielding more precise knowledge about the outcome. The prime example is type parameterized classes. This paper argues that these techniques should be clearly separated to work optimally, and also that current languages fail to do this. We have applied this design philosophy to a language based...... the result as family genericity. The presented language design has been implemented....

  3. Alternatives for operational cost reduction in oil pipelines; Alternativas para reducao de custos energeticos operacionais em oleodutos

    Energy Technology Data Exchange (ETDEWEB)

    Krause, Philipe Barroso; Carneiro, Leonardo Motta; Pires, Luis Fernando Goncalves [Pontificia Universidade Catolica do Rio de Janeiro (SIMDUT/DEM/ PUC-Rio), RJ (Brazil). Dept. de Engenharia Mecancia. Nucleo de Simulacao Termo-Hidraulica de Dutos

    2012-07-01

    This paper intends to give a brief overview of some cost reduction alternatives in oil pipelines, to optimize the pipeline operation. Four different alternatives are presented, based on previous studies made on existing pipelines, to demonstrate the response obtained with these solutions. Pipeline operation, especially on mature ones, tends to have a high operational cost, be by tradition, the aging of the installation, change of operational characteristics - such as nominal flow, product, or even flow direction - for which the pipeline wasn't originally designed. The alternatives showed allow for an increase survival time of the pipeline, without resorting to major changes, such as replacement of pipes or adding pumping stations to the system. The alternative studied varies from no implementation cost to high installation cost or operational cost increase, depending on the system and the alternative chosen. From changing the pump arrays during operation or changing the products viscosity with different blends, that represent virtually no cost to the pipeline operation, to the use of VFDs, with a high installation cost or DRA, which increase the operational cost. (author)

  4. Submental intubation: an alternative and cost-effective technique for complex maxillofacial surgeries.

    Science.gov (United States)

    Kar, Chiradip; Mukherjee, Srijon

    2010-09-01

    Management of airway is a significant issue especially in cases of complex maxillofacial trauma like panfacial fractures or concomitant nasoethmoidal injuries, where the nasotracheal intubation is contraindicated or possess a significant problem. In these cases the only other alternative is tracheostomy. Submental intubation is an alternative to tracheostomy and it can be easily performed with little or lesser post-operative complications. This method involves lesser expenses as it does away with longer post-operative stay in the hospital as required by tracheostomy patients. The patient is orally intubated with a reinforced armoured tube with a detachable plastic gas connector. An incision is made in the submental area of the patient and a tunnel is prepared from this region to the floor of the mouth through which the proximal end of the tube is diverted. Thus the occlusion of the patient can be checked intraoperatively. After completion of the surgery the proximal end in reintroduced onto the oral cavity and the patient is extubated orally. Originally proposed by Altemir in 1986, this method cannot be used in all cases as it is not without limitations. In spite of these, submental intubation can be a useful alternative to tracheostomy, especially in regions where cost cutting is a major factor in health infrastructure. Maxillofacial surgeons addressing major facial trauma surgery may have this procedure in mind before opting for tracheostomy. It avoids a lot of complications associated with tracheostomy.

  5. Assessment of costs and benefits of flexible and alternative fuel use in the US transportation sector

    Energy Technology Data Exchange (ETDEWEB)

    1991-07-01

    The Alternative Motor Fuels Act of 1988 (Public Law 100-494), Section 400EE, states that the Secretary of Energy ...shall study methanol plants, including the costs and practicability of such plants that are (A) capable of utilizing current domestic supplies of unutilized natural gas; (B) relocatable; or (C) suitable for natural gas to methanol conversion by natural gas distribution companies...'' The purpose of this report is to characterize unutilized gas within the lower 48 states and to perform an economic analysis of methanol plants required by the act. The approach with regard to unutilized lower 48 gas is to (1) compare the costs of converting such gas to methanol against the expected price of gasoline over the next 20 years, and (2) compare the economics of converting such gas to methanol against the economics of using the gas as a pipeline-transported fuel. This study concludes that remote gas and low-Btu gas generally cannot be converted to methanol at costs near the expected competitive value of gasoline because of the poor economies of scale of small methanol plants.

  6. RCMP detachments - British Columbia: Using alternative fuels to reduce fleet operating costs

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1997-06-01

    RCMP detachments in British Columbia operate some 2,500 vehicles primarily for general policing duties and highway patrol. General duty vehicles are driven 3,000 to 5,000 km per month, while highway patrol vehicles average anywhere from 6,000 to 12,000 km per month. The search for a less expensive alternative fuel began in the early 1980s. Many of the conversions since then have been bi-fuel configurations that offer the advantage of extended range, which is necessary for some detachments. However, officers are expected to use propane whenever possible to achieve maximum cost savings. Using the Langley detachment as an example, operating cost for a propane vehicle was calculated at $0.034 per km, compared to $0.087 per km for a gasoline-powered vehicle of the same type. The detachment estimates that using propane in 20 of its vehicles since 1993 has resulted in savings of about $100,000. Vehicle maintenance costs also have decreased since spark plug replacements and oil changes are required less frequently. Handling characteristics are about the same as before, and the structural integrity and safety of the mono-fuel propane and bi-fuel vehicles has been excellent.

  7. A consumer register: an acceptable and cost-effective alternative for accessing patient populations

    Directory of Open Access Journals (Sweden)

    Jamie Bryant

    2016-10-01

    register. Use of volunteer data collectors contributed to an annual saving of $14,183, however paid data collectors achieved significantly higher consent rates. Successful enrolment onto the register was completed for 42 % of the sample. Conclusions A Consumer Register is a promising and feasible alternative to population-based registries, with the majority of participants willing to be contacted multiple times via low-resource methods such as email. There is an effectiveness/cost trade off in the use of paid versus volunteer data collectors.

  8. Impacts of generic competition and benefit management practices on spending for prescription drugs: evidence from Medicare's Part D benefit.

    Science.gov (United States)

    Sheingold, Steven; Nguyen, Nguyen Xuan

    2014-01-01

    This study estimates the effects of generic competition, increased cost-sharing, and benefit practices on utilization and spending for prescription drugs. We examined changes in Medicare price and utilization from 2007 to 2009 of all drugs in 28 therapeutic classes. The classes accounted for 80% of Medicare Part D spending in 2009 and included the 6 protected classes and 6 classes with practically no generic competition. All variables were constructed to measure each drug relative to its class at a specific plan sponsor. We estimated that the shift toward generic utilization had cut in half the rate of increase in the price of a prescription during 2007-2009. Specifically, the results showed that (1) rapid generic penetration had significantly held down costs per prescription, (2) copayment and other benefit practices shifted utilization to generics and favored brands, and (3) price increases were generally greater in less competitive classes of drugs. In many ways, Part D was implemented at a fortuitous time; since 2006, there have been relatively few new blockbuster drugs introduced, and many existing high-volume drugs used by beneficiaries were in therapeutic classes with multiple brands and generic alternatives. Under these conditions, our paper showed that plan sponsors have been able to contain costs by encouraging use of generics or drugs offering greater value within therapeutic classes. It is less clear what will happen to future Part D costs if a number of new and effective drugs for beneficiaries enter the market with no real competitors.

  9. Cost-effectiveness of alternative colonoscopy surveillance strategies to mitigate metachronous colorectal cancer incidence.

    Science.gov (United States)

    Erenay, Fatih Safa; Alagoz, Oguzhan; Banerjee, Ritesh; Said, Adnan; Cima, Robert R

    2016-08-15

    The incidence of metachronous colorectal cancer (MCRC) among colorectal cancer (CRC) survivors varies significantly, and the optimal colonoscopy surveillance practice for mitigating MCRC incidence is unknown. A cost-effectiveness analysis was used to compare the performances of the US Multi-Society Task Force guideline and all clinically reasonable colonoscopy surveillance strategies for 50- to 79-year-old posttreatment CRC patients with a computer simulation model. The US guideline [(1,3,5)] recommends the first colonoscopy 1 year after treatment, whereas the second and third colonoscopies are to be repeated at 3- and 5-year intervals. Some promising alternative cost-effective strategies were identified. In comparison with the US guideline, under various scenarios for a 20-year period, 1) reducing the surveillance interval of the guideline after the first colonoscopy by 1 year [(1,2,5)] would save up to 78 discounted life-years (LYs) and prevent 23 MCRCs per 1000 patients (incremental cost-effectiveness ratio [ICER] ≤ $23,270/LY), 2) reducing the intervals after the first and second negative colonoscopies by 1 year [(1,2,4)] would save/prevent up to 109 discounted LYs and 36 MCRCs (ICER ≤ $52,155/LY), and 3) reducing the surveillance intervals after the first and second negative colonoscopy by 1 and 2 years [(1,2,3)] would save/prevent up to 141 discounted LYs and 50 MCRCs (ICER ≤ $63,822/LY). These strategies would require up to 1100 additional colonoscopies per 1000 patients. Although the US guideline might not be cost-effective in comparison with a less intensive oncology guideline [(3,3,5); the ICER could be as high as $140,000/LY], the promising strategies would be cost-effective in comparison with such less intensive guidelines unless the cumulative MCRC incidence were very low. The US guideline might be improved by a slight increase in the surveillance intensity at the expense of moderately increased cost. More research is warranted to explore the

  10. Linking gas turbine with lignite fired steam generators: alternatives, limitations, benefits and costs

    Energy Technology Data Exchange (ETDEWEB)

    Stamatelopoulos, G.N.; Leithner, R.; Karakas, E.; Papageorgiou, N. [Technische Universitaet Braunschweig, Braunschweig (Germany). Inst. fuer Waerme und Breunnstofftechnik

    1996-09-01

    In this paper the possibility of linking high efficiency gas turbines with lignite fired steam generators is examined. The possible combinations of gas and steam turbine and the experience gained from their practical application are presented. The technical limitations set by the existing boilers and steam turbines are discussed. For the efficiency and power output increase of the power plant Kardia in Northern Greece the following alternatives are suggested: supplementary firing of oil or natural gas together with lignite; topping of every steam generator with small gas turbines and installation of a gas turbine with turbine with heat recovery steam generator and water/steam side link with every steam generator. The possibility of using the exhaust gas from the gas turbine as the only oxygen carrier is also discussed. These alternatives are calculated with a process simulation program and are compared to each other with emphasis on the technical and the economical aspects. A sensitivity analysis concerning the natural gas price was carried out in order to evaluate its influence on the costs and the affectivity of the investment. 16 refs., 7 figs., 4 tabs.

  11. Potential Clinical and Economic Impact of Switching Branded Medications to Generics

    Science.gov (United States)

    Straka, Robert J.; Keohane, Denis J.; Liu, Larry Z.

    2017-01-01

    Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003–2013 using key words of “generic switching” or “substitution” was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases. PMID:26099048

  12. Potential Clinical and Economic Impact of Switching Branded Medications to Generics.

    Science.gov (United States)

    Straka, Robert J; Keohane, Denis J; Liu, Larry Z

    2017-05-01

    Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003-2013 using key words of "generic switching" or "substitution" was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.

  13. Efficient and cost-reduced glucoamylase fed-batch production with alternative carbon sources.

    Science.gov (United States)

    Luo, Hongzhen; Liu, Han; He, Zhenni; Zhou, Cong; Shi, Zhongping

    2015-02-01

    Glucoamylase is an important industrial enzyme. Glucoamylase production by industrial Aspergillus niger strain featured with two major problems: (i) empirical substrate feeding methods deteriorating the fermentation performance; and (ii) the high raw materials cost limiting the economics of the glucoamylase product with delegated specification. In this study, we first proposed a novel three-stage varied-rate substrate feeding strategy for efficient glucoamylase production in a 5 L bioreactor using the standard feeding medium, by comparing the changing patterns of the important physiological parameters such as DO, OUR, RQ, etc., when using different substrate feeding strategies. With this strategy, the glucoamylase activity and productivity reached higher levels of 11,000 U/ml and 84.6 U/ml/h, respectively. The performance enhancement in this case was beneficial from the following results: DO and OUR could be controlled at the higher levels (30%, 43.83 mmol/l/h), while RQ was maintained at a stable/lower level of 0.60 simultaneously throughout the fed-batch phase. Based on this three-stage varied-rate substrate feeding strategy, we further evaluated the economics of using alternative carbon sources, attempting to reduce the raw materials cost. The results revealed that cornstarch hydrolysate could be considered as the best carbon source to replace the standard and expensive feeding medium. In this case, the production cost of the glucoamylase with delegated specification (5,000 U/ml) could be saved by more than 61% while the product quality be ensured simultaneously. The proposed strategy showed application potential in improving the economics of industrial glucoamylase production.

  14. Generic drugs in dermatology: part I.

    Science.gov (United States)

    Payette, Michael; Grant-Kels, Jane M

    2012-03-01

    The cost of health care in the United States is increasing. In order to help control these rising costs, all parties involved in the delivery of health care, including dermatologists, need to be part of the solution of ethically reducing the cost of delivery of care. One potential means of meeting this goal is to increase the use of generic medications in daily practice. Generic medications can offer equally efficacious therapy at significantly lower prices, which can translate into large scale savings for the individual patient, the payer, and the overall health care system. Herein we provide an overview of new drug development, review the history of the generic drug industry, describe how generic drugs are approved by the US Food and Drug Administration, and define the concepts of bioequivalence and therapeutic equivalence. In part II, we explore various factors impacting generic drug use, provide cost analyses of dermatologic brand name and generic drugs, and review data addressing potential differences in the effectiveness of brand name versus generic drugs in dermatology. The cost of brand name and generic medications is highly variable by pharmacy, state, and payer. We used one source (www.drugstore.com) as an example and for consistency across all medications discussed herein. Prices included here may not reflect actual retail prices across the United States. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  15. Use of complementary and alternative medicine by patients with cancer in northern Turkey: analysis of cost and satisfaction.

    Science.gov (United States)

    Aydin Avci, Ilknur; Koç, Zeliha; Sağlam, Zeynep

    2012-03-01

    The aims of this study were to determine (1) the prevalence of complementary and alternative medicine use among patients with cancer, (2) the method of use of the particular therapy, (3) the reasons for using complementary and alternative medicine therapies, (4) the benefits experienced by the use of complementary and alternative medicine, (5) the source of information about complementary and alternative medicine therapies and, (6) the satisfaction and cost of complementary and alternative medicine. Complementary and alternative medicine consists of diverse medical and healthcare systems, practices and products that are not considered at present to be a part of conventional medicine. The majority of patients who use complementary and alternative medicine use more than one method. Complementary and alternative medicine use is more common in cases of advanced disease or poor prognosis. This is a descriptive study of complementary and alternative medicine. This study was conducted in the Chemotherapy Unit at Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey, between 18 March 2008-30 June 2008. Two hundred fifty-three patients with cancer, among 281 patients who applied to the chemotherapy clinic between these dates, agreed to take part in the study with whom contact could be made were included. A questionnaire including descriptive characteristics in collecting data, characteristics about diseases and their treatments, complementary and alternative medicine information and implementation situations and a control list about complementary and alternative medicine implementations were given. The collected data were evaluated by computer using descriptive statistics, the chi-square test and Student's t-test. In this study, 94·1% of the patients were content with medical treatment, 58·9% of them used complementary and alternative medicine treatments, 41·1% did not use any complementary and alternative medicine treatments. The satisfaction level of the

  16. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Sue J Goldie

    2010-04-01

    Full Text Available BACKGROUND: Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. METHODS AND FINDINGS: Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants. Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35% without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC. An integrated and stepwise approach was

  17. Is complementary and alternative medicine (CAM cost-effective? a systematic review

    Directory of Open Access Journals (Sweden)

    Caspi Opher

    2005-06-01

    Full Text Available Abstract Background Out-of-pocket expenditures of over $34 billion per year in the US are an apparent testament to a widely held belief that complementary and alternative medicine (CAM therapies have benefits that outweigh their costs. However, regardless of public opinion, there is often little more than anecdotal evidence on the health and economic implications of CAM therapies. The objectives of this study are to present an overview of economic evaluation and to expand upon a previous review to examine the current scope and quality of CAM economic evaluations. Methods The data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35-item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding. Results A total of 56 economic evaluations (39 full evaluations of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36% studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with

  18. TEAM: A Low-Cost Alternative to ATLS for Providing Trauma Care Teaching in Haiti.

    Science.gov (United States)

    Kurdin, Anton; Caines, Andrew; Boone, Darrell; Furey, Andrew

    2017-08-23

    Trauma resuscitation protocols have unified the care of trauma patients and significantly improved outcomes. However, the success of the Advanced Trauma Life Support course is difficult to reproduce in developing countries due to set-up costs, limitations of resources, and variations of practice. The objective of this study is to assess the Trauma Evaluation and Management (TEAM) course as a low-cost alternative for trauma resuscitation teaching in Low and Middle Income Countries (LMIC). As part of the Team Broken Earth initiative, TEAM course was provided to the health care professionals in Haiti. At its conclusion, participants were asked to complete a survey evaluating the course. Qualitative and quantitative data were analyzed to evaluate the perception of the course. The course was provided in Port-au-Prince, Haiti. A total of 80 health care professionals participated in the course. Response was obtained from 69 participants, which comprised of 32 physicians, 10 Emergency Medical Technicians (EMT), 22 nurses, and 5 medical trainees. The course was well received by physicians, nurses, and EMT with an average score of 90.6%. Question analysis revealed a lower satisfaction of physicians for the course manual and teaching materials, and information related to decisions for transfer of patients. EMT consistently felt that the course was not tailored to their learning and practice needs. Written feedback demonstrated several areas of weaknesses including need for improvements in translations, hands-on practice, and educational materials. Overall, the TEAM course was well received. Analysis demonstrated a need for adjustments specific to LMIC including a focus on prehospital assessment, increased nursing responsibilities, and unavailability of specialist's referrals. Team Broken Earth intends to take these findings into consideration and continue to provide the TEAM course to other LMIC. Copyright © 2017 Association of Program Directors in Surgery. Published by

  19. The Registration and Control of the Quality Costs. An Alternative Analysis in the Manufacture of an Exportable Product

    Directory of Open Access Journals (Sweden)

    Suraya Lavielle-Laugart

    2015-12-01

    Full Text Available The processes of entrepreneurial management are developing under a dynamic environment, where the proactive action of the decisions guarantees the exploitation of improving opportunities. The enterprises make an effort to negotiate the quality of the products and services, with an appropriate administration of the costs. This suggests the mensuration of the expenses, as key tool in the efficiency of this process. This study aims at presenting an alternative and a control design of the quality costs supported by a calculus algorithm in the information process. This will serve as a basis for the analysis of the efficiency of the quality management exemplified with the manufacture of the exportable product. Analysis methods are used to evaluate essential aspects of the topic, interviews, experts’  approaches, and the calculation method and cost registration for event that facilitate a vision of the costs of quality in the search of alternatives for the taking of decisions. 

  20. Digital HF communications for the polar regions - a low-cost alternative to satellite?

    Science.gov (United States)

    Prior-Jones, Michael; Warrington, Mike

    2010-05-01

    Digital HF communications for the polar regions - a low-cost alternative to satellite? Prior-Jones, M.R. and Warrington, E. M Communications within the polar regions pose unique technical challenges, due to the physical isolation, lack of infrastructure and extreme weather conditions. Geostationary satellite links are widely used, but they cannot function poleward of 80 degrees due to the curvature of the Earth. Low-earth-orbit systems like Iridium and ARGOS will function all the way to the poles. However, they are expensive, particularly for experiments requiring long time-series. Transferring data by Iridium satellite phone costs of the order of 60USD per megabyte. HF (i.e. 3-30 MHz) radio signals propagate via the ionosphere, allowing long distance transmission beyond the horizon. Ranges of thousands of kilometres can be easily achieved with relatively low transmission powers when propagation is favourable. The polar ionosphere is, however, a challenging environment for radio signals - the signals often reflect from multiple regions of the ionosphere and by multiple hops with intermediate ground reflections producing multipath effects. As the ionosphere is moving, these signals are also subject to very significant Doppler shifts that add to the complexity of the environment. These effects may make data communications at polar latitudes difficult or impossible at times and often only at low data rates. In this paper we discuss our experiments to use modern signal-processing and modulation techniques for digital transmission on HF, offering a similar speed to satellite but without paying the high cost of satellite airtime. Using an HF channel simulator developed by Warrington et al based on measurements of propagation at high latitudes, we have tested the performance of an OFDM-based modem derived from the Digital Radio Mondiale standard used for digital HF broadcasting and found that it outperforms current military modems developed by NATO (STANAG 4285 and 4539

  1. A pharmaco-economic analysis of patients with schizophrenia switching to generic risperidone involving a possible compliance loss

    Directory of Open Access Journals (Sweden)

    Möller Hans-Jürgen

    2009-02-01

    Full Text Available Abstract Background As schizophrenia patients are typically suspicious of, or are hostile to changes they may be reluctant to accept generic substitution, possibly affecting compliance. This may counteract drug costs savings due to less symptom control and increased hospitalization risk. Although compliance losses following generic substitution have not been quantified so far, one can estimate the possible health-economic consequences. The current study aims to do so by considering the case of risperidone in Germany. Methods An existing DES model was adapted to compare staying on branded risperidone with generic substitution. Differences include the probability of non-compliance and medication costs. Incremental probability of non-compliance after generic substitution was varied between 2.5% and 10%, while generic medication costs were assumed to be 40% lower. Effect of medication price was assessed as well as the effect of applying compliance losses to all treatment settings. The probability of staying on branded risperidone being cost-effective was calculated for various outcomes of a hypothetical study that would investigate non-compliance following generic substitution of risperidone. Results If the incremental probability of non-compliance after generic substitution is 2.5%, 5.0%, 7.5% and 10% respectively, incremental effects of staying on branded risperidone are 0.004, 0.007, 0.011 and 0.015 Quality Adjusted Life Years (QALYs. Incremental costs are €757, €343, -€123 and -€554 respectively. Benefits of staying on branded risperidone include improved symptom control and fewer hospitalizations. If generic substitution results in a 5.2% higher probability of non-compliance, the model predicts staying on branded risperidone to be cost-effective (NICE threshold of ₤30,000 per QALY gained. Compliance losses of more than 6.9% makes branded risperidone the dominant alternative. Results are sensitive to the locations at which compliance

  2. Low-Cost Alternative for Signal Generators in the Physics Laboratory

    Science.gov (United States)

    Pathare, Shirish Rajan; Raghavendra, M. K.; Huli, Saurabhee

    2017-05-01

    Recently devices such as the optical mouse of a computer, webcams, Wii remote, and digital cameras have been used to record and analyze different physical phenomena quantitatively. Devices like tablets and smartphones are also becoming popular. Different scientific applications available at Google Play (Android devices) or the App Store (iOS devices) make them versatile. One can find many websites that provide information regarding various scientific applications compatible with these systems. A variety of smartphones/tablets are available with different types of sensors embedded. Some of them have sensors that are capable of measuring intensity of light, sound, and magnetic field. The camera of these devices has been used to study projectile motion, and the same device, along with a sensor, has been used to study the physical pendulum. Accelerometers have been used to study free and damped harmonic oscillations and to measure acceleration due to gravity. Using accelerometers and gyroscopes, angular velocity and centripetal acceleration have been measured. The coefficient of restitution for a ball bouncing on the floor has been measured using the application Oscilloscope on the iPhone. In this article, we present the use of an Android device as a low-cost alternative for a signal generator. We use the Signal Generator application installed on the Android device along with an amplifier circuit.

  3. The costs of production of alternative jet fuel: A harmonized stochastic assessment.

    Science.gov (United States)

    Bann, Seamus J; Malina, Robert; Staples, Mark D; Suresh, Pooja; Pearlson, Matthew; Tyner, Wallace E; Hileman, James I; Barrett, Steven

    2017-03-01

    This study quantifies and compares the costs of production for six alternative jet fuel pathways using consistent financial and technical assumptions. Uncertainty was propagated through the analysis using Monte Carlo simulations. The six processes assessed were HEFA, advanced fermentation, Fischer-Tropsch, aqueous phase processing, hydrothermal liquefaction, and fast pyrolysis. The results indicate that none of the six processes would be profitable in the absence of government incentives, with HEFA using yellow grease, HEFA using tallow, and FT revealing the lowest mean jet fuel prices at $0.91/liter ($0.66/liter-$1.24/liter), $1.06/liter ($0.79/liter-$1.42/liter), and $1.15/liter ($0.95/liter-$1.39/liter), respectively. This study also quantifies plant performance in the United States with a Renewable Fuel Standard policy analysis. Results indicate that some pathways could achieve positive NPV with relatively high likelihood under existing policy supports, with HEFA and FPH revealing the highest probability of positive NPV at 94.9% and 99.7%, respectively, in the best-case scenario. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Scilab software as an alternative low-cost computing in solving the linear equations problem

    Science.gov (United States)

    Agus, Fahrul; Haviluddin

    2017-02-01

    Numerical computation packages are widely used both in teaching and research. These packages consist of license (proprietary) and open source software (non-proprietary). One of the reasons to use the package is a complexity of mathematics function (i.e., linear problems). Also, number of variables in a linear or non-linear function has been increased. The aim of this paper was to reflect on key aspects related to the method, didactics and creative praxis in the teaching of linear equations in higher education. If implemented, it could be contribute to a better learning in mathematics area (i.e., solving simultaneous linear equations) that essential for future engineers. The focus of this study was to introduce an additional numerical computation package of Scilab as an alternative low-cost computing programming. In this paper, Scilab software was proposed some activities that related to the mathematical models. In this experiment, four numerical methods such as Gaussian Elimination, Gauss-Jordan, Inverse Matrix, and Lower-Upper Decomposition (LU) have been implemented. The results of this study showed that a routine or procedure in numerical methods have been created and explored by using Scilab procedures. Then, the routine of numerical method that could be as a teaching material course has exploited.

  5. Comparing Sustainable Performance of Industrial System Alternatives by Integrating Environment, Costs, Clients and Exploitation Context

    OpenAIRE

    Leroy, Yann; Cluzel, François; Lamé, Guillaume

    2014-01-01

    International audience; Life Cycle Assessment (LCA) is a methodology to assess environmental performances of products throughout their life cycles. Traditionally, LCA-based decision-making focuses on environmental impacts, excluding customer expectations and economic considerations. Moreover, it usually uses generic data while environmental performances of industrial systems often depend on local contexts. The aim of this paper is to provide a comprehensive framework to identify the solution ...

  6. Costs for Alternatives to District Heating. A study of real costs on local heating markets; Alternativkostnad till fjaerrvaerme. En studie av verkliga kostnader paa lokala vaermemarknader

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, Annelie; Lehtmets, Marti; Andersson, Sofie

    2008-07-01

    Heating comprise the major part of the cost of supporting a building with necessities like electricity, heat, refuse collection and water and sewage. As these costs increase, it is becoming more interesting to find other solutions in order to reduce them. One alternative is to convert to another heating system. Several price analyses comparing different heating systems have been performed. Avgiftsgruppen publishes one report on a yearly basis, where the costs to support a building with necessities and how they vary between communities are listed. The latest report states that it is less expensive in 75 % of the communities in Sweden to convert from district heating to a pellets boiler or a ground-source pump. However, other studies have established that the heat market is a local market with local conditions. Therefore you need to compare alternative heating costs that are specific to the area instead of estimated average costs at a national level. The purpose of this survey is to study a local heat market in order to verify the real cost of the alternative heating systems to district heating and if these costs vary between different communities. The hypothesis is that it is not possible to generalize the heating cost on a national level. Instead, a local market should be studied to make an accurate cost comparison between heating options. Three communities are studied in order to find real and verified investment costs in pellet boilers and heat pumps. The investments that are of primary interest are those performed in buildings similar to the multi-dwelling house used in earlier price analyses. Furthermore, the building should be located within the distribution network of district heating in order to illustrate the competition between the heating alternatives. The result of the study illustrates the difficulties to find real and verified costs of completed investments in alternative heating systems in buildings that is of primary interest for this study. Contacts

  7. [Generic drugs: good or bad? Physician's knowledge of generic drugs and prescribing habits].

    Science.gov (United States)

    García, A J; Martos, F; Leiva, F; Sánchez de la Cuesta, F

    2003-01-01

    In this article we analyze the responses of 1220 Spanish physicians who participated in a survery about generic drugs. A previously validated questionnaire was sent to physicians through the Spanish Medical Councils of the different provinces. Four items were analyzed: what doctors know about generic drugs (knowledge); physicians' prescribing habits concerning these drugs (attitude and professional competence); how prescription of generic drugs effects pharmaceutical costs amd, finally, what doctors believe a generic drug should be. The influence of physician-related variables (age, type of contract, specialty, workload, etc.) on prescribing of generic drugs was also analyzed. In view of the results, we believe that to rationalize expenditure through and appropriate policy on generic drugs Spanish health authorities should offer more and better training and information (clear and independent) about what generic drugs are.

  8. 41 CFR 102-85.170 - Can flexitime and other alternative work schedules cost the customer agency more?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Can flexitime and other alternative work schedules cost the customer agency more? 102-85.170 Section 102-85.170 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 85-PRICING POLICY...

  9. Modeling the fiscal costs and benefits of alternative treatment strategies in the United Kingdom for chronic hepatitis C.

    Science.gov (United States)

    Connolly, Mark P; Kotsopoulos, Nikos; Ustianowski, Andrew

    2018-01-01

    Hepatitis C (HCV) infection causes substantial direct health costs, but also impacts broader societal and governmental costs, such as tax revenue and social protection benefits. This study investigated the broader fiscal costs and benefits of curative interventions for chronic Hepatitis C (CHC) that allow individuals to avoid long-term HCV attributed health conditions. A prospective cohort model, assessing the long-term fiscal consequences of policy decisions, was developed for HCV infected individuals, following the generational accounting analytic framework that combines age-specific lifetime gross taxes paid and governmental transfers received (i.e. healthcare and social support costs). The analysis assessed the burden of a theoretical cohort of untreated HCV infected patients with the alternative of treating these patients with a highly efficacious curative intervention (ledipasvir/sofosbuvir [LDV/SOF]). It also compared treating patients at all fibrosis stages (Stages F0-F4) compared to late treatment (Stage F4). Based on projected lifetime work activity and taxes paid, the treated cohort paid an additional £5,900 per patient compared to the untreated cohort. Lifetime government disability costs of £97,555 and £125,359 per patient for treated cohort vs no treatment cohort were estimated, respectively. Lifetime direct healthcare costs in the treated cohort were £32,235, compared to non-treated cohort of £26,424, with an incremental healthcare costs increase of £5,901 per patient. The benefit cost ratio (BCR) of total government benefits and savings relative to government treatment costs (including LDV/SOF) ranged from 1.8-5.6. Treating patients early resulted in 77% less disability costs, 43% lower healthcare costs, and 33% higher tax revenue. The ability to cure Hepatitis C offers considerable fiscal benefits beyond direct medical costs and savings attributed to reduced disability costs, public allowances, and improved tax revenue. Changes in parameters

  10. Alternate bidding strategies for asphalt and concrete pavement projects utilizing life cycle cost analysis (LCCA).

    Science.gov (United States)

    2012-07-01

    Recent changes in pavement materials costs have impacted the competitive environment relative to the : determination of the most cost effective pavement structure for a specific highway project. In response, State : highway agencies have renewed thei...

  11. Costs of two alternative Salmonella control policies in Finnish broiler production.

    Science.gov (United States)

    Kangas, Susanna; Lyytikäinen, Tapani; Peltola, Jukka; Ranta, Jukka; Maijala, Riitta

    2007-12-04

    Costs and benefits of two Salmonella control policies for broiler production were described and compared. The control options were the Zoonosis Directive 92/117/EC and the more intense strategy, the Finnish Salmonella Control Programme (FSCP). The comparison included the Salmonella control costs in primary and secondary production and the direct and indirect losses due to Salmonella infections in humans in 2000. The total annual costs of the FSCP were calculated to be 990 400 EUR (0.02 euro/kg broiler meat). The average control costs in the broiler production chain were seven times higher with the FSCP than with the Zoonosis Directive alone. However, the public health costs were 33 times higher with the Zoonosis Directive alone. The value of one prevented loss of life per year exceeded the annual control costs of the FSCP. Due to significant savings in public health costs compared to costs of FSCP, the FSCP was found to be economically feasible.

  12. Beyond free electricity: the costs of electric cooking in poor households and a market-friendly alternative

    Energy Technology Data Exchange (ETDEWEB)

    Howells, M.; Alfstad, T. [Cape Town Univ. (South Africa). Energy Research Centre; Victor, D.G.; Elias, R.J. [Stanford Univ., CA (United States). Program on Energy and Sustainable Development; Gaunt, T. [Cape Town Univ. (South Africa). Dept. of Electrical Engineering

    2006-11-15

    The South African government is introducing a poverty-reduction policy that will supply households with a monthly 50 kWh free basic electricity (FBE) subsidy. We show that FBE distorts the energy choices of poor households by encouraging them to cook with electricity, whereas alternatives such as liquefied petroleum gas (LPG) can deliver a similar cooking service at a much lower cost to society. An alternative energy scheme, such as providing households with clean energy credits equivalent in value to the FBE's cost, could deliver additional energy services worth at least 6% of total household welfare (and probably much more) at no additional public cost; those benefits are so large that they would cover the entire cost of LPG fuel needed to implement the scheme. The analysis is extremely sensitive to the coincidence of electric cooking with peak power demand on the South African grid and to assumptions regarding how South Africa will meet its looming shortfall in peak power capacity. One danger of FBE is that actual peak coincidence and the costs of supplying peak power could be much less favorable than we assume, and such uncertainties expose the South African power system to potentially very high costs of service. (author)

  13. 42 CFR 447.68 - Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan...

    Science.gov (United States)

    2010-10-01

    ... families are at risk of reaching the total aggregate limit for premiums and cost sharing under Medicaid... to determine family income, for purposes of the limitations on cost sharing related to family income... family out-of-pocket expenses up to that limit and are no longer subject to further cost sharing for the...

  14. State generic substitution laws can lower drug outlays under medicaid

    OpenAIRE

    Shrank, William H.; Choudhry, Niteesh K.; Agnew-Blais, Jessica; Federman, Alex D.; Liberman, Joshua N.; Liu, Jun; Kesselheim, Aaron S.; Brookhart, M. Alan; Fischer, Michael A.

    2010-01-01

    To stem the rising costs of medications, states have implemented varying generic substitution policies. These policies differ in the extent to which pharmacists or patients can influence medication choice. Using national Medicaid data, we evaluated the relationship between different generic substitution policies and generic simvastatin use after patent expiration of branded Zocor. States implementing policies that require patient consent prior to generic substitution experienced 25% lower rat...

  15. Generic drugs in dermatology: part II.

    Science.gov (United States)

    Payette, Michael; Grant-Kels, Jane M

    2012-03-01

    In part I, we discussed new drug development, reviewed the history of the generic drug industry, described how generic drugs are approved by the US Food and Drug Administration, and defined the concepts of bioequivalence and therapeutic equivalence. Herein, we explore various factors impacting generic drug use across the different parties involved: the prescriber, the pharmacist, the patient, and the payer. We also include original cost analysis of dermatologic brand name and generic drugs and show the potential cost savings that can be achieved through generic substitution. We conclude with a review of the data addressing potential differences in the effectiveness of brand name versus generic drugs in dermatology. The cost of brand name and generic medications is highly variable by pharmacy, state, and payer. We used one source (www.drugstore.com) as an example and for consistency across all medications discussed herein. Prices included here may not reflect actual retail prices across the United States. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  16. The generic article

    NARCIS (Netherlands)

    Farkas, D.F.; Swart, Henriëtte de

    2005-01-01

    We take a fresh look at the connection between genericity and (in)definiteness by reconsidering a long-standing puzzle concerning the relation between definiteness and genericity. We contrast English on the one hand and Romance languages and Hungarian on the other, focusing on generic sentences

  17. Assessment of costs and benefits of flexible and alternative fuel use in the US transportation sector

    Energy Technology Data Exchange (ETDEWEB)

    None

    1993-01-01

    The primary objective of this report is to provide estimates of volumes and development costs of known nonassociated gas reserves in selected, potentially important supplier nations, using a standard set of costing algorithms and conventions. Estimates of undeveloped nonassociated gas reserves and the cost of drilling development wells, production equipment, gas processing facilities, and pipeline construction are made at the individual field level. A discounted cash-flow model of production, investment, and expenses is used to estimate the present value cost of developing each field on a per-thousand-cubic-foot (Mcf) basis. These gas resource cost estimates for individual accumulations (that is, fields or groups of fields) then were aggregated into country-specific price-quantity curves. These curves represent the cost of developing and transporting natural gas to an export point suitable for tanker shipments or to a junction with a transmission line. The additional costs of LNG or methanol conversion are not included. A brief summary of the cost of conversion to methanol and transportation to the United States is contained in Appendix D: Implications of Gas Development Costs for Methanol Conversion.

  18. Modelling the Costs of Preserving Digital Assets

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad; Nielsen, Anders Bo; Thirifays, Alex

    2012-01-01

    on experiences from a Danish project to develop a cost model. It was found that a generic cost model should account for the nature of the organisation and the assets to be preserved, and for all major preservation activities and cost drivers. In addition, it should describe accounting principles. It was proposed......Information is increasingly being produced in digital form, and some of it must be preserved for the longterm. Digital preservation includes a series of actively managed activities that require on-going funding. To obtain sufficient resources, there is a need for assessing the costs...... and the benefits accrued by preserving the assets. Cost data is also needed for optimizing activities and comparing the costs of different preservation alternatives. The purpose of this study is to analyse generic requirements for modelling the cost of preserving digital assets. The analysis was based...

  19. Cost benefit analysis of waste compaction alternatives at Lawrence Livermore National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-01

    This report presents a cost benefit analysis of the potential procurement and operation of various solid waste compactors, or, of the use of commercial compaction services, for compaction of solid transuranic (TRU), low-level radioactive, hazardous, and mixed wastes at Lawrence Livermore National Laboratory (LLNL) Hazardous Waste Management (HWM) facilities. The cost benefit analysis was conducted to determine if increased compaction capacity at HWM might afford the potential for significant waste volume reduction and annual savings in material, shipping, labor, and disposal costs. In the following cost benefit analysis, capital costs and recurring costs of increased HWM compaction capabilities are considered. Recurring costs such as operating and maintenance costs are estimated based upon detailed knowledge of system parameters. When analyzing the economic benefits of enhancing compaction capabilities, continued use of the existing HWM compaction units is included for comparative purposes. In addition, the benefits of using commercial compaction services instead of procuring a new compactor system are evaluated. 31 refs., 1 fig., 6 tabs.

  20. Cost comparison of the satellite power system and six alternative technologies

    Energy Technology Data Exchange (ETDEWEB)

    Wolsko, T.; Samsa, M.

    1981-04-01

    A framework is described for comparing the Satellite Power System (SPS) with various projected alternative energy sources on the basis of technical possibility, economic viability, and social and environmental acceptability. Each of the following energy sources is briefly described: conventional coal, light water reactor, coal gasification/combined cycle, liquid-metal fast-breeder reactor, central station terrestrial photovoltaic, fusion, and the SPS. The analysis consists of comparison of characterizations, side-by-side analysis, and alternative futures analysis. (LEW)

  1. Generic torus canards

    Science.gov (United States)

    Vo, Theodore

    2017-10-01

    Torus canards are special solutions of fast/slow systems that alternate between attracting and repelling manifolds of limit cycles of the fast subsystem. A relatively new dynamic phenomenon, torus canards have been found in neural applications to mediate the transition from tonic spiking to bursting via amplitude-modulated spiking. In R3, torus canards are degenerate: they require one-parameter families of 2-fast/1-slow systems in order to be observed and even then, they only occur on exponentially thin parameter intervals. The addition of a second slow variable unfolds the torus canard phenomenon, making it generic and robust. That is, torus canards in fast/slow systems with (at least) two slow variables occur on open parameter sets. So far, generic torus canards have only been studied numerically, and their behaviour has been inferred based on averaging and canard theory. This approach, however, has not been rigorously justified since the averaging method breaks down near a fold of periodics, which is exactly where torus canards originate. In this work, we combine techniques from Floquet theory, averaging theory, and geometric singular perturbation theory to show that the average of a torus canard is a folded singularity canard. In so doing, we devise an analytic scheme for the identification and topological classification of torus canards in fast/slow systems with two fast variables and k slow variables, for any positive integer k. We demonstrate the predictive power of our results in a model for intracellular calcium dynamics, where we explain the mechanisms underlying a novel class of elliptic bursting rhythms, called amplitude-modulated bursting, by constructing the torus canard analogues of mixed-mode oscillations. We also make explicit the connection between our results here with prior studies of torus canards and torus canard explosion in R3, and discuss how our methods can be extended to fast/slow systems of arbitrary (finite) dimension.

  2. Reliability and cost-benefits of adding alternate power sources to an independent micro-grid community

    Science.gov (United States)

    Tanrioven, M.

    Interest in alternative energy resources such as wind, solar energy and fuel cell (FC) has been on the increase due to improved public awareness of the high energy cost and adverse environmental impacts of conventional energy sources. Therefore, the rapid growth and potential future demand for these energy sources suggest a need to consider both reliability and cost-benefits of the supply for each case. This paper presents a simulation methodology for reliability and cost assessment of these energy sources in an independent micro-grid (IMG) system, which is a distribution system with distributed energy sources such as micro-turbine, photovoltaic and fuel cells. A systematic technique and a computer program for reliability and cost assessment of the IMG system containing FC, photovoltaic (PV) and wind energy (WE) have been developed. The adequacy of the IMG is evaluated in three steps: (i) atmospheric data is generated for PV and WE in addition to the development of a 50 kW PEM FC generation and energy conversion model, (ii) the power delivered by these energy sources is calculated, and (iii) system adequacy and energy indices are calculated based on the system load balance equation, which is the combination of generated power and system load demand. The suggested technique can then be used to help system planners to provide objective indicators for suitable installation locations, operating policies, and energy type and size selection for IMG system containing alternative energy sources.

  3. Comparative review of three cost-effectiveness models for rotavirus vaccines in national immunization programs; a generic approach applied to various regions in the world

    NARCIS (Netherlands)

    Postma, Maarten J.; Jit, Mark; Rozenbaum, Mark H.; Standaert, Baudouin; Hong-Anh Tu, [No Value; Hutubessy, Raymond C. W.

    2011-01-01

    Background: This study aims to critically review available cost-effectiveness models for rotavirus vaccination, compare their designs using a standardized approach and compare similarities and differences in cost-effectiveness outcomes using a uniform set of input parameters. Methods: We identified

  4. The National Shipbuilding Research Program: Producibility Cost Reductions through Alternative Materials and Processes

    National Research Council Canada - National Science Library

    Horsmon, Jr., Albert W; Johnson, Karl; Gans-Devney, Barbara

    1999-01-01

    .... The research, sponsored by the National Shipbuilding Research Program (NSRP), looks specifically at increased use of fiberglass and plastic pipe, adhesives, and flexible and rubber hose as areas where cost and producibility gains may be found...

  5. [Variability and opportunity costs among the surgical alternatives for breast cancer].

    Science.gov (United States)

    Angulo-Pueyo, Ester; Ridao-López, Manuel; Martínez-Lizaga, Natalia; García-Armesto, Sandra; Bernal-Delgado, Enrique

    2014-01-01

    To analyze medical practice variation in breast cancer surgery (either inpatient-based or day-case surgery), by comparing conservative surgery (CS) plus radiotherapy vs. non-conservative surgery (NCS). We also analyzed the opportunity costs associated with CS and NCS. We performed an observational study of age- and sex-standardized rates of CS and NCS, performed in 199 Spanish healthcare areas in 2008-2009. Costs were calculated by using two techniques: indirectly, by using All-Patients Diagnosis Related Groups (AP-DRG) based on hospital admissions, and directly by using full costing from the Spanish Network of Hospital Costs (SNHC) data. Standardized surgery rates for CS and NCS were 6.84 and 4.35 per 10,000 women, with variation across areas ranging from 2.95 to 3.11 per 10,000 inhabitants. In 2009, 9% of CS was performed as day-case surgery, although a third of the health care areas did not perform this type of surgery. Taking the SNHC as a reference, the cost of CS was estimated at 7,078 € and that of NCS was 6,161 €. Using AP-DRG, costs amounted to 9,036 € and 8,526 €, respectively. However, CS had lower opportunity costs than NCS when day-case surgery was performed frequently-more than 46% of cases (following SNHC estimates) or 23% of cases (following AP-DRG estimates). Day-case CS for breast cancer was found to be the best option in terms of opportunity-costs beyond a specific threshold, when both CS and NCS are elective. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  6. Estimating the capital recovery costs of alternative patch retention treatments in eastern hardwoods

    Science.gov (United States)

    Chris B. LeDoux; Andrew Whitman

    2006-01-01

    We used a simulation model to estimate the economic opportunity costs and the density of large stems retained for patch retention in two temperate oak stands representative of the oak/hickory forest type in the eastern United States. Opportunity/retention costs ranged from $321.0 to $760.7/ha [$129.9 to $307.8/acre] depending on the species mix in the stand, the...

  7. Generic tacrolimus in solid organ transplantation

    DEFF Research Database (Denmark)

    Taube, D; Jones, G; O'Beirne, J

    2014-01-01

    are similar in quality, safety, and efficacy to their approved innovator drugs. There are data available for three generic brands, tacrolimus (Intas), tacrolimus (PharOS), and tacrolimus (Sandoz). Bioequivalence has been demonstrated for generic tacrolimus (Sandoz) within a narrow therapeutic range to its......The availability of a wide range of immunosuppressive therapies has revolutionized the management of patients who have undergone solid organ transplantation (SOT). However, the cost of immunosuppressive drugs remains high. This situation has led to the development of generic equivalents, which...

  8. Estimating costs of low-level radioactive waste disposal alternatives for the Commonwealth of Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    This report was prepared for the Commonwealth of Massachusetts by the Idaho National Engineering Laboratory, National Low-Level Waste Management Program. It presents planning life-cycle cost (PLCC) estimates for four sizes of in-state low-level radioactive waste (LLRW) disposal facilities. These PLCC estimates include preoperational and operational expenditures, all support facilities, materials, labor, closure costs, and long-term institutional care and monitoring costs. It is intended that this report bc used as a broad decision making tool for evaluating one of the several complex factors that must be examined when deciding between various LLRW management options -- relative costs. Because the underlying assumptions of these analyses will change as the Board decides how it will manage Massachusett`s waste and the specific characteristics any disposal facility will have, the results of this study are not absolute and should only be used to compare the relative costs of the options presented. The disposal technology selected for this analysis is aboveground earth-mounded vaults. These vaults are reinforced concrete structures where low-level waste is emplaced and later covered with a multi-layered earthen cap. The ``base case`` PLCC estimate was derived from a preliminary feasibility design developed for the Illinois Low-Level Radioactive Waste Disposal Facility. This PLCC report describes facility operations and details the procedure used to develop the base case PLCC estimate for each facility component and size. Sensitivity analyses were performed on the base case PLCC estimate by varying several factors to determine their influences upon the unit disposal costs. The report presents the results of the sensitivity analyses for the five most significant cost factors.

  9. Costs and Effectiveness of Treating Homeless Persons with Cocaine Addiction with Alternative Contingency Management Strategies.

    Science.gov (United States)

    Mennemeyer, Stephen T; Schumacher, Joseph E; Milby, Jesse B; Wallace, Dennis

    2017-03-01

    Between 1990 and 2006 in Birmingham, Alabama USA, 4 separate randomized controlled studies, called "Homeless 1" through "Homeless 4", treated cocaine substance abuse among chronically homeless adults, largely black men, many with non-psychotic mental health problems. The 4 studies had 9 treatment arms that used various counseling methods plus, in some arms, the provision of housing and work therapy usually with a contingent requirement of urine-test verified abstinence from substances. Participants in the abstinent-contingent arms who lapsed on abstinence were removed from housing and sent to an evening public shelter from which they were daily transported to day treatment until they returned to abstinence. This paper compares the cost effectiveness of the treatment arms. Societal cost per participant (in 2014 dollars) for each arm is defined as direct treatment cost plus cost of jail or hospital plus societal expense of public shelter use by lapsed participants. An untreated Base Case is defined as 5 percent abstinence with 95 percent usage of a public shelter. Incremental Cost Effectiveness Ratios (ICERs) for paired arms are defined as the change in cost per participant divided by the change in abstinence. Bootstrapping estimates confidence intervals. Average cost per participant at the end of 6 months of active treatment in 7 arms with comparable data ranged from USD 10,447 to USD 36,194 with corresponding average weeks abstinent ranging from 6.1 to 15.3 out of a possible 26 weeks. In contrast, the Base Case would cost USD 6,123 for 1.3 weeks of abstinence. Compared to the Base Case, the least expensive "DT2" treatment has an ICER of USD 901 (95% CI = USD 571 to USD 1,681) per additional week of abstinence and the most expensive "CMP4" has an ICER of USD 2,147 (95% CI = USD 1,701 to USD 2,848). Additionally, the Homeless 3 study found that the abstinent contingent housing (ACH3) treatment compared to the Non Abstinent Contingent Housing (NAC3), analogous to

  10. Technical Evaluation Report 24: Open Source Software: an alternative to costly Learning Management Systems

    Directory of Open Access Journals (Sweden)

    Jim Depow

    2003-10-01

    Full Text Available This is the first in a series of two reports discussing the use of open source software (OSS and free software (FS in online education as an alternative to expensive proprietary software. It details the steps taken in a Canadian community college to download and install the Linux Operating System in order to support an OSS/ FS learning management system (LMS.

  11. Technical Evaluation Report 24: Open Source Software: an alternative to costly Learning Management Systems

    OpenAIRE

    Jim Depow

    2003-01-01

    This is the first in a series of two reports discussing the use of open source software (OSS) and free software (FS) in online education as an alternative to expensive proprietary software. It details the steps taken in a Canadian community college to download and install the Linux Operating System in order to support an OSS/ FS learning management system (LMS).

  12. Assessing the costs and benefits of alternative approaches to high speed rail.

    Science.gov (United States)

    2013-05-01

    With high-speed rail (HSR) on the national agenda in the U.S. for the first time in quite a few : years, and with the support of the executive branch of the US government, it is of value to turn : our attention to studying various alternatives in ter...

  13. Comparative review of three cost-effectiveness models for rotavirus vaccines in national immunization programs; a generic approach applied to various regions in the world.

    Science.gov (United States)

    Postma, Maarten J; Jit, Mark; Rozenbaum, Mark H; Standaert, Baudouin; Tu, Hong-Anh; Hutubessy, Raymond C W

    2011-07-08

    This study aims to critically review available cost-effectiveness models for rotavirus vaccination, compare their designs using a standardized approach and compare similarities and differences in cost-effectiveness outcomes using a uniform set of input parameters. We identified various models used to estimate the cost-effectiveness of rotavirus vaccination. From these, results using a standardized dataset for four regions in the world could be obtained for three specific applications. Despite differences in the approaches and individual constituting elements including costs, QALYs Quality Adjusted Life Years and deaths, cost-effectiveness results of the models were quite similar. Differences between the models on the individual components of cost-effectiveness could be related to some specific features of the respective models. Sensitivity analysis revealed that cost-effectiveness of rotavirus vaccination is highly sensitive to vaccine prices, rotavirus-associated mortality and discount rates, in particular that for QALYs. The comparative approach followed here is helpful in understanding the various models selected and will thus benefit (low-income) countries in designing their own cost-effectiveness analyses using new or adapted existing models. Potential users of the models in low and middle income countries need to consider results from existing studies and reviews. There will be a need for contextualization including the use of country specific data inputs. However, given that the underlying biological and epidemiological mechanisms do not change between countries, users are likely to be able to adapt existing model designs rather than developing completely new approaches. Also, the communication established between the individual researchers involved in the three models is helpful in the further development of these individual models. Therefore, we recommend that this kind of comparative study be extended to other areas of vaccination and even other

  14. Comparative review of three cost-effectiveness models for rotavirus vaccines in national immunization programs; a generic approach applied to various regions in the world

    Directory of Open Access Journals (Sweden)

    Tu Hong-Anh

    2011-07-01

    Full Text Available Abstract Background This study aims to critically review available cost-effectiveness models for rotavirus vaccination, compare their designs using a standardized approach and compare similarities and differences in cost-effectiveness outcomes using a uniform set of input parameters. Methods We identified various models used to estimate the cost-effectiveness of rotavirus vaccination. From these, results using a standardized dataset for four regions in the world could be obtained for three specific applications. Results Despite differences in the approaches and individual constituting elements including costs, QALYs Quality Adjusted Life Years and deaths, cost-effectiveness results of the models were quite similar. Differences between the models on the individual components of cost-effectiveness could be related to some specific features of the respective models. Sensitivity analysis revealed that cost-effectiveness of rotavirus vaccination is highly sensitive to vaccine prices, rotavirus-associated mortality and discount rates, in particular that for QALYs. Conclusions The comparative approach followed here is helpful in understanding the various models selected and will thus benefit (low-income countries in designing their own cost-effectiveness analyses using new or adapted existing models. Potential users of the models in low and middle income countries need to consider results from existing studies and reviews. There will be a need for contextualization including the use of country specific data inputs. However, given that the underlying biological and epidemiological mechanisms do not change between countries, users are likely to be able to adapt existing model designs rather than developing completely new approaches. Also, the communication established between the individual researchers involved in the three models is helpful in the further development of these individual models. Therefore, we recommend that this kind of comparative study

  15. Cost/Schedule Uncertainty Analysis of the XM1/Alternative Armament Programs

    Science.gov (United States)

    1976-04-01

    120mm system; expected cost incurred is about $ 55M with either system. These delays and costs are caused by the additional redesign activities and...Tank Armament Study indicated a 1-1/2 year delay to full production at an expected cost increase of $ 55M (FY74) (measured from October 75 to...4-1 1-1 to U cfl 4J 1-1 T\\ H 4-1 rj M CJ CO td c 4-1 C8 sf 3 0) M CO c •H •H M CX •H IT) u ~~ U u CO U •H •H E M »-i o; o 4-1 •H

  16. Comparação do volume da gota e custo do tratamento dos genéricos de maleato de timolol 0,5% Drop volume and cost of treatment with generic 0.5% timolol maleate preparations

    Directory of Open Access Journals (Sweden)

    João Antonio Prata Junior

    2004-06-01

    Full Text Available OBJETIVO: Comparar o volume da gota das medicações genéricas de maleato de timolol a fim de determinar o custo real do tratamento em relação à medicação de referência. MÉTODOS: Foi determinado o volume da gota do Timoptol® 0,5% (Merck Sharp & Dome e dos genéricos maleato de timolol 0,5% dos laboratórios Allergan-Lok, Cristália e Falcon. Cinco frascos de 5 ml de cada medicação foram adquiridos no mercado. Dez gotas de cada frasco foram pesadas em balança de precisão individualmente, bem como, um mililitro de cada frasco para a determinação do volume da gota. Com base no volume da gota foi calculada a duração média em dias e o custo anual, considerando-se o gasto diário de 4 gotas e o preço máximo ao consumidor publicado em maio de 2003 com alíquota de 18%. RESULTADOS: Observaram-se diferenças estatisticamente significantes do volume da gota entre as medicações (pPURPOSE: To compare drop volume and treatment cost of generic 0.5% timolol maleate preparations. METHODS: The drop volume of Timoptol® 0.5% (Merck Sharp & Dohme and its generic preparations (Allergan-Lok, Cristália and Falcon were determined. Five bottles of each medication were purchased at local drugstores. Using a precision scale, ten drops and one mililiter of each bottle were weighed. Drop volume was calculated by the relation between volume and weight. Duration, in days, of each bottle and annual cost were calculated considering a daily use of 4 drops and maximum price to consumers published May, 2003. RESULTS: Statistically significant differences were observed between drop volumes (p<0.0001%. Allergan-Lok timolol maleate had the largest drop (35.1 µl and the smallest was Falcon timolol maleate (27.3 µl. Timoptol® drop volume was 27.9 µl. Annual treatment costs were R$ 68.87 for Timoptol, R$ 72.76 for Allergan-Lok timolol maleate, R$ 50.00 for Cristalia timolol maleate and R$ 43.11 for Falcon timolol maleate (p<0.0001. Allergan-Lok timolol

  17. Harvesting alternative, accumulation and procurement cost of small-diameter thinning wood for fuel in Central Finland

    Energy Technology Data Exchange (ETDEWEB)

    Laitila, J.; Heikkilae, J.; Anttila, P.

    2010-07-01

    This study compared harvesting alternatives, accumulation and procurement costs of small-diameter thinning wood chips for fuel, when trees were harvested either as delimbed stemwood or whole trees. The calculation was made for a hypothetical plant located in Central Finland and the radius of the procurement area was 100 km via the existing road network. Cutting was done with conventional harvester head equipped with multi-tree-handling (MTH) accessories, with the logged trees being chipped at the roadside storage. The cost of delimbed stemwood chips at heating plant was 24% higher compared to the cost of whole tree chips. The availability analysis attested that delimbing lowered the regional cutting removal by 42% compared to the whole tree harvesting, when the minimum accumulation for the fuel fraction at the stand was set at 25 m3/ha. Delimbing diminishes the recovery rate at the site, resulting in a diminishing number of potential recovery sites meeting the threshold volume. However, the study showed that the forest energy potential is increased and procurement costs are reduced, if delimbed stemwood is harvested from stands where the whole tree harvesting is not acceptable due to nutrient loss or for other ecological reasons. Intelligent selection of cutting methods for different stands enables minimization of transport distance and control of procurement cost. (orig.)

  18. COST-EFFECTIVENESS ANALYSIS OF ALTERNATIVE WATER HEATER SYSTEMS OPERATING WITH UNRELIABLE WATER SUPPLIES

    OpenAIRE

    Arif Yurtsev; Jenkins, Glenn P.

    2015-01-01

    This paper reports on a cost-effectiveness analysis of four types of water heating systems operating in a situation where there is an unreliable water supply. These systems are electric water heating, a solar water heating system (SWHS) with electricity back-up, the SWHS with an LPG water heater, and an LPG water heater alone. It is found that in the conditions of North Cyprus, that an SWHS with an LPG heater back-up is the most cost-effective, most convenient and most environmentally friendl...

  19. A risk adjusted cost-effectiveness analysis of alternative models of nurse involvement in obesity management in primary care.

    Science.gov (United States)

    Karnon, J; Ali Afzali, H Haji; Gray, J; Holton, C; Banham, D; Beilby, J

    2013-03-01

    Controlled evaluations are subject to uncertainty regarding their replication in the real world, particularly around systems of service provision. Using routinely collected data, we undertook a risk adjusted cost-effectiveness (RAC-E) analysis of alternative applied models of primary health care for the management of obese adult patients. Models were based on the reported level of involvement of practice nurses (registered or enrolled nurses working in general practice) in the provision of clinical-based activities. Linked, routinely collected clinical data describing clinical outcomes (weight, BMI, and obesity-related complications) and resource use (primary care, pharmaceutical, and hospital resource use) were collected. Potential confounders were controlled for using propensity weighted regression analyses. Relative to low level involvement of practice nurses in the provision of clinical-based activities to obese patients, high level involvement was associated with lower costs and better outcomes (more patients losing weight, and larger mean reductions in BMI). Excluding hospital costs, high level practice nurse involvement was associated with slightly higher costs. Incrementally, the high level model gets one additional obese patient to lose weight at an additional cost of $6,741, and reduces mean BMI by an additional one point at an additional cost of $563 (upper 95% confidence interval $1,547). Converted to quality adjusted life year (QALY) gains, the results provide a strong indication that increased involvement of practice nurses in clinical activities is associated with additional health benefits that are achieved at reasonable additional cost. Dissemination activities and incentives are required to encourage general practices to better integrate practice nurses in the active provision of clinical services. Copyright © 2013 The Obesity Society.

  20. Costs of Alternative Environmental Policy Instruments in the Presence of Industry Compensation Requirements

    NARCIS (Netherlands)

    Bovenberg, A.L.; Goulder, L.H.; Jacobson, M.R.

    2006-01-01

    This paper explores how the costs of meeting given aggregate targets for pollution emissions change with the imposition of the requirement that key pollution-related industries be compensated for potential losses of profit from the pollution regulation.Using analytically and numerically solved

  1. Technological Minimalism: A Cost-Effective Alternative for Course Design and Development.

    Science.gov (United States)

    Lorenzo, George

    2001-01-01

    Discusses the use of minimum levels of technology, or technological minimalism, for Web-based multimedia course content. Highlights include cost effectiveness; problems with video streaming, the use of XML for Web pages, and Flash and Java applets; listservs instead of proprietary software; and proper faculty training. (LRW)

  2. Analysis of Potential Alternatives to Reduce NASA's Cost of Human Access to Space

    Science.gov (United States)

    1998-01-01

    The purpose of this report is to analyze NASA's potential options for significantly reducing the cost of human access to space. The opinions expressed in this report are based on Hawthorne, Krauss & Associates' ("HKA") interaction with NASA and several of its key contractors over the past nine months. This report is not intended to be an exhaustive quantitative analysis of the various options available to NASA. Instead, its purpose is to outline key decision-related issues that the agency should consider prior to making a decision as to which option to pursue. This report attempts to bring a private-sector perspective to bear on the issue of reducing the cost of human access to space. HKA believes that the key to the NASA's success in reducing those costs over the long-term is the involvement of the private-sector incentives and disciplines--which is achieved only through the assumption of risk by the private sector, not through a traditional contractor relationship--is essential to achieve significant long-term cost reductions.

  3. Risks and psychic costs of alternative energy sources for generating electricity

    Energy Technology Data Exchange (ETDEWEB)

    Spangler, M.B.

    1981-01-01

    Divisive personal issues will continue to impede the formulation of a coherent national energy policy until we come to grips with the disagreements and anxieties behind the issues. Variations in individual anxiety profiles and limited knowledge are the major sources of conflict. A structured approach for analyzing psychic costs in the risk-cost-benefit analyses of energy options focuses on the electric-utility industry. Coupling psychic costs with economic costs requires an understanding of how social values interact to produce either risk acceptance or risk rejection. A review of the literature shows that people experiencing a continuous anxiety state may come to value the focus of their fear as a policy issue more than on loss of life. Public reaction after the Three Mile Island accident illustrates this condition. Personal bias in risk perception is variable partly because of differences in information. Information and personal values, however, can be mutually incompatible and lead to psychic conflicts. Proponents of soft energy technology, for example, are criticized for their lack of information about the associated risks and not credited for the psychic benefits of their goals. 58 references. (DCK)

  4. Assessing the ecological benefits and opportunity costs of alternative stream management zone widths for eastern hardwoods

    Science.gov (United States)

    Chris B. LeDoux; Ethel Wilkerson

    2008-01-01

    Leaving buffer zones adjacent to waterways can effectively reduce the water quality concerns associated with timber harvesting. However, riparian areas are also some of the most productive sites and can yield high quality wood. The amount of unharvested timber left in SMZs (Streamside Management Zones) can represent a substantial opportunity cost to landowners. In this...

  5. Assessing the ecological benefits and opportunity costs of alternative stream management zone widths

    Science.gov (United States)

    Chris B. LeDoux; Ethel Wilkerson

    2008-01-01

    Leaving buffer zones adjacent to waterways can effectively reduce the water quality concerns associated with timber harvesting. However, riparian areas are also some of the most productive sites and can yield high quality wood. The amount of unharvested timber left in SMZs (Streamside Management Zones) can represent a substantial opportunity cost to landowners. In this...

  6. Monitoring of Landslides with Mass Market Gps: AN Alternative Low Cost Solution

    Science.gov (United States)

    Cina, A.; Piras, M.; Bendea, H. I.

    2013-01-01

    The territory of Italy is seriously afflicted by hydrological risk, with 82% of its area affected by this phenomenon. In recent years, technologies and advanced research have played an important role in realizing complex automatic systems devoted to landslide monitoring and to alerting the population. Sometimes, the cost of these systems (communications network, sensors, software, technologies) prevents their use, and in particular the cost of sensors has a large impact on the final investment. For example, geodetic GNSS receivers are usually employed to conduct landslide monitoring, but they are costly. Nowadays, new technologies make it possible to use small and efficient low cost single frequency GPS receivers, which are able to achieve a centimetric or better level of accuracy, in static positioning. The rapid development and diffusion of the GNSS network to provide a positioning service has made it possible to use single frequency receivers, thanks to the use of virtual RINEX. This product is generated by a network of permanent stations. In this research, the actual performance of a mass market GPS receiver was tested, with the purpose of verifying if these sensors can be used for landslide monitoring. A special slide was realized, in order to conduct a dedicated test of the detection of displacements. Tests were carried out considering two factors: acquisition time and distance from the Virtual Station. The accuracy and precision of movement determination were evaluated and compared, for each test, considering the different factors. The tests and results are described in this contribution.

  7. Economic Costs and Adaptations for Alternative Regulations of California's Sacramento–San Joaquin Delta

    Directory of Open Access Journals (Sweden)

    Stacy K. Tanaka

    2011-07-01

    Full Text Available Stacy K. Tanaka, Christina R. Connell–Buck, Kaveh Madani, Josue Medellín-Azuara, Jay R. Lund, and Ellen Hanakdoi: http://dx.doi.org/10.15447/sfews.2014v9iss2art4Water exports from California’s Sacramento–San Joaquin Delta are an environmental concern because they reduce net outflows of fresh water from the Delta, and can entrain fish and disrupt flows within the Delta. If exports were no longer pumped from within the Delta, the regulatory issue becomes one of maintaining appropriate flows into and out of the Delta. This paper presents the results of two sets of hydro-economic optimization modeling runs, which were developed to represent a range of modified Delta operations and their economic and operational effects on California’s water supply system. The first set of runs represents decreasing export capacity from the Delta. The second set increases minimum net Delta outflow (MNDO requirements. The hydro-economic model seeks the least–cost statewide water management scheme for water supply, including a wide range of resources and water management options. Results show that reducing exports or increasing MNDO requirements increase annual average statewide water scarcity, scarcity costs, and operating costs (from greater use of desalination, wastewater recycling, water treatment, and pumping. Effects of reduced exports are especially concentrated in agricultural communities in the southern Central Valley because of their loss of access to overall water supply exports and their ability to transfer remaining water to southern California. Increased outflow requirements increase water scarcity and associated costs throughout California. For an equivalent amount of average Delta outflows, statewide costs increase more rapidly when exports alone are reduced than when minimum outflow requirements are increased and effects are more widely distributed statewide.

  8. Nutritionism, Commercialization and Food; Comment on “Buying Health: The Costs of Commercialism and an Alternative Philosophy”

    Directory of Open Access Journals (Sweden)

    Anne Barnhill

    2013-01-01

    Full Text Available In “Buying Health: the Costs of Commercialization and an Alternative Philosophy”, Larry R. Churchill and Shelley C. Churchill discuss the commercialization of health and, in particular, the commercialization of nutrition. In this commentary on their article, I draw a connection between Churchill and Churchill’s account of the commercialization of nutrition and Michael Pollan’s critique of “nutritionism”. I also offer a friendly amendment to Churchill and Churchill’s account, suggesting that the commercialization of nutrition is not a monolithic experience but it is rather widely challenged.

  9. 3D printing scanning electron microscopy sample holders: A quick and cost effective alternative for custom holder fabrication.

    Science.gov (United States)

    Meloni, Gabriel N; Bertotti, Mauro

    2017-01-01

    A simple and cost effective alternative for fabricating custom Scanning Electron Microscope (SEM) sample holders using 3D printers and conductive polylactic acid filament is presented. The flexibility of the 3D printing process allowed for the fabrication of sample holders with specific features that enable the high-resolution imaging of nanoelectrodes and nanopipettes. The precise value of the inner semi cone angle of the nanopipettes taper was extracted from the acquired images and used for calculating their radius using electrochemical methods. Because of the low electrical resistivity presented by the 3D printed holder, the imaging of non-conductive nanomaterials, such as alumina powder, was found to be possible. The fabrication time for each sample holder was under 30 minutes and the average cost was less than $0.50 per piece. Despite being quick and economical to fabricate, the sample holders were found to be sufficiently resistant, allowing for multiple uses of the same holder.

  10. Increasing the competitiveness of maintenance contract rates by using an alternative methodology for the calculation of average vehicle maintenance costs

    Directory of Open Access Journals (Sweden)

    Stephen Carstens

    2008-11-01

    Full Text Available Companies tend to outsource transport to fleet management companies to increase efficiencies if transport is a non-core activity. The provision of fleet management services on contract introduces a certain amount of financial risk to the fleet management company, specifically fixed rate maintenance contracts. The quoted rate needs to be sufficient and also competitive in the market. Currently the quoted maintenance rates are based on the maintenance specifications of the manufacturer and the risk management approach of the fleet management company. This is usually reflected in a contingency that is included in the quoted maintenance rate. An alternative methodology for calculating the average maintenance cost for a vehicle fleet is proposed based on the actual maintenance expenditures of the vehicles and accepted statistical techniques. The proposed methodology results in accurate estimates (and associated confidence limits of the true average maintenance cost and can beused as a basis for the maintenance quote.

  11. 3D printing scanning electron microscopy sample holders: A quick and cost effective alternative for custom holder fabrication.

    Directory of Open Access Journals (Sweden)

    Gabriel N Meloni

    Full Text Available A simple and cost effective alternative for fabricating custom Scanning Electron Microscope (SEM sample holders using 3D printers and conductive polylactic acid filament is presented. The flexibility of the 3D printing process allowed for the fabrication of sample holders with specific features that enable the high-resolution imaging of nanoelectrodes and nanopipettes. The precise value of the inner semi cone angle of the nanopipettes taper was extracted from the acquired images and used for calculating their radius using electrochemical methods. Because of the low electrical resistivity presented by the 3D printed holder, the imaging of non-conductive nanomaterials, such as alumina powder, was found to be possible. The fabrication time for each sample holder was under 30 minutes and the average cost was less than $0.50 per piece. Despite being quick and economical to fabricate, the sample holders were found to be sufficiently resistant, allowing for multiple uses of the same holder.

  12. Lignin – an alternative precursor for sustainable and cost-effective automotive carbon fiber

    OpenAIRE

    Mainka, Hendrik; Täger, Olaf; Körner, Enrico; Hilfert, Liane; BUSSE Sabine; Edelmann, Frank T.; Herrmann, Axel S.

    2015-01-01

    Lightweight design is an essential part of the overall Volkswagen strategy for reducing the CO2 emission. The use of carbon fiber reinforced polymers (CFRP) offers an enormous lightweight potential in comparison to aluminum, enabling a weight reduction, if a load-adapted (unidirectional) CFRP-design is used, of up to 60% in automobile parts without a degradation of the functionalities. Today, the use of CFRP is limited in mass series applications of the automotive industry by the cost of the ...

  13. Xanthium strumarium L. seed hull as a zero cost alternative for Rhodamine B dye removal.

    Science.gov (United States)

    Khamparia, Shraddha; Jaspal, Dipika Kaur

    2017-07-15

    Treatment of polluted water has been considered as one of the most important aspects in environmental sciences. Present study explores the decolorization potential of a low cost natural adsorbent Xanthium strumarium L. seed hull for the adsorption of a toxic xanthene dye, Rhodamine B (RHB). The characterization of the adsorbent revealed the presence of high amount of carbon, when exposed to Electron Dispersive Spectroscopy (EDS). Further appreciable decolorization took place which was confirmed by Fourier Transform Infrared Spectroscopy (FTIR) analysis noticing shift in peaks. Isothermal studies indicated multilayer adsorption following Freundlich isotherm. The rate of adsorption was supported by second order kinetics directing a chemical phenomenon during the process with dominance of film diffusion as the rate governing step. Moreover paper aims at correlating the chemical arena to the mathematical aspect providing an in-depth information of the studied treatment process. For proper assessment and validation of the observed data, experimental data has been statistically treated by applying different error functions namely, Chi-square test (χ 2 ), Sum of absolute errors (EABS) and Normalized standard deviation (NSD). Further practical applicability of the low cost adsorbent was evaluated by continuous column mode studies with 72.2% of dye recovery. Xanthium strumarium L. proved to be environment friendly low cost natural adsorbent for decolorizing RHB from aquatic system. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Non-Dam Alternatives for Delivering Water Services at Least Cost and Risk

    Directory of Open Access Journals (Sweden)

    Michael P. Totten

    2010-06-01

    We present evidence that a value-adding and risk-minimising water planning process can be achieved by shifting from the conventional focus on supply expansion to one that concentrates on efficiently delivering services at and near the point of use. The State of California has two decades of experience with this approach, demonstrating that market-based policy and regulatory innovations can unleash efficiency gains resulting in more utility water services and energy services delivered with less supply expansion at lower costs, while minimising climate-change risk, pollution and the social cost that accompany large infrastructural projects. Efficiency in delivered water services could be accomplished with investments in the range of US$10-25 billion annually, while obviating the need for spending hundreds of billions of dollars on more expensive hydropower and related infrastructural expansion projects. The shift to a regulatory system that encompasses cost-effective end-use efficiency improvements in delivering water and energy services could eliminate the need for an estimated half of all proposed dams globally, thus allowing for the maintenance of other ecosystem service benefits and offer the best hopes of meeting basic human needs for water at a more achievable level of investment.

  15. Student peer teaching in paediatric simulation training is a feasible low-cost alternative for education.

    Science.gov (United States)

    Wagner, Michael; Mileder, Lukas P; Goeral, Katharina; Klebermass-Schrehof, Katrin; Cardona, Francesco S; Berger, Angelika; Schmölzer, Georg M; Olischar, Monika

    2017-06-01

    The World Health Organization recommends regular simulation training to prevent adverse healthcare events. We used specially trained medical students to provide paediatric simulation training to their peers and assessed feasibility, cost and confidence of students who attended the courses. Students at the Medical University of Vienna, Austria were eligible to participate. Students attended two high-fidelity simulation training sessions, delivered by peers, which were videorecorded for evaluation. The attendees then completed questionnaires before and after the training. Associated costs and potential benefits were analysed. From May 2013 to June 2015, 152 students attended the sessions and 57 (37.5%) completed both questionnaires. Satisfaction was high, with 95% stating their peer tutor was competent and 90% saying that peer tutors were well prepared. The attendees' confidence in treating critically ill children significantly improved after training (p training was a feasible and low-cost option that increased the number of medical students who could be trained and increased the self-confidence of the attendees. Satisfaction with the peer tutors was high. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  16. Compensating the opportunity cost of forest functional zoning - two alternative options for the Romanian forest policy

    Directory of Open Access Journals (Sweden)

    Marian Drăgoi,

    2010-09-01

    Full Text Available An important challenge of the environmental policy is conceivingappropriate economic instruments able to account for the positive externalities provided by forest ecosystems. This issue is extremely important for implementing the provisions of the Romanian Forest Act, which states that forest owners shall be compensated for the opportunity costs of giving up harvesting operations due to various conservation purposes. The paper presents a statistical method based on analytical assessment of the effective forgone revenues brought about by banning the harvesting operations in 96 cases, each case being a distinctive forest management plan conceived for a large forest area, i.e. a production unit. Doing so, the scale effect has been taken into account because all legal provisions referring to forest management planning systems are focused on production units, considered the basic reference elements for sustainable forest management. The multiple regression function produced by the statistical analysis was turned into a simple formula allowing for a straightforward set up of the average compensation worth being paid per year and hectare. In order to better fetch the real opportunity cost paid for each hectare of protected forest, the algorithmwas further improved in order to account for the differences in stumpage residual value. Actually, the average compensation is differentiated onto five categories of hauling distances, using the same algorithm used by the National Forest Administration for differentiating the average reservation price established at national level on the ground of full-cost method stumpage pricing system.

  17. Complementary and alternative medicine use and cost in functional bowel disorders: A six month prospective study in a large HMO

    Directory of Open Access Journals (Sweden)

    Drossman Douglas A

    2008-07-01

    Full Text Available Abstract Background Functional Bowel Disorders (FBD are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM used for FBDs other than Irritable Bowel Syndrome (IBS, or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. Methods 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS, quality of life (IBS-QoL, psychological distress (BSI and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. Results CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. Conclusion CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

  18. A cost and technical efficiency analysis of two alternative models for implementing the basic package of health services in Afghanistan.

    Science.gov (United States)

    Blaakman, Aaron Philip; Salehi, Ahmad Shah; Boitard, Romain

    2014-01-01

    Since 2003, the Afghan Ministry of Public Health (MoPH) and international partners have directed a contracting-out model through which non-governmental organisations (NGOs) deliver the Basic Package of Health Services (BPHS) in 31 of the 34 Afghan provinces. The MoPH also managed health service delivery in three provinces under an alternative initiative entitled Strengthening Mechanisms (SM). In 2011, under the authority of the MoPH and Delegation of the European Union to Afghanistan, EPOS Health Management conducted a cost and technical efficiency study of the contracting-out and SM mechanisms in six provinces to examine economic trade-offs in the provision of the BPHS. The study provides analyses of all resource inputs and primary outputs of the BPHS in the six provinces during 2008 and 2009. The authors examined technical efficiency using Data Envelopment Analysis (DEA) at the BPHS facility level. Cost analysis results indicate that the weighted average cost per BPHS outpatient visit totalled $3.41 in the SM provinces and $5.39 in the NGO-led provinces in 2009. Furthermore, the data envelopment analyses (DEAs) indicate that facilities in the three NGO-led provinces scored 0.168 points higher on the DEA scale (0-1) than SM facilities. The authors conclude that an approximate 60% increase in costs yielded a 16.8% increase in technical efficiency in the delivery of the BPHS during 2009 in the six provinces.

  19. Is there a relationship between patient beliefs or communication about generic drugs and medication utilization?

    Science.gov (United States)

    Shrank, William H; Cadarette, Suzanne M; Cox, Emily; Fischer, Michael A; Mehta, Jyotsna; Brookhart, Alan M; Avorn, Jerry; Choudhry, Niteesh K

    2009-03-01

    Insurers and policymakers strive to stimulate more cost-effective prescribing and, increasingly, are educating beneficiaries about generics. To evaluate the relationship between patient beliefs and communication about generic drugs and actual drug use. We performed a national mailed survey of a random sample of 2500 commercially-insured adults. Patient responses were linked to pharmacy claims data to assess actual generic medication use. We used factor analysis to develop 5 multi-item scales from patient survey responses that measured: (1) general preferences for generics, (2) generic safety/effectiveness, (3) generic cost/value, (4) comfort with generic substitution, and (5) communication with providers about generics. The relationship between each scale and the proportion of prescriptions filled for generics was assessed using linear regression, controlling for demographic, health, and insurance characteristics. Separate models were created for each scale and then all 5 scales were included simultaneously in a fully-adjusted model. The usable response rate was 48%. When evaluated independently, a 1 SD increase in each of the 5 scales was associated with a 3.1% to 6.3% increase in generic drug use (P generic drug use: comfort with generic substitution (P = 0.021) and communication with providers about generic drugs (P = 0.012). Generic drug use is most closely associated with the 2 actionable items we evaluated: communication with providers about generics and comfort with generic substitution. Educational campaigns that focus on these 2 domains may be most effective at influencing generic drug use.

  20. Generic Fortran Containers (GFC)

    Energy Technology Data Exchange (ETDEWEB)

    2016-09-01

    The Fortran language does not provide a standard library that implements generic containers, like linked lists, trees, dictionaries, etc. The GFC software provides an implementation of generic Fortran containers natively written in Fortran 2003/2008 language. The following containers are either already implemented or planned: Stack (done), Linked list (done), Tree (done), Dictionary (done), Queue (planned), Priority queue (planned).

  1. Comparison of alternative models for estimating the cost of equity capital for electric utilities

    Energy Technology Data Exchange (ETDEWEB)

    Makhija, A.K.; Thompson, H.E.

    1984-02-01

    Five models used to estimate the cost of equity capital for electric utilities are systematically compared. The authors show the impact of model specification, data definitions, and estimation techniques on the estimates. Their search for the best model is based on reasonableness of estimates and the Pesaran-Deaton test for non-nested hypotheses. Conclusions emerging from the study are: all models explain approximately the same proportion of the variation; recognition of natural nonlinearities in the models does not lead to improvement; and no model can consistently reject the other models. 10 references, 5 figures, 11 tables.

  2. [Policies encouraging price competition in the generic drug market: Lessons from the European experience].

    Science.gov (United States)

    Puig-Junoy, Jaume

    2010-01-01

    To describe alternative policies aimed at encouraging price competition in generic drug markets in countries with strict price regulation, and to present some case studies drawn from the European experience. Systematic literature review of articles and technical reports published after 1999. The shortcomings in consumer price competition observed in some European generic markets, including Spain, may be reduced through three types of public reimbursement or financing reforms: policies aimed at improving the design of current maximum reimbursement level policies; policies aimed at monitoring competitive prices in order to reimburse real acquisition cost to pharmacies; and, more radical and market-oriented policies such as competitive tendering of public drug purchases. The experience of recent reforms adopted in Germany, Belgium, Holland, Norway, and Sweden offers a useful guide for highly price-regulated European countries, such as Spain, currently characterized by limited consumer price competition and the high discounts offered to pharmacy purchases. Direct price regulation and/or the generic reference pricing systems used to reduce generic drug prices in many European countries can be successfully reformed by adopting measures more closely aimed at encouraging consumer price competition in generic drug markets. Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.

  3. Windpower project ownership and financing: The cost impacts of alternative development structures

    Energy Technology Data Exchange (ETDEWEB)

    Wiser, R.H. [Lawrence Berkeley National Lab., CA (United States)

    1997-12-31

    This paper uses traditional financial cash-flow techniques to examine the impact of different ownership and financing structures on the cost of wind energy. While most large-scale wind projects are constructed, operated, and financed by non-utility generators (NUGs) via project financing, investor- and publicly-owned utilities have expressed interest in owning and financing their own facilities rather than purchasing wind energy from independent generators. A primary justification for utility ownership is that, because of financing and tax benefits, windpower may be cheaper when developed in this fashion. The results presented in this paper support that justification, though some of the estimated cost savings associated with utility ownership are found to be a result of shortcomings in utility analysis procedures and implicit risk shifting. This paper also discusses the comparative value of the federal production tax credit and renewable energy production incentive; estimates the financing premium paid by NUG wind owners compared to traditional gas-fired generation facilities; and explores the impact of electricity restructuring on financing.

  4. Brand loyalty, patients and limited generic medicines uptake.

    Science.gov (United States)

    Costa-Font, Joan; Rudisill, Caroline; Tan, Stefanie

    2014-06-01

    The sluggish development of European generic drug markets depends heavily on demand side factors, and more specifically, patients' and doctors' loyalty to branded products. Loyalty to originator drugs, to the point where originator prices rise upon generic entry has been described as the 'generics paradox'. Originator loyalty can emerge for a plethora of reasons; including costs, perceptions about quality and physician advice. We know very little about the behavioural underpinnings of brand loyalty from the consumer or patient standpoint. This paper attempts to test the extent to which patients are brand loyal by drawing upon Spain's 2002 Health Barometer survey as it includes questions about consumer acceptance of generics in a country with exceptionally low generic uptake and substitution at the time of the study. Our findings suggest that at least 13% of the population would not accept generics as substitutes to the originator. These results confirm evidence of brand loyalty for a minority. Alongside high levels of awareness of generics, we find that low cost-sharing levels explain consumer brand loyalty but their impact on acceptance of generic substitution is very small. Higher cost-sharing and exempting fewer patients from cost-sharing have the potential to encourage generic acceptance. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Office-based andrology and male infertility procedures-a cost-effective alternative.

    Science.gov (United States)

    Alom, Manaf; Ziegelmann, Matthew; Savage, Josh; Miest, Tanner; Köhler, Tobias S; Trost, Landon

    2017-08-01

    From 2014-2016, our clinical practice progressively incorporated several male infertility and andrology procedures performed under local anesthesia, including circumcision, hydrocelectomy, malleable penile prostheses, orchiectomy, penile plication, spermatocelectomy, testicular prostheses, varicocelectomy, vasectomy reversal (VR), and testicular and microepididymal sperm aspiration (TESE/MESA). Given the observed outcomes and potential financial and logistical benefits of this approach for surgeons and patients, we sought to describe our initial experience. A retrospective analysis was performed of all andrologic office-based (local anesthesia only) and select OR (general or monitored anesthesia care) procedures performed from 2014-2016. Financial and outcomes analyses were performed for infertility cases due to the homogeneity of payment modalities and number of cases available. Demographic, clinicopathologic, and procedural costs (direct and indirect) were reviewed and compared. A total of 32 VRs, 24 hydrocelectomies, 24 TESEs, 10 circumcisions, 9 MESA/TESEs, 4 spermatocelectomies, 3 orchiectomies (1 inguinal), 2 microTESEs, 2 testicular prostheses, 1 malleable penile prosthesis, 1 penile plication, and 1 varicocelectomy. Compared to the OR, male infertility procedures performed in the clinic with local anesthesia were performed for a fraction of the cost: MESA/TESE (78% reduction), TESE (89% reduction), and VR (62% reduction). All office-based procedures were completed successfully without significant modifications to technique. Outcomes were similar between the office and OR including operative time (VR: 181 vs. 190 min, P=0.34), rate of vasoepididymostomy (VE) (23% vs. 32%, P=0.56), total sperm counts (72.2 vs. 50.9 million, P=0.56), and successful sperm retrieval (MESA/TESE 100% vs. 100%, P=1.00; TESE 80% vs. 100%, P=0.36). To our knowledge, the current study also represents the first report of office-based VE under local anesthesia alone. For hydrocelectomy

  6. GENERIC VERIFICATION PROTOCOL FOR DETERMINATION OF EMISSIONS REDUCTIONS OBTAINED BY USE OF ALTERNATIVE OR REFORMULATED LIQUID FUELS, FUEL ADDITIVES, FUEL EMULSIONS AND LUBRICANTS FOR HIGHWAY AND NONROAD USE DISEL ENGINES AND LIGHT DUTY GASOLINE ENGINES AND VEHICLES

    Science.gov (United States)

    This report sets standards by which the emissions reduction provided by fuel and lubricant technologies can be tested and be tested in a comparable way. It is a generic protocol under the Environmental Technology Verification program.

  7. Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?

    Science.gov (United States)

    Candido, Kenneth D; Chiweshe, Joseph; Anantamongkol, Utchariya; Knezevic, Nebojsa Nick

    2016-01-01

    According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medications is a key component of the discussion of health payers, physicians and their patients. This review evaluates some of the important medications in the armamentarium of pain physicians that are frequently used in the management of chronic pain, and that are currently at the forefront of this issue, including Opana (oxymorphone; Endo Pharmaceuticals, Inc., Malvern, PA), Gralise (gabapentin; Depomed, Newark, CA), and Horizant (gabapentin enacarbil; XenoPort, Santa Clara, CA) that are each available in generic forms as well. We also discuss the use of Lyrica (pregabalin; Pfizer, New York, NY), which is currently unavailable as generic medication, and Cymbalta (duloxetine; Eli Lilly, Indianapolis, IN), which has been recently FDA approved to be available in a generic form. It is clear that the use of generic medications results in large financial savings for the cost of prescriptions on a national scale. However, cost-analysis is only part of the equation when treating chronic pain patients and undervalues the relationships of enhanced compliance due to single-daily dosing and stable and reliable pharmacokinetics associated with extended-duration preparations using either retentive

  8. An alternative cost-effective image processing based sensor for continuous turbidity monitoring

    Science.gov (United States)

    Chai, Matthew Min Enn; Ng, Sing Muk; Chua, Hong Siang

    2017-03-01

    Turbidity is the degree to which the optical clarity of water is reduced by impurities in the water. High turbidity values in rivers and lakes promote the growth of pathogen, reduce dissolved oxygen levels and reduce light penetration. The conventional ways of on-site turbidity measurements involve the use of optical sensors similar to those used in commercial turbidimeters. However, these instruments require frequent maintenance due to biological fouling on the sensors. Thus, image processing was proposed as an alternative technique for continuous turbidity measurement to reduce frequency of maintenance. The camera was kept out of water to avoid biofouling while other parts of the system submerged in water can be coated with anti-fouling surface. The setup developed consisting of a webcam, a light source, a microprocessor and a motor used to control the depth of a reference object. The image processing algorithm quantifies the relationship between the number of circles detected on the reference object and the depth of the reference object. By relating the quantified data to turbidity, the setup was able to detect turbidity levels from 20 NTU to 380 NTU with measurement error of 15.7 percent. The repeatability and sensitivity of the turbidity measurement was found to be satisfactory.

  9. Bioequivalence studies: need for the reability of generic drugs

    OpenAIRE

    Laosa, Olga; Centro de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Universidad Autónoma de Madrid. Madrid, España. Médico especialista en Farmacología Clínica.; Guerra, Pedro; Centro de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Universidad Autónoma de Madrid. Madrid, España. Médico especialista en Farmacología Clínica.; López-Durán, Jose Luis; Centro de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Universidad Autónoma de Madrid. Madrid, España. Médico especialista en Farmacología Clínica.; Mosquera, Beatriz; Centro de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Universidad Autónoma de Madrid. Madrid, España. Licenciada en Ciencias Químicas.; Frías, Jesús; Centro de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Universidad Autónoma de Madrid. Madrid, España. Servicio de Farmacología Clínica, Hospital Universitario la Paz. Madrid, España. Médico especialista en Farmacología Clínica.

    2009-01-01

    A generic medicine is a pharmaceutical product containing an active ingredient already known and previously developed and invented by others. The cost of these generic or multisource products should be less than their counterparts original. The clinical effects and the risk-benefit balance of a medicine do not depend exclusively on the activity of a pharmacologically active substance. Demonstration of bioequivalence of generic medicine is of great importance. In Europe and the United States g...

  10. The performance of low-cost commercial cloud computing as an alternative in computational chemistry.

    Science.gov (United States)

    Thackston, Russell; Fortenberry, Ryan C

    2015-05-05

    The growth of commercial cloud computing (CCC) as a viable means of computational infrastructure is largely unexplored for the purposes of quantum chemistry. In this work, the PSI4 suite of computational chemistry programs is installed on five different types of Amazon World Services CCC platforms. The performance for a set of electronically excited state single-point energies is compared between these CCC platforms and typical, "in-house" physical machines. Further considerations are made for the number of cores or virtual CPUs (vCPUs, for the CCC platforms), but no considerations are made for full parallelization of the program (even though parallelization of the BLAS library is implemented), complete high-performance computing cluster utilization, or steal time. Even with this most pessimistic view of the computations, CCC resources are shown to be more cost effective for significant numbers of typical quantum chemistry computations. Large numbers of large computations are still best utilized by more traditional means, but smaller-scale research may be more effectively undertaken through CCC services. © 2015 Wiley Periodicals, Inc.

  11. Electric arc furnace dust as an alternative low-cost oxygen carrier for chemical looping combustion.

    Science.gov (United States)

    Kuo, Yu-Lin; Huang, Wei-Chen; Tseng, Yao-Hsuan; Chang, Shu-Huai; Ku, Young; Lee, Hao-Yeh

    2018-01-15

    The relative abundance and low cost of electric arc furnace dust (EAFD) make it a viable oxygen carrier for chemical looping combustion (CLC) system. Under a reducing agent, zinc ferrite (ZnFe2O4) phase in EAFD releases zinc vapor in a complex gas-solid reaction. In an effort to suppress the emission of zinc vapor, the reaction mechanism of ZnFe2O4 prepared as an oxygen carrier in a redox cycling test is primarily discussed, as well as the issue of coupling with an inert Al2O3 support. The study focused the investigation on redox cycling behavior and CO2 conversion in ZnFe2O4/Al2O3 and EAFD/Al2O3 systems using a thermogravimetric analyzer (TGA) and fixed-bed reactor (FxBR). In a lab-scaled semi-fluidized bed reactor (semi-FzBR) of EAFD/Al2O3 as an oxygen carrier system, a high CO gas yield approximately 0.98 after fifty redox cycles is also experimentally obtained. It can be anticipated that the use of EAFD/Al2O3 system as an oxygen carrier in a reversible CLC process could be economical and environmentally beneficial. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Exploring alternatives to reduce economical costs associated with FNA pre-treatment of waste activated sludge.

    Science.gov (United States)

    Zahedi, S; Icaran, P; Yuan, Z; Pijuan, M

    2017-11-01

    Recent studies have shown the effectiveness of Free Nitrous Acid (FNA) pre-treatment in enhancing sludge biodegradability and improving its methane production potential. FNA is regarded as an environmental friendly pre-treatment which can be easily applied when a source of nitrite is present in wastewater treatment plants. However, when nitrite is not available and needs to be purchased, this treatment can become less attractive due to the costs associated to nitrite. In order to overcome this possible limitation, two different strategies to optimize the use of nitrite during FNA treatment were investigated: i) Recovering NO2(-) after the pre-treatment is completed; and ii) Concentrating the sludge before FNA pre-treatment. Results show that recovering NO2(-) from the pre-treated sludge is not suitable due to the loss of soluble organic matter present in the supernatant after the pre-treatment. However, concentrating the sludge before the pre-treatment seems a good strategy to optimize the use of nitrite. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. High SO{sub 2} removal duct injection: A low-cost FGD alternative

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, S.G. [Sorbent Technologies Corp., Twinsburg, OH (United States)

    1995-12-01

    Sorbent Technologies Corporation, of the United States, is currently developing and demonstrating a new waste free, retrofitable, high-SO{sub 2} removal duct-injection process. Up to 85 percent SO{sub 2} removal is achieved by simply injecting a new dry lime-based sorbent into the flue-gas duct, collecting the sorbent downstream in a particulate collector, and then recycling the sorbent. By avoiding large, expensive components, the process can have low capital costs, making it especially appropriate for smaller, older, less-utilized plants. The key to the new technology is the use of sorbent supports. Supported sorbents are produced by coating hydrated lime onto inexpensive mineral supports, such as exfoliated vermiculite or perlite. Consequently, there are no liquid, sludge, or solid wastes with the new technology. Once saturated with SO{sub 2}, the spent sorbent can be easily pelletized into a valuable soil-conditioning agricultural by-product, for the sustainable development that the future requires. This paper describes Sorbent Technologies` pilot demonstration of supported sorbent injection at the Ohio Edison Company`s R.E. Burger station. The Burger effort is also the first demonstration of the Electric Power Research Institute`s new {open_quotes}COHPAC{close_quotes} baghouse technology in a sorbent-injection desulfurization application.

  14. Generic patch inference

    DEFF Research Database (Denmark)

    Andersen, Jesper; Lawall, Julia

    2010-01-01

    A key issue in maintaining Linux device drivers is the need to keep them up to date with respect to evolutions in Linux internal libraries. Currently, there is little tool support for performing and documenting such changes. In this paper we present a tool, spdiff, that identifies common changes...... made in a set of files and their updated versions, and extracts a generic patch performing those changes. Library developers can use our tool to extract a generic patch based on the result of manually updating a few typical driver files, and then apply this generic patch to other drivers. Driver...

  15. Influencers of generic drug utilization: A systematic review.

    Science.gov (United States)

    Howard, Jennifer N; Harris, Ilene; Frank, Gavriella; Kiptanui, Zippora; Qian, Jingjing; Hansen, Richard

    2017-08-04

    With an increase in prescription drug spending and rising drug costs there is a need to encourage the use of generic prescription drugs. However, maximizing generic drug use is not possible without the public's positive perception and meeting their informational needs about generic drugs. Thus, improving the public's confidence in, and knowledge of generic drugs on the market is critical. The objective of this systematic review is to examine and evaluate the studies focusing on the nature and extent of key factors influencing generic drug use in the United States in order to help guide policy, education and practice interventions. Using multiple search engines and key word screening criteria, empirical studies published in English between January 1, 2005 and December 31, 2015 were identified. A qualitative synthesis of the evidence identified domains of key factors that influenced generic drug use across studies. Over 3000 citations met the key word screening criteria; 67 of these met inclusion criteria for the systematic review. Seven domains of factors that influence generic drug utilization were identified: 1) patient-related factors, 2) formulary management or cost containment, 3) healthcare policies, 4) promotional activities, 5) educational initiatives, 6) technology, and 7) physician-related factors. Patients, physicians, pharmacists, formulary managers, and policymakers play an important role in generic drug use. Understanding the factors influencing generic drug use can help guide future policy, education, and practice interventions to increase generic drug use. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Step-feed biofiltration: a low cost alternative configuration for off-gas treatment.

    Science.gov (United States)

    Estrada, José M; Quijano, Guillermo; Lebrero, Raquel; Muñoz, Raúl

    2013-09-01

    Clogging due to biomass accumulation and the loss of structural stability of the packing media are common operational drawbacks of standard gas biofiltration inherent to the traditional biofilter design, which result in prohibitive pressure drop buildups and media channeling. In this work, an innovative step-feed biofilter configuration, with the air emission supplied in either two or three locations along the biofilter height, was tested and compared with a standard biofilter using toluene as a model pollutant and two packing materials: compost and perlite. When using compost, the step-feed biofilter supported similar elimination capacities (EC ≈ 80 g m(-3) h(-1)) and CO2 production rates (200 g m(-3) h(-1)) to those achieved in the standard biofilter. However, while the pressure drop in the step-feed system remained below 300 Pa m bed(-1) for 61 days, the standard biofilter reached this value in only 14 days and 4000 Pa m bed(-1) by day 30, consuming 75% more compression energy throughout the entire operational period. Operation with perlite supported lower ECs compared to compost in both the step-feed and standard biofilters (≈ 30 g m(-3) h(-1)), probably due to the high indigenous microbial diversity present in this organic packing material. The step-feed biofilter exhibited 65% lower compression energy requirements than the standard biofilter during operation with perlite, while supporting similar ECs. In brief, step-feed biofiltration constitutes a promising operational strategy capable of drastically reducing the operating costs of biofiltration due to a reduced energy consumption and an increased packing material lifespan. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. An audit of generic prescribing in a general surgical department.

    LENUS (Irish Health Repository)

    Gleeson, M

    2013-01-17

    BACKGROUND: The Health Service Executive introduced a generic prescription policy to reduce costs. Despite this, generic prescription rates remain low. AIM: To audit in-patient prescription practice in a single surgical department and identify potential savings which could be realised by adherence to the generic prescribing policy. METHODS: Surgical in-patient charts were obtained at the point of discharge and their drug prescription information was recorded. RESULTS: 51 % of prescriptions involved a trade-name prescription where an appropriate generic equivalent existed. The cost implications for hospital and community patients were found to be greatly affected by substitution policies that exist at hospital pharmacy level. CONCLUSION: There is a need to promote greater adherence to generic prescribing amongst hospital doctors in line with international best practice. It can have a positive impact in terms of safe prescribing and can have cost implications at both hospital and community level.

  18. Costs of slurry separation technologies and alternative use of the solid fraction for biogas production or burning

    DEFF Research Database (Denmark)

    Jacobsen, Brian H.

    2011-01-01

    a problem. Separation of the slurry into a liquid nitrogen rich fraction and a more solid phosphorus rich fraction, which is exported away from the farm, may alleviate this problem. Separation offers an alternative to transporting the slurry further away, renting more land or buying more land. The need...... for P-balance is stricter in Denmark than before, but developments in feeding, changes in regulation and the reduction of livestock numbers have made separation less favourable. This article compares dominant separation technologies in Denmark, such as decanter and flocculation, as well as source....... Decanter separation can be the cheapest if area is limited and cooperation with neighbours is possible as large volumes reduce separation costs per tonne. Flocculation is the best if much P has to be removed from the farm in the solid fraction. Separation will in the future in many cases be combined...

  19. Transportation Energy Futures Series: Alternative Fuel Infrastructure Expansion: Costs, Resources, Production Capacity, and Retail Availability for Low-Carbon Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, W. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Heath, Garvin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sandor, Debra [National Renewable Energy Lab. (NREL), Golden, CO (United States); Steward, Darlene [National Renewable Energy Lab. (NREL), Golden, CO (United States); Vimmerstedt, Laura [National Renewable Energy Lab. (NREL), Golden, CO (United States); Warner, Ethan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Webster, Karen W. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-04-01

    The petroleum-based transportation fuel system is complex and highly developed, in contrast to the nascent low-petroleum, low-carbon alternative fuel system. This report examines how expansion of the low-carbon transportation fuel infrastructure could contribute to deep reductions in petroleum use and greenhouse gas (GHG) emissions across the U.S. transportation sector. Three low-carbon scenarios, each using a different combination of low-carbon fuels, were developed to explore infrastructure expansion trends consistent with a study goal of reducing transportation sector GHG emissions to 80% less than 2005 levels by 2050.These scenarios were compared to a business-as-usual (BAU) scenario and were evaluated with respect to four criteria: fuel cost estimates, resource availability, fuel production capacity expansion, and retail infrastructure expansion.

  20. Practicing the Generic (City)

    DEFF Research Database (Denmark)

    Hansen, Lone Koefoed

    2010-01-01

    Flanagan proposes that most locative media artworks neglect the particularities of spaces, their historical and political layers. Koolhaas, on the other hand, states that all urban areas are alike, that we are facing a global Generic City. The paper analyses digital media artist Esther Polak’s No......’s NomadicMILK project in light of the generic and particular properties of space as laid out by Flanagan and Koolhaas in order to discuss the possible reconfiguring practices of locative media....

  1. Complementary, Alternative, and Mainstream Service use Among Families with Young Children with Multiple Disabilities: Family Costs to Access Choices.

    Science.gov (United States)

    Bourke-Taylor, Helen; Cotter, Claire; Stephan, Rebecca

    2014-11-03

    ABSTRACT Families raising a young child with multiple disabilities are charged with significant responsibilities such as learning about their child's condition and navigating mainstream and alternative services. Aim: Describe service choices, costs, out of pocket expenses, and the impact on families. Methods: Survey design using a custom questionnaire was used to collect extensive retrospective and current data. Purposive sampling (N = 29) occurred from one early intervention facility specialized in servicing children with cerebral palsy (CP) and, or multiple disabilities in Australia. Descriptive statistics were used for analysis of data. Results: Twenty-three (79%) families reported caring for a child with CP. Twenty-three families reported using at least one complementary/alternative intervention. Out-of-pocket amounts were reported including: chiropractic services (10 families); naturopathy (9 families); point percussion therapy (7 families), and Chinese medicine (6 families). Expenses resulted in families reporting forgoing clothing items, family entertainment, recreation/hobbies for parents (55%); family holidays (59%); time for parents alone (66%); and health services for parents (38%). Conclusions: Families of young children with multiple disabilities select a wide range of services for their child, with consequential out of pocket expenses. Early intervention professionals can be an important resource for families as they evaluate their choices and select interventions for their child.

  2. South African patient's acceptance of generic drugs

    African Journals Online (AJOL)

    DOI: http://dx.doi.org/10.4314/ahs.v15i1.37. Introduction. Access to therapeutic drugs form an integral part of any successful healthcare system. The high cost of drugs, however, remains a barrier to accessibility and improved health to the majority of the South Afri- can population1. The promotion of generic drug con-.

  3. Scripting XML with Generic Haskell

    NARCIS (Netherlands)

    Atanassow, F.; Clarke, D.; Jeuring, J.T.

    2007-01-01

    A generic program is written once and works on values of many data types. Generic Haskell is a recent extension of the functional programming language Haskell that supports generic programming. This paper discusses how Generic Haskell can be used to implement XML tools whose behaviour depends on

  4. Scripting XML with Generic Haskell

    NARCIS (Netherlands)

    Atanassow, F.; Clarke, D.; Jeuring, J.T.

    2003-01-01

    A generic program is written once and works on values of many data types. Generic Haskell is a recent extension of the functional programming language Haskell that supports generic programming. This paper discusses how Generic Haskell can be used to implement XML tools whose behaviour depends on

  5. The Economic Evaluation of Alternatives (EEoA): Rethinking the Application of Cost-effectiveness Analysis, Multi-criteria Decision-making (MCDM) and the Analysis of Alternatives (AoA) in Defense Procurement

    Science.gov (United States)

    2009-04-22

    MULTI-CRITERIA DECISION-MAKING ( MCDM ) AND THE ANALYSIS OF ALTERNATIVES (AOA) IN DEFENSE PROCUREMENT Published: 22 April 2009 by Dr. Francois Melese...Application of Cost-effectiveness Analysis, Multi-criteria Decision-making ( MCDM ) and the Analysis of Alternatives (AoA) in Defense Procurement 5a...study identifies a significant weakness in the Multicriteria Decision-making ( MCDM ) approach that currently underpins many contemporary AoAs. While

  6. Impact of medicare part D plan features on use of generic drugs.

    Science.gov (United States)

    Tang, Yan; Gellad, Walid F; Men, Aiju; Donohue, Julie M

    2014-06-01

    Little is known about how Medicare Part D plan features influence choice of generic versus brand drugs. To examine the association between Part D plan features and generic medication use. Data from a 2009 random sample of 1.6 million fee-for-service, Part D enrollees aged 65 years and above, who were not dually eligible or receiving low-income subsidies, were used to examine the association between plan features (generic cost-sharing, difference in brand and generic copay, prior authorization, step therapy) and choice of generic antidepressants, antidiabetics, and statins. Logistic regression models accounting for plan-level clustering were adjusted for sociodemographic and health status. Generic cost-sharing ranged from $0 to $9 for antidepressants and statins, and from $0 to $8 for antidiabetics (across 5th-95th percentiles). Brand-generic cost-sharing differences were smallest for statins (5th-95th percentiles: $16-$37) and largest for antidepressants ($16-$64) across plans. Beneficiaries with higher generic cost-sharing had lower generic use [adjusted odds ratio (OR)=0.97, 95% confidence interval (CI), 0.95-0.98 for antidepressants; OR=0.97, 95% CI, 0.96-0.98 for antidiabetics; OR=0.94, 95% CI, 0.92-0.95 for statins]. Larger brand-generic cost-sharing differences and prior authorization were significantly associated with greater generic use in all categories. Plans could increase generic use by 5-12 percentage points by reducing generic cost-sharing from the 75th ($7) to 25th percentiles ($4-$5), increasing brand-generic cost-sharing differences from the 25th ($25-$26) to 75th ($32-$33) percentiles, and using prior authorization and step therapy. Cost-sharing features and utilization management tools were significantly associated with generic use in 3 commonly used medication categories.

  7. Confidence in generic drug substitution.

    Science.gov (United States)

    Lionberger, R; Jiang, W; Huang, S-M; Geba, G

    2013-10-01

    Patients should have confidence that the generic drugs they are prescribed in the United States can be effectively substituted for the brand product or another generic product. Through new bioequivalence study designs for narrow therapeutic index (NTI) drugs and postapproval studies of generic substitution, the US Food and Drug Administration's (FDA's) ongoing generic drug regulatory science activities are designed to ensure successful generic substitution for all drug products.

  8. Developing a sustainable bioprocessing strategy based on a generic feedstock.

    Science.gov (United States)

    Webb, C; Koutinas, Wang R; Wang, R

    2004-01-01

    Based on current average yields of wheat per hectare and the saccharide content of wheat grain, it is feasible to produce wheat-based alternatives to many petrochemicals. However, the requirements in terms of wheat utilization would be equivalent to 82% of current production if intermediates and primary building blocks such as ethylene, propylene, and butadiene were to be produced in addition to conventional bioproducts. If only intermediates and bioproducts were produced this requirement would fall to just 11%, while bioproducts alone would require only 7%. These requirements would be easily met if the global wheat yield per hectare of cultivated land was increased from the current average of 2.7 to 5.5 tonnes ha(-1) (well below the current maximum). Preliminary economic evaluation taking into account only raw material costs demonstrated that the use of wheat as a generic feedstock could be advantageous in the case of bioproducts and specific intermediate petrochemicals. Gluten plays a significant role considering the revenue occurring when it is sold as a by-product. A process leading to the production of a generic fermentation feedstock from wheat has been devised and evaluated in terms of efficiency and economics. This feedstock aims at providing a replacement for conventional fermentation media and petrochemical feedstocks. The process can be divided into four major stages--wheat milling; fermentation of whole wheat flour by A. awamori leading to the production of enzymes and fungal cells; glucose enhancement via enzymatic hydrolysis of flour suspensions; and nitrogen/micronutrient enhancement via fungal cell autolysis. Preliminary costings show that the operating cost of the process depends on plant capacity, cereal market price, presence and market value of added-value by-products, labour costs, and mode of processing (batch or continuous).

  9. Management of acute kidney injury in the intensive care unit: a cost-effectiveness analysis of daily vs alternate-day hemodialysis.

    Science.gov (United States)

    Desai, Amar A; Baras, Jacqueline; Berk, Benjamin B; Nakajima, Aya; Garber, Alan M; Owens, Douglas; Chertow, Glenn M

    2008-09-08

    Although evidence suggests that a higher hemodialysis dose and/or frequency may be associated with improved outcomes, the cost-effectiveness of a daily hemodialysis strategy for critically ill patients with acute kidney injury (AKI) is unknown. We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of daily hemodialysis, compared with alternate-day hemodialysis, for patients with AKI in the intensive care unit (ICU). We employed a societal perspective with a lifetime analytic time horizon. We modeled the efficacy of daily hemodialysis as a reduction in the relative risk of death on the basis of data reported in the 2004 clinical trial published by Schiffl et al. We performed 1- and 2-way sensitivity analyses across cost, efficacy, and utility input variables. The main outcome measure was cost per quality-adjusted life-year (QALY). In the base case for a 60-year-old man, daily hemodialysis was projected to add 2.14 QALYs and $10,924 in cost. We found that the cost-effectiveness of daily hemodialysis compared with alternate-day hemodialysis was $5084 per QALY gained. The incremental cost-effectiveness ratio became less favorable (>$50,000 per QALY gained) when the maintenance hemodialysis rate of the daily hemodialysis group was varied to more than 27% and when the difference in 14-day postdischarge mortality between the alternatives was varied to less than 0.5%. Daily hemodialysis is a cost-effective strategy compared with alternate-day hemodialysis for patients with severe AKI in the ICU.

  10. COMPLEAT (Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies): A planning tool for publicly owned electric utilities. [Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies (Compleat)

    Energy Technology Data Exchange (ETDEWEB)

    1990-09-01

    COMPLEAT takes its name, as an acronym, from Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies. It is an electric utility planning model designed for use principally by publicly owned electric utilities and agencies serving such utilities. As a model, COMPLEAT is significantly more full-featured and complex than called out in APPA's original plan and proposal to DOE. The additional complexity grew out of a series of discussions early in the development schedule, in which it became clear to APPA staff and advisors that the simplicity characterizing the original plan, while highly desirable in terms of utility applications, was not achievable if practical utility problems were to be addressed. The project teams settled on Energy 20/20, an existing model developed by Dr. George Backus of Policy Assessment Associates, as the best candidate for the kinds of modifications and extensions that would be required. The remainder of the project effort was devoted to designing specific input data files, output files, and user screens and to writing and testing the compute programs that would properly implement the desired features around Energy 20/20 as a core program. This report presents in outline form, the features and user interface of COMPLEAT.

  11. Generic robot architecture

    Science.gov (United States)

    Bruemmer, David J [Idaho Falls, ID; Few, Douglas A [Idaho Falls, ID

    2010-09-21

    The present invention provides methods, computer readable media, and apparatuses for a generic robot architecture providing a framework that is easily portable to a variety of robot platforms and is configured to provide hardware abstractions, abstractions for generic robot attributes, environment abstractions, and robot behaviors. The generic robot architecture includes a hardware abstraction level and a robot abstraction level. The hardware abstraction level is configured for developing hardware abstractions that define, monitor, and control hardware modules available on a robot platform. The robot abstraction level is configured for defining robot attributes and provides a software framework for building robot behaviors from the robot attributes. Each of the robot attributes includes hardware information from at least one hardware abstraction. In addition, each robot attribute is configured to substantially isolate the robot behaviors from the at least one hardware abstraction.

  12. Pharmacists' experiences and attitudes regarding generic drugs and generic substitution: two sides of the coin.

    Science.gov (United States)

    Olsson, Erika; Kälvemark Sporrong, Sofia

    2012-12-01

    Generic drug substitution reduces costs for medicines, but the downsides include unintentional double medication, confusion and anxiety among patients. Information from pharmacists affects patients' experiences of substitution with generic drugs. The aim of this study was to explore experiences and attitudes to generic substitution among Swedish community pharmacists. An interview guide was developed. Semi-structured interviews with community pharmacists were conducted and transcribed verbatim. Analysis was inductive; extracts from the transcripts were compared and combined to form themes and subcategories. Pharmacists from a heterogeneous convenience sample of pharmacies were interviewed until data saturation had been achieved. Sixteen pharmacists were interviewed. Three main themes and twelve subcategories were identified, with the main themes being the role of the pharmacist, pharmacists' concerns regarding patients, and the generic drug. Pharmacists found it positive that generic substitution decreases the costs for pharmaceuticals but also emphasized that the switch can confuse and worry patients, which could result in less benefit from treatment. Respondents claimed that generic substitution has changed the focus in the pharmacist-patient meeting towards economics and regulations. According to the interviewed pharmacists generic substitution is not primarily an issue of generic versus brand-name products, but concerns above all the challenges that the switch implies for patients and pharmacists. To prevent known confusion and concerns among patients it is important that community pharmacists acquire the necessary tools and knowledge to manage this situation; pharmacists themselves as well as pharmacy owners and authorities share responsibility for this. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  13. Edible Cricothyrotomy Model: A Low-Cost Alternative to Pig Tracheas and Plastic Models for Teaching Cricothyrotomy

    Directory of Open Access Journals (Sweden)

    Robert J Bryant

    2017-01-01

    , Interquartile Range [IQR] 24-41 sec and PM (median 33 sec, IQR 28-39 sec than on the EC (44 sec, IQR 35-63. There was a statistically significant divergence in preference (p=0.0001 with participants rating the PT first (median rank 1, IQR 1-1, the EC second (median rank 2, IQR 2-2, and the PM third (median rank 3, IQR 2.5-3. Cost of the models at the time of analysis (October, 2104 was $2.77 for EC and $7.64 for PT. The plastic model was built from materials obtained in the emergency department (ventilator tubing, 4-inch white foam tape, ½ inch white tape, and Coban. These materials were not purchased, so cost per plastic model was not calculated. Conclusion: A novel, edible cricothyrotomy training model is a suitable and cost effective alternative to a pig trachea and has a role for learners seeking multiple attempts at the procedure for skills maintenance and retention.

  14. Generic Integrating Business Architecture

    Directory of Open Access Journals (Sweden)

    Mihaela MURESAN

    2006-01-01

    Full Text Available The generic business architecture offers an efficient solution for the business engineering and re-engineering processes. This approach strengthen the cooperation between the main actors involved in the business architecture design and implementation, aiming at including all the significant views in a integrated model. The main goal of the development of generic business architectures is to offer a standard model for the integration of the internal processes and for a better management of the technological and informational resources of the enterprise. Such standardization has as main benefits the increase of the management quality and the efficiency in the business engineering processes.

  15. Generic Kalman Filter Software

    Science.gov (United States)

    Lisano, Michael E., II; Crues, Edwin Z.

    2005-01-01

    The Generic Kalman Filter (GKF) software provides a standard basis for the development of application-specific Kalman-filter programs. Historically, Kalman filters have been implemented by customized programs that must be written, coded, and debugged anew for each unique application, then tested and tuned with simulated or actual measurement data. Total development times for typical Kalman-filter application programs have ranged from months to weeks. The GKF software can simplify the development process and reduce the development time by eliminating the need to re-create the fundamental implementation of the Kalman filter for each new application. The GKF software is written in the ANSI C programming language. It contains a generic Kalman-filter-development directory that, in turn, contains a code for a generic Kalman filter function; more specifically, it contains a generically designed and generically coded implementation of linear, linearized, and extended Kalman filtering algorithms, including algorithms for state- and covariance-update and -propagation functions. The mathematical theory that underlies the algorithms is well known and has been reported extensively in the open technical literature. Also contained in the directory are a header file that defines generic Kalman-filter data structures and prototype functions and template versions of application-specific subfunction and calling navigation/estimation routine code and headers. Once the user has provided a calling routine and the required application-specific subfunctions, the application-specific Kalman-filter software can be compiled and executed immediately. During execution, the generic Kalman-filter function is called from a higher-level navigation or estimation routine that preprocesses measurement data and post-processes output data. The generic Kalman-filter function uses the aforementioned data structures and five implementation- specific subfunctions, which have been developed by the user on

  16. Satisfying the Energy Demand of a Rural Area by Considering the Investment on Renewable Energy Alternatives and Depreciation Costs

    Directory of Open Access Journals (Sweden)

    Masoud Rabbani

    2014-01-01

    Full Text Available In this paper, a fuzzy multiobjective model which chooses the best mix of renewable energy options and determines the optimal amount of energy to be transferred from each resource to each end use is proposed. The depreciation of equipment along with time value of money has been taken into account in the first objective function while the second and the third objective functions minimize the greenhouse gas emissions and water consumption, respectively. Also, this study is one of the pioneer works that has considered demand-side management (DSM as a competitive option against supply-side alternatives for making apt energy planning decisions. Moreover, the intrinsic uncertainty of demand parameter is considered and modeled by fuzzy numbers. To convert the proposed fuzzy multiobjective formulation to a crisp single-objective formulation the well-known fuzzy goal programming approach together with Jimenez defuzzifying technique is employed. The model is validated through setting up a diversity of datasets whose data were mostly derived from the literature. The obtained results show that DSM programs have greatly contributed to cost reductions in the network. Also, it is concluded that the model is capable of solving even large-scaled instances of problems in negligible central processing unit (CPU times using Lingo 8.0 software.

  17. Comparison of risks and costs of hazardous-waste alternatives: methods development and pilot studies. Draft report (Final)

    Energy Technology Data Exchange (ETDEWEB)

    Lawless, E.W.; Lapp, T.W.; Ferguson, T.L.; Kelso, G.L.; Ellis, H.V.

    1984-11-19

    The report was designed to illustrate the extent to which the assessment of risks was feasible for programs under the Resource Conservation and Recovery Act (RCRA), using state-of-the-art methodologies and available data, with a focus on land disposal. The project examines whether changes in health risks could be estimated as a hazardous-waste stream is shifted from one disposal technology to another. To determine whether the methodology could be applied in realistic situations, the report includes three case studies, with four or five management options appropriate for each. The case-study wastes are mercury-contaminated brine muds from chlorine production, distillation residues from production of carbon tetrachloride, and dioxin contaminated soil. Potential sources, probabilities, and magnitudes of releases are identified, along with their movement through all environmental media to estimate potential exposures at any point. Dose-response functions for each health effect are then combined with estimates of population distribution to yield risk estimates for the most exposed individual and the total number of cases over 200 years. Uncertainty analysis is applied to the health risk estimates, using a propagation of errors approach. Costs of installing and operating each alternative also are estimated.

  18. Generic Market Models

    NARCIS (Netherlands)

    R. Pietersz (Raoul); M. van Regenmortel

    2005-01-01

    textabstractCurrently, there are two market models for valuation and risk management of interest rate derivatives, the LIBOR and swap market models. In this paper, we introduce arbitrage-free constant maturity swap (CMS) market models and generic market models featuring forward rates that span

  19. A generic mine model

    NARCIS (Netherlands)

    Veldhoven, J. van; Riet, M.W.G. van; Dol, H.S.; Mohamoud, A.A.; Keus, D.; Beckers, A.L.D.

    2009-01-01

    In the field of mine laying and of mine countermeasures, understanding of the actuation behaviour of influence mines is of vital importance. Modelling can enhance such understanding. In this paper, a flexible generic mine model is presented that allows the user to easily generate different computer

  20. The impact of generic goods in the pharmaceutical industry.

    Science.gov (United States)

    Ferrándiz, J M

    1999-11-01

    This paper studies the effects of generic drugs in the pharmaceutical industry. Two firms produce two branded goods, with a different active ingredient, and the patent for one of them has expired, so that a generic alternative is in the market. This paper focuses on the case where the branded goods are perfect substitutes and where there exists a degree of differentiation between the branded and the generic goods. The study looks at whether the firm producing the branded good whose patent has expired has incentives to produce its own generic alternative too. For this purpose, the scenario where the firm producing the branded good also produces the generic drug is compared with the situation where the generic good is produced by a third firm. It is found that the firm producing the branded good has incentives to produce its generic alternative, owing to a market segmentation effect. This induces an increase in the price of the branded good produced by this firm, which in turn implies a welfare reduction. Copyright 1999 John Wiley & Sons, Ltd.

  1. Generic substitution - comparing the clinical efficacy of a generic ...

    African Journals Online (AJOL)

    1998-03-03

    Mar 3, 1998 ... There are currently numerous generic psychopharmacological agents available in South Africa, among them two generic substitutes for fluphenazine decanoate.' These products are both cheaper than the innovator product. Substitution of a generic drug product for an innovator product requires that the ...

  2. Acceptability and confidence in antiretroviral generics of physicians and HIV-infected patients in France

    OpenAIRE

    Clotilde Allavena; Christine Jacomet; Bruno Pereira; Laurence Morand-Joubert; Haleh Bagheri; Laurent Cotte; Rodolphe Garaffo; Laurent Gerbaud; Pierre Dellamonica

    2014-01-01

    Introduction: Switching brand name medications to generics is recommended in France in the interest of cost effectiveness but patients and physicians are sometimes not convinced that switching is appropriate. Some antiretroviral (ARV) generics (ZDV, 3TC, NVP) have been marketed in France since 2013. Materials and Methods: A multicentric cross-sectional survey was performed in September 2013 to evaluate the perception of generics overall and ARV generics in physicians and HIV-infected patients...

  3. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

    NARCIS (Netherlands)

    Hitzert, M.; Hermus, M.M.; Boesveld, I.I.; Franx, A.; Pal-de Bruin, K.K. van der; Steegers, E.E.; Akker-van Marle, E.M. van den

    2017-01-01

    Objectives To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Design Economic evaluation

  4. Generic and biosimilar medicines: quid?

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2012-12-01

    Full Text Available Once intellectual property protection, data and marketing exclusivity of reference medicines have expired, generic medicines and biosimilar medicines can enter the off-patent market. This market entry is conditional on the approval of marketing authorization, pricing and reimbursement. Given that there tends to be confusion surrounding generic and biosimilar medicines, this Editorial introduces basic concepts related to generic and biosimilar medicines and presents the different studies and articles included in this supplement dedicated to generic and biosimilar medicines.

  5. Generics Pricing: The Greek Paradox.

    Science.gov (United States)

    Karafyllis, Ioannis; Variti, Lamprini

    2017-01-01

    This paper explains and develops a methodological framework to help evaluate the performance of generic pharmaceutical policies and the correct evaluation of generics sales. Until today erroneous recording of generics does not help proper pricing and their penetration in the Greek market. This classifies Greece on the outliners in every study or comparison that is referred on papers or studies.

  6. An alternative to the orthopaedic traction table (fracture table: A prototype of low cost, easy reproduction and good applicability

    Directory of Open Access Journals (Sweden)

    Diego Ariel de Lima

    2017-03-01

    Full Text Available Abstract Background: Orthopaedic traction tables are used as an aid in numerous surgical procedures. The present paper aims to present a prototype of an external device of lower limb traction, which is portable, of simple construction, and can be installed on any operating table, with possible application in surgical and teaching practices. We will compare the quality of radiographic images obtained with the help of this prototype (PT to those images obtained with the aid of the conventional traction table (CT. Materials and methods: Cross-sectional, observational, and double blind study, approved by the Research Ethics Committee. On two occasions 36 randomly selected radiographs of the lower limbs, 18 of which obtained on the CT and the remaining on the PT, were evaluated by nine physicians. These radiographs were obtained from three volunteer and none of them presented musculoskeletal system disorders previously diagnosed in the study. Examiners rated each picture from 1 to 5, according to the quality of the image obtained. The responses were submitted to statistical analysis by SPSS ®, v23. Comparisons were considered significant when p <0.05, with a 95% confidence interval. Results: The average ratings were similar and all significance tests between the averages were higher than 0.9. The intra-observer agreement was 76.13% for the PT and 82.69% for the CT. The inter-observer agreement was low for both models. Due to its lower weight and smaller size compared to the CT and the material used for prototyping, the production cost of the PT is quite affordable. Conclusions: The PT presented in this paper is a good alternative to CT.   Keywords: Traction table, Fracture table, Orthopaedic surgery, Orthopaedic prototype, Lower limbs.

  7. Sun-dried raisins are a cost-effective alternative to Sports Jelly Beans in prolonged cycling.

    Science.gov (United States)

    Rietschier, Helena L; Henagan, Tara M; Earnest, Conrad P; Baker, Birgitta L; Cortez, Cory C; Stewart, Laura K

    2011-11-01

    The purpose of this study was to examine the effects of a natural carbohydrate (CHO) source in the form of sun-dried raisins (SDRs) vs. Sports Jelly Beans™ (SJBs) on endurance performance in trained cyclists and triathletes. Ten healthy men (18-33 years) completed 1 water-only acclimatization exercise trial and 2 randomized exercise trials administered in a crossover fashion. Each trial consisted of a 120-minute constant-intensity glycogen depletion period followed by a 10-km time trial (TT). During each experimental trial, participants consumed isocaloric amounts of SDRs or SJBs in 20-minute intervals. Measurements included time to complete 10-km TT, power output during 10-km TT, blood glucose levels and respiratory exchange ratio during glycogen depletion period, rate of perceived exertion (RPE), 'flow' questionnaire responses, and a hedonic (i.e., pleasantness) sensory acceptance test. There were no significant differences in endurance performance for TT time (SDRs vs. SJBs, 17.3 ± 0.4 vs. 17.3 ± 0.4 seconds) or power (229.3 ± 13.0 vs. 232.0 ± 13.6 W), resting blood glucose levels (5.8 ± 04 mmol·L(-1) for SDRs and 5.4 ± 0.2 mmol·L(-1) for SJBs), RPE, or flow experiences between SDR and SJB trials. However, the mean sensory acceptance scores were significantly higher for the SDRs compared to the SJBs (50.7 ± 1.7 vs. 44.3 ± 2.7). Consuming SDRs or SJBs during 120 minutes of intense cycling results in similar subsequent TT performances and are equally effective in maintaining blood glucose levels during exercise. Therefore, SDRs are a natural, pleasant, cost-effective CHO alternative to commercial SJBs that can be used during moderate- to high-intensity endurance exercise.

  8. Acceptability and confidence in antiretroviral generics of physicians and HIV-infected patients in France.

    Science.gov (United States)

    Allavena, Clotilde; Jacomet, Christine; Pereira, Bruno; Morand-Joubert, Laurence; Bagheri, Haleh; Cotte, Laurent; Garaffo, Rodolphe; Gerbaud, Laurent; Dellamonica, Pierre

    2014-01-01

    Switching brand name medications to generics is recommended in France in the interest of cost effectiveness but patients and physicians are sometimes not convinced that switching is appropriate. Some antiretroviral (ARV) generics (ZDV, 3TC, NVP) have been marketed in France since 2013. A multicentric cross-sectional survey was performed in September 2013 to evaluate the perception of generics overall and ARV generics in physicians and HIV-infected patients and factors associated to their acceptability. Adult HIV outpatients were asked to complete a self-questionnaire on their perception of generics. Physicians completed a questionnaire on the acceptability of generics and ARV generics. Socio-demographic data, medical history and HIV history were collected. 116 physicians in 33 clinics (68% in University Hospital) included 556 patients (France-native 77%, active employment 59%, covered by social Insurance 100%, homosexual/bisexual contamination 47%, median HIV duration 13 years, hepatitis coinfection 16%, on ARV therapy 95%). Overall, patients accepted and had confidence in generics in 76% and 55% of the cases, respectively. Switching ARVs for generics was accepted by 44% of the patients but only by 17% if the pill burden was going to increase. 75% of the physicians would prescribe generics, but this decreased to only 26% if the combo had to be broken. The main reasons for non-prescription of generics were previous brand name ARV-induced side effects (35%), refusal of generics overall (37%), lack of understanding of generics (26%), risk of non-observance of treatment (44%), anxiety (47%) and depressive symptoms (25%). In multivariate analysis, factors associated with the acceptability of ARV generics in patients were the use of generics overall (pHIV status or comorbidities had a constrictive influence on the use of ARV generics. Acceptability of ARV generics in this French population is mostly dictated by the patient's and physician's knowledge and use of generics

  9. Generics: keep a balanced view.

    Science.gov (United States)

    2014-02-01

    Once the different kinds of commercial protection (patents, etc.) granted to the manufacturer of an "originator" drug have expired, the drug in question may be copied by other companies. These copies are known as generics. The characteristics and pharmaceutical quality of generics are governed by international standards. The marketing authorisation procedure for generic drugs dispenses with preclinical and clinical trials, which already exist for the originator drug. In contrast, proof of bioequivalence must be provided. In practice, this means demonstrating that the effects of the generic are similar (but not necessarily identical) to those of the originator drug. Slight differences between a generic and its brand-name counterpart are allowed, provided they do not markedly affect the efficacy or adverse effect profile in comparison to the originator drug. The accepted degree of difference between a generic and the original brand-name drug is the same as the acceptable difference between two batches of the originator drug. The rules governing generic manufacturing conditions are identical to those applying to originator drugs. And issues raised by drug production abroad, particularly to Asian countries, apply to originator just as much as to generic drugs. Generics represent a significant source of financial savings for society. In France, various measures have been introduced to encourage doctors, pharmacists and patients, respectively, to prescribe, dispense and use generics. Criticisms of the efficacy or quality of generics are often unfounded and sometimes deliberately orchestrated. Smear campaigns conducted by drug companies that market originator drugs, and also by some healthcare professionals, sow confusion, to the detriment of generic use. There is no tangible proof that generics are less safe than originator drugs, provided they are chosen wisely, taking into account factors such as their packaging quality. It is up to healthcare professionals to decide

  10. Technology, safety, and costs of decommissioning a reference pressurized water reactor power station. Appendices

    Energy Technology Data Exchange (ETDEWEB)

    Smith, R.I.; Konzek, G.J.; Kennedy, W.E. Jr.

    1978-05-01

    Detailed appendices are presented under the following headings: reference PWR facility description, reference PWR site description, estimates of residual radioactivity, alternative methods for financing decommissioning, radiation dose methodology, generic decommissioning activities, intermediate dismantlement activities, safe storage and deferred dismantlement activities, compilation of unit cost factors, and safety assessment details.

  11. Generic Network Location Service

    Directory of Open Access Journals (Sweden)

    Laban Mwansa

    2010-11-01

    Full Text Available This work presents the Generic Network Location Service based on the Chord implementation utilizing data structures called distributed hash tables (DHT or structured overlay networks, which are used to build scalable self-managing distributed systems. The provided algorithms guarantee resilience in the presence of dynamism: they guarantee consistent lookup results in the presence of nodes failing and leaving. Generic Network Location Service provides a Location Service system based on DHT technology, which is storing device location records in nodes within a Chord DHT. Location records are consisting of network device identification keys as attributes, which are used to create replicas of additional location records through established Chord hashing mechanisms. Storing device location records, in places address-able (using the DHT lookup by individual location record keys provides a simple way of implementing transla¬tion functions similar to well¬ known network services (e.g. ARP, DNS, ENUM. The generic network location ser¬vice presented in the paper is not supposed to be a substitu¬tion of the existing translation techniques (e.g. ARP, DNS, ENUM, but it is considered as an overlay service that uses data available in existing systems and provides some translations currently unavailable.

  12. Electrorefining of copper from a cuprous ion complexing electrolyte. II. Experimental comparison of possible alternative electrolytes and preliminary cost engineering analysis

    Energy Technology Data Exchange (ETDEWEB)

    Brown, A.P.; Loutfy, R.O.; Cook, G.M.

    1980-04-01

    The energy saving potential and refining capability of three copper(I)/electrolyte systems for the electrorefining of copper were compared experimentally. The alternative electrolyte systems studied were copper(I)/acid chloride, copper(I)/acetonitrile and sulfuric acid, and copper(I)/ammonia solutions. These were compared to the conventional copper(II)/sulfuric acid electrolyte. All of the alternative electrolyte systems demonstrated at least some potential for saving energy when run at an equal deposition rate to the conventional process; the chloride electrolyte showed the greatest energy saving potential, about 70%, and the ammonia electrolyte showed the least, about 25%. All of the alternative electrolyte systems, however, exhibited performance problems, primarily with regard to inadequate separation of impurities. A preliminary capital cost estimate was made for the copper(I)/chloride system. This estimate showed that, for the alternative electrolyte system to be cost competitive (that is, a reduction of capital cost of about 15 to 20%) with the conventional electrorefining process, the refining cells would have to be operated at a current density of about 25 to 30 mA-cm/sup -2/. At this current density, the estimated energy saving potential for the copper(I)/chloride system was still about 50%.

  13. Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community-based settings.

    Science.gov (United States)

    Gore, Mugdha; Tai, Kei-Sing; Sadosky, Alesia; Leslie, Douglas; Stacey, Brett R

    2012-09-01

    To evaluate the use and direct medical costs of pharmacologic and alternative treatments for patients with osteoarthritis (OA) and chronic low back pain (CLBP). The LifeLink™ Health Plan Claims Database was used to identify patients ≥18 years old, diagnosed with OA (N = 112,951) or CLBP (N = 101,294). Of these patients, 64,085 with OA and 47,386 with CLBP received pain-related treatments during CY2008 and were selected for inclusion. For patients in both cohorts, pharmacologic and alternative treatments, and direct medical costs were examined during CY2008. Opioids were the most frequently prescribed medication (>70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs (>50%). Over 30% received antidepressants, >20% received benzodiazepines, and 15% in each group received sedative hypnotics. Use of alternative treatments was as follows: chiropractor, OA 11%, CLBP 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), OA 14%, CLBP 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, pain-related and adjunctive medications. Although, alternative treatments are widely recommended, we found limited use of several of these in clinical practice, potentially due to the source of our data (commercial claims). Further research is needed to ascertain the extent to which such therapies contribute to the total costs of OA and CLBP management. © 2012 The Authors. Pain Practice © 2012 World Institute of Pain.

  14. The introduction of generic risperidone in Medicare Part D.

    Science.gov (United States)

    Fung, Vicki; Price, Mary; Busch, Alisa B; Landrum, Mary Beth; Fireman, Bruce; Nierenberg, Andrew A; Newhouse, Joseph P; Hsu, John

    2016-01-01

    The introduction of generic second-generation antipsychotics (SGAs), starting with risperidone in July 2008, could reduce antipsychotic spending and cost-related use barriers. This study examines associations between generic risperidone use and spending and adherence after introduction among Medicare Advantage (MA) beneficiaries. Historic cohort study. The study included MA beneficiaries receiving SGA treatment prior to July 2008. We examined antipsychotic spending using linear models, adherence (proportion of days covered ≥ 80%) using logistic models, and nonpersistence (time to first gap in antipsychotic use > 30 days) in 2009 using Cox proportional hazard models, comparing beneficiaries with versus without generic use, adjusting for individual and plan characteristics. Between July 2008 and December 2009, 22.8% of beneficiaries had ≥ 1 fill of generic risperidone: 73% of those previously using branded risperidone and 6.7% of those previously using other SGAs. Beneficiaries in private fee-for-service (FFS) versus health maintenance organization (HMO) plans had lower rates of generic use (hazard ratio [HR], 0.73 [95% CI, 0.56-0.96]); however, cost-sharing levels were not associated with generic use. Compared with beneficiaries who continued using other SGAs, those who switched from other SGAs to generic risperidone in 2008 had lower out-of-pocket spending (-$214; 95% CI, -$314 to -$115), higher adherence (odds ratio, 2.34; 95% CI, 1.62-3.40) and lower rates of nonpersistence (HR, 0.56; 95% CI, 0.46-0.69) in 2009. Generic use was concentrated among patients previously using branded risperidone. HMO plans appeared to be more effective at encouraging generic use than unmanaged private FFS plans; however, patient financial incentives had limited influence on switching. Additional opportunity remains to encourage greater generic SGA use, reduce spending, and potentially improve treatment adherence and outcomes.

  15. Need for multicriteria evaluation of generic drug policies.

    Science.gov (United States)

    Kaló, Zoltán; Holtorf, Anke-Peggy; Alfonso-Cristancho, Rafael; Shen, Jie; Ágh, Tamás; Inotai, András; Brixner, Diana

    2015-03-01

    Policymakers tend to focus on improving patented drug policies because they are under pressure from patients, physicians, and manufacturers to increase access to novel therapies. The success of pharmaceutical innovation over the last few decades has led to the availability of many off-patent drugs to treat disease areas with the greatest public health need. Therefore, the success of public health programs in improving the health status of the total population is highly dependent on the efficiency of generic drug policies. The objective of this article was to explore factors influencing the true efficiency of generic prescription drug policies in supporting public health initiatives in the developed world. Health care decision makers often assess the efficiency of generic drug policies by the level of price erosion and market share of generics. Drug quality, bioequivalence, in some cases drug formulations, supply reliability, medical adherence and persistence, health outcomes, and nondrug costs, however, are also attributes of success for generic drug policies. Further methodological research is needed to measure and improve the efficiency of generic drug policies. This also requires extension of the evidence base of the impact of generic drugs, partly based on real-world evidence. Multicriteria decision analysis may assist policymakers and researchers to evaluate the true value of generic drugs. Copyright © 2015. Published by Elsevier Inc.

  16. Generic medicines: Perceptions of Physicians in Basrah, Iraq

    Directory of Open Access Journals (Sweden)

    Adheed Khalid Sharrad

    2009-08-01

    Full Text Available BackgroundThe use of cheaper generic medicines is a strategy promotedin many countries to reduce rising health care costs. The aimof this study was to explore factors affecting generic medicineprescribing by physicians in Basrah, Iraq.MethodologyA purposive sample of ten physicians practicing in Basrahwas interviewed using a semi-structured interview guide.ResultsAnalysis of the interviews identified seven major themes:medicine prescribing practice, knowledge of therapeuticequivalency of generic medicine, patients’ acceptance ofgeneric medicine, counterfeit medicine, drug informationsource and effect of drug advertising on medicines choice,brand substitution practice by community pharmacists, and,finally strategies to improve generic medicine usefulness.Participants identified helpful strategies to increase genericprescribing including; physician and patient education ongeneric medicine; persuading physicians about the safety andefficacy of generic medicines; and finally educating seniormedical students on generic prescribing.ConclusionThe data suggest that participants were enthusiasticabout prescribing generic medicines. However physiciansinsist that pharmacists should not be allowed tosubstitute generic drugs without prior approval ofdoctors.

  17. Development of the generic drug industry in the US after the Hatch-Waxman Act of 1984

    Directory of Open Access Journals (Sweden)

    Garth Boehm

    2013-09-01

    Full Text Available The key events in the development of the US generic drug industry after the Hatch-Waxman Act of 1984 are systematically reviewed, including the process of approval for generic drugs, bioequivalence issues including “switchability”, bioequivalence for complicated dosage forms, patent extension, generic drug safety, generic substitution and low-cost generics. The backlog in generic review, generic drug user fees, and “quality by design” for generic drugs is also discussed. The evolution of the US generic drug industry after the Hatch-Waxman Act in 1984 has afforded several lessons of great benefit to other countries wishing to establish or re-establish a domestic generic drug industry.

  18. Regulation of Generic Drugs in Japan: the Current Situation and Future Prospects.

    Science.gov (United States)

    Kuribayashi, Ryosuke; Matsuhama, Maki; Mikami, Kenichi

    2015-09-01

    Generic drugs are interchangeable with original proprietary drugs, as they have the same active pharmaceutical ingredients, dosage forms, strength, quality, indications, effects, directions, and dosage. The cost of generic drugs is lower than original drugs, because the developmental cost is lower. The expansion of medical expenses is an important issue in many countries, including Japan, the USA, and Europe, and promotion of generic drugs has been demanded to solve this issue in Japan. Generic drug approval review in Japan is conducted by the Pharmaceuticals and Medical Devices Agency (PMDA), which reviews the equivalence of the original drugs from the viewpoint of quality, efficacy, and safety, based on documentation submitted by the generic drug applicants. However, the details of the generic drug review in Japan have not been reported. In this report, we introduce the application types, the number of applications and approvals, and the review timeline of generic drugs in Japan. In addition, we discuss recent consultations and future prospects.

  19. Towards a Generic Manual Scanner for Nondestructive Inspection

    Science.gov (United States)

    Barnard, D. J.; Peters, J. J.; Hsu, D. K.

    2005-04-01

    Although NDE imaging modalities are gaining acceptance in airline maintenance hangars operations, the high cost/complexity of these units precludes their wide use. With low cost position encoders (for handwriting capture) available for PC's and hand held inspection instruments available with data ports or alarm outputs, a low cost generic manual scanning instrument should be realizable. This report summarizes recent efforts at a generic manual scanning platform, which includes software and minimal electronics, that is aimed at facilitating the merging of available handheld NDE instruments and an encoder to produce C-scans.

  20. Knowledge, perceptions and use of generic drugs: a cross sectional study.

    Science.gov (United States)

    Lira, Claudio Andre Barbosa de; Oliveira, Jéssica Nathalia Soares; Andrade, Marília Dos Santos; Vancini-Campanharo, Cássia Regina; Vancini, Rodrigo Luiz

    2014-09-01

    To assess the level of knowledge, perceptions and usage profile for generic drugs among laypersons. A cross-sectional study was conducted with 278 volunteers (180 women and 98 men, aged 37.1±15.8 years). A questionnaire was drawn up with questions on their use, perceptions and knowledge of generic drugs. Most respondents (99.6%) knew that generic drugs exist, but only 48.6% were able to define them correctly, while 78.8% of the respondents had some information about generics. This information was obtained mainly through television (49.3%). In terms of generic drug characteristics, 79.1% stated that they were confident about their efficacy, 74.8% believed that generic drugs have the same effect as branded medications, 88.8% said that generics were priced lower than branded medications, and 80.2% stated that they bought generic drugs because of price. With regard to drugs prescribed by medical practitioners, 17.6% of the participants said that their doctors never prescribed generics and only 7.5% confirmed that their doctors always prescribed generics. For the lay public, the sample in this study has sufficient knowledge of generic drugs in terms of definition, efficacy and cost. Consequently, the volunteers interviewed are very likely to use generics. Furthermore, the results of this study indicate that programs should be implemented in order to boost generic drug prescriptions by medical practitioners.

  1. Do higher-priced generic medicines enjoy a competitive advantage under reference pricing?

    Science.gov (United States)

    Puig-Junoy, Jaume

    2012-11-01

    In many countries with generic reference pricing, generic producers and distributors compete by means of undisclosed discounts offered to pharmacies in order to reduce acquisition costs and to induce them to dispense their generic to patients in preference over others. The objective of this article is to test the hypothesis that under prevailing reference pricing systems for generic medicines, those medicines sold at a higher consumer price may enjoy a competitive advantage. Real transaction prices for 179 generic medicines acquired by pharmacies in Spain have been used to calculate the discount rate on acquisition versus reimbursed costs to pharmacies. Two empirical hypotheses are tested: the discount rate at which pharmacies acquire generic medicines is higher for those pharmaceutical presentations for which there are more generic competitors; and, the discount rate at which pharmacies acquire generic medicines is higher for those pharmaceutical forms for which the consumer price has declined less in relation to the consumer price of the brand drug before generic entry (higher-priced generic medicines). An average discount rate of 39.3% on acquisition versus reimbursed costs to pharmacies has been observed. The magnitude of the discount positively depends on the number of competitors in the market. The higher the ratio of the consumer price of the generic to that of the brand drug prior to generic entry (i.e. the smaller the price reduction of the generic in relation to the brand drug), the larger the discount rate. Under reference pricing there is intense price competition among generic firms in the form of unusually high discounts to pharmacies on official ex-factory prices reimbursed to pharmacies. However, this effect is highly distorting because it favours those medicines with a higher relative price in relation to the brand price before generic entry.

  2. Toward better quality of anticancer generics in India.

    Science.gov (United States)

    Gota, V S; Patial, P

    2014-01-01

    Treatment of cancer is limited by affordability of patients in the many developing countries including India. Generic drug manufacturers have responded to this scenario by making drugs available at affordable costs, often at less than 10% the cost of the original brand. In our practice, it is found that there is a three-fold higher prescription of generic brands compared to innovator, accompanied by cost savings of up to 80% per prescription. Unfortunately, the regulatory environment prevailing in India is not geared to ensure satisfactory quality of generic products. The standards set by the regulatory agencies for establishing equivalence of generics vis-ΰ-vis the innovator product allow anticancer generics to enter markets without undergoing clinical evaluation. Many drug manufacturing units in India flout good manufacturing practice norms, which was evident during the center for drug evaluation and research classifications inspection in the year 2006. Inferior drugs have therefore, made their way into the Indian markets, compromising the quality of care. The system of drug manufacturing and marketing approval needs a major overhaul, including regular inspection of manufacturing facilities. Bioequivalence should be made mandatory for all oral formulations. Unless these measures are rigidly implemented, the benefits of generic substitution would be seriously undermined.

  3. Cost benefit indicators associated with the integration of alternative energy sources: A systems approach for Carinthia, Austria

    DEFF Research Database (Denmark)

    Wohlgemuth, N.

    1999-01-01

    Studies on how to promote the use of alternative energy sources (AES) typically focus on the relative efficiency and effectiveness of alternative subsidising mechanisms. Positive externalities of an increased AES utilisation are in general not explicitly taken into account. This paper analyses...... of AES use. Analysis of two strategies, "Subsidy" and "High Tax", shows that none of these strategies is dominant with respect to all indicators, i.e., there are conflicting objectives. (C) 1998 Elsevier Science Ltd. All rights reserved....

  4. Linguistic reflections on the generic feminine

    Directory of Open Access Journals (Sweden)

    Javier San Julián Solana

    2017-12-01

    After comparing the underlying assumptions of the feminists’ position with some linguistic principles, we analyze the conditions under which the generic interpretations of feminine forms take place in ordinary language. We then present the problems that the generalization of the phenomenon can give rise to: limitation of «displacement» capacity (Hockett, 1960, poor processing effort / cognitive effect ratio, and difficulty in accomplishing the communicative function of language. This brings us to the point that the generic feminine is most unlikely to become established in general uses of Spanish; it also seem not to be feasible to achieve a free alternation of masculine and feminine forms as a means of expressing gender neutralization. However, the occasional use of the feminine with extensive value could be made habitual —considering the social function of language— in political discourse, where it would function as a badge that shows membership of (or solidarity with a social group.

  5. Accounting for costs, QALYs, and capacity constraints: using discrete-event simulation to evaluate alternative service delivery and organizational scenarios for hospital-based glaucoma services.

    Science.gov (United States)

    Crane, Glenis J; Kymes, Steven M; Hiller, Janet E; Casson, Robert; Martin, Adam; Karnon, Jonathan D

    2013-11-01

    Decision-analytic models are routinely used as a framework for cost-effectiveness analyses of health care services and technologies; however, these models mostly ignore resource constraints. In this study, we use a discrete-event simulation model to inform a cost-effectiveness analysis of alternative options for the organization and delivery of clinical services in the ophthalmology department of a public hospital. The model is novel, given that it represents both disease outcomes and resource constraints in a routine clinical setting. A 5-year discrete-event simulation model representing glaucoma patient services at the Royal Adelaide Hospital (RAH) was implemented and calibrated to patient-level data. The data were sourced from routinely collected waiting and appointment lists, patient record data, and the published literature. Patient-level costs and quality-adjusted life years were estimated for a range of alternative scenarios, including combinations of alternate follow-up times, booking cycles, and treatment pathways. The model shows that a) extending booking cycle length from 4 to 6 months, b) extending follow-up visit times by 2 to 3 months, and c) using laser in preference to medication are more cost-effective than current practice at the RAH eye clinic. The current simulation model provides a useful tool for informing improvements in the organization and delivery of glaucoma services at a local level (e.g., within a hospital), on the basis of expected effects on costs and health outcomes while accounting for current capacity constraints. Our model may be adapted to represent glaucoma services at other hospitals, whereas the general modeling approach could be applied to many other clinical service areas.

  6. Cost-effectiveness analysis of paclitaxel + carboplatin vs. alternative combinations in the treatment of non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Mario Eandi

    2006-06-01

    Full Text Available Non-small cell lung cancer (NSCLC is the most common type of lung cancer and its medical and economical burden represents a serious matter in Europe and Usa, due to its high mortality rates and drug costs. Lung cancer is responsible for about 30% of cancer death in men and women; in Europe only about 8 per cent of people with lung cancer survive for 5 years. At present combination chemotherapy based on cisplatin or carboplatin associated with paclitaxel, vinorelbine or gemcitabine is the state of the art for the treatment in patients with stage IIIb or IV NSCLC. Aim of this study was to compare the cost-effectiveness of paclitaxel/carboplatin (PCb, gemcitabine/cisplatin (GC and vinorelbine/cisplatin (VC in the perspective of the Italian National Health Service. Therefore we perfomed a semi-Markov decision model mainly based on clinical results from the Italian Lung Cancer Project. The model included differential direct medical costs registered for two years from starting chemotherapy, using tariffs valid for 2005. Benefits was measured by years of life saved (YOLs. The model also allowed to estimate only costs accrued over the period of time, performing a cost-minimisation analysis. According to cost-effectiveness analysis, VC is dominated because it’s more costly and less effective than GC. On the contrary, combination chemotherapy with GC is more inexpensive but less effective than paclitaxel/carboplatin (PCb: in this case we compared the incremental cost-effectiveness ratio (ICER with a maximum acceptable willingness-to-pay (WTP value. In the base scenario the ICER of PCb over GC treatment is 52,326 euro/ YOLs, which is definitely lower than the maximum acceptable WTP value. Sensitivity analyses confirmed the robustness of the results from cost-effectiveness analysis in the base scenario.

  7. Advertising and generic market entry.

    Science.gov (United States)

    Königbauer, Ingrid

    2007-03-01

    The effect of purely persuasive advertising on generic market entry and social welfare is analysed. An incumbent has the possibility to invest in advertising which affects the prescribing physician's perceived relative qualities of the brand-name and the generic version of the drug. Advertising creates product differentiation and can induce generic market entry which is deterred without differentiation due to strong Bertrand competition. However, over-investment in advertising can deter generic market entry under certain conditions and reduces welfare as compared to accommodated market entry.

  8. United States biomass energy: An assessment of costs and infrastructure for alternative uses of biomass energy crops as an energy feedstock

    Science.gov (United States)

    Morrow, William Russell, III

    Reduction of the negative environmental and human health externalities resulting from both the electricity and transportation sectors can be achieved through technologies such as clean coal, natural gas, nuclear, hydro, wind, and solar photovoltaic technologies for electricity; reformulated gasoline and other fossil fuels, hydrogen, and electrical options for transportation. Negative externalities can also be reduced through demand reductions and efficiency improvements in both sectors. However, most of these options come with cost increases for two primary reasons: (1) most environmental and human health consequences have historically been excluded from energy prices; (2) fossil energy markets have been optimizing costs for over 100 years and thus have achieved dramatic cost savings over time. Comparing the benefits and costs of alternatives requires understanding of the tradeoffs associated with competing technology and lifestyle choices. As bioenergy is proposed as a large-scale feedstock within the United States, a question of "best use" of bioenergy becomes important. Bioenergy advocates propose its use as an alternative energy resource for electricity generation and transportation fuel production, primarily focusing on ethanol. These advocates argue that bioenergy offers environmental and economic benefits over current fossil energy use in each of these two sectors as well as in the U.S. agriculture sector. Unfortunately, bioenergy research has offered very few comparisons of these two alternative uses. This thesis helps fill this gap. This thesis compares the economics of bioenergy utilization by a method for estimating total financial costs for each proposed bioenergy use. Locations for potential feedstocks and bio-processing facilities (co-firing switchgrass and coal in existing coal fired power plants and new ethanol refineries) are estimated and linear programs are developed to estimate large-scale transportation infrastructure costs for each sector

  9. Technology, safety and costs of decommissioning a reference boiling water reactor power station. Appendices. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Oak, H.D.; Holter, G.M.; Kennedy, W.E. Jr.; Konzek, G.J.

    1980-06-01

    Appendices are presented concerning the evaluations of decommissioning financing alternatives; reference site description; reference BWR facility description; radiation dose rate and concrete surface contamination data; radionuclide inventories; public radiation dose models and calculated maximum annual doses; decommissioning methods; generic decommissioning information; immediate dismantlement details; passive safe storage, continuing care, and deferred dismantlement details; entombment details; demolition and site restoration details; cost estimating bases; public radiological safety assessment details; and details of alternate study bases.

  10. Comparison of Generic-to-Brand Switchback Rates Between Generic and Authorized Generic Drugs.

    Science.gov (United States)

    Hansen, Richard A; Qian, Jingjing; Berg, Richard; Linneman, James; Seoane-Vazquez, Enrique; Dutcher, Sarah K; Raofi, Saeid; Page, C David; Peissig, Peggy

    2017-04-01

    Generic drugs contain identical active ingredients as their corresponding brand drugs and are pharmaceutically equivalent and bioequivalent, whereas authorized generic drugs (AGs) contain both identical active and inactive ingredients as their corresponding brand drugs but are marketed as generics. This study compares generic-to-brand switchback rates between generic and AGs. Retrospective cohort study. Claims and electronic health record data from a regional U.S. health care system. The full cohort consisted of 5542 unique patients who received select branded drugs during the 6 months prior to their generic drug market availability (between 1999 and 2014) and then were switched to an AG or generic drug within 30 months of generic drug entry. For these patients, 5929 unique patient-drug combinations (867 with AGs and 5062 with generic drugs) were evaluated. Ten drugs with AGs and generics marketed between 1999 and 2014 were evaluated. The date of the first generic prescription was considered the index date for each drug, and it marked the beginning of follow-up to evaluate the occurrence of generic-to-brand switchback patterns over the subsequent 30 months. Switchback rates were compared between patients receiving AGs versus those receiving generics using multivariable Cox proportional hazards models, controlling for individual drug effects, age, sex, Charlson Comorbidity Score, pre-index drug use characteristics, and pre-index health care utilization. Among the 5542 unique patients who switched from brand to generic or brand to AG, 264 (4.8%) switched back to the brand drug. Overall switchback rates were similar for AGs compared with generics (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.65-1.15). The likelihood of switchback was higher for alendronate (HR 1.64, 95% CI 1.20-2.23) and simvastatin (HR 1.81, 95% CI 1.30-2.54) and lower for amlodipine (HR 0.27, 95% CI 0.17-0.42) compared with the other drugs evaluated. Overall switchback rates were similar

  11. Consumer choice between common generic and brand medicines in a country with a small generic market.

    Science.gov (United States)

    Fraeyman, Jessica; Peeters, Lies; Van Hal, Guido; Beutels, Philippe; De Meyer, Guido R Y; De Loof, Hans

    2015-04-01

    Generic medicines offer an opportunity for governments to contain pharmaceutical expenditures, since generics are generally 10%-80% lower in price than brand medicines. Belgium has a small generic market that takes up 15% of the total pharmaceutical market in packages sold. To determine the knowledge of consumers about the different available packages of a common over-the-counter medicine (acetaminophen) with regard to price advantage, quality, and effectiveness in a country with a small generic market. We conducted an online survey in the general Flemish population using a questionnaire with 25 statements. The questionnaire also contained 2 informative interventions. First, we showed the price per package and per tablet that the patient would pay in the pharmacy. Second, we provided the respondent with general information about generic medication (equivalence, effectiveness, price, and recognition). Before and after the interventions, we probed for preferences and knowledge about the different packages. Multivariate logistic models were used to examine the independent effects of consumer characteristics on responses to the survey statements. We obtained a sample of 1,636 respondents. The general attitude towards generic medication was positive-only 5% would rather not use a generic. Nevertheless, only 17% of the respondents were able to recognize a generic medicine. Older consumers (aged 60 years and above) were more often confused about the different packages (OR = 2.59, 95% CI = 1.76-3.80, P ≤ 0.001). Consumers without a higher education degree tended to be more doubtful about the difference in effectiveness and quality between the different brands (OR = 0.59, 95% CI = 0.44-0.79, P ≤ 0.001). Consumer recognition of the name of the active substance of acetaminophen was poor. When different brands were displayed, possible price advantage seemed to be an important motive to switch to a cheaper brand. Consumers generally found medicines

  12. Pharmacokinetics and 48-week safety and efficacy of generic lopinavir/ritonavir in Thai HIV-infected patients

    NARCIS (Netherlands)

    Ramautarsing, R.A.; Lugt, J. van der; Gorowara, M.; Sophonphan, J.; Ananworanich, J.; Lange, J.M.A.; Burger, D.M.; Phanuphak, P.; Ruxthungtham, K.; Avihingsanon, A.

    2013-01-01

    BACKGROUND: Generic products reduce the costs of HIV treatment. Few generic second-line antiretroviral products are available. We assessed pharmacokinetics, safety and efficacy of generic lopinavir/ritonavir (LPV/r) produced by the Government Pharmaceutical Organization (GPO) of Thailand in Thai

  13. Pharmacokinetics and 48-week safety and efficacy of generic lopinavir/ritonavir in Thai HIV-infected patients

    NARCIS (Netherlands)

    Ramautarsing, Reshmie A.; van der Lugt, Jasper; Gorowara, Meena; Sophonphan, Jiratchaya; Ananworanich, Jintanat; Lange, Joep M. A.; Burger, David M.; Phanuphak, Praphan; Ruxthungtham, Kiat; Avihingsanon, Anchalee

    2013-01-01

    Background: Generic products reduce the costs of HIV treatment. Few generic second-line antiretroviral products are available. We assessed pharmacokinetics, safety and efficacy of generic lopinavir/ritonavir (LPV/r) produced by the Government Pharmaceutical Organization (GPO) of Thailand in Thai

  14. A cost-utility analysis of alternative drug regimens for newly diagnosed severe lupus nephritis patients in Thailand.

    Science.gov (United States)

    Mohara, Adun; Pérez Velasco, Román; Praditsitthikorn, Naiyana; Avihingsanon, Yingyos; Teerawattananon, Yot

    2014-01-01

    The aim of this study was to assess the value of four drug regimens for newly diagnosed severe LN from a societal perspective. A model-based cost-utility analysis was devised to measure lifetime costs and health outcomes. Current treatment options consisting of different combinations of i.v. CYC, AZA and MMF were compared with a baseline regimen of i.v. CYC in both the induction and maintenance phases. Resource use and costs were derived from medical records reviews and databases. Event rates were elicited from randomized controlled trials. Relative treatment effects were obtained from meta-analyses. Health utilities were obtained from a real cohort of patients to estimate the outcome of quality-adjusted life years. It was found that a treatment regimen that combined i.v. CYC in the induction phase with AZA in the maintenance phase was cost saving compared with the baseline regimen. Treatment with i.v. CYC in the induction phase and MMF in the maintenance phase and treatment with MMF in the induction phase and a reduced dose of the same in the maintenance phase turned out to be a negatively dominated regimen. In the Thai context, the combination of i.v. CYC for the induction phase followed by AZA for the maintenance phase should be considered as the first-line therapy for newly diagnosed severe LN, as it seems to be the most cost-saving regimen.

  15. Alternative technology concepts for low-cost and high-speed 2D and 3D interconnect manufacturing

    NARCIS (Netherlands)

    Roozeboom, F.; Smets, M.; Kniknie, B.; Hoppenbrouwers, M.; Dingemans, G.; Keuning, W.; Kessels, W.M.M.; Pohl, Ralph; Huis in 't Veld, Bert

    2013-01-01

    The current industrial process of choice for Deep Reactive Ion Etching (DRIE) of 3D features, e.g. Through-Silicon Vias (TSVs), Microelectromechanical Systems (MEMS), etc., is the Bosch process, which uses alternative SF6 etch cycles and C4F8-based sidewall passivation cycles in a time-sequenced

  16. Alternative technology concepts for low-cost and high-speed 2D and 3D interconnect manufacturing

    NARCIS (Netherlands)

    Roozeboom, F.; Smets, M.; Kniknie, B.; Hoppenbrouwers, M.; Dingemans, G.; Keuning, W.; Kessels, W.M.M.; Pohl, R.; Huis In't Veld, A.J.

    2013-01-01

    The current industrial process of choice for Deep Reactive Ion Etching (DRIE) of 3D features, e.g. Through-Silicon Vias (TSVs), Microelectromechanical Systems (MEMS), etc., is the Bosch process, which uses alternative SF 6 etch cycles and C4F8-based sidewall passivation cycles in a time-sequenced

  17. A nested case-control study of influenza vaccination was a cost-effective alternative to a full cohort analysis

    NARCIS (Netherlands)

    Hak, E; Wei, F; Grobbee, D E; Nichol, K L

    OBJECTIVE: In the absence of trial results that are applicable to the target population, nested case-control studies might be an alternative to full-cohort analysis. We compared relative and absolute estimates of associations in an influenza vaccine study using both designs. STUDY DESIGN AND

  18. Article choice in plural generics

    NARCIS (Netherlands)

    Farkas, D.F.; Swart, Henriëtte de

    2007-01-01

    We discuss two groups of languages where article use contrasts in generic plural sentences but is otherwise essentially similar. The languages in the first group (English and Dutch) use bare plurals in the expression of kind reference (‘Dinosaurs are extinct’) and in generic

  19. ECONOMIC REASONS FOR GENERIC CHOICE

    Directory of Open Access Journals (Sweden)

    N. P. Kutishenko

    2008-01-01

    Full Text Available Many generic medicines appear in the pharmaceutical market now. However, they are not always completely comparable with original drugs on efficacy and safety. In this article pharmacoeconomical estimation of some generics and original drugs was performed on example of therapeutic equivalency studies.

  20. Use of generic drugs in São Paulo city, Brazil, in 2003: a population-based study.

    Science.gov (United States)

    Monteiro, Camila Nascimento; Gianini, Reinaldo José; Segri, Neuber José; Goldbaum, Moisés; Barros, Marilisa Berti de Azevedo; Cesar, Chester Luiz Galvão

    2016-01-01

    to analyze the use and perception of generic drugs by people with diabetes and hypertension in São Paulo City, Brazil, considering the Brazilian Generic Drug Policy. this was a cross-sectional study using data from a household health survey (ISA-Capital) in 2003; analysis was performed on knowledge regarding generic drugs and on the association between their use and sociodemographic and socio-economic characteristics. 603 people with hypertension and diabetes were included in the study, low use of generic drugs was found (33.3% and 26.3, respectively) and low cost was the major reported advantage of generic drugs (71.0% and 71.1%, respectively); there was no statistically significant difference between the use of generic medication and age, sex or schooling. low cost and there being no difference between generic drug use and education level strengthen the importance of generic drugs for promoting equity and universal access to medication.

  1. Generic drugs: Review and experiences from South India

    Directory of Open Access Journals (Sweden)

    Philip Mathew

    2015-01-01

    Full Text Available The cost of pharmaceuticals, as a percentage of total healthcare spending, has been rising worldwide. This has resulted in strained national budgets and a high proportion of people without access to essential medications. Though India has become a global hub of generic drug manufacturing, the expected benefits of cheaper drugs are not translating into savings for ordinary people. This is in part due to the rise of branded generics, which are marketed at a price point close to the innovator brands. Unbranded generic medicines are not finding their way into prescriptions due to issues of confidence and perception, though they are proven to be much cheaper and comparable in efficacy to branded medicines. The drug inventory of unbranded generic manufacturers fares reasonably when reviewed using the World Health Organization-Health Action International (WHO-HAI tool for analysing drug availability. Also, unbranded generic medicines are much cheaper when compared to the most selling brands and they can bring down the treatment costs in primary care and family practice. We share our experience in running a community pharmacy for an urban health center in the Pathanamthitta district of Kerala State, which is run solely on generic medicines. The drug availability at the community pharmacy was 73.3% when analyzed using WHO-HAI tool and the savings for the final consumers were up to 93.1%, when compared with most-selling brand of the same formulation.

  2. Generic drugs: Review and experiences from South India.

    Science.gov (United States)

    Mathew, Philip

    2015-01-01

    The cost of pharmaceuticals, as a percentage of total healthcare spending, has been rising worldwide. This has resulted in strained national budgets and a high proportion of people without access to essential medications. Though India has become a global hub of generic drug manufacturing, the expected benefits of cheaper drugs are not translating into savings for ordinary people. This is in part due to the rise of branded generics, which are marketed at a price point close to the innovator brands. Unbranded generic medicines are not finding their way into prescriptions due to issues of confidence and perception, though they are proven to be much cheaper and comparable in efficacy to branded medicines. The drug inventory of unbranded generic manufacturers fares reasonably when reviewed using the World Health Organization-Health Action International (WHO-HAI) tool for analysing drug availability. Also, unbranded generic medicines are much cheaper when compared to the most selling brands and they can bring down the treatment costs in primary care and family practice. We share our experience in running a community pharmacy for an urban health center in the Pathanamthitta district of Kerala State, which is run solely on generic medicines. The drug availability at the community pharmacy was 73.3% when analyzed using WHO-HAI tool and the savings for the final consumers were up to 93.1%, when compared with most-selling brand of the same formulation.

  3. Using loose-fill perlite with normal weight precast wall panels to lower the cost, time of construction projects, and to provide an alternative to lightweight concrete

    Science.gov (United States)

    Al kulabi, Ahmed Kamil

    Lightweight concrete has been used in construction because of its properties, such as thermal, and fire resistances although it is more expensive and less available than normal weight concrete. One way to save time, cost, and to provide an alternative to lightweight concrete in construction projects is to reduce the number of installed insulations on precast wall panels and to improve the properties of normal weight concrete panels, respectively. These goals can be achieved by improving the four properties of precast panels, such as thermal resistance, fire resistance, heat capacity, and sound insulation by using perlite as insulation. The main goals of this research are getting buildings constructed or modified in less time and cost by producing superior wall panels and improving the properties of normal weight panels. Superior wall panels are new panels that provide the four properties listed above. Precast panels with different cross sections, concrete type, and different amounts of perlite will be investigated to observe the impact of each factor on the mentioned properties. The cost of each panel will be studied, and analytical methods will be used to find the optimum panel that provides the four mentioned properties with least cost. Moreover, theoretical methods will be applied to calculate the four properties for each panel. The preliminary theoretical calculations approved a good improvement in the four properties. In summary, the four properties of precast panels can be improved, time, and cost of construction can be reduced by using perlite as insulation.

  4. Generic drugs for hypertension: are they really equivalent?

    Science.gov (United States)

    Cooper-DeHoff, Rhonda M; Elliott, William J

    2013-08-01

    Many antihypertensive drugs are now available in generic formulations at fractions of the cost of their branded counterparts. In the United States, marketing approval for generic medications is usually granted by the Food and Drug Administration on the basis of two simple studies involving dissolution rates and bioavailability in 24 - 36 healthy people, without data regarding antihypertensive efficacy, safety, or long-term outcomes. This process leaves many true disciples of "Evidence-Based Medicine" in a quandary: prescribe only brand-name medications that have been demonstrated in clinical trials to both lower blood pressure and prevent cardiovascular events, or instead recommend lower-priced generic agents that are usually supported by no such data. This review summarizes the current evidence that generic antihypertensive drugs are likely to be safe and effective, may increase the probability of medication availability and adherence for many patients, but, by law, must have a different physical appearance than the original product.

  5. Life-cycle cost analysis of residential heat pumps and alternative HVAC (heating, ventilating, and air-conditioning) systems

    Energy Technology Data Exchange (ETDEWEB)

    Mei, V.C.; Nephew, E.A.

    1987-09-01

    A simple methodology is presented for calculating the life-cycle cost of a residential heat pump, an electric furnace with a central air conditioner, and a gas furnace with a central air conditioner. The procedure described in this report involves application of the Annual Performance Factor computer model developed by the Oak Ridge National Laboratory. This model was used to calculate the annual energy consumption of each of the three systems for 117 different climatic locations within the United States for residential buildings of varying sizes and insulation levels. Nine example calculations are included in the report to better explain the calculational procedure. These examples show that the life-cycle costs of the residential heat pump are somewhat higher than those of the gas furnace with central air conditioner. However, the cost advantage of the gas-fired system is not decisive and could disappear in locations having low power costs or if relative fuel prices change. 17 refs., 5 figs., 11 tabs.

  6. Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana.

    Science.gov (United States)

    Hu, Delphine; Grossman, Daniel; Levin, Carol; Blanchard, Kelly; Adanu, Richard; Goldie, Sue J

    2010-06-01

    To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality.

  7. Emulation-Based Virtual Laboratories: A Low-Cost Alternative to Physical Experiments in Control Engineering Education

    Science.gov (United States)

    Goodwin, G. C.; Medioli, A. M.; Sher, W.; Vlacic, L. B.; Welsh, J. S.

    2011-01-01

    This paper argues the case for emulation-based virtual laboratories in control engineering education. It demonstrates that such emulation experiments can give students an industrially relevant educational experience at relatively low cost. The paper also describes a particular emulation-based system that has been developed with the aim of giving…

  8. Life-cycle cost comparison of alternative surfacing for steep slopes on low-volume roads in Ghana

    CSIR Research Space (South Africa)

    Anochie-Boateng, Joseph K

    2017-05-01

    Full Text Available and erosion problems on the steep section than gravel wearing courses currently used by the Department of Feeder Roads (DFR). The objective of this paper is to present a life-cycle cost comparison of six pavement options proposed for steep hilly sections...

  9. Generic substitution: additional challenge for adherence in hypertensive patients?

    Science.gov (United States)

    Håkonsen, Helle; Eilertsen, Marlene; Borge, Hilde; Toverud, Else-Lydia

    2009-10-01

    This study aims to investigate whether, and in what way, generic substitution affects drug adherence in hypertensive patients. Personal interviews with 174 Norwegian patients (50-80 years) who had had their brand-name antihypertensive drug generically substituted were conducted using a semi-structured questionnaire. On average, 4.4 (1-14) prescription drugs were used by the participants. Of these, 2.0 (1-4) drugs were antihypertensives. More than 50% of the patients had been using antihypertensive drugs for more than 10 years. One in four found it difficult to remember to take their medication every day. One in three said generic substitution made keeping track of their medications more demanding. Twenty-nine percent were anxious when they started to use a generically substituted drug. Eight percent felt that the effect of the drug had changed, and 15% reported having new or more side-effects. A negative attitude towards generics was significantly associated with low educational attainment, increasing number of drugs, having general concerns about medicine use, and having received insufficient information regarding generic substitution. Five percent of the patients had been using more than one equivalent generic drug at the same time. These were among those who used several different drugs and also among those who got their medications from more than one pharmacy. Five percent is a too small number to draw general conclusions; however, there is no reason to suspect that these mistakes do not occur from time to time. This study shows that generic substitution can be an additional factor in poor drug adherence in hypertensive patients and contributes to concerns and confusion among the patients. Although generic substitution is an important measure of cost containment, health personnel should approach each patient individually. Clearly, many patients feel insecure about substituting their medication and demand more information.

  10. Alternative bio-based solvents for extraction of fat and oils: solubility prediction, global yield, extraction kinetics, chemical composition and cost of manufacturing.

    Science.gov (United States)

    Sicaire, Anne-Gaëlle; Vian, Maryline; Fine, Frédéric; Joffre, Florent; Carré, Patrick; Tostain, Sylvain; Chemat, Farid

    2015-04-15

    The present study was designed to evaluate the performance of alternative bio-based solvents, more especially 2-methyltetrahydrofuran, obtained from crop's byproducts for the substitution of petroleum solvents such as hexane in the extraction of fat and oils for food (edible oil) and non-food (bio fuel) applications. First a solvent selection as well as an evaluation of the performance was made with Hansen Solubility Parameters and the COnductor-like Screening MOdel for Realistic Solvation (COSMO-RS) simulations. Experiments were performed on rapeseed oil extraction at laboratory and pilot plant scale for the determination of lipid yields, extraction kinetics, diffusion modeling, and complete lipid composition in term of fatty acids and micronutrients (sterols, tocopherols and tocotrienols). Finally, economic and energetic evaluations of the process were conducted to estimate the cost of manufacturing using 2-methyltetrahydrofuran (MeTHF) as alternative solvent compared to hexane as petroleum solvent.

  11. Predictors of generic substitution: The role of psychological, sociodemographic, and contextual factors.

    Science.gov (United States)

    Drozdowska, Aleksandra; Hermanowski, Tomasz

    2016-01-01

    Escalating pharmaceutical costs have become a global challenge for both governments and patients. Generic substitution is one way of decreasing these costs. The aim of this study was to investigate factors associated with patients' choice between generic drugs and innovator drugs. The survey was conducted in June 2013, 1000 people from across Poland were chosen as a representative population sample. The outcome (a preference for generics/a preference for innovator pharmaceuticals/no preference) was modeled by multinomial logistic regression, adjusted for several variables describing patients' sensitivity to selected generic features (price, brand, and country of origin), to third-party opinions about generics (information on generics in the mass media, opinions of health professionals (i.e. physicians, pharmacists), relatives/friends), as well as patients' personal experiences and income per household. The results supported the predictive capacity of most independent variables (except for patient sensitivity to the country of origin and to the information on generics in the mass media), denoting patients' preferences toward generic substitution. Patient sensitivity to recommendations by physicians, generic brand, and household income were the strongest predictors of the choice between generic and innovator pharmaceuticals (P < 0.001). The probability of choosing generics over innovator drugs was significantly higher among respondents with the lowest income levels, in those who were indifferent to generic brand or their physician's opinion, as well as in respondents who were sensitive to recommendations by pharmacists or attached a greater value to a past experience with generics (their own experience or that of relatives/friends). In consideration of the foregoing, awareness-raising campaigns may be recommended, supported by a variety of systemic solutions and tools to encourage generic substitution. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Generic drug names and social welfare.

    Science.gov (United States)

    Lobo, Félix; Feldman, Roger

    2013-06-01

    This article studies how well International Nonproprietary Names (INNs), the "generic" names for pharmaceuticals, address the problems of imperfect information. Left in private hands, the identification of medicines leads to confusion and errors. Developed in the 1950s by the World Health Organization, INNs are a common, global, scientific nomenclature designed to overcome this failure. Taking stock after sixty years, we argue that the contribution of INNs to social welfare is paramount. They enhance public health by reducing errors and improving patient safety. They also contribute to economic efficiency by creating transparency as the foundation of competitive generic drug markets, reducing transaction costs, and favoring trade. The law in most countries requires manufacturers to designate pharmaceuticals with INNs in labeling and advertising. Generic substitution is also permitted or mandatory in many countries. But not all the benefits of INNs are fully realized because prescribers may not use them. We advocate strong incentives or even legally binding provisions to extend the use of INNs by prescribing physicians and dispensing pharmacists, but we do not recommend replacing brand names entirely with INNs. Instead, we propose dual use of brand names and INNs in prescribing, as in drug labeling.

  13. Costs of slurry separation technologies and alternative use of the solid fraction for biogas production or burning

    DEFF Research Database (Denmark)

    Jacobsen, Brian H.

    2011-01-01

    Separation is an option when livestock are produced in livestock intensive areas producing a surplus of nutrients. Separation of the slurry into a liquid nitrogen rich fraction and a more solid phosphorus rich fraction, which is exported away from the farm, may alleviate this problem. Separation...... and the reduction of livestock numbers in Denmark have made separation less favourable. This article discusses the many options with focus on the dominant separation technologies in Denmark, such as decanter and flocculation, as well as source separation, in order to compare them with to traditional handling. Key...... parameters are livestock density, transport distance and cost of separation. The conclusion is that unless land prices or prices on slurry agreements are very high, traditional handling of animal manure has the lowest costs. Decanter separation can be the cheapest if area is limited and co...

  14. Generic file format

    Science.gov (United States)

    Felgate, Nick

    2002-11-01

    The Generic File Format (GFF) is a file format developed within the UK ASW community for the interchange and storage of underwater sonar data. Originally developed for the interchange of time-series data between analysis systems, it has been extended to provide for storage of processed acoustic data (e.g., power and DEMON spectrum, lofargram grey-scale), nonacoustic data (e.g., own-ship dynamics, sensor configuration) and event data (e.g., tracker output, sonar intercepts). The format employs the chunk concept, as used in the WAV and AIFF file formats, to provide extendability (including local variants) while providing a measure of backward compatability. However, the basic concept has been adapted to allow for the mixing in the one file of multiple channels of different sample-rates and data-types through the inclusion of a data frame concept and multiple data blocks. Chunk cross-referencing has been employed to ensure data consistency. A provision is made in the header of the file to store details of the sensor and processing for the data (e.g., the number of hydrophones, beam direction, FFT size) so that an analysis system does not need to know about the sensor or other system from which the data originated.

  15. Generic flux coupling analysis.

    Science.gov (United States)

    Reimers, Arne C; Goldstein, Yaron; Bockmayr, Alexander

    2015-04-01

    Flux coupling analysis (FCA) has become a useful tool for aiding metabolic reconstructions and guiding genetic manipulations. Originally, it was introduced for constraint-based models of metabolic networks that are based on the steady-state assumption. Recently, we have shown that the steady-state assumption can be replaced by a weaker lattice-theoretic property related to the supports of metabolic fluxes. In this paper, we further extend our approach and develop an efficient algorithm for generic flux coupling analysis that works with any kind of qualitative pathway model. We illustrate our method by thermodynamic flux coupling analysis (tFCA), which allows studying steady-state metabolic models with loop-law thermodynamic constraints. These models do not satisfy the lattice-theoretic properties required in our previous work. For a selection of genome-scale metabolic network reconstructions, we discuss both theoretically and practically, how thermodynamic constraints strengthen the coupling results that can be obtained with classical FCA. A prototype implementation of tFCA is available at http://hoverboard.io/L4FC. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults.

    Science.gov (United States)

    Raviotta, Jonathan M; Smith, Kenneth J; DePasse, Jay; Brown, Shawn T; Shim, Eunha; Nowalk, Mary Patricia; Wateska, Angela; France, Glenson S; Zimmerman, Richard K

    2017-10-09

    High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50-64year-olds. Markov model CE analysis compared 5 strategies in 50-64year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided. The least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values. Based on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Potential Clinical and Economic Impact of Switching Branded Medications to Generics

    OpenAIRE

    Straka, Robert J.; Keohane, Denis J.; Liu, Larry Z.

    2015-01-01

    Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003?2013 using key words of ?generic s...

  18. Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study.

    Science.gov (United States)

    Hitzert, Marit; Hermus, Marieke Maa; Boesveld, Inge Ic; Franx, Arie; van der Pal-de Bruin, Karin Km; Steegers, Eric Eap; van den Akker-van Marle, EIske Me

    2017-09-11

    To estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres. Economic evaluation based on a prospective cohort study. 21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible. 3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013. Costs and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score. The total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI). We found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Acceptability and confidence in antiretroviral generics of physicians and HIV-infected patients in France

    Directory of Open Access Journals (Sweden)

    Clotilde Allavena

    2014-11-01

    Full Text Available Introduction: Switching brand name medications to generics is recommended in France in the interest of cost effectiveness but patients and physicians are sometimes not convinced that switching is appropriate. Some antiretroviral (ARV generics (ZDV, 3TC, NVP have been marketed in France since 2013. Materials and Methods: A multicentric cross-sectional survey was performed in September 2013 to evaluate the perception of generics overall and ARV generics in physicians and HIV-infected patients and factors associated to their acceptability. Adult HIV outpatients were asked to complete a self-questionnaire on their perception of generics. Physicians completed a questionnaire on the acceptability of generics and ARV generics. Socio-demographic data, medical history and HIV history were collected. Results: 116 physicians in 33 clinics (68% in University Hospital included 556 patients (France-native 77%, active employment 59%, covered by social Insurance 100%, homosexual/bisexual contamination 47%, median HIV duration 13 years, hepatitis coinfection 16%, on ARV therapy 95%. Overall, patients accepted and had confidence in generics in 76% and 55% of the cases, respectively. Switching ARVs for generics was accepted by 44% of the patients but only by 17% if the pill burden was going to increase. 75% of the physicians would prescribe generics, but this decreased to only 26% if the combo had to be broken. The main reasons for non-prescription of generics were previous brand name ARV-induced side effects (35%, refusal of generics overall (37%, lack of understanding of generics (26%, risk of non-observance of treatment (44%, anxiety (47% and depressive symptoms (25%. In multivariate analysis, factors associated with the acceptability of ARV generics in patients were the use of generics overall (p<0.001 and in physicians, the absence of concern regarding the drug efficacy (p<0.001 and being aware that the patient would accept generics overall (p=0.03 and ARV

  20. Alternative additives; Alternative additiver

    Energy Technology Data Exchange (ETDEWEB)

    2007-08-15

    In this project a number of industrial and agricultural waste products have been characterised and evaluated in terms of alkali-getter performance. The intended use is for biomass-fired power stations aiming at reducing corrosion or slagging related problems. The following products have been obtained, characterised and evaluated: 1) Brewery draff 2) Danish de-gassed manure 3) Paper sludge 4) Moulding sand 5) Spent bleaching earth 6) Anorthosite 7) Sand 8) Clay-sludge. Most of the above alternative additive candidates are deemed unsuitable due to insufficient chemical effect and/or expensive requirements for pre-treatment (such as drying and transportation). 3 products were selected for full-scale testing: de-gassed manure, spent bleaching earth and clay slugde. The full scale tests were undertaken at the biomass-fired power stations in Koege, Slagelse and Ensted. Spent bleaching earth (SBE) and clay sludge were the only tested additive candidates that had a proven ability to react with KCl, to thereby reduce Cl-concentrations in deposits, and reduce the deposit flux to superheater tubes. Their performance was shown to nearly as good as commercial additives. De-gassed manure, however, did not evaluate positively due to inhibiting effects of Ca in the manure. Furthermore, de-gassed manure has a high concentration of heavy metals, which imposes a financial burden with regard to proper disposal of the ash by-products. Clay-sludge is a wet clay slurring, and drying and transportation of this product entails substantial costs. Spent bleaching does not require much pre-treatment and is therefore the most promising alternative additive. On the other hand, bleaching earth contains residual plant oil which means that a range of legislation relating to waste combustion comes into play. Not least a waste combustion fee of 330 DKK/tonne. For all alternative (and commercial) additives disposal costs of the increase ash by-products represents a significant cost. This is

  1. Economic Evaluation of Munitions Manufacturing Pink Wastewater Treatment Alternatives Using a Present Value-Unit Cost Methodology

    Science.gov (United States)

    1982-02-01

    BASIC) and is run on a Vector Graphics Micronet II system. 2.7.2 The program is subdivided into five programs identified as PVUC-PART1, PVUC-PART2...to either PART3 or PART4. Once this option is taken, the chaining automatically occurs. 2.7.2.3 PVUC-PART3: If PART3 is t-lected, the Micronet will...sizes and modes and the corresponding capital and O&M costs were used as inputs to the Interactive PVUC Computer Model by means of the Micronet systems

  2. Theoretical analysis of the cumulative costs of different diesel bus alternatives for a public transport in the city of Belgrade

    Directory of Open Access Journals (Sweden)

    Jovanović Stevan S.

    2017-01-01

    Full Text Available This paper includes comparative analysis of the environmental, energetic, and financial costs of different bus propulsion, possibly applied on the public transport in the city of Belgrade. It considers the modern diesel bus, the trolleybus, the natural gas bus with the spark ignition engine, the electric bus using LiFePO4 battery, and the electric bus with ultra-capacitor. The results are presented according to the real data and the real electro-energetic situation in Serbia, with the dominantly used lignite coal as primary fuel. This model gives the exact exhaust emission of electric vehicles at the thermal power plant, enables its comparison to the internal combustion engine vehicles. The result in analysis shows that the natural gas bus is the most cost efficient in economical way with overall exploitation price of $87 per 100 km. The trolleybus is more economical then the natural gas powered bus only at high departures rate, higher than 230 per workday.

  3. Commercialism, Holism, and Individual Responsibility; Comment on “Buying Health: The Costs of Commercialism and an Alternative Philosophy”

    Directory of Open Access Journals (Sweden)

    Berit Bringedal

    2013-01-01

    Full Text Available Churchill and Churchill’s editorial discusses negative (health effects of commercialism in the provision of health care and nutrition. Three parts of their argument are commented: the claim that the fundamental problem of markets is the decomposition of the whole into parts (“reductionism”; the call for individual responsibility; and the notion of holism. On the three aspects the commentary concludes thus: Because provision of health and food must be controlled and managed in some form, an alternative to some kind of decomposition is hard to see. The call for individual responsibility is controversial due to its lack of attention to socioeconomic inequalities. The concept of “holism” is problematic due to its epistemological and normative status.

  4. Hanford Generic Interim Safety Basis

    Energy Technology Data Exchange (ETDEWEB)

    Lavender, J.C.

    1994-09-09

    The purpose of this document is to identify WHC programs and requirements that are an integral part of the authorization basis for nuclear facilities that are generic to all WHC-managed facilities. The purpose of these programs is to implement the DOE Orders, as WHC becomes contractually obligated to implement them. The Hanford Generic ISB focuses on the institutional controls and safety requirements identified in DOE Order 5480.23, Nuclear Safety Analysis Reports.

  5. Clinical effectiveness and cost-effectiveness of second- and third-generation left ventricular assist devices as either bridge to transplant or alternative to transplant for adults eligible for heart transplantation: systematic review and cost-effectiveness model.

    Science.gov (United States)

    Sutcliffe, P; Connock, M; Pulikottil-Jacob, R; Kandala, N-B; Suri, G; Gurung, T; Grove, A; Shyangdan, D; Briscoe, S; Maheswaran, H; Clarke, A

    2013-11-01

    Advanced heart failure (HF) is a debilitating condition for which heart transplant (HT) offers the best treatment option. However, the supply of donor hearts is diminishing and demand greatly exceeds supply. Ventricular assist devices (VADs) are surgically implanted pumps used as an alternative to transplant (ATT) or as a bridge to transplant (BTT) while a patient awaits a donor heart. Surgery and VADs are costly. For the NHS to allocate and deliver such services in a cost-effective way the relative costs and benefits of these alternative treatments need to be estimated. To investigate for patients aged ≥ 16 years with advanced HF eligible for HT: (1) the clinical effectiveness and cost-effectiveness of second- and third-generation VADs used as BTT compared with medical management (MM); and (2) the clinical effectiveness and cost-effectiveness of second- and third-generation VADs used as an ATT in comparison with their use as BTT therapy. Searches for clinical effectiveness studies covered years from 2003 to March 2012 and included the following data bases: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), HTA databases [NHS Centre for Reviews and Dissemination (CRD)], Science Citation Index and Conference Proceedings (Web of Science), UK Clinical Research Network (UKCRN) Portfolio Database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and National Library of Medicine (NLM) Gateway, Cochrane Central Register of Controlled Trials (CENTRAL), Current Controlled Trials and ClinicalTrials.gov. Reference lists of relevant articles were checked, and VAD manufacturers' websites interrogated. For economic analyses we made use of individual patient data (IPD) held in the UK Blood and Transplant Database (BTDB). Systematic reviews of evidence on clinical effectiveness and cost

  6. Cost-effectiveness analysis of the direct and indirect impact of intranasal live attenuated influenza vaccination strategies in children: alternative country profiles.

    Science.gov (United States)

    Gibson, Edward; Begum, Najida; Martinón-Torres, Federico; Safadi, Marco Aurélio; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

    2016-01-01

    Influenza poses a significant burden on healthcare systems and society, with under-recognition in the paediatric population. Existing vaccination policies (largely) target the elderly and other risk groups where complications may arise. The goal of this study was to evaluate the cost-effectiveness of annual paediatric vaccination (in 2-17-year-olds) with live attenuated influenza vaccination (LAIV), as well as the protective effect on the wider population in England and Wales (base). The study aimed to demonstrate broad applications of the model in countries where epidemiological and transmission data is limited and that have sophisticated vaccination policies (Brazil, Spain, and Taiwan). The direct and indirect impact of LAIV in the paediatric cohort was simulated using an age-stratified dynamic transmission model over a 5-year time horizon of daily cycles and applying discounting of 3.5% in the base case. Pre-existing immunity structure was based on a 1-year model run. Sensitivity analyses were conducted. In the base case for England and Wales, the annual paediatric strategy with LAIV was associated with improvements in influenza-related events and quality-adjusted life years (QALYs) lost, yielding an incremental cost per QALY of £6,208. The model was robust to change in the key input parameters. The probabilistic analysis demonstrated LAIV to be cost effective in more than 99% of iterations, assuming a willingness-to-pay threshold of £30,000. Incremental costs per QALY for Brazil were £2,817, and for the cases of Spain and Taiwan the proposed strategy was dominant over the current practice. In addition to existing policies, annual paediatric vaccination using LAIV provides a cost-effective strategy that offers direct and indirect protection in the wider community. Paediatric vaccination strategies using LAIV demonstrated clinical and economic benefits over alternative (current vaccination) strategies in England and Wales as well as Brazil, Spain, and Taiwan.

  7. Life-Cycle Cost and Risk Analysis of Alternative Configurations for Shipping Low-Level Radioactive Waste to the Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    PM Daling; SB Ross; BM Biwer

    1999-12-17

    The Nevada Test Site (NTS) is a major receiver of low-level radioactive waste (LLW) for disposal. Currently, all LLW received at NTS is shipped by truck. The trucks use highway routes to NTS that pass through the Las Vegas Valley and over Hoover Dam, which is a concern of local stakeholder groups in the State of Nevada. Rail service offers the opportunity to reduce transportation risks and costs, according to the Waste Management Programmatic Environmental Impact Statement (WM-PEIS). However, NTS and some DOE LLW generator sites are not served with direct rail service so intermodal transport is under consideration. Intermodal transport involves transport via two modes, in this case truck and rail, from the generator sites to NTS. LLW shipping containers would be transferred between trucks and railcars at intermodal transfer points near the LLW generator sites, NTS, or both. An Environmental Assessment (EA)for Intermodal Transportation of Low-Level Radioactive Waste to the Nevada Test Site (referred to as the NTSIntermodal -M) has been prepared to determine whether there are environmental impacts to alterations to the current truck routing or use of intermodal facilities within the State of Nevada. However, an analysis of the potential impacts outside the State of Nevada are not addressed in the NTS Intermodal EA. This study examines the rest of the transportation network between LLW generator sites and the NTS and evaluates the costs, risks, and feasibility of integrating intermodal shipments into the LLW transportation system. This study evaluates alternative transportation system configurations for NTS approved and potential generators based on complex-wide LLW load information. Technical judgments relative to the availability of DOE LLW generators to ship from their sites by rail were developed. Public and worker risk and life-cycle cost components are quantified. The study identifies and evaluates alternative scenarios that increase the use of rail (intermodal

  8. Challenging sequential approach to treatment resistant depression: cost-utility analysis based on the Sequenced Treatment Alternatives to Relieve Depression (STAR(⁎)D) trial.

    Science.gov (United States)

    Olgiati, Paolo; Bajo, Emanuele; Bigelli, Marco; Montgomery, Stuart; Serretti, Alessandro

    2013-12-01

    In major depression, when a first antidepressant does not cause remission of symptoms (60%-75%), there are several options for continuing treatment in the next step. This study is a cost-utility analysis (CUA) of different second-line approaches. In a simulated trial outpatients with MDD were treated with citalopram for 13 weeks (level 1), then based on two alternative algorithms implemented from the Sequenced Treatment Alternatives to Relieve Depression (STAR(*)D) study. Algorithm A: citalopram was continued until study endpoint (week 26). Algorithm B: patients who remitted during level 1 continued citalopram. Those who did not remit could opt for switching to another antidepressant (venlafaxine; sertraline) (b1) or adding bupropion to citalopram treatment (augmentation; b2). Algorithm B increased remission rate by 10.6% over Algorithm A (number needed to treat: 9.9; sensitivity range: 9.1-12.5). As a comparison, differences between active antidepressants and placebo are associated with NNT values of 6 to 8. In CUA Algorithm B was dominant with an ICER of $11,813 (sensitivity range=$1783 - $21,784), which is cost-effectiveness threshold (USA=$47,193). Among Algorithm B options, switching (b1) dominated Algorithm A with a smaller number of responders than augmentation approach (b2) (NNT 11 vs. 7.7), whereas ICER values were similar (b1: $14,738; b2: $15,458). However we cannot exclude a bias in selecting second treatment. This cost-utility analysis shows (in line with current guidelines) a benefit in modifying antidepressant treatment if response to first-line agent does not occur within 3 months, but not a clear-cut evidence in terms of NNT. © 2013 Elsevier B.V. and ECNP. All rights reserved.

  9. Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending.

    Science.gov (United States)

    Wouters, Olivier J; Kanavos, Panos G; McKEE, Martin

    2017-09-01

    Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy

  10. [Switching to a generic drugA blessing or a curse?

    NARCIS (Netherlands)

    Ebbelaar, C.F.; Lammers, H.A.; Schobben, A.F.

    2016-01-01

    A patient suffering from Zollinger-Ellison was treated with Nexium, but after patent expiry only the costs of generic omeprazol were reimbursed. Generic tablets and capsules, pantoprazol and rabeprazol, were tried without success and finally the pharmacist dispensed Nexium at his own expense.

  11. Generic substitution of antihypertensive drugs : does it affect adherence?

    NARCIS (Netherlands)

    Van Wijk, Boris L G; Klungel, Olaf H; Heerdink, Eibert R; de Boer, Anthonius

    BACKGROUND: Generic substitution is an important opportunity to reduce the costs of pharmaceutical care. However, pharmacists and physicians often find that patients and brand-name manufacturers have doubt about the equivalence of the substituted drug. This may be reflected by decreased adherence to

  12. Towards emotion modeling based on gaze dynamics in generic interfaces

    DEFF Research Database (Denmark)

    Vester-Christensen, Martin; Leimberg, Denis; Ersbøll, Bjarne Kjær

    2005-01-01

    Gaze detection can be a useful ingredient in generic human computer interfaces if current technical barriers are overcome. We discuss the feasibility of concurrent posture and eye-tracking in the context of single (low cost) camera imagery. The ingredients in the approach are posture and eye regi...

  13. Avoidance of generic competition by Abbott Laboratories' fenofibrate franchise.

    Science.gov (United States)

    Downing, Nicholas S; Ross, Joseph S; Jackevicius, Cynthia A; Krumholz, Harlan M

    2012-05-14

    The ongoing debate concerning the efficacy of fenofibrate has overshadowed an important aspect of the drug's history: Abbott Laboratories, the maker of branded fenofibrate, has produced several bioequivalent reformulations that dominate the market, although generic fenofibrate has been available for almost a decade. This continued use of branded formulations, which cost twice as much as generic versions of fenofibrate, imposes an annual cost of approximately $700 million on the US health care system. Abbott Laboratories maintained its dominance of the fenofibrate market in part through a complex switching strategy involving the sequential launch of branded reformulations that had not been shown to be superior to the first-generation product and patent litigation that delayed the approval of generic formulations. The small differences in dose of the newer branded formulations prevented their substitution with generics of older-generation products. As soon as direct generic competition seemed likely at the new dose level, where substitution would be allowed, Abbott would launch another reformulation, and the cycle would repeat. Based on the fenofibrate example, our objective is to describe how current policy can allow pharmaceutical companies to maintain market share using reformulations of branded medications, without demonstrating the superiority of next-generation products.

  14. A simple and cost-effective method, as an appropriate alternative for visible spectrophotometry: development of a dopamine biosensor.

    Science.gov (United States)

    Abbaspour, Abdolkarim; Khajehzadeh, Abdolreza; Ghaffarinejad, Ali

    2009-08-01

    In this study, a new, simple, fast and inexpensive method as an alternative to visible spectrophotometry is developed. In this method the cells containing the sample solution were scanned with a scanner, then the color of each cell was analyzed with software written in visual basic (VB 6) media to red, green and blue values. The cells were built by creating holes in the Plexiglas sheet. The dimensions of identical cells were examined by Cr (III) solution with known concentrations. The validity of this new method was studied by determination of dopamine (DA) without using any other reagent. The parameters which affect the system were optimized. The comparison between the current and traditional UV-Vis spectrophotometry methods was studied and the results revealed similar trends in both methods. The developed method was successfully applied to the determination of dopamine in serum and urine without using any pretreatment. Finally comparing the results obtained in the developed method showed that microwave irradiation of the solution can decrease the experimental time, increase sensitivity and improve the limit of detection.

  15. Generic penetration in the retail antidepressant market.

    Science.gov (United States)

    Ventimiglia, Jeffrey; Kalali, Amir H

    2010-06-01

    In this article, we explore the accelerated penetration of generic antidepressants in the United States market following the availability of generic citalopram and sertraline. Analysis suggests that overall, generic penetration into the antidepressant market has grown from approximately 41 percent in January 2004 to over 73 percent in January 2010. Similar trends are uncovered when branded and generic prescriptions are analyzed by specialty.

  16. Local infiltration of rabies immunoglobulins without systemic intramuscular administration: An alternative cost effective approach for passive immunization against rabies.

    Science.gov (United States)

    Bharti, Omesh Kumar; Madhusudana, Shampur Narayan; Gaunta, Pyare Lal; Belludi, Ashwin Yajaman

    2016-03-03

    Presently the dose of rabies immunoglobulin (RIG) which is an integral part of rabies post exposure prophylaxis (PEP) is calculated based on body weight though the recommendation is to infiltrate the wound(s). This practice demands large quantities of RIG which may be unaffordable to many patients. In this background, we conducted this study to know if the quantity and cost of RIG can be reduced by restricting passive immunization to local infiltration alone and avoiding systemic intramuscular administration based on the available scientific evidence. Two hundred and sixty nine category III patients bitten by suspect or confirmed rabid dogs/animals were infiltrated with equine rabies immunoglobulin (ERIGs) in and around the wound. The quantity of ERIG used was proportionate to the size and number of wounds irrespective of their body weight. They were followed with a regular course of rabies vaccination by intra-dermal route. As against 363 vials of RIGs required for all these cases as per current recommendation based on body weight, they required only 42 vials of 5ml RIG. Minimum dose of RIGs given was 0.25 ml and maximum dose given was 8 ml. On an average 1.26 ml of RIGs was required per patient that costs Rs. 150 ($3). All the patients were followed for 9 months and they were healthy and normal at the end of observation period. With local infiltration, that required small quantities of RIG, the RIGs could be made available to all patients in times of short supply in the market. A total of 30 (11%) serum samples of patients were tested for rabies virus neutralizing antibodies by the rapid fluorescent focus inhibition test (RFFIT) and all showed antibody titers >0.5 IU/mL by day 14. In no case the dose was higher than that required based on body weight and no immunosuppression resulted. To conclude, this pilot study shows that local infiltration of RIG need to be considered in times of non-availability in the market or unaffordability by poor patients. This

  17. low-Cost, High-Performance Alternatives for Target Temperature Monitoring Using the Near-Infrared Spectrum

    Energy Technology Data Exchange (ETDEWEB)

    Virgo, Mathew [Argonne National Lab. (ANL), Argonne, IL (United States); Quigley, Kevin J. [Argonne National Lab. (ANL), Argonne, IL (United States); Chemerisov, Sergey [Argonne National Lab. (ANL), Argonne, IL (United States); Vandegrift, George F. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2017-02-01

    A process is being developed for commercial production of the medical isotope Mo-99 through a photo-nuclear reaction on a Mo-100 target using a highpower electron accelerator. This process requires temperature monitoring of the window through which a high-current electron beam is transmitted to the target. For this purpose, we evaluated two near infrared technologies: the OMEGA Engineering iR2 pyrometer and the Ocean Optics Maya2000 spectrometer with infrared-enhanced charge-coupled device (CCD) sensor. Measuring in the near infrared spectrum, in contrast to the long-wavelength infrared spectrum, offers a few immediate advantages: (1) ordinary glass or quartz optical elements can be used; (2) alignment can be performed without heating the target; and (3) emissivity corrections to temperature are typically less than 10%. If spatial resolution is not required, the infrared pyrometer is attractive because of its accuracy, low cost, and simplicity. If spatial resolution is required, we make recommendations for near-infrared imaging based on our data augmented by calculations

  18. A Critical Comparison of Alternative Distribution Configurations in Omni-Channel Retailing in Terms of Cost and Greenhouse Gas Emissions

    Directory of Open Access Journals (Sweden)

    Marco Melacini

    2018-01-01

    Full Text Available New opportunities and challenges forced by the ever-increasing importance of the online channel have arisen for retailers. The retailing industry is moving to a new phase, in which the distinctions between traditional and online channels disappear, namely omni-channel (OC retailing. At the same time, the awareness of environmentally sustainable processes has been enhanced around the world and the environmental impact that results from the online order fulfilment process is becoming a key issue for logistics managers. The new challenge is to understand how multiple channels can be synergistically managed to provide a seamless customer experience, taking an economic and environmental perspective simultaneously. Retailers need to define the distribution configuration for serving the online demand, making decisions on the integration level between online and traditional channels. In this paper, we developed an assessment model of the operational costs and greenhouse gas emissions for three distribution configurations in OC retailing. The model was also applied to a real case operating in the consumer electronics industry. Results highlighted that the search for synergies between online and traditional flows in both warehouse and transport activities is a key factor for the economic and environmental sustainability of OC systems.

  19. Transportation Energy Futures Series: Alternative Fuel Infrastructure Expansion: Costs, Resources, Production Capacity, and Retail Availability for Low-Carbon Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, M. W.; Heath, G.; Sandor, D.; Steward, D.; Vimmerstedt, L.; Warner, E.; Webster, K. W.

    2013-04-01

    Achieving the Department of Energy target of an 80% reduction in greenhouse gas emissions by 2050 depends on transportation-related strategies combining technology innovation, market adoption, and changes in consumer behavior. This study examines expanding low-carbon transportation fuel infrastructure to achieve deep GHG emissions reductions, with an emphasis on fuel production facilities and retail components serving light-duty vehicles. Three distinct low-carbon fuel supply scenarios are examined: Portfolio: Successful deployment of a range of advanced vehicle and fuel technologies; Combustion: Market dominance by hybridized internal combustion engine vehicles fueled by advanced biofuels and natural gas; Electrification: Market dominance by electric drive vehicles in the LDV sector, including battery electric, plug-in hybrid, and fuel cell vehicles, that are fueled by low-carbon electricity and hydrogen. A range of possible low-carbon fuel demand outcomes are explored in terms of the scale and scope of infrastructure expansion requirements and evaluated based on fuel costs, energy resource utilization, fuel production infrastructure expansion, and retail infrastructure expansion for LDVs. This is one of a series of reports produced as a result of the Transportation Energy Futures (TEF) project, a Department of Energy-sponsored multi-agency project initiated to pinpoint underexplored transportation-related strategies for abating GHGs and reducing petroleum dependence.

  20. Generic Graph Grammar: A Simple Grammar for Generic Procedural Modelling

    DEFF Research Database (Denmark)

    Christiansen, Asger Nyman; Bærentzen, Jakob Andreas

    2012-01-01

    of greater complexity. Consequently, there is a need for a simple, general method which is capable of generating both types of objects. Generic Graph Grammar has been developed to address this need. The production rules consist of a small set of basic productions which are applied directly onto primitives...... in a directed cyclic graph. Furthermore, the basic productions are chosen such that Generic Graph Grammar seamlessly combines the capabilities of L-systems to imitate biological growth (to model trees, animals, etc.) and those of split grammars to design structured objects (chairs, houses, etc.). This results...... in a highly expressive grammar capable of generating a wide range of types of models. Models which consist of skeletal structures or surfaces or any combination of these. Besides generic modelling capabilities, the focus has also been on usability, especially userfriendliness and efficiency. Therefore several...

  1. Computer simulation of energy use, greenhouse gas emissions, and costs for alternative methods of processing fluid milk.

    Science.gov (United States)

    Tomasula, P M; Datta, N; Yee, W C F; McAloon, A J; Nutter, D W; Sampedro, F; Bonnaillie, L M

    2014-07-01

    Computer simulation is a useful tool for benchmarking electrical and fuel energy consumption and water use in a fluid milk plant. In this study, a computer simulation model of the fluid milk process based on high temperature, short time (HTST) pasteurization was extended to include models for processes for shelf-stable milk and extended shelf-life milk that may help prevent the loss or waste of milk that leads to increases in the greenhouse gas (GHG) emissions for fluid milk. The models were for UHT processing, crossflow microfiltration (MF) without HTST pasteurization, crossflow MF followed by HTST pasteurization (MF/HTST), crossflow MF/HTST with partial homogenization, and pulsed electric field (PEF) processing, and were incorporated into the existing model for the fluid milk process. Simulation trials were conducted assuming a production rate for the plants of 113.6 million liters of milk per year to produce only whole milk (3.25%) and 40% cream. Results showed that GHG emissions in the form of process-related CO₂ emissions, defined as CO₂ equivalents (e)/kg of raw milk processed (RMP), and specific energy consumptions (SEC) for electricity and natural gas use for the HTST process alone were 37.6g of CO₂e/kg of RMP, 0.14 MJ/kg of RMP, and 0.13 MJ/kg of RMP, respectively. Emissions of CO2 and SEC for electricity and natural gas use were highest for the PEF process, with values of 99.1g of CO₂e/kg of RMP, 0.44 MJ/kg of RMP, and 0.10 MJ/kg of RMP, respectively, and lowest for the UHT process at 31.4 g of CO₂e/kg of RMP, 0.10 MJ/kg of RMP, and 0.17 MJ/kg of RMP. Estimated unit production costs associated with the various processes were lowest for the HTST process and MF/HTST with partial homogenization at $0.507/L and highest for the UHT process at $0.60/L. The increase in shelf life associated with the UHT and MF processes may eliminate some of the supply chain product and consumer losses and waste of milk and compensate for the small increases in GHG

  2. Generic hierarchical engine for mask data preparation

    Science.gov (United States)

    Kalus, Christian K.; Roessl, Wolfgang; Schnitker, Uwe; Simecek, Michal

    2002-07-01

    Electronic layouts are usually flattened on their path from the hierarchical source downstream to the wafer. Mask data preparation has certainly been identified as a severe bottleneck since long. Data volumes are not only doubling every year along the ITRS roadmap. With the advent of optical proximity correction and phase-shifting masks data volumes are escalating up to non-manageable heights. Hierarchical treatment is one of the most powerful means to keep memory and CPU consumption in reasonable ranges. Only recently, however, has this technique acquired more public attention. Mask data preparation is the most critical area calling for a sound infrastructure to reduce the handling problem. Gaining more and more attention though, are other applications such as large area simulation and manufacturing rule checking (MRC). They all would profit from a generic engine capable to efficiently treat hierarchical data. In this paper we will present a generic engine for hierarchical treatment which solves the major problem, steady transitions along cell borders. Several alternatives exist how to walk through the hierarchy tree. They have, to date, not been thoroughly investigated. One is a bottom-up attempt to treat cells starting with the most elementary cells. The other one is a top-down approach which lends itself to creating a new hierarchy tree. In addition, since the variety, degree of hierarchy and quality of layouts extends over a wide range a generic engine has to take intelligent decisions when exploding the hierarchy tree. Several applications will be shown, in particular how far the limits can be pushed with the current hierarchical engine.

  3. Evidence for enhancing charge collection efficiency with an alternative cost-effective binary ionic liquids electrolyte based dye-sensitized solar cells

    Energy Technology Data Exchange (ETDEWEB)

    Hao Feng [State Key Laboratory of New Ceramics and Fine Processing, Department of Material Science and Engineering, Tsinghua University, Beijing 100084 (China); Lin Hong, E-mail: Hong-lin@tsinghua.edu.cn [State Key Laboratory of New Ceramics and Fine Processing, Department of Material Science and Engineering, Tsinghua University, Beijing 100084 (China); Liu Yizhu [State Key Laboratory of New Ceramics and Fine Processing, Department of Material Science and Engineering, Tsinghua University, Beijing 100084 (China); Yang Guijun; Wang Gang [School of Mechanical Engineering, Qinghai University, Xining 810016 (China); Li Jianbao [State Key Laboratory of New Ceramics and Fine Processing, Department of Material Science and Engineering, Tsinghua University, Beijing 100084 (China)

    2011-06-30

    Highlights: > Cost-effective and highly conductive binary ionic liquids electrolyte. > Dynamics of electron transport and charge recombination processes. > Significantly decreased diffusion resistance and retarded charge recombination. > Improving the effective electron diffusion length and charge collection efficiency. - Abstract: To mitigate the mass transfer limitations of a highly viscous room temperature ionic liquid (RTIL) electrolyte, systematic characterizations of viscosity, ionic conductivity, apparent triiodide diffusion coefficient and photovoltaic response of an alternative cost-effective and highly conductive binary RTIL mixture of 1-ethyl-3-methylimidazolium trifluoroacetate (EMIATF) and 1-methyl-3-propylimidazolium iodide (PMII) were investigated. An emphasis was placed on the dynamics of electron transport and charge recombination processes; specifically, a focus was placed on the effective electron diffusion length and charge collection efficiency in the devices. Notably, the introduction of perfluorinated anions, with a strong delocalization of the negative charge over the anion backbone, was able to weaken the hydrogen bonding with the imidazolium cations and, thus, decrease the viscosity and increase the ionic conductivity of the electrolyte. A sealed device that employed the binary RTIL achieved an overall conversion efficiency of 5.22% under irradiation of 100 mW cm{sup -2}, which increased the value by 30% compared to a device with a blank PMII-based RTIL electrolyte. Electrochemical impedance spectroscopy and intensity-modulated photovoltage/photocurrent spectroscopy analysis revealed that employment of this alternative binary RTIL electrolyte system was able to significantly decrease the diffusion resistance of triiodide species in the electrolyte and retard the charge recombination between the injected electrons with triiodide anions in the electrolyte, thus improving the effective electron diffusion length and charge collection

  4. Alternative Test Methods for Electronic Parts

    Science.gov (United States)

    Plante, Jeannette

    2004-01-01

    It is common practice within NASA to test electronic parts at the manufacturing lot level to demonstrate, statistically, that parts from the lot tested will not fail in service using generic application conditions. The test methods and the generic application conditions used have been developed over the years through cooperation between NASA, DoD, and industry in order to establish a common set of standard practices. These common practices, found in MIL-STD-883, MIL-STD-750, military part specifications, EEE-INST-002, and other guidelines are preferred because they are considered to be effective and repeatable and their results are usually straightforward to interpret. These practices can sometimes be unavailable to some NASA projects due to special application conditions that must be addressed, such as schedule constraints, cost constraints, logistical constraints, or advances in the technology that make the historical standards an inappropriate choice for establishing part performance and reliability. Alternate methods have begun to emerge and to be used by NASA programs to test parts individually or as part of a system, especially when standard lot tests cannot be applied. Four alternate screening methods will be discussed in this paper: Highly accelerated life test (HALT), forward voltage drop tests for evaluating wire-bond integrity, burn-in options during or after highly accelerated stress test (HAST), and board-level qualification.

  5. 'Genericism' in Danish welfare professions

    DEFF Research Database (Denmark)

    Larsen, Verner

    and skills in the basic disciplines of the professions also termed as disciplinary and procedural knowledge '. Thus the main research question for this paper is: What consequences do recent reform actions in Danish welfare education concerning generic competence have on developing professional knowledge......Our paper is based on an ongoing research project about ‘genericism’ in Danish professional education. We critically discuss the concept of 'generic skills' and argue that the ability to act professionally and reflective, even in changing contexts, should foremost be based on extensive knowledge...

  6. Generic substitution comparing the clinical efficacy of a generic ...

    African Journals Online (AJOL)

    The study was a double-blind randomised trial involving two parallel groups - generic substitution v. original product. Chronic schizophrenics, aged between 18 and 65 years, who had been on a constant dose of fluphenazine decanoate for at least 3 months preceding the trial, all treated as outpatients in the community, ...

  7. Translation and validation of the Arabic version of generic medicines scale.

    Science.gov (United States)

    Alefan, Qais; Karasneh, Aseel; El-Dahiyat, Faris; Alshara, Mohd; Abu-Naser, Dania

    Generic drugs are considered the best alternative for the originator brand drugs because they have the same quality, safety, and efficacy yet offered at considerbaly lower cost. Prior research has developed instrumentation to assess patients' perceptions of generic drugs; however, little has been done to translate these measures in other languages. This study's aim was to translate and validate an Arabic version of the generic drug scale (GMS) in a Jordanian sample. This was a cross-sectional study. The English version of the GMS was translated to an Arabic version using the standard "forward-backward" procedure of translation. The questionnaire was distributed to 225 patients. The translated version was then validated in a sample of patients. Face validity of the translated GMS was confirmed with pilot testing. Content validity of the translated GMS was evaluated by a number of pharmacists and academicians. Confirmatory factor analysis (CFA) was used to test a pre-specified relationship of observed measures. The GMS consisted of two subscales: efficacy, and similarity of generic drugs to originator brand drugs. The efficacy subscale consisted of ten items while the similarity subscale consisted of six. The responses to the items were framed on five-point, Likert-type scales. The instrument demonstrated good internal consistency (Cronbach's alpha = 0.83). The range model fit was good for some fit indices. The RMSEA value was 0.08, which indicates good fit. Also, CMIN/DF indicated a good fit model with a value of 2.7, as well as GFI and CFI values of 0.95 and 0.91, respectively. NFI and CFI values were 0.92 and 0.93, respectively. Factor loadings were over 0.30 for all items, which means the scale has CFA validity indictors. The Arabic version of GMS was proved to be a reliable and valid measure to investigate patients' belief regarding generic drugs as it showed acceptable, internal consistency reliability, face and content validity. Copyright © 2016 Elsevier

  8. ASSESSMENT OF QUALITY OF GENERICS IN CARDIOLOGY: REALITY AND POSSIBILITIES

    Directory of Open Access Journals (Sweden)

    V. V. Yakusevich

    2015-12-01

    Full Text Available Wide presence of original drugs’ copies, the so-called “generics”, on the pharmaceutical market is analyzed. The positive side of this expansion is connected with the lower price of generics, which makes it possible to decrease the costs of treatment. From the other side with the advent of big number of copies of the original drugs it becomes more difficult to assess the quality of each particular generic. Russian legislation in the field of registration allows selling in the country almost all drugs, which have at least minimal similarity to the original. The problem of pre-registration studies of bioequivalency of original and analogue drugs, therapeutical equivalency is widely observed. Concrete proposals of how to prevent the overflow of the Russian market with the generics with the unproved efficacy and safety are considered.

  9. ASSESSMENT OF QUALITY OF GENERICS IN CARDIOLOGY: REALITY AND POSSIBILITIES

    Directory of Open Access Journals (Sweden)

    V. V. Yakusevich

    2005-01-01

    Full Text Available Wide presence of original drugs’ copies, the so-called “generics”, on the pharmaceutical market is analyzed. The positive side of this expansion is connected with the lower price of generics, which makes it possible to decrease the costs of treatment. From the other side with the advent of big number of copies of the original drugs it becomes more difficult to assess the quality of each particular generic. Russian legislation in the field of registration allows selling in the country almost all drugs, which have at least minimal similarity to the original. The problem of pre-registration studies of bioequivalency of original and analogue drugs, therapeutical equivalency is widely observed. Concrete proposals of how to prevent the overflow of the Russian market with the generics with the unproved efficacy and safety are considered.

  10. Attitudes of Slovene general practitioners towards generic drug prescribing and comparison with international studies.

    Science.gov (United States)

    Kersnik, J; Peklar, J

    2006-12-01

    Over the recent years there has been a steady 7% yearly increase in prescribing costs, which accounts for 17% of the Slovene national health care budget. Substitution of branded products by generic equivalents can offer savings. General practitioners (GPs) are often concerned about the quality of generic products and possible legal liabilities associated with their use. We wanted to examine the attitudes of GPs in Slovenia towards generic drug prescribing. We conducted a postal survey of a random sample of 200 out of 800 GPs in Slovenia from the National Health Insurance Institute database. GPs were asked 21 questions regarding their knowledge on generic drugs, awareness of prescribing costs, prices of generic drugs relative to brand name drugs and their attitude towards use of generic drugs. The 117 (58.5%) replies we received represent 15% of the GP population in Slovenia. 66.1% of GPs considered rising costs of medicines to be a serious problem for the health care budget. Each week, over 50% of GPs experienced demands from patients for specific drugs and the majority of GPs usually met their patients' demands or requests from hospital consultants for branded products. 38.3% of GPs did not take price into consideration when prescribing drugs. The majority of GPs (88.9%) perceived generics to have the same effectiveness as branded drugs. One quarter of GPs would prescribe more generics if additional clinical trials were presented. 37.3% would follow advice of academic detailers and 30.3% expected the generics to be even cheaper than they were. Independent detailing was welcomed by 63.8% of GPs because of the big influence of the pharmaceutical industry on the prescribing habits. 15.5% thought that the industry had a tremendous impact on their prescribing patterns. Slovene GPs are aware of the cost of prescribed drugs. They are willing to accept independent academic detailing to improve their prescribing and are willing to increase generic drugs under certain

  11. Brand Medications and Medicare Part D: How Eye Care Providers' Prescribing Patterns Influence Costs.

    Science.gov (United States)

    Newman-Casey, Paula Anne; Woodward, Maria A; Niziol, Leslie M; Lee, Paul P; De Lott, Lindsey B

    2018-03-01

    To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. Retrospective cross-sectional study. Eye care providers prescribing medications through Medicare Part D in 2013. Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). Total cost of brand and generic medications prescribed by eye care providers. Eye care providers accounted for $2.4 billion in total Medicare part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, P < 0.001; 79% vs. 56% by total cost, P < 0.001). The total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, CA), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings). Eye care

  12. HOW IS CURRENT PHARMACEUTICALS PRICING POLICY ON GENERICS PERFORMING IN TURKEY REGARDING PRICE EROSION?

    Directory of Open Access Journals (Sweden)

    Kadir GÜRSOY

    2017-02-01

    Full Text Available Generics are commonly accepted to contribute significantly to treating disease by improving the affordability of pharmaceuticals. Once the patent expires for an originator brand, generics erode prices through creating fierce competition. The objective of this study is to investigate on Turkish pharmaceutical policies over generics through measuring how much they lower the prices, and then develop alternative strategies to maintain higher level of price reduction, and hence saving. Claims data from Turkish Social Security Institution (SSI for all ambulatory care drugs reimbursed were collected monthly in the period of January 2009 to December 2013 and for selected 12 equivalent groups price erosion and saving impacts due to generic entry be computed. Moreover, the price erosion for 15 generics entering the reimbursement list in 2012 as first generics was measured. For 12 equivalent groups constituting nearly 7% of SSI drug spending, the price erosion was nearly 41% ranging from 8% to 74%. In the first year of the first generic entry, on average the prices were only shrank by 39% with an increase of 41% in units sold. As a result of those analyses, it is concluded that Turkey is not maximizing its full potential with respect to generic medicines. Therefore, it is of great importance that policies such as therapeutic equivalence, tendering, and aggressive generic pricing policy to stimulate higher savings need to be introduced in the near future.

  13. GENERIC model for multiphase systems

    NARCIS (Netherlands)

    Sagis, L.M.C.

    2010-01-01

    GENERIC is a nonequilibrium thermodynamic formalism in which the dynamic behavior of a system is described by a single compact equation involving two types of brackets: a Poisson bracket and a dissipative bracket. This formalism has proved to be a very powerful instrument to model the dynamic

  14. Perception of antiretroviral generic medicines: one-day survey of HIV-infected patients and their physicians in France.

    Science.gov (United States)

    Jacomet, Christine; Allavena, Clotilde; Peyrol, Fleur; Pereira, Bruno; Joubert, Laurence Morand; Bagheri, Haleh; Cotte, Laurent; Garaffo, Rodolphe; Gerbaud, Laurent; Dellamonica, Pierre

    2015-01-01

    In the interest of cost effectiveness, switching antiretroviral brand name medications to generics is recommended in France since 2013. The study objective was to evaluate the perception of generics per se and antiretroviral generics in HIV-infected patients and their hospital physicians. 556 out of 703 (79%) adult HIV+ outpatients and 116 physicians in 33 clinics were included in a multicentric cross-sectional survey performed in September 2013. Patients completed a self-questionnaire on their perception and acceptability of generics. Physicians completed a questionnaire on their acceptability of switching antiretroviral to generic. Socio-demographic data, medical history and HIV history were collected. Among the 556 patients with a median HIV duration of 13 years, 77% were France native, 59% in active employment, 100% covered by social insurance, 95% on antiretroviral therapy. Seventy-six percent of the patients accepted generics and 55% trusted them overall. Antiretroviral generics were accepted by 44% of them but only by 17% if the pill burden was going to increase. The factor significantly associated with acceptability of antiretroviral generics was acceptance of generics per se (p<0.001). Among the 116 physicians following a median of 100 HIV-patients/year, 75% would prescribe generics, dropping to 26% if the combo had to be broken. Factors significantly associated with willingness to prescribe antiretroviral generics were the absence of concern regarding the chemical entity (OR = 0.33), being aware that the patient would accept generics for other pathologies (OR = 2.04) and would accept antiretroviral generics (OR = 1.94). No factor related to sociodemographic conditions, HIV status or comorbidities was associated with the acceptability of antiretroviral generics. Acceptability of antiretroviral generics in this French population was mostly dictated by the patient's and physician's knowledge and use of generics overall. It should be improved with an

  15. Perception of antiretroviral generic medicines: one-day survey of HIV-infected patients and their physicians in France.

    Directory of Open Access Journals (Sweden)

    Christine Jacomet

    Full Text Available In the interest of cost effectiveness, switching antiretroviral brand name medications to generics is recommended in France since 2013. The study objective was to evaluate the perception of generics per se and antiretroviral generics in HIV-infected patients and their hospital physicians.556 out of 703 (79% adult HIV+ outpatients and 116 physicians in 33 clinics were included in a multicentric cross-sectional survey performed in September 2013. Patients completed a self-questionnaire on their perception and acceptability of generics. Physicians completed a questionnaire on their acceptability of switching antiretroviral to generic. Socio-demographic data, medical history and HIV history were collected. Among the 556 patients with a median HIV duration of 13 years, 77% were France native, 59% in active employment, 100% covered by social insurance, 95% on antiretroviral therapy. Seventy-six percent of the patients accepted generics and 55% trusted them overall. Antiretroviral generics were accepted by 44% of them but only by 17% if the pill burden was going to increase. The factor significantly associated with acceptability of antiretroviral generics was acceptance of generics per se (p<0.001. Among the 116 physicians following a median of 100 HIV-patients/year, 75% would prescribe generics, dropping to 26% if the combo had to be broken. Factors significantly associated with willingness to prescribe antiretroviral generics were the absence of concern regarding the chemical entity (OR = 0.33, being aware that the patient would accept generics for other pathologies (OR = 2.04 and would accept antiretroviral generics (OR = 1.94. No factor related to sociodemographic conditions, HIV status or comorbidities was associated with the acceptability of antiretroviral generics.Acceptability of antiretroviral generics in this French population was mostly dictated by the patient's and physician's knowledge and use of generics overall. It should be improved

  16. Perceived and actual cost of healthier foods versus their less healthy alternatives: a case study in a predominantly black urban township in South Africa.

    Science.gov (United States)

    Muzigaba, M; Puoane, T

    2011-12-01

    There is an increasing awareness of the role played by the food retail characteristics in determining individuals' healthy food purchasing and consumption behaviors. The perceived costs of healthier food alternatives have been shown to contribute negatively to individual's food choices in developed societies. However, there is still a dearth of knowledge regarding this phenomenon in low to middle income countries particularly in Africa. This study explored health club member's experiences in buying healthier food options and compared their perceived cost of selected healthier and less healthy foods with actual market costs in a South African township. A cross-sectional study design using quantitative and qualitative research methods. The study was conducted in Khayelitsha, a township in the Western Cape Province in South Africa. Participants were 50 members of a health club, mostly female and above 50 years of age. The study was conducted in three phases. The first phase involved interviews with all 50 health club members. During the second phase ten purposively selected members participated in in-depth interviews based on their unhealthy food-purchasing and consumption patterns identified in the first phase. The third phase involved food price audits from supermarkets as well as convenient stores located in the study setting. Quantitative data were subjected to descriptive statistical analysis, while content analysis was used to analyze qualitative data. Most of the members were illiterate and unemployed, largely dependent on government grants. Qualitative findings showed that low household incomes, their inability to read and interpret nutritional information and personal food preferences contributed to Health club members' unhealthy food-purchasing behaviour. When objectively measured in local stores, the healthier food options proved to be more expensive than their less healthy equivalents. This was consistent with subjects' perceptions about the relative cost

  17. Generic small modular reactor plant design.

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Tom Goslee,; Cipiti, Benjamin B.; Jordan, Sabina Erteza; Baum, Gregory A.

    2012-12-01

    This report gives an overview of expected design characteristics, concepts, and procedures for small modular reactors. The purpose of this report is to provide those who are interested in reducing the cost and improving the safety of advanced nuclear power plants with a generic design that possesses enough detail in a non-sensitive manner to give merit to their conclusions. The report is focused on light water reactor technology, but does add details on what could be different in a more advanced design (see Appendix). Numerous reactor and facility concepts were used for inspiration (documented in the bibliography). The final design described here is conceptual and does not reflect any proposed concept or sub-systems, thus any details given here are only relevant within this report. This report does not include any design or engineering calculations.

  18. DRUG COSTS UPDATE ON THE PHARMACEUTICAL INDUSTRY

    African Journals Online (AJOL)

    Enrique

    to costs of medication, generic medication and antiretroviral therapy. This article aims to provide a summary of the publication and provide background information where necessary. Generic medicines are copies of branded (original) medicines that are produced and sold at lower costs once the originator's patent protection ...

  19. Water Use in Enhanced Geothermal Systems (EGS): Geology of U.S. Stimulation Projects, Water Costs, and Alternative Water Source Policies

    Energy Technology Data Exchange (ETDEWEB)

    Harto, C. B. [Argonne National Lab. (ANL), Argonne, IL (United States); Schroeder, J. N. [Argonne National Lab. (ANL), Argonne, IL (United States); Horner, R. M. [Argonne National Lab. (ANL), Argonne, IL (United States); Patton, T. L. [Argonne National Lab. (ANL), Argonne, IL (United States); Durham, L. A. [Argonne National Lab. (ANL), Argonne, IL (United States); Murphy, D. J. [Argonne National Lab. (ANL), Argonne, IL (United States); Clark, C. E. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2014-10-01

    According to the Energy Information Administration (EIA) of the U.S. Department of Energy (DOE), geothermal energy generation in the United States is projected to more than triple by 2040 (EIA 2013). This addition, which translates to more than 5 GW of generation capacity, is anticipated because of technological advances and an increase in available sources through the continued development of enhanced geothermal systems (EGSs) and low-temperature resources (EIA 2013). Studies have shown that air emissions, water consumption, and land use for geothermal electricity generation have less of an impact than traditional fossil fuel–based electricity generation; however, the long-term sustainability of geothermal power plants can be affected by insufficient replacement of aboveground or belowground operational fluid losses resulting from normal operations (Schroeder et al. 2014). Thus, access to water is therefore critical for increased deployment of EGS technologies and, therefore, growth of the geothermal sector. This paper examines water issues relating to EGS development from a variety of perspectives. It starts by exploring the relationship between EGS site geology, stimulation protocols, and below ground water loss, which is one of the largest drivers of water consumption for EGS projects. It then examines the relative costs of different potential traditional and alternative water sources for EGS. Finally it summarizes specific state policies relevant to the use of alternative water sources for EGS, and finally explores the relationship between EGS site geology, stimulation protocols, and below ground water loss, which is one of the largest drivers of water consumption for EGS projects.

  20. The effect of generic competition on the price of brand-name drugs.

    Science.gov (United States)

    Lexchin, Joel

    2004-04-01

    Literature from the US has shown that brand-name manufacturers do not compete on price once generic competitors become available. This study was undertaken to investigate if this is also true in Canada. Editions of the Ontario Drug Benefit Formulary were used to identify brand-name drugs that lacked generic competition in July 1990 but had acquired one or more generic competitors by December 1998. Prices of the brand-name drugs were compared before generic competition, at the point when generic competition started and subsequent to the initiation of competition. Price changes for 81 different products in 144 separate presentations were analysed. There was no statistically significant change in brand-name prices when generic competition started. The movement of brand-name prices was not influenced by whether the generic was made by the company producing the brand-name product or price freezes imposed by the Ontario government. When generics first became available having four or more generics was associated with a rise in the price of the brand-name drugs compared to having one, two or three generic competitor(s). The lack of price competition may lead to increased costs in the private market. Private insurance companies generally do not require generic substitution and some provinces do not require generic substitution for cash-paying customers. Maintaining higher prices on brand-name drugs impacts on the prices of new patented medications coming onto the Canadian market under the current pricing guidelines of the Patented Medicine Prices Review Board.

  1. Generic medications for you, but brand-name medications for me.

    Science.gov (United States)

    Keenum, Amy J; Devoe, Jennifer E; Chisolm, Deena J; Wallace, Lorraine S

    2012-01-01

    Because generic medications are less expensive than brand-name medications, government and private insurers have encouraged and/or mandated the use of generics. This study aimed at evaluating perceptions about generic medications among English-speaking women of childbearing age currently enrolled in U.S. TennCare (Medicaid). We recruited a convenience sample of patients from the waiting room of a primary care/gynecology health clinic, with 80% recruitment rate among those approached. We orally administered a 25-item questionnaire to gather sociodemographic information and to assess beliefs regarding the efficacy, safety, cost, and preferences for personal use of generic medications. The average age of the women (n=172) was 28.8 ± 6.4 years, and most were white (82.0%) and currently married (58.1%). Nearly one-fifth (19.2%) had not completed high school. Most women believed that generic medications were less expensive (97.6%) and better value (60.5%) than brand-name medications, but only 45.3% preferred to take generics themselves. About a quarter (23.3%) believed that brand-name medications were more effective than generics, whereas 13.4% believed that generics caused more side effects. Few women reported that their doctor (29.7%) and/or pharmacist (35.5%) had ever talked to them about taking generics. Awareness of the benefits of generics did not equal preferences for personal use of generics among this sample of women enrolled in U.S. TennCare. Furthermore, women reported that providers-both physicians and pharmacists-infrequently discussed generic substitution with them. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Identifying the spatial and temporal variability of economic opportunity costs to promote the adoption of alternative land uses in grain growing agricultural areas: an Australian example.

    Science.gov (United States)

    Lyle, G; Bryan, B A; Ostendorf, B

    2015-05-15

    Grain growers face many future challenges requiring them to adapt their land uses to changing economic, social and environmental conditions. To understand where to make on ground changes without significant negative financial repercussions, high resolution information on income generation over time is required. We propose a methodology which utilises high resolution yield data collected with precision agriculture (PA) technology, gross margin financial analysis and a temporal standardisation technique to highlight the spatial and temporal consistency of farm income. On three neighbouring farms in Western Australia, we found non-linear relationships between income and area. Spatio-temporal analysis on one farm over varying seasons found that between 37 and 49% (1082-1433ha) of cropping area consistently produced above the selected income thresholds and 43-32% (936-1257ha) regularly produced below selected thresholds. Around 20% of area showed inconsistent temporal variation in income generation. Income estimated from these areas represents the income forgone if a land use change is undertaken (the economic opportunity cost) and the average costs varied spatially from $190±114/ha to $560±108/ha depending on what scenario was chosen. The interaction over space and time showed the clustering of areas with similar values at a resolution where growers make input decisions. This new evidence suggests that farm area could be managed with two strategies: (a) one that maximises grain output using PA management in temporally stable areas which generate moderate to high income returns and (b) one that proposes land use change in low and inconsistent income returning areas where the financial returns from an alternative land use may be comparable. The adoption of these strategies can help growers meet the demand for agricultural output and offer income diversity and adaptive capacity to deal with the future challenges to agricultural production. Copyright © 2015 Elsevier Ltd

  3. Physicians’ Trust in the FDA’s Use of Product-Specific Pathways for Generic Drug Approval

    Science.gov (United States)

    Kesselheim, Aaron S.; Eddings, Wesley; Raj, Tara; Campbell, Eric G.; Franklin, Jessica M.; Ross, Kathryn M.; Fulchino, Lisa A.; Avorn, Jerry; Gagne, Joshua J.

    2016-01-01

    Background Generic drugs are cost-effective versions of brand-name drugs approved by the Food and Drug Administration (FDA) following proof of pharmaceutical equivalence and bioequivalence. Generic drugs are widely prescribed by physicians, although there is disagreement over the clinical comparability of generic drugs to brand-name drugs within the physician community. The objective of this survey was to assess physicians' perceptions of generic drugs and the generic drug approval process. Methods and Findings A survey was administered to a national sample of primary care internists and specialists between August 2014 and January 2015. In total, 1,152 physicians comprising of internists with no reported specialty certification and those with specialty certification in hematology, infectious diseases, and endocrinology were surveyed. The survey assessed physicians’ perceptions of the FDA’s generic drug approval process, as well as their experiences prescribing six generic drugs approved between 2008 and 2012 using product-specific approval pathways and selected comparator drugs. Among 718 respondents (62% response rate), a majority were comfortable with the FDA’s process in ensuring the safety and effectiveness of generic drugs overall (91%) and with letting the FDA determine which tests were necessary to determine bioequivalence in a particular drug (92%). A minority (13–26%) still reported being uncomfortable prescribing generic drugs approved using product-specific pathways. Overall, few physicians heard reports of concerns about generic versions of the study drugs or their comparators, with no differences between the two groups. Physicians tended to hear about concerns about the safety or effectiveness of generic drugs from patients, pharmacists, and physician colleagues. Conclusions Physicians hold largely positive views of the FDA's generic drug approval process even when some questioned the performance of certain generic drugs in comparison to brand

  4. Is There Evidence to Support Brand to Generic Interchange of the Mycophenolic Acid Products?

    Science.gov (United States)

    Phillips, Karen; Reddy, Prabashni; Gabardi, Steven

    2017-02-01

    The uptake of generic immunosuppressants lags comparatively to other drug classes, despite that the Food and Drug Administration (FDA) uses identical bioequivalence standards for all drugs. Transplant societies acknowledge the cost savings associated with generic immunosuppressants and support their use following heart, lung, kidney, or bone marrow transplantation. Seven studies of the pharmacokinetics or clinical efficacy of generic mycophenolate mofetil compared to the innovator product are published; all studies and products were ex-United States. Three studies did not demonstrate any pharmacokinetic differences between generic and innovator products in healthy subjects, achieving FDA bioequivalence requirements. Two studies in renal allograft recipients demonstrated no difference in area under the curves between generic and innovator products, and in one, the maximum concentration (Cmax) fell outside the FDA regulatory range. Two studies revealed no difference in acute organ rejection or graft function in renal allograft recipients. Patient surveys indicate that cost is a barrier to immunosuppressant adherence. Generics present a viable method to reduce costs to payers, patients, and health care systems. Adherence to immunosuppressants is crucial to prevent graft failure. An affordable regimen potentially confers greater adherence. Concerns regarding the presumed inferiority of generic immunosuppressants should be assuaged by regulatory requirements for bioequivalency testing, transplant society position statements, and pharmacokinetic and clinical studies.

  5. Proceedings Workshop on Generic Programming (WGP2000)

    NARCIS (Netherlands)

    Jeuring, J.T.

    2000-01-01

    This report contains the papers selected for presentation at the 2nd Workshop on Generic Programming (WGP2000), which was held on July 6, 2000 in Ponte de Lima, Portugal. Generic programming is about making programs more adaptable by making them more general. Generic programs often embody

  6. Enhancing Safety through Generic Competencies

    Directory of Open Access Journals (Sweden)

    S. Mockel

    2014-03-01

    Full Text Available This article provides insights into proactive safety management and mitigation. An analysis of accident reports reveals categories of supervening causes of accidents which can be directly linked to the concept of generic competencies (information management, communication and coordination, problem solving, and effect control. These findings strongly suggest adding the human element as another safety-constituting pillar to the concept of ship safety next to technology and regulation. We argue that the human element has unique abilities in dealing with critical and highly dynamic situations which can contribute to the system's recovery from non-routine or critical situations. By educating seafarers in generic competencies we claim to enable the people onboard to successfully deal with critical situations.

  7. Generic Separations and Leaf Languages

    OpenAIRE

    Matthias Galota; Sven Kosub (Hrsg.); Heribert Vollmer

    2017-01-01

    In the early nineties of the previous century, leaf languages were introduced as a means for the uniform characterization of many complexity classes, mainly in the range between P (polynomial time) and PSPACE (polynomial space). It was shown that the separability of two complexity classes can be reduced to a combinatorial property of the corresponding defining leaf languages. In the present paper, it is shown that every separation obtained in this way holds for every generic oracle in the sen...

  8. Small satellite generic bus structure

    Science.gov (United States)

    Fiore, John N.; Summers, George D.

    1993-02-01

    A 'Smallsat' generic structure has been developed for LEO and expendable launch vehicles. The structure makes extensive use of Al-alloy honeycomb-stabilized panels in order to satisfy stiffness, weight, strength and thermal stability requirements in the LEO environment, in conjunction with discrete applications of multilayered insulation blankets and silverized Teflon radiators. The Smallsat structure is ideally suited for assembly-line manufacturing and storage until required.

  9. Impact of generic substitution practice on care of diabetic patients.

    Science.gov (United States)

    Oyetunde, Olubukola O; Aina, Bolajoko A; Tayo, Fola

    2014-06-01

    Patients with chronic diseases like type II diabetes mellitus often have their prescriptions substituted with generic medicines in the course of care to save costs of medicines and to improve access. There is need to assess impact of this practice on patient care. To assess patient's knowledge of generic substitution practice and its impact on patient care. An outpatient diabetic clinic of a tertiary hospital in Nigeria. The study is a cross sectional survey of patients attending a diabetic clinic. A structured questionnaire was used to interview willing patients. A total of 120 patients were enrolled for the study, but only 102 responded (85 % overall response rate). Patients' knowledge of generic substitution practice, patients' report of abstaining from drug use, experiences of more side effects and patients' confusion. Over half (57.8 %) of surveyed patients (n = 59) had noticed brand switches, out of which, 30.5 % experienced brand switches more than 3 times within a year. More than a third of the respondents (38.6 %) did not know when pharmacists actually substituted their medicines. About one in five (19.6 %) patients did not use their medicines after substitution because they were not sure of the brand supplied but 35.6 % have rejected substitution at one time and insisted on doctors' prescription. Respondents (14.9 %) agreed that brand substitution resulted in confusion while 24 % reported receiving brands that resulted in more side effects. More respondents (58.6 %) indicated that they never had a discussion with their pharmacists about the reasons for generic substitution and switches. Generic substitution without adequate information resulted in confusion and subsequent lack of adherence. There is the vital need for appropriate policy and guidelines for generic substitution in Nigeria.

  10. Generic-reference and generic-generic bioequivalence of forty-two, randomly-selected, on-market generic products of fourteen immediate-release oral drugs.

    Science.gov (United States)

    Hammami, Muhammad M; De Padua, Sophia J S; Hussein, Rajaa; Al Gaai, Eman; Khodr, Nesrine A; Al-Swayeh, Reem; Alvi, Syed N; Binhashim, Nada

    2017-12-08

    The extents of generic-reference and generic-generic average bioequivalence and intra-subject variation of on-market drug products have not been prospectively studied on a large scale. We assessed bioequivalence of 42 generic products of 14 immediate-release oral drugs with the highest number of generic products on the Saudi market. We conducted 14 four-sequence, randomized, crossover studies on the reference and three randomly-selected generic products of amlodipine, amoxicillin, atenolol, cephalexin, ciprofloxacin, clarithromycin, diclofenac, ibuprofen, fluconazole, metformin, metronidazole, paracetamol, omeprazole, and ranitidine. Geometric mean ratios of maximum concentration (Cmax) and area-under-the-concentration-time-curve, to last measured concentration (AUCT), extrapolated to infinity (AUCI), or truncated to Cmax time of reference product (AUCReftmax) were calculated using non-compartmental method and their 90% confidence intervals (CI) were compared to the 80.00%-125.00% bioequivalence range. Percentages of individual ratios falling outside the ±25% range were also determined. Mean (SD) age and body-mass-index of 700 healthy volunteers (28-80/study) were 32.2 (6.2) years and 24.4 (3.2) kg/m2, respectively. In 42 generic-reference comparisons, 100% of AUCT and AUCI CIs showed bioequivalence, 9.5% of Cmax CIs barely failed to show bioequivalence, and 66.7% of AUCReftmax CIs failed to show bioequivalence/showed bioinequivalence. Adjusting for 6 comparisons, 2.4% of AUCT and AUCI CIs and 21.4% of Cmax CIs failed to show bioequivalence. In 42 generic-generic comparisons, 2.4% of AUCT, AUCI, and Cmax CIs failed to show bioequivalence, and 66.7% of AUCReftmax CIs failed to show bioequivalence/showed bioinequivalence. Adjusting for 6 comparisons, 2.4% of AUCT and AUCI CIs and 14.3% of Cmax CIs failed to show bioequivalence. Average geometric mean ratio deviation from 100% was ≤3.2 and ≤5.4 percentage points for AUCI and Cmax, respectively, in both generic

  11. Perceptions and utilization of generic medicines in Guatemala: a mixed-methods study with physicians and pharmacy staff.

    Science.gov (United States)

    Flood, David; Mathieu, Irène; Chary, Anita; García, Pablo; Rohloff, Peter

    2017-01-13

    Access to low-cost essential generic medicines is a critical health policy goal in low-and-middle income countries (LMICs). Guatemala is an LMIC where there is both limited availability and affordability of these medications. However, attitudes of physicians and pharmacy staff regarding low-cost generics, especially generics for non-communicable diseases (NCDs), have not been fully explored in Guatemala. Semi-structured interviews with 30 pharmacy staff and 12 physicians in several highland towns in Guatemala were conducted. Interview questions related to perceptions of low-cost generic medicines, prescription and dispensing practices of generics in the treatment of two NCDs, diabetes and hypertension, and opinions about the roles of pharmacy staff and physicians in selecting medicines for patients. Pharmacy staff were recruited from a random sample of pharmacies and physicians were recruited from a convenience sample. Interview data were analyzed using a thematic approach for qualitative data as well as basic quantitative statistics. Pharmacy staff and physicians expressed doubt as to the safety and efficacy of low-cost generic medicines in Guatemala. The low cost of generic medicines was often perceived as proof of their inferior quality. In the case of diabetes and hypertension, the decision to utilize a generic medicine was based on multiple factors including the patient's financial situation, consumer preference, and, to a large extent, physician recommendations. Interventions to improve generic medication utilization in Guatemala must address the negative perceptions of physicians and pharmacy staff toward low-cost generics. Strengthening state capacity and transparency in the regulation and monitoring of the drug supply is a key goal of access-to-medicines advocacy in Guatemala.

  12. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

    Science.gov (United States)

    Robinson, M; Palmer, S; Sculpher, M; Philips, Z; Ginnelly, L; Bowens, A; Golder, S; Alfakih, K; Bakhai, A; Packham, C; Cooper, N; Abrams, K; Eastwood, A; Pearman, A; Flather, M; Gray, D; Hall, A

    2005-07-01

    To identify and prioritise key areas of clinical uncertainty regarding the medical management of non-ST elevation acute coronary syndrome (ACS) in current UK practice. Electronic databases. Consultations with clinical advisors. Postal survey of cardiologists. Potential areas of important uncertainty were identified and 'decision problems' prioritised. A systematic literature review was carried out using standard methods. The constructed decision model consisted of a short-term phase that applied the results of the systematic review and a long-term phase that included relevant information from a UK observational study to extrapolate estimated costs and effects. Sensitivity analyses were undertaken to examine the dependence of the results on baseline parameters, using alternative data sources. Expected value of information analysis was undertaken to estimate the expected value of perfect information associated with the decision problem. This provided an upper bound on the monetary value associated with additional research in the area. Seven current areas of clinical uncertainty (decision problems) in the drug treatment of unstable angina patients were identified. The agents concerned were clopidogrel, low molecular weight heparin, hirudin and intravenous glycoprotein antagonists (GPAs). Twelve published clinical guidelines for unstable angina or non-ST elevation ACS were identified, but few contained recommendations about the specified decision problems. The postal survey of clinicians showed that the greatest disagreement existed for the use of small molecule GPAs, and the greatest uncertainty existed for decisions relating to the use of abciximab (a large molecule GPA). Overall, decision problems concerning the GPA class of drugs were considered to be the highest priority for further study. Selected papers describing the clinical efficacy of treatment were divided into three groups, each representing an alternative strategy. The strategy involving the use of GPAs

  13. Long-term Medicaid excess payments from alleged price manipulation of generic lorazepam.

    Science.gov (United States)

    Bian, Boyang; Gorevski, Elizabeth; Kelton, Christina M L; Guo, Jeff J; Martin Boone, Jill E

    2012-09-01

    Cost savings from the use of generic drugs versus brand-name drugs are well known. Both private and public prescription drug plans encourage the use of generic drugs through a variety of mechanisms. The magnitude of cost savings for a given generic drug is dependent on the degree to which the generic market is competitive. Should the competitive structure become compromised, higher prices and reduced cost savings may result. An alleged conspiracy between Mylan Laboratories and its active-ingredient suppliers in 1997 was associated with an increase in seller concentration in the generic lorazepam market. The Federal Trade Commission (FTC) alleged that Mylan raised costs to consumers by $120 million because of price increases for generic lorazepam from March through December 1998 and for generic clorazepate from January through December 1998. In November 2002, a settlement with Mylan was approved by the FTC, and a federal district court required Mylan to pay $147 million, including $28.2 million to state agencies including Medicaid. To (a) describe the seller concentration in the national Medicaid generic lorazepam market over a 19-year period from January 1991 through December 2009, (b) estimate the excess payments for generic lorazepam by Medicaid between 1998 and 2009, and (c) investigate potentially increased utilization and prices of 2 substitute pharmaceuticals: branded lorazepam (Ativan) and generic alprazolam (another widely used intermediate-acting benzodiazepine). Using Medicaid State Drug Utilization Data from the Centers for Medicare Medicaid Services, we calculated the 4-firm concentration ratio (CR₄) and the Herfindahl-Hirschman Index (HHI) for the Medicaid generic lorazepam market, along with pre-rebate reimbursement for pharmacy claims, number of claims (utilization), and average pre-rebate reimbursement per claim (average "price") for generic lorazepam, from 1991 through 2009. Medicaid's excess payments were estimated under 2 different assumptions

  14. Generic antiretrovirals for the treatment of HIV: a novel challenge for Western countries?
.

    Science.gov (United States)

    Cattaneo, Dario; Andreoni, Massimo; Carosi, Gianpiero; Cauda, Roberto; Lazzarin, Adriano; Rizzardini, Giuliano

    2017-05-01

    The introduction of generic antiretroviral medications in developing countries has resulted in significant CD4 cell restoration, HIV viral decline, and a noteworthy reduction in the time to initiation of therapy. Projection models have also predicted significant cost saving associated with the extensive diffusion of generic antiretrovirals in developed countries. However, some uncertainties on generics have recently been raised. These concerns mainly relate to the adequacy of the study design for bioequivalence testing, the potential for uncontrolled switching from one generic to another, and the loss of adherence if patients switched from fixed-dose coformulations to single components in order to incorporate the new generic drugs. In the present review, we deal with current evidence and potential controversial issues regarding generic antiretrovirals and their underlying economic implications and provide some proposals on how to favor the widespread diffusion of generics in HIV medicine. This may be particularly relevant considering that the safe, systematic switch from patented to generic antiretrovirals could potentially guarantee access to therapies for HIV-infected patients worldwide and lead to money savings that would compensate the expenditure increase resulting from new, innovative HIV drugs.
.

  15. A pilot survey on perceptions and knowledge of generic medicines among consumers in Penang, Malaysia.

    Science.gov (United States)

    Al-Gedadi, Nabil A; Hassali, Mohamed A; Shafie, Asrul A

    2008-04-01

    To explore the consumers' perceptions and knowledge towards issues surrounding generic medicines utilization in Penang, Malaysia. A cross sectional survey was conducted with consumers who attended the annual University open day. Using convenience sampling, survey forms were distributed to the respective consumers via the help of a group of trained 1st year pharmacy students. For a period of 5 days, 400 respondents had participated in the survey. Analysis of the response from the collected forms yielded in 396 usable forms. Only 28.3% (n=112) of the respondents were familiar with the term "generic medicines". More than 70% of the respondents do not know that generic medicines can be marketed under different names. About 34% (n=38) of consumers stated that they had been given information regarding generics by their pharmacists. In terms of side effects, about 32% (n=127) of the respondents felt that generic medicines may cause more side effects than branded medicines. Majority of the consumers surveyed (64%) understand that generic cost less compared to their branded counterparts. This survey showed that there is a gap in consumers' knowledge and understanding about generic medicines. The findings also suggest that direct patient education by the healthcare providers on issues relating to safety and efficacy of generic medicines could further enhance their uptake.

  16. A pilot survey on perceptions and knowledge of generic medicines among consumers in Penang, Malaysia

    Directory of Open Access Journals (Sweden)

    Al-Gedadi NA

    2008-06-01

    Full Text Available Objective: To explore the consumers’ perceptions and knowledge towards issues surrounding generic medicines utilization in Penang, Malaysia.Methods: A cross sectional survey was conducted with consumers who attended the annual University open day. Using convenience sampling, survey forms were distributed to the respective consumers via the help of a group of trained 1st year pharmacy students. For a period of 5 days, 400 respondents had participated in the survey. Analysis of the response from the collected forms yielded in 396 usable forms.Results: Only 28.3% (n=112 of the respondents were familiar with the term “generic medicines”. More than 70% of the respondents do not know that generic medicines can be marketed under different names. About 34% (n=38 of consumers stated that they had been given information regarding generics by their pharmacists. In terms of side effects, about 32% (n=127 of the respondents felt that generic medicines may cause more side effects than branded medicines. Majority of the consumers surveyed (64% understand that generic cost less compared to their branded counterparts.Conclusion: This survey showed that there is a gap in consumers’ knowledge and understanding about generic medicines. The findings also suggest that direct patient education by the healthcare providers on issues relating to safety and efficacy of generic medicines could further enhance their uptake.

  17. Comparison of Generic Drug Reviews for Marketing Authorization between Japan and Canada.

    Science.gov (United States)

    Kuribayashi, Ryosuke; Appleton, Scott

    2017-09-01

    Generic drugs are assuming an increasingly important role in sustaining modern healthcare systems, as the cost of healthcare, including drug usage, is gradually expanding around the world. To date, published articles comparing generic drug reviews between different countries are scarce. The objective of this study was to examine generic drug reviews in Japan and Canada. We surveyed generic drug reviews from Japan and Canada and compared the following points: general matter (application types, type of partial change or Supplement to an Abbreviated New Drug Submission, application and approval numbers, review period, application format, review report, responsibility for review), bioequivalence studies for solid oral dosage forms, and bioequivalence guidelines, guidance, or basic principles regarding various dosage forms. This survey described the many similarities and differences in generic drug reviews between the two countries and points that should be improved to promote better generic drug reviews. In particular, regulations for the definition of the same or different active pharmaceutical ingredients (APIs) are similar for both authorities. The results clarified the future challenges of generic drug reviews, and the differences highlighted by this survey will be important considerations for the future. This is the first article to present and discuss the details of generic drug reviews between Japan and Canada.

  18. Generation of dried tube specimen for HIV-1 viral load proficiency test panels: a cost-effective alternative for external quality assessment programs.

    Science.gov (United States)

    Ramos, Artur; Nguyen, Shon; Garcia, Albert; Subbarao, Shambavi; Nkengasong, John N; Ellenberger, Dennis

    2013-03-01

    Participation in external quality assessment programs is critical to ensure quality clinical laboratory testing. Commercially available proficiency test panels for HIV-1 virus load testing that are used commonly in external quality assessment programs remain a financial obstacle to resource-limited countries. Maintaining cold-chain transportation largely contributes to the cost of traditional liquid proficiency test panels. Therefore, we developed and evaluated a proficiency test panel using dried tube specimens that can be shipped and stored at ambient temperature. This dried tube specimens panel consisted of 20 μl aliquots of a HIV-1 stock that were added to 2 ml tubes and left uncapped for drying, as a preservation method. The stability of dried tube specimens at concentrations ranging from 10² to 10⁶·⁵ RNA copies/ml was tested at different temperatures over time, showing no viral load reduction at 37 °C and a decrease in viral load smaller than 0.5 Log₁₀ at 45 °C for up to eight weeks when compared to initial results. Eight cycles of freezing-thawing had no effect on the stability of the dried tube specimens. Comparable viral load results were observed when dried tube specimen panels were tested on Roche CAPTAQ, Abbott m2000, and Biomerieux easyMAG viral load systems. Preliminary test results of dried proficiency test panels shipped to four African countries at ambient temperature demonstrated a low inter assay variation (SD range: 0.29-0.41 Log₁₀ RNA copies/ml). These results indicated that HIV-1 proficiency test panels generated by this methodology might be an acceptable alternative for laboratories in resource-limited countries to participate in external quality assessment programs. Published by Elsevier B.V.

  19. Competition in prescription drug markets: the roles of trademarks, advertising, and generic names.

    Science.gov (United States)

    Feldman, Roger; Lobo, Félix

    2013-08-01

    We take on two subjects of controversy among economists-advertising and trademarks-in the context of the market for generic drugs. We outline a model in which trademarks for drug names reduce search costs but increase product differentiation. In this particular framework, trademarks may not benefit consumers. In contrast, the generic names of drugs or "International Nonproprietary Names" (INN) have unquestionable benefits in both economic theory and empirical studies. We offer a second model where advertising of a brand-name drug creates recognition for the generic name. The monopoly patent-holder advertises less than in the absence of a competitive spillover.

  20. Alternative Media Technologies for the Open University. A Research Report on Costed Alternatives to the Direct Transmission of Audio-Visual Materials. Final Report. I.E.T. Papers on Broadcasting No. 79.

    Science.gov (United States)

    Bates, Tony; Kern, Larry

    This study examines alternatives to direct transmission of television and radio programs for courses with low student enrollment at the Open University. Examined are cut-off points in terms of student numbers at which alternative means of distributing audio or audio-visual materials become more economical than direct television or radio…

  1. Generic Crystalline Disposal Reference Case

    Energy Technology Data Exchange (ETDEWEB)

    Painter, Scott Leroy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Chu, Shaoping [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Harp, Dylan Robert [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Perry, Frank Vinton [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Wang, Yifeng [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-02-20

    A generic reference case for disposal of spent nuclear fuel and high-level radioactive waste in crystalline rock is outlined. The generic cases are intended to support development of disposal system modeling capability by establishing relevant baseline conditions and parameters. Establishment of a generic reference case requires that the emplacement concept, waste inventory, waste form, waste package, backfill/buffer properties, EBS failure scenarios, host rock properties, and biosphere be specified. The focus in this report is on those elements that are unique to crystalline disposal, especially the geosphere representation. Three emplacement concepts are suggested for further analyses: a waste packages containing 4 PWR assemblies emplaced in boreholes in the floors of tunnels (KBS-3 concept), a 12-assembly waste package emplaced in tunnels, and a 32-assembly dual purpose canister emplaced in tunnels. In addition, three failure scenarios were suggested for future use: a nominal scenario involving corrosion of the waste package in the tunnel emplacement concepts, a manufacturing defect scenario applicable to the KBS-3 concept, and a disruptive glaciation scenario applicable to both emplacement concepts. The computational approaches required to analyze EBS failure and transport processes in a crystalline rock repository are similar to those of argillite/shale, with the most significant difference being that the EBS in a crystalline rock repository will likely experience highly heterogeneous flow rates, which should be represented in the model. The computational approaches required to analyze radionuclide transport in the natural system are very different because of the highly channelized nature of fracture flow. Computational workflows tailored to crystalline rock based on discrete transport pathways extracted from discrete fracture network models are recommended.

  2. Generic thin-shell gravastars

    Energy Technology Data Exchange (ETDEWEB)

    Martin-Moruno, Prado; Visser, Matt [School of Mathematics, Statistics, and Operations Research, Victoria University of Wellington, PO Box 600, Wellington 6140 (New Zealand); Garcia, Nadiezhda Montelongo [Departamento de Física, Centro de Investigación y Estudios avanzados del I.P.N., A.P. 14-700,07000 México, DF (Mexico); Lobo, Francisco S.N., E-mail: prado@msor.vuw.ac.nz, E-mail: nmontelongo@fis.cinvestav.mx, E-mail: flobo@cii.fc.ul.pt, E-mail: matt.visser@msor.vuw.ac.nz [Centro de Astronomia e Astrofísica da Universidade de Lisboa, Campo Grande, Edifício C8 1749-016 Lisboa (Portugal)

    2012-03-01

    We construct generic spherically symmetric thin-shell gravastars by using the cut-and-paste procedure. We take considerable effort to make the analysis as general and unified as practicable; investigating both the internal physics of the transition layer and its interaction with 'external forces' arising due to interactions between the transition layer and the bulk spacetime. Furthermore, we discuss both the dynamic and static situations. In particular, we consider 'bounded excursion' dynamical configurations, and probe the stability of static configurations. For gravastars there is always a particularly compelling configuration in which the surface energy density is zero, while surface tension is nonzero.

  3. Generic maximum likely scale selection

    DEFF Research Database (Denmark)

    Pedersen, Kim Steenstrup; Loog, Marco; Markussen, Bo

    2007-01-01

    in this work is on applying this selection principle under a Brownian image model. This image model provides a simple scale invariant prior for natural images and we provide illustrative examples of the behavior of our scale estimation on such images. In these illustrative examples, estimation is based......The fundamental problem of local scale selection is addressed by means of a novel principle, which is based on maximum likelihood estimation. The principle is generally applicable to a broad variety of image models and descriptors, and provides a generic scale estimation methodology. The focus...

  4. Intervention thresholds for denosumab in the UK using a FRAX®-based cost-effectiveness analysis.

    Science.gov (United States)

    Ström, O; Jönsson, B; Kanis, J A

    2013-04-01

    The objective was to undertake a health economic analysis of denosumab for the treatment of osteoporosis in women from the UK, using the FRAX® tool. Denosumab was cost-effective in women with a risk of major osteoporotic fracture meeting or exceeding approximately 20% who are unable to take, comply with or tolerate generic alendronate. Denosumab is a novel biologic agent developed for the treatment of osteoporosis, which has been shown to reduce the risk of fractures in a phase-III trial. The objective of the present study was to undertake a health economic analysis of denosumab in women from the UK. Ten-year probabilities of a major osteoporotic fracture at which denosumab is a cost-effective alternative to no treatment, generic alendronate, risedronate and strontium ranelate were estimated. A previously published Markov model was adapted to incorporate fracture and mortality risk assessments based on absolute fracture probability, as estimated by FRAX®. The model included treatment persistence and residual effect after discontinuation. At a willingness-to-pay (WTP) of £30,000 per quality-adjusted life year and a 10-year fracture probability equivalent to a woman with a prior fragility fracture, denosumab was cost-effective compared to no treatment from the age of 70 years. At the same WTP, denosumab was-irrespective of age-cost-effective compared to no treatment at a major osteoporotic fracture probability of approximately 20%. Denosumab was estimated to cost-effectively replace strontium, risedronate and generic alendronate at 10-year probabilities exceeding 11, 19 and 32%, respectively. FRAX® facilitates the estimation of cost-effectiveness-based intervention thresholds applicable to patients with different combinations of clinical risk factors, which more closely matches the situation in clinical practice. Denosumab is cost-effective in patients with major osteoporotic fracture probabilities meeting or exceeding approximately 20% who are unable to take

  5. Cost-effectiveness Analysis of Denosumab in the Prevention of Skeletal-related Events in Patients with Prostate Cancer in Kazakhstan

    Directory of Open Access Journals (Sweden)

    Carina Bektur

    2014-12-01

    .Conclusions.With the assumption that brand and generic ZAs are equally effective in the prevention of SREs in PC patients, denosumab seems to be a cost-effective alternative for brand ZA (insignificant difference in costs – less than 5% and a costly alternative for generic ZA from the perspective of MoH of Kazakhstan.

  6. Incremental cost per quality-adjusted life year gained? The need for alternative methods to evaluate medical interventions for ultra-rare disorders

    NARCIS (Netherlands)

    Schlander, Michael; Garattini, Silvio; Holm, Søren; Kolominsky-Rabas, Peter; Nord, Erik; Persson, Ulf; Postma, Maarten; Richardson, Jeff; Simoens, Steven; De Solà Morales, Oriol; Tolley, Keith; Toumi, Mondher

    2014-01-01

    Drugs for ultra-rare disorders (URDs) rank prominently among the most expensive medicines on a cost-per-patient basis. Many of them do not meet conventional standards for cost-effectiveness. In light of the high fixed cost of R&D, this challenge is inversely related to the prevalence of URDs. The

  7. Generic medicines and generic substitution: contrasting perspectives of stakeholders in Ireland.

    Science.gov (United States)

    O'Leary, A; Usher, C; Lynch, M; Hall, M; Hemeryk, L; Spillane, S; Gallagher, P; Barry, M

    2015-12-15

    The Health (Pricing and Supply of Medical Goods) Act 2013 passed into law in July 2013 and legislated for generic substitution in Ireland. The aim of the study was to ascertain the knowledge and perceptions of stakeholders i.e. patients, pharmacists and prescribers, of generic medicines and to generic substitution with the passing of legislation. Three stakeholder specific questionnaires were developed to assess knowledge of and perceptions to generic medicines and generic substitution. Purposive samples of patients, prescribers and pharmacists were analysed. Descriptive quantitative and qualitative analyses were undertaken. A total of 762 healthcare professionals and 353 patients were recruited. The study highlighted that over 84% of patients were familiar with generic medicines and are supportive of the concept of generic substitution. Approximately 74% of prescribers and 84% of pharmacists were supportive of generic substitution in most cases. The main areas of concern highlighted by the healthcare professionals that might impact on the successful implementation of the policy, were the issue of bioequivalence with generic medicines, the computer software systems used at present in general practitioner (GP) surgeries and the availability of branded generics. The findings from this study identify a high baseline rate of acceptance to generic medicines and generic substitution among patients, prescribers and pharmacists in the Irish setting. The concerns of the main stakeholders provide a valuable insight into the potential difficulties that may arise in its implementation, and the need for on-going reassurance and proactive dissemination of the impact of the generic substitution policy. The existing positive attitude to generic medicines and generic substitution among key stakeholders in Ireland to generic substitution, combined with appropriate support and collaboration should result in the desired increase in rates of prescribing, dispensing and use of generic

  8. PROBLEM OF GENERIC REPLACEMENT: ADVANTAGES AND DISADVANTAGES

    Directory of Open Access Journals (Sweden)

    S. N. Tolpygina

    2009-01-01

    Full Text Available The main differences between original and generic drugs as well as registration criteria for generics are described. Possible reasons of discrepancy in bioequivalence and therapeutic equivalence of original and generic drugs are reviewed. The examples of such a discrepancy as a result of comparative clinical trails (enalapril maleate are discussed. Approaches to planning of comparative trails on drug therapeutic equivalence are presented. 

  9. PROBLEM OF GENERIC REPLACEMENT: ADVANTAGES AND DISADVANTAGES

    Directory of Open Access Journals (Sweden)

    S. N. Tolpygina

    2016-01-01

    Full Text Available The main differences between original and generic drugs as well as registration criteria for generics are described. Possible reasons of discrepancy in bioequivalence and therapeutic equivalence of original and generic drugs are reviewed. The examples of such a discrepancy as a result of comparative clinical trails (enalapril maleate are discussed. Approaches to planning of comparative trails on drug therapeutic equivalence are presented. 

  10. Calculation of economic viability of alternative energy sources considering its environmental costs for small communities of Northeast Brazil; Calculo de viabilidade economica de fontes alternativas de energia considerando seus custos ambientais para pequenas comuidades da regiao nordeste brasileira

    Energy Technology Data Exchange (ETDEWEB)

    Stecher, Luiza Chourkalo

    2014-09-01

    There has been an increasing concern about current environmental issues caused by human activity, as the world searches for development. The production of electricity is an extremely relevant factor in this scenario since it is responsible for a large portion of the emissions that cause the greenhouse effect. Due to this fact, a sustainable development with alternative energy sources, which are attractive for such purpose, must be proposed, especially in places that are not supplied by the conventional electricity grid such as many communities in the Northeast Brazil. This work aims to calculate the environmental cost for the alternative sources of energy - solar, wind and biomass - during electricity generation, and to estimate the economic feasibility of those sources in small communities of Northeast Brazil, considering the avoided costs. The externalities must be properly identified and valued so the costs or benefits can be internalized and reflect accurately the economic feasibility or infeasibility of those sources. For this, the method of avoided costs was adopted for the calculation of externalities. This variable was included in the equation developed for all considered alternative energy sources. The calculations of economic feasibility were performed taking the new configurations in consideration, and the new equation was reprogrammed in the Programa de Calculo de Custos de Energias Alternativas, Solar, Eolica e Biomassa (PEASEB). The results demonstrated that the solar photovoltaic energy in isolated systems is the most feasible and broadly applicable source for small communities of Northeast Brazil. (author)

  11. Analyzing generic and branded substitution patterns in the Netherlands using prescription data

    Directory of Open Access Journals (Sweden)

    Postma Maarten J

    2011-04-01

    Full Text Available Abstract Background As in other societies, pharmaceutical expenditures in the Netherlands are rising every year. As a consequence, needs for cost control are often expressed. One possible solution for cost control could come through increasing generic substitution by pharmacists. We aim to analyse the extent and nature of substitution in recent years and estimate the likelihood of generic or branded substitution in Dutch pharmacies in relation to various characteristics. Methods We utilized a linked prescription dataset originating from a general practitioner (GP and a pharmacy database, both from the northern Netherlands. We selected specific drugs of interest, containing about 55,000 prescriptions from 15 different classes. We used a crossed generalized linear mixed model to estimate the effects that certain patient and pharmacy characteristics as well as timing have on the likelihood that a prescription will eventually be substituted by the pharmacist. Results Generic substitution occurred at 25% of the branded prescriptions. Generic substitution was more likely to occur earlier in time after patent expiry and to patients that were older and more experienced in their drug use. Individually owned pharmacies had a lower probability of generic substitution compared to chain pharmacies. Oppositely, branded substitution occurred in 10% of generic prescriptions and was positively related to the patients' experience in branded use. Individually owned pharmacies were more likely to substitute a generic drug to a branded compared to other pharmacies. Antidepressant and PPI prescriptions were less prone to generic and more prone to branded substitution. Conclusion Analysis of prescription substitution by the pharmacist revealed strong relations between substitution and patient experience on drug use, pharmacy status and timing. These findings can be utilised to design further strategies to enhance generic substitution.

  12. Analyzing generic and branded substitution patterns in the Netherlands using prescription data

    Science.gov (United States)

    2011-01-01

    Background As in other societies, pharmaceutical expenditures in the Netherlands are rising every year. As a consequence, needs for cost control are often expressed. One possible solution for cost control could come through increasing generic substitution by pharmacists. We aim to analyse the extent and nature of substitution in recent years and estimate the likelihood of generic or branded substitution in Dutch pharmacies in relation to various characteristics. Methods We utilized a linked prescription dataset originating from a general practitioner (GP) and a pharmacy database, both from the northern Netherlands. We selected specific drugs of interest, containing about 55,000 prescriptions from 15 different classes. We used a crossed generalized linear mixed model to estimate the effects that certain patient and pharmacy characteristics as well as timing have on the likelihood that a prescription will eventually be substituted by the pharmacist. Results Generic substitution occurred at 25% of the branded prescriptions. Generic substitution was more likely to occur earlier in time after patent expiry and to patients that were older and more experienced in their drug use. Individually owned pharmacies had a lower probability of generic substitution compared to chain pharmacies. Oppositely, branded substitution occurred in 10% of generic prescriptions and was positively related to the patients' experience in branded use. Individually owned pharmacies were more likely to substitute a generic drug to a branded compared to other pharmacies. Antidepressant and PPI prescriptions were less prone to generic and more prone to branded substitution. Conclusion Analysis of prescription substitution by the pharmacist revealed strong relations between substitution and patient experience on drug use, pharmacy status and timing. These findings can be utilised to design further strategies to enhance generic substitution. PMID:21524312

  13. OSTEOPOROSIS DRUGS MARKETED IN THE UNITED STATES: GENERIC COMPETITION, PRICING STRUCTURE, AND DISPERSION AMONG PAYERS.

    Science.gov (United States)

    Balkhi, Bander; Seoane-Vazquez, Enrique; Rodriguez-Monguio, Rosa

    2016-01-01

    Despite the cost of pharmaceuticals, studies assessing prices of osteoporosis drugs are lacking. This study examined trends in prices of osteoporosis drugs in the United States in the period 1988-2014, assessed pricing structure of osteoporosis drugs, and evaluated price trends before and after generic drugs market entry. Data were derived from the U.S. Food and Drug Administration, the RedBook, the Centers for Medicare & Medicaid Services, and the Federal Supply Schedule (FSS). Descriptive statistics and segmented linear regression analyses were performed. In the period 1988-2014, osteoporosis drug prices increased faster than the inflation. The average wholesale price (AWP) of generic products at market entry represented 90 percent of the AWP for the corresponding brand. Prices of brand products continued to increase after generic entry. Drug prices showed a significant variation when compared with the brand AWP. The brand wholesale acquisition cost (WAC) was typically set at 83.3 percent of the AWP. Community pharmacies acquired osteoporosis brand drugs at a median of 80.5 percent of the brand AWP. Significant reductions in brand AWP were observed for Medicare Part B (78.5 percent of the brand AWP), generic National Average Drug Acquisition Cost (33.7 percent), and FSS (22.5 percent). There are significant differences in the manufacturer prices, pharmacy acquisition costs and reimbursement rates of osteoporosis drugs. Pharmaceutical companies listed prices are higher than the pharmacy actual estimated acquisitions costs, and the prices used for reimbursement to providers. Generic drugs entry significantly drives down prices; still, prices of branded drugs facing generic competition continued to increase after generic market entry.

  14. Generic Reliability-Based Inspection Planning for Fatigue Sensitive Details

    DEFF Research Database (Denmark)

    Sørensen, John Dalsgaard; Straub, Daniel; Faber, Michael Havbro

    2005-01-01

    expected costs for design, inspections, repairs and failures are minimized. The method is based on the assumption of “no-finds” of cracks during inspections. Each fatigue sensitive detail is categorized according to their type of details (SN curves), FDF values, RSR values, inspection, repair and failure......The generic approach for planning of in-service NDT inspections is extended to cover the case where the fatigue load is modified during the design lifetime of the structure. Generic reliability-based inspection planning has been developed as a practical approach to perform inspection planning...... of fatigue sensitive details in fixed offshore steel jacket platforms and FPSO ship structures. Inspection and maintenance activities are planned such that code based requirements to the safety of personnel and environment for the considered structure are fulfilled and at the same time such that the overall...

  15. Hospitals plan to start their own generic drug company

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-01-01

    Full Text Available The New York Times reports that groups representing more than 450 hospitals plan to form their own generic drug company (1. Intermountain Healthcare is leading the collaboration with several other large hospital groups, Ascension, SSM Health and Trinity Health, in consultation with the U.S. Department of Veterans Affairs, to form a not-for-profit drug company. The new firm is looking to create generic versions of about 20 existing drugs that the group says cost too much now or are in short supply. The article did not name the drugs targeted but expects the first of its pharmaceutical products to become available in 2019. Members of the consortium will contribute funds to finance the new drug company.

  16. Patient knowledge, perceptions, and acceptance of generic medicines: a comprehensive review of the current literature

    Directory of Open Access Journals (Sweden)

    Alrasheedy AA

    2014-04-01

    Full Text Available Alian A Alrasheedy,1 Mohamed Azmi Hassali,1 Kay Stewart,2 David CM Kong,2 Hisham Aljadhey,3 Mohamed Izham Mohamed Ibrahim,4 Saleh Karamah Al-Tamimi1 1Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; 3Medication Safety Research Chair, Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 4College of Pharmacy, Qatar University, Doha, Qatar Background: Generic medicines have the same quality, safety, and efficacy as their counterpart original brand medicines. Generic medicines provide the same therapeutic outcomes but at a much cheaper cost, so are promoted in many countries to contain pharmaceutical expenditure and sustain the health care system. Thus, the perspective of patients and medicine consumers as end users of these medicines is an important factor to enhance the use and utilization of generic medicines. The objective of this paper is to review patients’ and consumers’ knowledge, perceptions, acceptance, and views of generic medicines in the current literature. Methods: An extensive literature search was performed in several databases, namely Scopus, PubMed, ISI Web of Knowledge, Proquest, and the Wiley online library, to identify relevant studies published in the English literature for the period 1990–2013. Results: A total of 53 studies were included in the review, comprising 24 studies from Europe, ten from North America, six from Asia, five from Australia and New Zealand, five from the Middle East, one from Africa, one from Latin America, and one from the Caribbean region. A large body of literature has reported misconceptions and negative perceptions about generic medicines on the part of patients and medicine consumers. Moreover, although it is reported in almost all countries, the percentage of consumers who had

  17. Predicted savings to the UK National Health Service from switching to generic antiretrovirals, 2014–2018

    Directory of Open Access Journals (Sweden)

    Andrew Hill

    2014-11-01

    Full Text Available Introduction: In other disease areas, generic drugs are normally used after patent expiry. Patents on zidovudine, lamivudine, nevirapine and efavirenz have already expired. Patents will expire for abacavir in late 2014, lopinavir/r in 2016, and tenofovir, darunavir and atazanavir in 2017. However, patents on single-tablet regimens do not expire until after 2026. Methods: The number of people taking each antiretroviral in the UK was estimated from 23,655 individuals in the UK CHIC cohort (2012 database. Costs of patented drugs were taken from the British National Formulary database, assuming a 30% discount. Costs of generic antiretrovirals were estimated using an 80% discount from patented prices, or actual costs where available. Two options were analysed: 1 – all patients use single-tablet regimens and patented versions of drugs; prices remain stable over time; 2 – all people switch from patented to generic drugs when available, after patent expiry (dates shown above. Results: There were an estimated 67,000 people taking antiretrovirals in the UK in 2014, estimated to rise by 8% per year until 2018 (in line with previous rises. The most widely used antiretrovirals in the CHIC cohort were tenofovir (TDF (75%, emtricitabine (FTC (69%, efavirenz (EFV (39%, lamivudine (3TC (23%, abacavir (ABC (18%, darunavir (DRV (21% and atazanavir (ATV (16%. The predicted annual UK cost of generic ABC/3TC/EFV (three generic tablets once daily was £1018 per person-year. Costs of patented single-tablet regimens ranged from £5000 to £7500 per person-year. Assuming continued use of patented antiretrovirals in the UK, the predicted total national costs of antiretroviral treatment were predicted to rise from £425 million in 2014 to £459 m in 2015, £495 m in 2016, £536 m in 2017 and £578 m in 2018. With a 100% switch to generics, total predicted costs were £337 m in 2014, £364 m in 2015, £382 m in 2016, £144 m in 2017 and £169 m in 2018. The total

  18. Predicted savings to the UK National Health Service from switching to generic antiretrovirals, 2014-2018.

    Science.gov (United States)

    Hill, Andrew; Hill, Teresa; Jose, Sophie; Pozniak, Anton

    2014-01-01

    In other disease areas, generic drugs are normally used after patent expiry. Patents on zidovudine, lamivudine, nevirapine and efavirenz have already expired. Patents will expire for abacavir in late 2014, lopinavir/r in 2016, and tenofovir, darunavir and atazanavir in 2017. However, patents on single-tablet regimens do not expire until after 2026. The number of people taking each antiretroviral in the UK was estimated from 23,655 individuals in the UK CHIC cohort (2012 database). Costs of patented drugs were taken from the British National Formulary database, assuming a 30% discount. Costs of generic antiretrovirals were estimated using an 80% discount from patented prices, or actual costs where available. Two options were analysed: 1 - all patients use single-tablet regimens and patented versions of drugs; prices remain stable over time; 2 - all people switch from patented to generic drugs when available, after patent expiry (dates shown above). There were an estimated 67,000 people taking antiretrovirals in the UK in 2014, estimated to rise by 8% per year until 2018 (in line with previous rises). The most widely used antiretrovirals in the CHIC cohort were tenofovir (TDF) (75%), emtricitabine (FTC) (69%), efavirenz (EFV) (39%), lamivudine (3TC) (23%), abacavir (ABC) (18%), darunavir (DRV) (21%) and atazanavir (ATV) (16%). The predicted annual UK cost of generic ABC/3TC/EFV (three generic tablets once daily) was £1018 per person-year. Costs of patented single-tablet regimens ranged from £5000 to £7500 per person-year. Assuming continued use of patented antiretrovirals in the UK, the predicted total national costs of antiretroviral treatment were predicted to rise from £425 million in 2014 to £459 m in 2015, £495 m in 2016, £536 m in 2017 and £578 m in 2018. With a 100% switch to generics, total predicted costs were £337 m in 2014, £364 m in 2015, £382 m in 2016, £144 m in 2017 and £169 m in 2018. The total predicted saving over five years from a

  19. Diagnostic accuracy and cost-effectiveness of alternative methods for detection of soil-transmitted helminths in a post-treatment setting in western Kenya.

    Directory of Open Access Journals (Sweden)

    Liya M Assefa

    2014-05-01

    Full Text Available This study evaluates the diagnostic accuracy and cost-effectiveness of the Kato-Katz and Mini-FLOTAC methods for detection of soil-transmitted helminths (STH in a post-treatment setting in western Kenya. A cost analysis also explores the cost implications of collecting samples during school surveys when compared to household surveys.Stool samples were collected from children (n = 652 attending 18 schools in Bungoma County and diagnosed by the Kato-Katz and Mini-FLOTAC coprological methods. Sensitivity and additional diagnostic performance measures were analyzed using Bayesian latent class modeling. Financial and economic costs were calculated for all survey and diagnostic activities, and cost per child tested, cost per case detected and cost per STH infection correctly classified were estimated. A sensitivity analysis was conducted to assess the impact of various survey parameters on cost estimates.Both diagnostic methods exhibited comparable sensitivity for detection of any STH species over single and consecutive day sampling: 52.0% for single day Kato-Katz; 49.1% for single-day Mini-FLOTAC; 76.9% for consecutive day Kato-Katz; and 74.1% for consecutive day Mini-FLOTAC. Diagnostic performance did not differ significantly between methods for the different STH species. Use of Kato-Katz with school-based sampling was the lowest cost scenario for cost per child tested ($10.14 and cost per case correctly classified ($12.84. Cost per case detected was lowest for Kato-Katz used in community-based sampling ($128.24. Sensitivity analysis revealed the cost of case detection for any STH decreased non-linearly as prevalence rates increased and was influenced by the number of samples collected.The Kato-Katz method was comparable in diagnostic sensitivity to the Mini-FLOTAC method, but afforded greater cost-effectiveness. Future work is required to evaluate the cost-effectiveness of STH surveillance in different settings.

  20. Post-marketing surveillance of generic amoxicillin using a microbiological assay and pharmacokinetic approach in rats.

    Science.gov (United States)

    de Mattos, Livia I S; Ferraris, Fausto K; Machado, Tiago S C; de Brito, Thais M; Chaves, Amanda S; Pereira, Heliana M; Pinto, Douglas P; da Silva, Diego M D; Amendoeira, Fabio C

    2016-12-01

    Generic medicines were developed to increase population access to health treatment, to reduce costs and to allow drugs with the same outcomes to be purchased at lower prices. They are therapeutically equivalent to their brand-name counterparts and are interchangeable with them. However, the acceptance of generic medicines by physicians and general consumers is often affected by distrust related to quality and efficacy. In this study three different brands of generic amoxicillin were tested. The results showed that two of them were indistinguishable from the innovator in terms of microbiological potency; however, generic B was unable to reach the Brazilian Pharmacopoeia specifications for potency limits. In contrast, generic B was bioequivalent to the innovator amoxicillin in pharmacokinetic assessment and, surprisingly, generic A, which was approved in the microbiological potency assay, lacked pharmacokinetic equivalence compared with the innovator. Both tests, when used singly, may not be effective at detecting quality deviations in antimicrobial medicines, which indicates that pharmacokinetic tests in rats in association with microbiological potency assays are a valuable tool for post-marketing surveillance of generic antibiotics. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  1. Bioequivalence and in vitro antimicrobial activity between generic and brand-name levofloxacin.

    Science.gov (United States)

    Sun, Hsin-Yun; Liao, Hsiao-Wei; Sheng, Meng-Huei; Tai, Hui-Min; Kuo, Ching-Hua; Sheng, Wang-Huei

    2016-07-01

    Generic agents play a crucial role in reducing the cost of medical care in many countries. However, the therapeutic equivalence remains a great concern. Our study aims to assess the in vitro antimicrobial activity and bioequivalence between generic and brand-name levofloxacin. Enantiomeric purity test, dissolution test, and in vitro antimicrobial susceptibility against seven clinically important pathogens by the agar dilution method were employed to assess the similarity between four generic products and brand-name levofloxacin (Daiichi Sankyo). All the generic and brand-name levofloxacin passed enantiomeric purity test. The results of dissolution tests were not similar among the generic products and the brand-name levofloxacin. Compared with the generic products, the brand-name levofloxacin had the smallest mean variations (-25% to 13%) with reference standard (United States Pharmacopeia levofloxacin Reference Standards). Variations were observed particularly in dissolution profiles and in vitro activity between generic products and brand-name levofloxacin. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. DRUG COSTS UPDATE ON THE PHARMACEUTICAL INDUSTRY

    African Journals Online (AJOL)

    Enrique

    The initiative involves a venture with two Indian pharmaceutical companies and a South African generic medicine manufacturer (Aspen Pharmacare). These companies will be manufacturing generic antiretroviral medication — funding from the Foundation will allow a further reduction in price. A target annual cost quoted is.

  3. Typed generic traversals in $S_gamma^'$

    NARCIS (Netherlands)

    R. Lämmel (Ralf)

    2001-01-01

    textabstractA typed model of strategic rewriting is developed. An innovation is that generic traversals are covered. To this end, we define a rewriting calculus $S'_{gamma$. The calculus offers a few strategy combinators for generic traversals. There is, for example, a combinator to apply a strategy

  4. HTGR generic technology program plan (FY 80)

    Energy Technology Data Exchange (ETDEWEB)

    1980-01-01

    Purpose of the program is to develop base technology and to perform design and development common to the HTGR Steam Cycle, Gas Turbine, and Process Heat Plants. The generic technology program breaks into the base technology, generic component, pebble-bed study, technology transfer, and fresh fuel programs. (DLC)

  5. Brand vs generic adverse event reporting patterns: An authorized generic-controlled evaluation of cardiovascular medications.

    Science.gov (United States)

    Alatawi, Y; Rahman, Md M; Cheng, N; Qian, J; Peissig, P L; Berg, R L; Page, C D; Hansen, R A

    2017-11-01

    Some public scepticism exists about generics in terms of whether brand and generic drugs produce identical outcomes. This study explores whether adverse event (AE) reporting patterns are similar between brand and generic drugs, using authorized generics (AGs) as a control for possible generic drug perception biases. Events reported to the FDA Adverse Event Reporting System from the years 2004-2015 were analysed. Drugs were classified as brand, AG or generic based on drug and manufacturer names. Reports were included if amlodipine, losartan, metoprolol extended release (ER) or simvastatin were listed as primary or secondary suspect drugs. Disproportionality analyses using the reporting odds ratio (ROR) assessed the relative rate of reporting labelled AEs compared to reporting these AEs with all other drugs. The Breslow-Day test compared RORs across brand, AG and generic. Interrupted time series analysis evaluated the impact of generic entry on reporting trends. Generics accounted for significant percentages of total U.S. reports, but AGs accounted for smaller percentages of reports, including for amlodipine (14.26%), losartan (1.48%), metoprolol ER (0.35%) and simvastatin (0.70%). Whereas the RORs were significantly different for multiple brand vs generic comparisons, the AG vs generic comparisons yielded fewer statistically significant findings. Namely, only the ROR for AG differed from generic for amlodipine with peripheral oedema (P reporting patterns were observed more between brand and generic compared with AG and generic. Use of AGs as a control for perception biases against generics is useful, but this approach can be limited by small AG report numbers. Requiring the manufacturer name to be printed on the prescription bottle or packaging could improve the accuracy of assignment for products being reported. © 2017 John Wiley & Sons Ltd.

  6. Maximum potential cost-savings attributable to generic substitution ...

    African Journals Online (AJOL)

    D. Husselmann

    recommended by the World Health Organization (WHO). (WHO .... database. Data fields used from the database included date of treat- ... medical scheme contribution and patient contribution), trade names of ... Statistical analysis. The SAS ...

  7. Factors influencing consumer purchasing patterns of generic versus brand name over-the-counter drugs.

    Science.gov (United States)

    Kohli, Erol; Buller, Allison

    2013-02-01

    US consumers spend more than $20 billion/year on over-the-counter (OTC) drugs. Although generic and brand name OTC drugs share the same active ingredients and undergo the same rigorous Food and Drug Administration approval process, brand name formulations continue to lead the OTC drug market with a higher market share. There is a limited amount of publicly available information regarding consumer perceptions and awareness about generic and brand name OTC drugs. The main objective of this research was to understand what factors influence US consumers to purchase generic versus brand name OTC drugs. The researchers used a 20-question, self-administered, multiple-choice survey to collect data on the factors influencing consumers' preferences for generic versus brand name OTC drugs. Results revealed that the single most influential factor for participants when purchasing OTC drugs was lower cost. Although economic factors play an important role in influencing consumers to choose generic formulations, a variety of other factors including advertisements, duration of the OTC effectiveness, severity of sickness, preferable form of OTC medication, safety of the OTC, relief of multiple symptoms, and preferred company will persuade others to pay more for brand name drugs. Ultimately, increased awareness and use of generic OTC drugs may result in substantial cost savings for consumers.

  8. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study

    Science.gov (United States)

    2013-01-01

    Generic medicines are those where patent protection has expired, and which may be produced by manufacturers other than the innovator company. Use of generic medicines has been increasing in recent years, primarily as a cost saving measure in healthcare provision. Generic medicines are typically 20 to 90% cheaper than originator equivalents. Our objective is to provide a high-level description of what generic medicines are and how they differ, at a regulatory and legislative level, from originator medicines. We describe the current and historical regulation of medicines in the world’s two main pharmaceutical markets, in addition to the similarities, as well as the differences, between generics and their originator equivalents including the reasons for the cost differences seen between originator and generic medicines. Ireland is currently poised to introduce generic substitution and reference pricing. This article refers to this situation as an exemplar of a national system on the cusp of significant health policy change, and specifically details Ireland’s history with usage of generic medicines and how the proposed changes could affect healthcare provision. PMID:23289757

  9. International experiences of promoting generics use and its implications to China.

    Science.gov (United States)

    Sun, Jing

    2013-05-01

    To summarize international experiences in promoting use of generics and to extract essence for China's reference. This is a commentary of two systematic reviews about policies to promote use of generics and its implications to China. Price, reimbursement, and generic substitution policies in European countries, and approaches in low and middle income countries in promoting market competition, appropriate intellectual property right protection strategy, and necessary demand side incentives, are all meaningful for China to contain soaring pharmaceutical expenditures, and to maintain the achievements and outcomes of the national health system reform. Effective promotion of generics use must be practice based on the real situation. Tailor-made and comprehensive measures are needed to address both demand and supply sides barriers before achieving tangible cost containment effect without unexpected side effects. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

  10. Ballast Water Treatment, U.S. Great Lakes Bulk Carrier Engineering and Cost Study. Volume 2: Analysis of On-Board Treatment Methods, Alternative Ballast Water Management Practices, and Implementation Costs

    Science.gov (United States)

    2013-11-01

    but the largest sizes are very costly (Emco Wheaton, June 13, 2011; Connex SVT , June 9, 2011). The more cost-effective option is a hose diameter of...fire extinguishers and semiportable fire extinguishing systems, arrangements and details. CFR Part 46 - Shipping. U.S. Government. Connex SVT . (June 9

  11. Generic substitution: a potential risk factor for medication errors in hospitals.

    Science.gov (United States)

    Håkonsen, Helle; Hopen, Heidi Skjønhaug; Abelsen, Linda; Ek, Bjørg; Toverud, Else-Lydia

    2010-02-01

    Efforts to restrain pharmaceutical costs in the Norwegian hospital sector have focused on putting pharmaceuticals out to tender with resultant frequent changes in medicine inventories. Due to the extent of physicians failing to prescribe from the hospital drug list, the nurses have to perform generic substitution on the wards. The objective of the present study is to investigate the hospital nurses' experiences with generic substitution and to explore their views on this strategy as a risk factor for medication errors. Personal interviews with 100 nurses who were employed in a large Norwegian hospital were conducted using a semistructured questionnaire. In all, 75% of nurses thought it was problematic that the hospital's drug inventory was subject to frequent changes, and 91% believed that the high number of generic products may contribute to erroneous dispensing. Nevertheless, three out of four admitted that they seldom or never verified the feasibility of the substitution with the physician, and that it was seldom documented in the medical charts. In total, 42% of the nurses had experienced mistakes that occurred as a result of substitution. They claimed that the medication errors relating to generic substitution derived from difficult drug names, frequent changes in the drug inventory, and the increasing number of generic drugs, as well as from heavy workload and insufficient training. The present study shows that generic substitution is often carried out by nurses on the wards. The nurses feel insecure about the situation and report that they do not have the necessary training for the task. They clearly believe that a high number of generic drugs and frequent generic substitutions are risk factors for medication errors. Hence, hospital managers should be aware that such strategies to reduce costs may interfere with patient safety.

  12. Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?: International implications.

    Science.gov (United States)

    Bennie, M; Bishop, I; Godman, B; Barbui, C; Raschi, E; Campbell, S; Miranda, J; Gustafsson, L L

    2013-02-01

    National and regional authorities in Scotland have introduced multiple measures to appreciably enhance prescribing efficiency for the proton pump inhibitors (PPIs), statins and renin-angiotensin inhibitor drugs. Generic oral risperidone recently became available in Scotland; however, schizophrenia is a complex disease with advice from respected authorities suggesting that treatment should be individualised. To assess (i) changes in atypical antipsychotic drug (AAP) utilisation and expenditure following the availability of oral generic risperidone in Scotland; (ii) to determine (a) current INN prescribing rates for risperidone following generic availability and (b) decrease in expenditure/DDD for generic risperidone; (iii) to suggest additional measures that could possibly be introduced in Scotland to further enhance prescribing of generic AAPs; and (iv) to provide guidance to NHS Scotland as well as other European authorities on the implications. Retrospective observational study and an interrupted time series design. No appreciable change in the utilisation patterns of risperidone pre- and postgeneric availability. Appreciable INN prescribing averaged 93-98% of total oral risperidone. Generic risperidone was 84% below prepatent loss prices by study end, reducing annual expenditure for oral risperidone in 2010 by GB£3.19mn compared with prepatent loss situation. However, overall expenditure on AAPs increased by 42% from 2005 to 2010. As expected, there was no change in utilisation patterns for risperidone, although potential to influence prescribing patterns. Continued high INN prescribing suggests no problems with generic risperidone in practice. Costs will start to decrease as more AAPs lose their patents (olanzapine and quetiapine). There is the possibility to accelerate this reduction through educational activities. There is potential to realise some savings with generic AAPs. However, this is limited by the complexity of the disease area. Any measures

  13. Associations between generic substitution and patients' attitudes, beliefs and experience

    DEFF Research Database (Denmark)

    Østergaard Rathe, Jette; Larsen, Pia Veldt; Andersen, Morten

    2013-01-01

    Abstract Background Generic substitution has been implemented in many countries, but knowledge about patients’ attitudes, beliefs and experiences is still sparse. Aim To assess associations between generic switching and patients’ attitudes, beliefs and experiences with previous generic switching...

  14. Cost-effectiveness and total costs of three alternative strategies for the prevention and management of severe skin reactions attributable to thiacetazone in the treatment of Human Immunodeficiency Virus positive patients with tuberculosis in Kenya.

    Science.gov (United States)

    van Gorkom, J; Kibuga, D K

    1996-02-01

    Severe skin reactions due to thiacetazone (T) in Human Immunodeficiency Virus (HIV) positive tuberculosis patients have been reported in several publications, one of them from Kenya. However, the abandoning of T may not be feasible in Kenya as this may increase the cost of drugs by about three-fold per regimen. To compare the cost-effectiveness and total cost of three strategies in which T is replaced with ethambutol (E). Three strategies are compared with a baseline strategy in which T is not replaced. The indicator for cost-effectiveness is the cost-per-averted-death attributable to T. Education of patients on the possibility of side-effects and replacement of T with E is the most cost-effective strategy at HIV prevalence rates of 1-90%. Abandonment of T and replacement with E is the most cost-effective at over 90% HIV prevalence. In Kenya, education of patients on the possibility of skin reactions should be preferred at low range HIV prevalence rates. Routine HIV testing would be the most attractive strategy in the middle range, and total replacement of T with E is to be preferred in the higher range of HIV prevalence.

  15. Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease.

    Science.gov (United States)

    Carroll, Thomas L; Werner, Astrid; Nahikian, Kael; Dezube, Aaron; Roth, Douglas F

    2017-10-01

    Empiric proton pump inhibitor (PPI) trials for laryngopharyngeal reflux (LPR) are common. A majority of the patients respond to acid suppression. This work intends to evaluate once-daily, 40 mg omeprazole and once-nightly, 300 mg ranitidine (QD/QHS) dosing as an alternative regimen, and use this study's cohort to evaluate empiric regimens prescribed for LPR as compared to up-front testing with pH impedance multichannel intraluminal impedance (MII) with dual pH probes and high-resolution manometry (HRM) for potential cost minimization. Retrospective cohort review and cost minimization study. A chart review identified patients diagnosed with LPR. All subjects were treated sequentially and outcomes recorded. Initial QD/QHS dosing increased after 3 months to BID if no improvement and ultimately prescribed MII and HRM if they failed BID dosing. Decision tree diagrams were constructed to determine costs of two empiric regimens and up-front MII and HRM. Ninety-seven subjects met the criteria. Responders and nonresponders to empiric therapy were identified. Seventy-two subjects (74%) responded. Forty-eight (67% of responders and 49% of all) improved with QD/QHS dosing. Forty-nine (51%) subjects escalated to BID dosing. Twenty-four subjects (33% of responders and 25% of all) improved on BID therapy. Twenty-five subjects (26%) did not respond to acid suppression. Average weighted cost was $1,897.00 per patient for up-front testing, $3,033.00 for initial BID, and $3,366.00 for initial QD/QHS. An alternate QD/QHS regimen improved the majority who presented with presumed LPR. Cost estimates demonstrate that the QD/QHS regimen was more expensive than the initial BID high-dose PPI for 6 months. Overall per-patient cost appears less with up-front MII and HRM. 4. Laryngoscope, 127:S1-S13, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  16. A Generic Modeling Process to Support Functional Fault Model Development

    Science.gov (United States)

    Maul, William A.; Hemminger, Joseph A.; Oostdyk, Rebecca; Bis, Rachael A.

    2016-01-01

    Functional fault models (FFMs) are qualitative representations of a system's failure space that are used to provide a diagnostic of the modeled system. An FFM simulates the failure effect propagation paths within a system between failure modes and observation points. These models contain a significant amount of information about the system including the design, operation and off nominal behavior. The development and verification of the models can be costly in both time and resources. In addition, models depicting similar components can be distinct, both in appearance and function, when created individually, because there are numerous ways of representing the failure space within each component. Generic application of FFMs has the advantages of software code reuse: reduction of time and resources in both development and verification, and a standard set of component models from which future system models can be generated with common appearance and diagnostic performance. This paper outlines the motivation to develop a generic modeling process for FFMs at the component level and the effort to implement that process through modeling conventions and a software tool. The implementation of this generic modeling process within a fault isolation demonstration for NASA's Advanced Ground System Maintenance (AGSM) Integrated Health Management (IHM) project is presented and the impact discussed.

  17. Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium.

    Science.gov (United States)

    Fraeyman, J; Van Hal, G; De Loof, H; Remmen, R; De Meyer, G R Y; Beutels, P

    2012-01-01

    Pharmaceutical expenditures are increasing as a proportion of health expenditures in most rich countries. Antidepressants, acid blocking agents and cholesterol lowering medication are major contributors to medicine sales around the globe. We aimed to document the possible impact of policy regulations and generic market penetration on the evolution of sales volume and average cost per unit (Defined Daily Doses and packages) of antidepressants, acid blocking agents and cholesterol lowering medication. We extracted data from the IMS health database regarding the public price and sales volume of the antidepressants (selective serotonin reuptake inhibitors (SSRI's), monoamine oxidase inhibitors (MAOl's) and tricyclic and remaining antidepressants (TCA's)), acid blocking agents (proton pump inhibitors (PPl's) and H2 receptor antagonists) and cholesterol lowering medication (statins and fibrates) in Belgium between 1995 and 2009. We describe these sales data in relation to various national policy measures which were systematically searched in official records. Our analysis suggests that particular policy regulations have had immediate impact on sales figures and expenditures on pharmaceuticals in Belgium: changes in reimbursement conditions, a public tender and entry of generic competitors in a reference pricing system. However, possible sustainable effects seem to be counteracted by other mechanisms such as marketing strategies, prescribing behaviour, brand loyalty and the entry of pseudogenerics. It is likely that demand-side measures have a more sustainable impact on expenditure. Compared with other European countries, generic penetration in Belgium remains low. Alternative policy regulations aimed at enlarging the generic market and influencing pharmaceutical expenditures deserve consideration. This should include policies aiming to influence physicians' prescribing and a shared responsibility of pharmacists, physicians and patients towards expenditures.

  18. Generic Local Hamiltonians are Gapless

    Science.gov (United States)

    Movassagh, Ramis

    2017-12-01

    We prove that generic quantum local Hamiltonians are gapless. In fact, we prove that there is a continuous density of states above the ground state. The Hamiltonian can be on a lattice in any spatial dimension or on a graph with a bounded maximum vertex degree. The type of interactions allowed for include translational invariance in a disorder (i.e., probabilistic) sense with some assumptions on the local distributions. Examples include many-body localization and random spin models. We calculate the scaling of the gap with the system's size when the local terms are distributed according to a Gaussian β orthogonal random matrix ensemble. As a corollary, there exist finite size partitions with respect to which the ground state is arbitrarily close to a product state. When the local eigenvalue distribution is discrete, in addition to the lack of an energy gap in the limit, we prove that the ground state has finite size degeneracies. The proofs are simple and constructive. This work excludes the important class of truly translationally invariant Hamiltonians where the local terms are all equal.

  19. Generic physical protection logic trees

    Energy Technology Data Exchange (ETDEWEB)

    Paulus, W.K.

    1981-10-01

    Generic physical protection logic trees, designed for application to nuclear facilities and materials, are presented together with a method of qualitative evaluation of the trees for design and analysis of physical protection systems. One or more defense zones are defined where adversaries interact with the physical protection system. Logic trees that are needed to describe the possible scenarios within a defense zone are selected. Elements of a postulated or existing physical protection system are tagged to the primary events of the logic tree. The likelihood of adversary success in overcoming these elements is evaluated on a binary, yes/no basis. The effect of these evaluations is propagated through the logic of each tree to determine whether the adversary is likely to accomplish the end event of the tree. The physical protection system must be highly likely to overcome the adversary before he accomplishes his objective. The evaluation must be conducted for all significant states of the site. Deficiencies uncovered become inputs to redesign and further analysis, closing the loop on the design/analysis cycle.

  20. Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain.

    Science.gov (United States)

    Hidalgo-Vega, Álvaro; Villoro, Renata; Blasco, Juan Antonio; Talavera, Pablo; Ferro, Belén; Purcaru, Oana

    2015-01-01

    Certolizumab pegol, a PEGylated tumour necrosis factor (TNF)-inhibitor, improves the clinical signs and symptoms of rheumatoid arthritis (RA) when used in combination with methotrexate or as monotherapy. This study evaluatedthe cost-utility of certolizumab pegol versusTNF-inhibitors plus methotrexate in the treatment of moderate-to-severe RA in Spain. A Markov cohort health state transition model was developed to evaluate the cost-utility (costs and quality-adjusted life years [QALYs]) of certolizumab pegol versus other TNF-inhibitors licensed in Spain in 2009. Efficacy was measured using the American College of Rheumatology (ACR) responses at 6 months, based on adjusted indirect comparisons from published clinical trials. Utilities were derived from EQ-5D data from certolizumab pegol RA clinical trials. Clinical history and resource use data came from published literature. Unit costs were taken from Spanish databases or published data (cost year 2009). Base case analyses were conducted from the payer perspective, with a lifetime horizon, 3.5 % annual discounting rates for costs and outcomes, and 3 % inflation rate for 2009 onwards. One-way sensitivity analyses were conducted. The average lifetime costs for certolizumab pegol, etanercept, adalimumab (every 2 weeks and weekly) and infliximab (3 mg/kg and 5 mg/kg) in combination with methotrexate were €140,971, €141,197, €139,148, €164,741, €136,961 and €152,561, respectively. The QALYs gained were 6.578, 6.462, 6.430 (for both adalimumab doses), 6.430, and 6.318 (for both infliximab doses), respectively. At a €30,000/QALY willingness-to-pay threshold, certolizumab pegol plus methotrexate dominated adalimumab weekly, etanercept, and infliximab 5 mg/kg, and was cost-effective versus adalimumab every 2 weeks and infliximab 3 mg/kg (all with methotrexate), with estimated ICERs of €12,346/QALY and €15,414/QALY, respectively. Certolizumab pegol monotherapy was more cost-effective versus

  1. Further potential savings attributable to maximum generic substitution of antidepressants in South Africa: A retrospective analysis of medical claims

    Directory of Open Access Journals (Sweden)

    Jan H.P. Serfontein

    2010-03-01

    Full Text Available The main objective of the study was to calculate potential cost savings that could have been generated by maximum generic substitution of antidepressants within the private health care sector of South Africa from 2004 to 2006. Data on computerised medicine claims of patients receiving one or more antidepressants during three consecutive years (i.e. 2004, 2005 and 2006 were elicited from a South African pharmaceutical benefit management company. The total study population consisted of 292 071 items (N = 5 982 869 on 273 673 prescriptions (N = 5 213 765 at a total cost of R56 183 697.91(N = R1 346 210 929.00. A quantitative, retrospective drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Potential cost savings were computed for criteria-eligible substances in the study population. Generic medicine constituted 58.7% (N = 292 071 of all antidepressants claimed, at a total cost of 28.2% (N = R1 346 210 929.00of all incurred costs. With total substitution of the average price of all criteria-eligible innovators, a potential saving of 9.3% (N = R56 183 697.91 of the actual antidepressant cost over the study period was calculated. In developing countries with limited health care resources, generic medicines can be cost-saving treatment alternatives.

    Opsomming

    Die hoofmikpunt van hierdie studie was om die potensiële kostebesparing te bereken wat deur maksimale generiese vervanging van antidepressante in die Suid-Afrikaanse private gesondheidsorgsektor tussen 2004 en 2006 teweeggebring sou kon word. Data oor gerekenariseerde eise vir medisyne van pasiënte wat een of meer antidepressante gedurende die studietydperk ontvang het (d.i. 2004, 2005 en 2006 is van ʼn Suid-Afrikaanse maatskappy wat farmaseutiese voordele bestuur, verkry. Die totale studiepopulasie het bestaan uit 292 071 items (N = 5 982 869van 273 673 voorskrifte (N = 5 213 765 teen ʼn totale koste van R56

  2. Discrete element analysis methods of generic differential quadratures

    CERN Document Server

    Chen, Chang-New

    2008-01-01

    Presents generic differential quadrature, the extended differential quadrature and the related discrete element analysis methods. This book demonstrated their ability for solving generic scientific and engineering problems.

  3. Generic Patch Inference

    DEFF Research Database (Denmark)

    Andersen, Jesper; Lawall, Julia Laetitia

    2008-01-01

    A key issue in maintaining Linux device drivers is the need to update drivers in response to evolutions in Linux internal libraries. Currently, there is little tool support for performing and documenting such changes. In this paper we present a tool, spfind, that identifies common changes made...... in a set of pairs of files and their updated versions, and extracts a generic patch performing those changes. Library developers can use our tool to extract a generic patch based on the result of manually updating a few typical driver files, and then apply this generic patch to other drivers.  Driver...

  4. Generic Penetration of the SSRI Market.

    Science.gov (United States)

    Cascade, Elisa F; Kalali, Amir H

    2008-04-01

    In this article, we investigate the penetration of generic selective serotonin reuptake inhibitors (SSRIs) in the US market and the implications for patient out-of-pocket expense. The data suggest that generic penetration into the SSRI market has grown from approximately nine percent in 2000, the year that the patent for Prozac((R)) expired, to 72 percent in 2007. For December, 2007, the difference in patient out-of-pocket expense for branded vs. generic agents was, on average, $55.42 for patients paying by cash (i.e., they had no prescription drug insurance) and $22.39 for patients with insurance coverage.

  5. Organizational Implications of the Cost Leadership Strategies

    National Research Council Canada - National Science Library

    Anisoara Duica; Mircea Constantin Duica

    2014-01-01

      Included by M. Porter in the category of the generic competitive strategies, the cost leadership strategies still present interest for the researchers in the strategic management domain, a research domain...

  6. Organizational Implications of the Cost Leadership Strategies

    National Research Council Canada - National Science Library

    Anisoara Duica; Mircea Constantin Duica

    2014-01-01

      Included by M. Porter in the category of the generic competitive strategies, the cost leadership strategies still present interest for the researchers in the strategic management domain, a research domain on which...

  7. Effects of hospital generic drug substitution on diabetes therapy

    Directory of Open Access Journals (Sweden)

    Chen HY

    2014-01-01

    Full Text Available Hui-Yin Chen,1 Hui-Ru Chang,2 Hui-Chu Lang3 1Department of Auditing, Mackay Memorial Hospital, Taipei, Taiwan; 2Department of Social Insurance, Ministry of Health and Welfare, Taipei, Taiwan; 3Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan Objectives: To evaluate the effects on physicians’ prescribing behavior and on the therapeutic outcome of non-insulin-dependent diabetes patients of substituting different generic brands of metformin. Methods: We adopt a retrospective cohort study involving 280 type-2 diabetes patients who regularly used the outpatient services of one medical center and who had changed metformin brands five times between 2003 and 2008. The aim was to examine the effects of switching brands. The generalized estimating equation was used to determine whether drug brand switching affected patient glycated hemoglobin A1c (HbA1c levels, their prescribed daily dose, or their adherence to medication with metformin. Results: HbA1c levels increased from 7.91 to 8.34 throughout the study period, although it was found that brand switching did not adversely affect HbA1c levels after controlling for patient characteristics and the time course of the study. Furthermore, the prescribed daily dose of metformin was stable throughout the study period, and was approximately 0.8 of the defined daily dose. Finally, although adherence was significantly higher with the original metformin than with the four generic brands, patients still maintained high levels of adherence of >0.8. Conclusion: Although switching between different brands of metformin slightly affected the prescribing behavior of the physicians, there was no unfavorable effect on patient HbA1c levels. Thus, the policy of substituting between different generic brands of metformin is a good cost-effective approach that does not adversely affect the quality of diabetes patient care. Keywords: metformin, generic substitution, glycemic

  8. Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS).

    Science.gov (United States)

    Rahman, Md Motiur; Alatawi, Yasser; Cheng, Ning; Qian, Jingjing; Plotkina, Annya V; Peissig, Peggy L; Berg, Richard L; Page, David; Hansen, Richard A

    2017-09-01

    Despite the cost saving role of generic anti-epileptic drugs (AEDs), debate exists as to whether generic substitution of branded AEDs may lead to therapeutic failure and increased toxicity. This study compared adverse event (AE) reporting rates for brand vs. authorized generic (AG) vs. generic AEDs. Since AGs are pharmaceutically identical to brand but perceived as generics, the generic vs. AG comparison minimized potential bias against generics. Events reported to the U.S. Food and Drug Administration Adverse Event Reporting System between January 2004 to March 2015 with lamotrigine, carbamazepine, and oxcarbazepine listed as primary or secondary suspect were classified as brand, generic, or AG based on the manufacturer. Disproportionality analyses using the reporting odds ratio (ROR) assessed the relative rate of reporting of labeled AEs compared to reporting these events with all other drugs. The Breslow-Day statistic compared RORs across brand, AG, and other generics using a Bonferroni-corrected Pevents with lamotrigine, 13,950 events with carbamazepine, and 5077 events with oxcarbazepine were reported, with generics accounting for 27%, 41%, and 32% of reports, respectively. Although RORs for the majority of known AEs were different between brand and generics for all three drugs of interest (Breslow-Day Preports of suicide or suicidal ideation compared with the respective AGs based on a multiple comparison-adjusted Preporting rates were observed for the AG and generic comparisons for most outcomes and drugs, suggesting that brands and generics have similar reporting rates after accounting for generic perception biases. Disproportional suicide reporting was observed for generics compared with AGs and brand, although this finding needs further study. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Patients' Preferences for Generic and Branded Over-the-Counter Medicines: An Adaptive Conjoint Analysis Approach.

    Science.gov (United States)

    Halme, Merja; Linden, Kari; Kääriä, Kimmo

    2009-12-01

    : Despite increased use of generic medicines, little is known about either the attitudes of patients towards them or the decision-making process surrounding them. Young adults use over-the-counter (OTC) analgesics relatively often. : To assess the preferences of patients for generic and branded OTC pain medicines, to identify clusters with different preference structures, and to estimate the price elasticity of a generic alternative among university students. : Finnish university students (n = 256; students in courses at the Helsinki School of Economics) responded to an adaptive conjoint analysis (ACA) questionnaire on the choice between branded and generic OTC ibuprofen products. Product attributes of price, brand, onset time of effect, place of purchase and source of information were included in the questionnaire on the basis of the literature, a focus group and a previous pilot study. Several socioeconomic and health behavior descriptors were employed. Individual-level utility functions were estimated, preference clusters were identified, and the price elasticity of the generic medicine was assessed. : Five clusters with characteristic individual-level preferences and price elasticity but few differences in socioeconomic background were detected. Approximately half of the respondents were strongly price sensitive while the others had other preferences such as brand or an opportunity to buy the medicine at a pharmacy or to have a physician or a pharmacist as an information source. : The study provided new information on the concomitant effects of brand, price and other essential product attributes on the choice by patients between branded and generic medicines.

  10. Combining engineering and data-driven approaches: Development of a generic fire risk model facilitating calibration

    DEFF Research Database (Denmark)

    De Sanctis, G.; Fischer, K.; Kohler, J.

    2014-01-01

    are not detailed enough. Engineering risk models, on the other hand, may be detailed but typically involve assumptions that may result in a biased risk assessment and make a cost-benefit study problematic. In two related papers it is shown how engineering and data-driven modeling can be combined by developing......Fire risk models support decision making for engineering problems under the consistent consideration of the associated uncertainties. Empirical approaches can be used for cost-benefit studies when enough data about the decision problem are available. But often the empirical approaches...... a generic risk model that is calibrated to observed fire loss data. Generic risk models assess the risk of buildings based on specific risk indicators and support risk assessment at a portfolio level. After an introduction to the principles of generic risk assessment, the focus of the present paper...

  11. A cost and returns evaluation of alternative dairy products to determine capital investment and operational feasibility of a small-scale dairy processing facility.

    Science.gov (United States)

    Becker, K M; Parsons, R L; Kolodinsky, J; Matiru, G N

    2007-05-01

    This study examines the economic feasibility of 50- and 500-cow dairy processing facilities for fluid milk, yogurt, and cheese. Net present value and internal rate of return calculations for projected costs and returns over a 10-yr period indicate that larger yogurt and cheese processing plants offer the most profitable prospects, whereas a smaller yogurt plant would break even. A smaller cheese plant would have insufficient returns to cover the cost of capital, and fluid milk processing at either scale is economically infeasible. Economic success in processing is greatly contingent upon individual business, financial management, and marketing skills.

  12. Impacts of Generic Competition and Benefit Management...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impacts of Generic Competition and Benefit Management Practices on Spending for Prescription Drugs - Evidence from Medicares Part D...

  13. Are generic drugs really inferior medicines?

    Science.gov (United States)

    Moore, N; Berdaï, D; Bégaud, B

    2010-09-01

    In this issue Gagne et al. report an elegant case-crossover study of seizures in patients on antiepileptic drugs. They found that a dispensation episode approximately triples the risk of having a seizure within 21 days, but the risk is not statistically different whether the dispensation was of the same brand-name or generic drug as previously used or a switch from brand-name to a generic or from a generic to a brand name. The cause of the seizure might be a delay in taking medication or late redispensation, among others, but apparently the nature of the product dispensed is not relevant in this study; this may alleviate some of the concerns about generic drugs and epilepsy.

  14. White River Falls Fish Passage Project, Tygh Valley, Oregon : Final Technical Report, Volume III, Appendix B, Fisheries Report; Appendix C, Engineering Alternative Evaluation; Appendix D, Benefit/Cost Analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Oregon. Dept. of Fish and Wildlife; Mount Hood National Forest (Or.)

    1985-06-01

    Studies were conducted to describe current habitat conditions in the White River basin above White River Falls and to evaluate the potential to produce anadromous fish. An inventory of spawning and rearing habitats, irrigation diversions, and enhancement opportunities for anadromous fish in the White River drainage was conducted. Survival of juvenile fish at White River Falls was estimated by releasing juvenile chinook and steelhead above the falls during high and low flow periods and recapturing them below the falls in 1983 and 1984. Four alternatives to provide upstream passage for adult salmon and steelhead were developd to a predesign level. The cost of adult passage and the estimated run size of anadromous fish were used to determine the benefit/cost of the preferred alternative. Possible effects of the introduction of anadromous fish on resident fish and on nearby Oak Springs Hatchery were evaluated. This included an inventory of resident species, a genetic study of native rainbow, and the identification of fish diseases in the basin. This volume contains appendices of habitat survey data, potential production, resident fish population data, upstream passage designs, and benefit/cost calculations. (ACR)

  15. [General awareness and use of generic medication among citizens of Tubarão, state of Santa Catarina, Brazil].

    Science.gov (United States)

    Blatt, Carine Raquel; Trauthman, Silvana Cristina; Schmidt, Edegar Henrique; Marchesan, Samuel; da Silva, Luana May; Martins, João Luiz

    2012-01-01

    Although generic medication has been introduced in the country to offer an accessible alternative to brand-name medication, it represents only 14% of sales in number of units within the pharmaceutical market. The aim of this work was to research the level of awareness and the use of generic products among residents of the municipality of Tubarão, State of Santa Catarina, Brazil. A transversal study was carried out with a sample of 234 interviewees, distributed among municipal areas. With regard to use, the majority of those interviewed had used generic medication, and half of them had at least one such product in their home. To verify awareness of different types of medication, pictures with the generic, brand name and similar packaging for paracetamol and atenolol were shown and 91% were able to identify all products correctly. To be of higher economic standing, already having used generic products, believing that the generic medication has the same effect as the brand name medication, finding generic products in drugstores easily and being accustomed to buy generic products, were factors that were positively associated with the correct identification.

  16. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medecine for neck and low-back pain

    NARCIS (Netherlands)

    Furlan, A.D.; Yazdi, F.; Tsertsvadze, A.; Gross, A.; van Tulder, M.W.; Santaguida, L.; Gagnier, J.; Ammendolia, C.; Dryden, T.; Doucette, S.; Skidmore, B.; Daniel, R.; Ostermann, T.; Tsouros, S.

    2012-01-01

    Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records

  17. A Generic News Crawler and Extractor

    OpenAIRE

    Hamborg, Felix; Meuschke, Norman; Breitinger, Corinna; Gipp, Bela

    2017-01-01

    The amount of news published and read online has increased tremendously in recent years, making news data an interesting resource for many research disciplines, such as the social sciences and linguistics. However, large scale collection of news data is cumbersome due to a lack of generic tools for crawling and extracting such data. We present news-please, a generic, multilanguage, open-source crawler and extractor for news that works out-of-thebox for a large variety of news websites. ...

  18. Hematopoietic Progenitor Cell Mobilization with “Just-in-Time” Plerixafor Approach is a Cost Effective Alternative to Routine Plerixafor Use

    Science.gov (United States)

    Veltri, Lauren; Cumpston, Aaron; Shillingburg, Alexandra; Wen, Sijin; Luo, Jin; Leadmon, Sonia; Watkins, Kathy; Craig, Michael; Hamadani, Mehdi; Kanate, Abraham S.

    2015-01-01

    Hematopoietic progenitor cell (HPC) mobilization with granulocyte-colony stimulating factor (G-CSF) and plerixafor results in superior CD34+ cell yield, when compared to mobilization with G-CSF alone in patients with myeloma and lymphoma. However, plerixafor-based approaches are associated with high costs. To circumvent this, several institutions use a so-called “just-in-time” plerixafor (JIT-P) approach, where plerixafor is only administered to patients likely to fail mobilization with G-CSF alone. Whether such a JIT-P approach is cost effective has not been confirmed to date. We present here, results of 136 patients with myeloma or lymphoma who underwent mobilization with two different approaches of plerixafor utilization. Between Jan 2010-Oct 2012 (n=76) patients uniformly received mobilization with G-CSF and plerixafor (routine G+P cohort). To reduce mobilization costs, between Nov 2012-Jun 2014 (n=60) patients were mobilized with JIT-P where plerixafor was only administered to patients likely to fail mobilization with G-CSF alone. Patients in routine G+P group had a higher median peak peripheral blood CD34+ cell count (62 vs. 29 cells/μL, pmobilization failure rates. The mean number of plerixafor doses utilized in JIT-P was lower (1.3 vs. 2.1, p=0.0002). The mean estimated cost in the routine G+P group was higher than that in the JIT-P group (USD 27,513 vs. USD 23,597, p=0.01). Our analysis demonstrates that mobilization with a JIT-P approach is a safe, effective and cost efficient strategy for HPC collection. PMID:26475754

  19. The impact of generic substitution on the turnover and gross margin of pharmaceutical companies a survey 1 year and 5 years after the introduction of generic substitution in Finland.

    Science.gov (United States)

    Timonen, Johanna; Karttunen, Pekka; Bengtström, Marina; Ahonen, Riitta

    2009-10-01

    To explore and compare the impact of generic substitution (GS) on the turnover and gross margin per cent of pharmaceutical companies representing mainly original or generic products in Finland. A mail survey to pharmaceutical companies with an office in Finland and substitutable medicines in the Finnish pharmaceutical market 1 year (2004) and nearly 5 years (2008) after GS. The questionnaire were answered by 16 original and 7 generic product companies in 2004 (response rate 56%, n=41) and by 16 original and 6 generic product companies in 2008 (response rate 56%, n=39). Turnover had decreased in the original product companies and increased in the generic product companies. The gross margin per cent had decreased in the original and generic product companies, and the companies had also compensated for it in many ways. The study suggests that GS has promoted the sales of generic product companies in Finland. However, price competition caused by GS has generally decreased the proportion of profit from turnover in the original and generic product companies. The companies have also compensated for their decreased gross margin, which suggests that the profit in euros has not been sufficient to cover fixed costs in the companies.

  20. Assessment of costs and benefits of flexible and alternative fuel use in the U.S. transportation sector. Technical report fourteen: Market potential and impacts of alternative fuel use in light-duty vehicles -- A 2000/2010 analysis

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-01-01

    In this report, estimates are provided of the potential, by 2010, to displace conventional light-duty vehicle motor fuels with alternative fuels--compressed natural gas (CNG), liquefied petroleum gas (LPG), methanol from natural gas, ethanol from grain and from cellulosic feedstocks, and electricity--and with replacement fuels such as oxygenates added to gasoline. The 2010 estimates include the motor fuel displacement resulting both from government programs (including the Clean Air Act and EPACT) and from potential market forces. This report also provides an estimate of motor fuel displacement by replacement and alterative fuels in the year 2000. However, in contrast to the 2010 estimates, the year 2000 estimate is restricted to an accounting of the effects of existing programs and regulations. 27 figs., 108 tabs.

  1. What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.

    Science.gov (United States)

    Hunter, Wynn G; Zhang, Cecilia Z; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-10-01

    More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression). Focus on 3 conditions with potentially high out-of-pocket costs. Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes. © The Author(s) 2016.

  2. Validating the BTrackS Balance Plate as a low cost alternative for the measurement of sway-induced center of pressure.

    Science.gov (United States)

    O'Connor, Shawn M; Baweja, Harsimran S; Goble, Daniel J

    2016-12-08

    The BTrackS Balance Plate (BBP) is a low-cost force plate that provides objective balance assessment and true portability for the user. Given that this technology is relatively new, the purpose of the present study was to provide the first center of pressure (COP) validation of the BBP. Two BBP devices (one new and one used) were compared with a laboratory-grade force plate (LFP) during simultaneous collection of COP that was induced by an inverted pendulum device with human-like sway characteristics. The results of this study showed almost perfect agreement between the BBP devices and the LFP (ICC>0.999), as well as a high degree of BBP accuracy (<1% error magnitude) and precision (<0.2mm regression residuals). These results suggest the BBP can serve as an effective, low-cost solution for objective balance testing in the laboratory or clinic. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Hematopoietic progenitor cell mobilization with "just-in-time" plerixafor approach is a cost-effective alternative to routine plerixafor use.

    Science.gov (United States)

    Veltri, Lauren; Cumpston, Aaron; Shillingburg, Alexandra; Wen, Sijin; Luo, Jin; Leadmon, Sonia; Watkins, Kathy; Craig, Michael; Hamadani, Mehdi; Kanate, Abraham S

    2015-12-01

    Hematopoietic cell mobilization with granulocyte-colony stimulating factor (G-CSF) and plerixafor results in superior CD34+ cell yield compared with G-CSF alone in patients with myeloma and lymphoma. However, plerixafor-based approaches may be associated with high costs. Several institutions use a "just-in-time" plerixafor approach, in which plerixafor is only administered to patients likely to fail mobilization with G-CSF alone. Whether such an approach is cost-effective is unknown. We evaluated 136 patients with myeloma or lymphoma who underwent mobilization with 2 approaches of plerixafor utilization. Between January 2010 and October 2012, 76 patients uniformly received mobilization with G-CSF and plerixafor. Between November 2012 and June 2014, 60 patients were mobilized with plerixafor administered only to those patients likely to fail mobilization with G-CSF alone. The routine plerixafor group had a higher median peak peripheral blood CD34+ cell count (62 versus 29 cells/μL, P mobilization failure rates. The mean plerixafor doses used was lower with "just-in-time" approach (1.3 versus 2.1, P = 0.0002). The mean estimated cost in the routine plerixafor group was higher (USD 27,513 versus USD 23,597, P = 0.01). Our analysis demonstrates that mobilization with a just-in-time plerixafor approach is a safe, effective, and cost-efficient strategy for HPC collection. Copyright © 2015 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  4. Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh.

    Science.gov (United States)

    Gundre, Nitin P; Iyer, Sandhya P; Subramaniyan, Prabhakar

    2012-03-01

    Most patients who come to a general hospital in a developing country are poor. The most important prohibiting factor for use of polypropylene mesh in hernia repair is its exorbitant cost. Hence, research workers have been on the lookout for an equally effective but economically affordable mesh. Worldwide, surgical repair of inguinal hernia is the most common general surgery procedure performed at the present. Lifetime risk of groin hernia is 15% in males and 5% in females. Most of the patients who visit a general hospital are from either lower middle class or poor socioeconomic strata. The most important prohibiting factor for use of polypropylene mesh in hernia repair for the common man is its exorbitant cost. The aim of this study is to document the feasibility, safety and cost-effectiveness of the use of polyethylene mesh. A single blind, prospective, randomized controlled study, comparing 35 patients of two groups was conducted in a tertiary teaching hospital over a period of 5 years. The patients in both groups underwent inguinal hernioplasty, and were administered similar antibiotics and analgesics. The postoperative course with regard to pain, seroma formation, infection, hospital stay, recurrence and scar quality was evaluated and compared. Statistical analysis was performed with Chi square test. The properties of both meshes were the same with respect to ease of handling, pain score, seroma formation, infection rate, resumption of daily activities, scar quality and mesh rejection. Recurrence rate was zero for both groups. Polyethylene mesh was 2,808 times cheaper than the commercially available polypropylene mesh. This study proved the safety, simplicity, efficacy and cost-effectiveness of polyethylene mesh for inguinal hernia meshplasty, insuring economical, accessible health care for the financially weak section of the population.

  5. The role of natural gas as a primary fuel in the near future, including comparisons of acquisition, transmission and waste handling costs of as with competitive alternatives

    Directory of Open Access Journals (Sweden)

    Liang Fang-Yu

    2012-04-01

    Full Text Available Abstract Natural gas comprises about a quarter of the United States’ energy use. It is more environmentally friendly than oil and coal due to lower carbon dioxide (CO2 emissions per unit, less costly per unit of energy and more readily available domestically in abundant supply. However, due to a number of barriers in the political, infrastructural, pricing and other arenas, the use of natural gas as a significant energy source in the United States has been limited. In our paper, we highlight the favorable qualities of natural gas and its benefits for the consumer, producer, and environment, having compared the costs of the various components of the natural gas business such as drilling and transport to that of coal and oil. Moreover, we touch upon the major issues that have prevented a more prevalent use of the gas, such as the fact that the infrastructure of natural gas is more costly since it is transported though pipelines whereas other energy sources such as oil and coal have flexible systems that use trains, trucks and ships. In addition, the powerful lobbies of the coal and oil businesses, along with the inertia in the congress to pass a national climate change bill further dampens incentives for these industries to invest in natural gas, despite its various attractive qualities. We also include discussions of policy proposals to incentive greater use of natural gas in the future.

  6. The role of natural gas as a primary fuel in the near future, including comparisons of acquisition, transmission and waste handling costs of as with competitive alternatives.

    Science.gov (United States)

    Liang, Fang-Yu; Ryvak, Marta; Sayeed, Sara; Zhao, Nick

    2012-04-23

    Natural gas comprises about a quarter of the United States' energy use. It is more environmentally friendly than oil and coal due to lower carbon dioxide (CO2) emissions per unit, less costly per unit of energy and more readily available domestically in abundant supply. However, due to a number of barriers in the political, infrastructural, pricing and other arenas, the use of natural gas as a significant energy source in the United States has been limited. In our paper, we highlight the favorable qualities of natural gas and its benefits for the consumer, producer, and environment, having compared the costs of the various components of the natural gas business such as drilling and transport to that of coal and oil. Moreover, we touch upon the major issues that have prevented a more prevalent use of the gas, such as the fact that the infrastructure of natural gas is more costly since it is transported though pipelines whereas other energy sources such as oil and coal have flexible systems that use trains, trucks and ships. In addition, the powerful lobbies of the coal and oil businesses, along with the inertia in the congress to pass a national climate change bill further dampens incentives for these industries to invest in natural gas, despite its various attractive qualities. We also include discussions of policy proposals to incentive greater use of natural gas in the future.

  7. An alternative to the balance error scoring system: using a low-cost balance board to improve the validity/reliability of sports-related concussion balance testing.

    Science.gov (United States)

    Chang, Jasper O; Levy, Susan S; Seay, Seth W; Goble, Daniel J

    2014-05-01

    Recent guidelines advocate sports medicine professionals to use balance tests to assess sensorimotor status in the management of concussions. The present study sought to determine whether a low-cost balance board could provide a valid, reliable, and objective means of performing this balance testing. Criterion validity testing relative to a gold standard and 7 day test-retest reliability. University biomechanics laboratory. Thirty healthy young adults. Balance ability was assessed on 2 days separated by 1 week using (1) a gold standard measure (ie, scientific grade force plate), (2) a low-cost Nintendo Wii Balance Board (WBB), and (3) the Balance Error Scoring System (BESS). Validity of the WBB center of pressure path length and BESS scores were determined relative to the force plate data. Test-retest reliability was established based on intraclass correlation coefficients. Composite scores for the WBB had excellent validity (r = 0.99) and test-retest reliability (R = 0.88). Both the validity (r = 0.10-0.52) and test-retest reliability (r = 0.61-0.78) were lower for the BESS. These findings demonstrate that a low-cost balance board can provide improved balance testing accuracy/reliability compared with the BESS. This approach provides a potentially more valid/reliable, yet affordable, means of assessing sports-related concussion compared with current methods.

  8. 42 CFR 447.506 - Authorized generic drugs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Authorized generic drugs. 447.506 Section 447.506... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for Drugs § 447.506 Authorized generic drugs. (a) Authorized generic drug defined. For the purposes of this subpart, an authorized generic drug...

  9. The diffusion of generics after patent expiry in Germany.

    Science.gov (United States)

    Fischer, Katharina Elisabeth; Stargardt, Tom

    2016-11-01

    To identify the influences on the diffusion of generics after patent expiry, we analyzed 65 generic entries using prescription data of a large German sickness fund between 2007 and 2012 in a sales model. According to theory, several elements are responsible for technology diffusion: (1) time reflecting the rate of adaption within the social system, (2) communication channels, and (3) the degree of incremental innovation, e.g., the modifications of existing active ingredient's strength. We investigated diffusion in two ways: (1) generic market share (percentage of generic prescriptions of all prescriptions of a substance) and, (2) generic sales quantity (number of units sold) over time. We specified mixed regression models. Generic diffusion takes considerable time. An average generic market share of about 75 % was achieved not until 48 months. There was a positive effect of time since generic entry on generic market share (p < 0.001) and sales (p < 0.001). Variables describing the communication channels and the degree of innovation influenced generic market share (mostly p < 0.001), but not generic sales quantity. Market structure, e.g., the number of generic manufacturers (p < 0.001) and prices influenced both generic market share and sales. Imperfections in generic uptake through informational cascades seem to be largely present. Third-party payers could enhance means to promote generic diffusion to amplify savings through generic entry.

  10. Generic multiset programming with discrimination-based joins and symbolic Cartesian products

    DEFF Research Database (Denmark)

    Henglein, Fritz; Larsen, Ken Friis

    2010-01-01

    This paper presents GMP, a library for generic, SQL-style programming with multisets. It generalizes the querying core of SQL in a number of ways: Multisets may contain elements of arbitrary first-order data types, including references (pointers), recur- sive data types and nested multisets......: symbolic (term) repre- sentations of multisets, specifically for Cartesian products, for facilitating dynamic symbolic computation, which intersperses algebraic simplification steps with conventional data pro- cessing; and discrimination-based joins, a generic technique for computing equijoins based...... requisite algorithm and data structure engi- neering, is a realistic alternative to SQL even for SQL-expressible queries....

  11. COMPARATIVE EFFICACY AND SAFETY OF HYPOLIPIDEMIC THERAPY WITH GENERIC AND ORIGINAL MEDICINAL PRODUCTS OF SIMVASTATIN

    Directory of Open Access Journals (Sweden)

    E. I. Tarlovskaya

    2011-01-01

    Full Text Available Aim. To compare efficacy , safety and pharmacoeconomical characteristics of generic and original medicinal products of simvastatin in achievement of cholesterol and low density lipoprotein target levels. Material and methods. 38 patients with arterial hypertension accompanied by type 2 diabetes with dyslipidemia were included into the study. They had no clinically obvious ischemic heart disease and did not receive hypolipidemic pharmacotherapy for a month before the study start. The patients were randomized into group A or group B. Patients of group A (n=18 received original simvastatin, patients of group B (n=20 received generic simvastatin. Initial simvastatin dose was 20 mg daily. Lipid plasma profile, liver enzymes, creatine phosphokinase were evaluated every 4 weeks. Cost-effectiveness ratio was calculated. Results. 11 patients (61% in group A and only 5 patients (25% in group B (χ2=5.05; р<0.05 achieved cholesterol target level with simvastatin in dose of 20 mg daily in 3 months of the treatment. Creatine phosphokinase blood level did not increase significantly. Achievement of cholesterol target level cost 814 and 952 RUB per patient in groups A and B, respectively , in 1 month of simvastatin treatment. These costs were 643 and 417 RUB per patient in groups A and B, respectively , in 3 months of treatment. Conclusion. The original simvastatin in comparison with generic one has advantages in hypolipidemic effect. Safety profile is similar for both medications. Original simvastatin therapy has lower cost than this for generic simvastatin therapy in achievement of cholesterol target level in 1 month of treatment. In 3 months the cost of treatment per patient is 227 RUB higher for original medication in comparison with this for generic medication.

  12. Generic Advertising Optimum Budget for Iran’s Milk Industry

    Directory of Open Access Journals (Sweden)

    H. Shahbazi

    2016-05-01

    Full Text Available Introduction One of the main targets of planners, decision makers and governments is increasing society health with promotion and production of suitable and healthy food. One of the basic commodities that have important role in satisfaction of required human food is milk. So, some part of government and producer healthy budget allocate to milk consumption promotion by using generic advertising. If effectiveness of advertising budget on profitability is more, producer will have more willing to spend for advertising. Determination of optimal generic advertising budget is one of important problem in managerial decision making in producing firm as well as increase in consumption and profit and decrease in wasting and non-optimality of budget. Materials and Methods: In this study, optimal generic advertising budget intensity index (advertising budget share of production cost was estimated under two different scenarios by using equilibrium replacement model. In equilibrium replacement model, producer surplus are maximized in respect to generic advertising in retail level. According to market where two levels of farm and processing before retail exist and there is trade in farm and retail level, we present different models. Fixed and variable proportion hypothesis is another one. Finally, eight relations are presented for determination of milk generic advertising optimum budget. So, we use data from several resources such as previous studies, national (Iran Static center and international institute (Fao formal data and own estimation. Because there are several estimations in previous studies, we identify some scenarios (in two general scenarios for calculation of milk generic advertising optimum budget. Results and Discussion: Estimation of milk generic advertising optimum budget in scenario 1 shows that in case of one market level, fixed supplies and no trade, optimum budget is 0.4672539 percent. In case of one market level and no trade, optimum

  13. The carbapenem inactivation method (CIM, a simple and low-cost alternative for the Carba NP test to assess phenotypic carbapenemase activity in gram-negative rods.

    Directory of Open Access Journals (Sweden)

    Kim van der Zwaluw

    Full Text Available A new phenotypic test, called the Carbapenem Inactivation Method (CIM, was developed to detect carbapenemase activity in Gram-negative rods within eight hours. This method showed high concordance with results obtained by PCR to detect genes coding for the carbapenemases KPC, NDM, OXA-48, VIM, IMP and OXA-23. It allows reliable detection of carbapenemase activity encoded by various genes in species of Enterobacteriaceae (e.g., Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae, but also in non-fermenters Pseudomonas aeruginosa and Acinetobacter baumannii. The CIM was shown to be a cost-effective and highly robust phenotypic screening method that can reliably detect carbapenemase activity.

  14. The impact on health outcomes and healthcare utilisation of switching to generic medicines consequent to reference pricing: the case of lamotrigine in New Zealand.

    Science.gov (United States)

    Lessing, Charon; Ashton, Toni; Davis, Peter

    2014-10-01

    Many countries have implemented generic reference pricing and substitution as methods of containing pharmaceutical expenditure. However, resistance to switching between medicines is apparent, especially in the case of anti-epileptic medicines. This study sought to exploit a nation-wide policy intervention on generic reference pricing in New Zealand to evaluate the health outcomes of patients switching from originator to generic lamotrigine, an anti-epileptic medicine. A retrospective study using the national health collections and prescription records was conducted comparing patients who switched from originator brand to generic lamotrigine with patients who remained on the originator brand. Primary outcome measures included switch behaviour, changes in utilisation of healthcare services at emergency departments, hospitalisations and use of specialist services, and mortality. Approximately one-quarter of all patients using the originator brand of lamotrigine switched to generic lamotrigine, half of whom made the switch within 60 days of the policy implementation. Multiple switches (three or more) between generic and brand products were evident for around 10% of switchers. Switch-back rates of 3% were apparent within 30 days post-switch. No difference in heath outcome measures was associated with switching from originator lamotrigine to a generic equivalent and hence no increased costs could be found for switchers. Switching from brand to generic lamotrigine is largely devoid of adverse health outcomes; however, creating an incentive to ensure a greater proportion of patients switch to generic lamotrigine is required to achieve maximal financial savings from a policy of generic reference pricing.

  15. Costs and efficacy ofolanzapine and risperidone in schizophrenia

    Directory of Open Access Journals (Sweden)

    Vittorio Mapelli

    2007-06-01

    , compared respectively to -0.27, p<0.05 and +2.00 n.s.. Again average cost per reduced severity/increased functioning score was higher for risperidone than olanzapine patients (€ 4,568 vs. € 4,170 for CGI and € 2,284 vs. € 1,139 for GAF scales respectively.
Conclusion: the use of olanzapine in the treatment of schizophrenia is the most cost-effective alternative for the SSN (Italian National health service, as it minimizes the cost per score of severity reduction or functioning increase. Even if the price of risperidone were to be reduced by 50% (becoming a generic, total 12 months treatment costs would exceed those of olanzapine in its highest ddd (30 mg.


  16. A Danish cost-effectiveness model of escitalopram in comparison with citalopram and venlafaxine as first-line treatments for major depressive disorder in primary care

    DEFF Research Database (Denmark)

    Sørensen, Jan; Stage, Kurt B; Damsbo, Niels

    2007-01-01

    The objective of this study was to model the cost-effectiveness of escitalopram in comparison with generic citalopram and venlafaxine in primary care treatment of major depressive disorder (baseline scores 22-40 on the Montgomery-Asberg Depression Rating Scale, MADRS) in Denmark. A three-path dec......The objective of this study was to model the cost-effectiveness of escitalopram in comparison with generic citalopram and venlafaxine in primary care treatment of major depressive disorder (baseline scores 22-40 on the Montgomery-Asberg Depression Rating Scale, MADRS) in Denmark. A three...... in 2004 DDK. The expected overall 6-month remission rate was higher for escitalopram (64.1%) than citalopram (58.9%). From both perspectives, the total expected cost per successfully treated patient was lower for escitalopram (DKK 22,323 healthcare, DKK 72,399 societal) than for citalopram (DKK 25......,778 healthcare, DKK 87,786 societal). Remission rates and costs were similar for escitalopram and venlafaxine. Robustness of the findings was verified in multivariate sensitivity analyses. For patients in primary care, escitalopram appears to be a cost-effective alternative to (generic) citalopram, with greater...

  17. Georgetown University generic integrated community energy system GU-ICES demonstration project. Modified work management plan. Final report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1979-04-01

    This Phase II Modified Work Management Plan reflects the change from a Coal Using ICES to a Generic ICES Program. As such, it retains the essential elements relating to coal while broadening the number and types of alternative energy subsystems to be evaluated for eventual implementation on the Georgetown University Campus. In addition to the plan in Book I, Book II deals with an energy audit conducted at the campus in the fall of 1978 to establish a gross baseline from which to measure and evaluate the contributions of selected alternative energy subsystems both from an energy and cost standpoint. Book I proceeds from a discussion of an ICES through an explanation of the scope of effort in each phase expanded into detailed task descriptions by phase together with schedules, PERT and GANTT charts, milestones and levels of effort by task for the Feasibility Analysis, and schedules for the overall program. A description of examples of alternative subsystems to be considered is also included. A detailed Management Plan for the conduct of the effort by General Electric completes the plan. Appendices related to cogeneration, life-cycle costing, GE energy subsystems, the GU Master Energy Plan, and typical regulatory processes to be encountered are included. Book II treats the Energy Audit under the three committed task areas of System Description, Analysis and Survey, and Criteria for Energy Usage. The five major energy systems utilized at Georgetown are considered: electrical, chilled water, steam, gas and fuel oil, and city water. A top level analysis yields significant results and recommendations for further action with respect to a detailed measurements program, particularly of steam and electric power usage, over a one year period.

  18. Recognizing Severe Adverse Drug Reactions: Two Case Reports After Switching Therapies to the Same Generic Company.

    Science.gov (United States)

    Gallelli, Luca; Gallelli, Giuseppe; Codamo, Giuseppe; Argentieri, Angela; Michniewicz, Andzelika; Siniscalchi, Antonio; Stefanelli, Roberta; Cione, Erika; Caroleo, Maria C; Longo, Paola; De Sarro, Giovambattista

    2016-01-01

    Generic formulations represent a way to reduce the costs of brand compounds when their patent is expired. While, the bio-equivalence in generic drugs is guaranteed, some excipients as well as dyes could be different and this could reduce the drug safety. Herein, we report the development of Adverse Drug Reactions (ADRs) in two patients after the switch from brand to generic formulations. We have tested cytochrome P450 enzymes expression as well as drug serum levels. None of these markers were altered. Checking deeply into both patient's medical history, they harbored poly-sensitivity or allergy to pollen and graminacea and used different active ingredients for different health problems coming from the same generic company Almus(®). This company used different dyes and excipients compared to the branded drugs made by distinguished companies. In conclusion, we strongly suggest to both pharmacists and physicians to be careful in giving the advice to change the drug, thinking to reduce health sanitary costs without considering the personal clinical history of each one. Paradoxically this behavior is causing other health issues, bringing to an increase of the overall costs for patients as well as for National Health System.

  19. Cost-Benefit Analysis of Marine Corps Search and Rescue (SAR): A Study of Alternatives for Marine Corps Air Stations at Cherry Point and Yuma

    Science.gov (United States)

    2013-11-21

    61  2.  Economics ................................................................................... 61  ^Åèìáëáíáçå=oÉëÉ~êÅÜ=mêçÖê~ã= dê~Çì~íÉ...Fiscal Year ^Åèìáëáíáçå=oÉëÉ~êÅÜ=mêçÖê~ã= dê~Çì~íÉ=pÅÜççä=çÑ=_ìëáåÉëë=C=mìÄäáÅ=mçäáÅó= - xviii - k~î~ä=mçëíÖê~Çì~íÉ=pÅÜççä= GCE Ground Combat...Marine Corps Kts Knots I- level Intermediate Level JIC Joint Inflation Calculator LCC Life-Cycle Cost LCE Logistics Combat Element MAD Mean

  20. Microwave exposure as a fast and cost-effective alternative of oxygen plasma treatment of indium-tin oxide electrode for application in organic solar cells

    Science.gov (United States)

    Soultati, Anastasia; Kostis, Ioannis; Papadimitropoulos, Giorgos; Zeniou, Angelos; Gogolides, Evangelos; Alexandropoulos, Dimitris; Vainos, Nikos; Davazoglou, Dimitris; Speliotis, Thanassis; Stathopoulos, Nikolaos A.; Argitis, Panagiotis; Vasilopoulou, Maria

    2017-12-01

    Pre-treatment methods are commonly employed to clean as well as to modify electrode surfaces. Many previous reports suggest that modifying the surface properties of indium tin oxide (ITO) by oxygen plasma treatment is a crucial step for the fabrication of high performance organic solar cells. In this work, we propose a fast and cost-effective microwave exposure step for the modification of the surface properties of ITO anode electrodes used in organic solar cells. It is demonstrated that a short microwave exposure improves the hydrophilicity and reduces the roughness of the ITO surface, as revealed by contact angle and atomic force microscopy (AFM) measurements, respectively, leading to a better quality of the PEDOT:PSS film coated on top of it. Similar results were obtained with the commonly used oxygen plasma treatment of ITO suggesting that microwave exposure is an effective process for modifying the surface properties of ITO with the benefits of low-cost, easy and fast processing. In addition, the influence of the microwave exposure of ITO anode electrode on the performance of an organic solar cell based on the poly(3-hexylthiophene):[6,6]-phenyl C70 butyric acid methyl ester (P3HT:PC70BM) blend is investigated. The 71% efficiency enhancement obtained in the microwave annealed-ITO based device as compared to the device with the as-received ITO was mainly attributed to the improvement in the short circuit current (J sc) and decreased leakage current caused by the reduced series and the increased shunt resistances and also by the higher charge generation efficiency, and the reduced recombination losses.

  1. From antiretroviral originator to generic drugs: bioequivalence and pharmacovigilance.

    Science.gov (United States)

    Bagheri, H; Garraffo, R; Dellamonica, P

    2014-10-01

    Antiretroviral drugs have been available in generic form in developing countries, which has expanded access to treatment; they have also become available in developed countries more recently. The validation of generic drugs (GD) compared to originator drugs (OD) is mandatory to ensure that using generics will lead to a decreased cost of treatment. The results were obtained by analyzing published data as well as European Medicines Agency recommendations. The GD should have the same qualitative and quantitative active principle formula, the same pharmaceutical forms, and the same criteria in terms of quality, effectiveness, and safety. This equivalence is based on bioequivalence rules: comparison of the concentration/time curves (AUC); Cmax and Tmax (90%), for which the confidence intervals in the range of 80-125% should be included. Naturally, that does not mean that the concentrations can vary from 80 to 125%: this would indicate unacceptable deviations. Conforming to these criteria allows substituting an OD by a GD. Adverse effects should not be different from those observed for the OD. Adverse effects observed when the GD is used must be notified, as is the case for the OD. Accountability is established according to 4 essential pieces of information: a prescriber, a patient, a drug, and an adverse effect. It is sometimes difficult to identify the provider of the GD that has been delivered. The level of safety concerning effectiveness and tolerance required is identical for OD and GD, in Europe. Analyzing confirmed adverse effects and therapeutic failures is the only way to identify differences that could question a GD's effectiveness. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  2. The formal verification of generic interpreters

    Science.gov (United States)

    Windley, P.; Levitt, K.; Cohen, G. C.

    1991-01-01

    The task assignment 3 of the design and validation of digital flight control systems suitable for fly-by-wire applications is studied. Task 3 is associated with formal verification of embedded systems. In particular, results are presented that provide a methodological approach to microprocessor verification. A hierarchical decomposition strategy for specifying microprocessors is also presented. A theory of generic interpreters is presented that can be used to model microprocessor behavior. The generic interpreter theory abstracts away the details of instruction functionality, leaving a general model of what an interpreter does.

  3. The SENSEI Generic In Situ Interface

    Energy Technology Data Exchange (ETDEWEB)

    Ayachit, Utkarsh [Kitware, Inc., Clifton Park, NY (United States); Whitlock, Brad [Intelligent Light, Rutherford, NJ (United States); Wolf, Matthew [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Loring, Burlen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Geveci, Berk [Kitware, Inc., Clifton Park, NY (United States); Lonie, David [Kitware, Inc., Clifton Park, NY (United States); Bethel, E. Wes [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-04-11

    The SENSEI generic in situ interface is an API that promotes code portability and reusability. From the simulation view, a developer can instrument their code with the SENSEI API and then make make use of any number of in situ infrastructures. From the method view, a developer can write an in situ method using the SENSEI API, then expect it to run in any number of in situ infrastructures, or be invoked directly from a simulation code, with little or no modification. This paper presents the design principles underlying the SENSEI generic interface, along with some simplified coding examples.

  4. Towards Generic Interaction Styles for Product Design

    DEFF Research Database (Denmark)

    Buur, Jacob; Stienstra, Marcelle

    2008-01-01

    a wider range of interactive products. In this paper we report on five years of continued research into interaction styles for telephones, kitchen equipment, HiFi products and medical devices, and we show how it is indeed possible and beneficial to formulate a set of generic interaction styles....... qualities among designers in a team, and that the naming of interaction styles helps establish an aesthetics of interaction design. However, that research focused on one particular product field, namely industrial controllers, and it was yet to be proven, if interaction styles do have generic traits across...

  5. Space Generic Open Avionics Architecture (SGOAA): Overview

    Science.gov (United States)

    Wray, Richard B.; Stovall, John R.

    1992-01-01

    A space generic open avionics architecture created for NASA is described. It will serve as the basis for entities in spacecraft core avionics, capable of being tailored by NASA for future space program avionics ranging from small vehicles such as Moon ascent/descent vehicles to large ones such as Mars transfer vehicles or orbiting stations. The standard consists of: (1) a system architecture; (2) a generic processing hardware architecture; (3) a six class architecture interface model; (4) a system services functional subsystem architectural model; and (5) an operations control functional subsystem architectural model.

  6. Generic programming in POOMA and PETE

    Energy Technology Data Exchange (ETDEWEB)

    Crotinger, J.A.; Cummings, J.C.; Haney, S.W.; Humphrey, W.F.; Karmesin, S.R.; Reynders, J.V.; Smith, S.A.; Williams, T.J.

    1998-12-31

    POOMA is a C++ framework for developing portable scientific applications for serial and parallel computers using high-level physical abstractions. PETE is the expression template library used by POOMA. This paper discusses generic programming techniques that are used to achieve flexibility and high performance in POOMA and PETE. POOMA uses an engine class that factors the data representation out of its array classes. PETE`s expression templates are used to build up and operate efficiently on expressions. PETE itself uses generic techniques to adapt to a variety of client-class interfaces, and to provide a powerful and flexible compile-time expression-tree traversal mechanism.

  7. An Internet of Things Generic Reference Architecture

    DEFF Research Database (Denmark)

    Bhalerao, Dipashree M.; Riaz, Tahir; Madsen, Ole Brun

    2013-01-01

    , and keeping track of all these things for monitoring and controlling some information. IoT architecture is studied from software architecture, overall system architecture and network architecture point of view. Paper puts forward the requirements of software architecture along with, its component...... and deployment diagram, process and interface diagram at abstract level. Paper proposes the abstract generic IoT reference and concrete abstract generic IoT reference architectures. Network architecture is also put up as a state of the art. Paper shortly gives overviews of protocols used for IoT. Some...

  8. A critical review of complementary and alternative medicine use among people with arthritis: a focus upon prevalence, cost, user profiles, motivation, decision-making, perceived benefits and communication.

    Science.gov (United States)

    Yang, Lu; Sibbritt, David; Adams, Jon

    2017-03-01

    A critical review of complementary and alternative medicine (CAM) use among people with arthritis was conducted focusing upon prevalence and profile of CAM users as well as their motivation, decision-making, perceived benefits and communication with healthcare providers. A comprehensive search of peer-reviewed literature published from 2008 to 2015 was undertaken via CINAHL, Medline and AMED databases. The initial search identified 4331 articles, of which 49 articles met selection criteria. The review shows a high prevalence of CAM use (often multiple types and concurrent to conventional medical care) among those with arthritis which is not restricted to any particular geographic or social-economic status. A large proportion of arthritis sufferers using CAM consider these medicines to be somewhat or very effective but almost half do not inform their healthcare provider about their CAM use. It is suggested that rheumatologists and others providing health care for patients with arthritis should be cognizant of the high prevalence of CAM use and the challenges associated with possible concurrent use of CAM and conventional medicine among their patients.

  9. Creating New Economic Incentives for Repurposing Generic Drugs for Unsolved Diseases Using Social Finance.

    Science.gov (United States)

    Bloom, Bruce E

    2015-12-01

    Repurposing research improves patient lives by taking drugs approved for one disease and clinically testing them to create a treatment for a different disease. Repurposing drugs that are generic, inexpensive, and widely available and that can be taken in their current dosage and formulation in the new indication provide a quick, affordable, and effective way to create "new" treatments. However, generic drug repurposing often provides no profit potential, and so there is no economic incentive for industry to pursue this, and philanthropy and government funds are often insufficient. One way to create new economic incentive for the repurposing of generic drugs is through social finance. This perspective describes how social finance can create a new economic incentive by using a social impact bond, or similar financial structure, to repay for-profit investors who fund the repurposing research from the proceeds of healthcare cost reductions generated when these affordable, effective, and widely available repurposed therapies improve healthcare outcomes.

  10. “No generics, Doctor!” The perspective of general practitioners in two French regions

    Directory of Open Access Journals (Sweden)

    Béatrice Riner

    2017-11-01

    Full Text Available Abstract Background Generic medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs toward generic medicines in two French regions with the lowest penetration rate of these products. Methods An observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74% who were administered a structured questionnaire developed from the results of the first phase. Results Seventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%. The main drawbacks cited were the variability of their presentation (44%, the confusion that they caused for some patients (47%, frequent allegations of adverse side effects (37% and a lack of efficacy (24%, and frequent refusal by patients (26%. Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand. Conclusion Most surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.

  11. "No generics, Doctor!" The perspective of general practitioners in two French regions.

    Science.gov (United States)

    Riner, Béatrice; Bussy, Adèle; Hélène-Pelage, Jeannie; Moueza, Nycrees; Lamy, Sébastien; Carrère, Philippe

    2017-11-09

    Generic medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs) toward generic medicines in two French regions with the lowest penetration rate of these products. An observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74%) who were administered a structured questionnaire developed from the results of the first phase. Seventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%). The main drawbacks cited were the variability of their presentation (44%), the confusion that they caused for some patients (47%), frequent allegations of adverse side effects (37%) and a lack of efficacy (24%), and frequent refusal by patients (26%). Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand. Most surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.

  12. Safety of switching from brand-name to generic levetiracetam in patients with epilepsy

    Directory of Open Access Journals (Sweden)

    Bosak M

    2017-08-01

    Full Text Available Magdalena Bosak, Agnieszka Słowik, Wojciech Turaj Department of Neurology, Jagiellonian University Medical College, Kraków, Poland Purpose: The approach to the use of generic antiepileptic drugs has recently evolved from major concern to general acceptance, but the evidence related specifically to the safety of switching from brand-name to generic levetiracetam (LEV is scarce. The aim of the study was to assess the risk of increased frequency of seizures or other adverse events after replacement of a brand-name LEV with a generic one.Patients and methods: This retrospective analysis included 159 patients treated with LEV in a tertiary outpatient epilepsy clinic. We included all patients diagnosed with epilepsy who were treated with LEV as at March 1, 2013. Most patients were forced to switch to the generic LEV because of the sudden rise in cost of the branded LEV. We recorded data on age, sex, age at onset of epilepsy, type of epilepsy, and its treatment. We analyzed data from one visit before potential switching and from two visits after the potential switching. The interval between visits was typically 3 months. We registered an increase in the frequency of seizures and in the occurrence of adverse events.Results: Among 151 subjects who switched to generic LEV after March 1, 2013, increased frequency of seizures was noted in 9 patients (6% during the first follow-up visit. Patients with increased frequency of seizures did not differ from other patients regarding sex, age, age at the onset of epilepsy, and the median dose of LEV before switching or the median duration of treatment with LEV before switching. Two patients returned to brand-name LEV. Adverse events were noted in six other patients (4% and included somnolence, irritability, or dizziness.Conclusion: Switching from brand-name to generic LEV is generally safe. Keywords: levetiracetam, generic, branded, epilepsy, switching, adverse event 

  13. An Alternative Low-Cost Process for Deposition of MCrAlY Bond Coats for Advanced Syngas/Hydrogen Turbine Applications

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Ying [Tennessee Technological Univ., Cookeville, TN (United States)

    2015-09-11

    The objective of this project was to develop and optimize MCrAlY bond coats for syngas/hydrogen turbine applications using a low-cost electrolytic codeposition process. Prealloyed CrAlY-based powders were codeposited into a metal matrix of Ni, Co or Ni-Co during the electroplating process, and a subsequent post-deposition heat treatment converted it to the MCrAlY coating. Our research efforts focused on: (1) investigation of the effects of electro-codeposition configuration and parameters on the CrAlY particle incorporation in the NiCo-CrAlY composite coatings; (2) development of the post-deposition heat treating procedure; (3) characterization of coating properties and evaluation of coating oxidation performance; (4) exploration of a sulfurfree electroplating solution; (5) cost analysis of the present electrolytic codeposition process. Different electro-codeposition configurations were investigated, and the rotating barrel system demonstrated the capability of depositing NiCo-CrAlY composite coatings uniformly on the entire specimen surface, with the CrAlY particle incorporation in the range 37-42 vol.%. Post-deposition heat treatment at 1000-1200 °C promoted interdiffusion between the CrAlY particles and the Ni-Co metal matrix, resulting in β/γ’/γ or β/γ’ phases in the heat-treated coatings. The results also indicate that the post-deposition heat treatment should be conducted at temperatures ≤1100 °C to minimize Cr evaporation and outward diffusion of Ti. The electro-codeposited NiCrAlY coatings in general showed lower hardness and surface roughness than thermal spray MCrAlY coatings. Coating oxidation performance was evaluated at 1000-1100 °C in dry and wet air environments. The initial electro-codeposited NiCoCrAlY coatings containing relatively high sulfur did not show good oxidation resistance. After modifications of the coating process, the cleaner NiCoCrAlY coating exhibited good oxidation performance at 1000 °C during the 2,000 1-h cyclic

  14. Dose Calibrator Linearity Testing: Radioisotope (99m)Tc or (18)F? An Alternative for Reducing Costs in Nuclear Medicine Quality Control.

    Science.gov (United States)

    Willegaignon, José; Sapienza, Marcelo T; Coura-Filho, George Barberio; Garcez, Alexandre T; Alves, Carlos E; Cardona, Marissa R; Gutterres, Ricardo F; Buchpiguel, Carlos A

    2015-01-01

    Dose calibrator linearity testing is indispensable for evaluating the capacity of this equipment in measuring radioisotope activities at different magnitudes, a fundamental aspect of the daily routine of a nuclear medicine department, and with an impact on patient exposure. The main aims of this study were to evaluate the feasibility of substituting the radioisotope Fluorine-18 ((18)F) with Technetium-99m ((99m)Tc) in this test, and to indicate it with the lowest operational cost. The test was applied with sources of (99m)Tc (62 GBq) and (18)F (12 GBq), the activities of which were measured at different times, with the equipment preadjusted to measuring sources of (99m)Tc, (18)F, Gallium-67 ((67)Ga), and Iodine-131 ((131)I). Over time, the average deviation between measured and expected activities from (99m)Tc and (18)F were, respectively, 0.56 (±1.79)% and 0.92 (±1.19)%. The average ratios for 99(m)Tc source experimental activity, when measured with the equipment adjusted for measuring (18)F, (67)Ga, and (131)I sources, in real values, were, respectively, 3.42 (±0.06), 1.45 (±0.03), and 1.13 (±0.02), and those for the (18)F source experimental activity, measured through adjustments of (99m)Tc, (67)Ga, and (131)I, were, respectively, 0.295 (±0.004), 0.335 (±0.007), and 0.426 (±0.006). The adjustment of a simple exponential function for describing (99m)Tc and (18)F experimental activities facilitated the calculation of the physical half-lives of the radioisotopes, with a difference of about 1% in relation to the values described in the literature. Linearity test results, when using (99m)Tc, through being compatible with those acquired with (18)F, imply the possibility of using both radioisotopes during linearity testing. Nevertheless, this information, along with the high potential of exposure and the high cost of (18)F, implies that (99m)Tc should preferably be employed for linearity testing in clinics that normally use (18)F, without the risk of

  15. Design and Analysis of Generic Energy Management Strategy for Controlling Second-Life Battery Systems in Stationary Applications

    Directory of Open Access Journals (Sweden)

    Mohamed Abdel-Monem

    2016-10-01

    Full Text Available Recently, second-life battery systems have received a growing interest as one of the most promising alternatives for decreasing the overall cost of the battery storage systems in stationary applications. The high-cost of batteries represents a prominent barrier for their use in traction and stationary applications. To make second-life batteries economically viable for stationary applications, an effective power-electronics converter should be selected as well. This converter should be supported by an energy management strategy (EMS, which is needed for controlling the power flow among the second-life battery modules based on their available capacity and performance. This article presents the design, analysis and implementation of a generic energy management strategy (GEMS. The proposed GEMS aims to control and distribute the load demand between battery storage systems under different load conditions and disturbances. This manuscript provides the experimental verification of the proposed management strategy. The results have demonstrated that the GEMS can robustly handle any level of performance inequality among the used-battery modules with the aim to integrate different levels (i.e., size, capacity, and chemistry type of the second-life battery modules at the same time and in the same application.

  16. Transparent masks for aligned deep x-ray lithography/LIGA: low-cost high-performance alternative using glass membranes

    Science.gov (United States)

    Kupka, Roland K.; Megtert, Stephan; Roulliay, Marc; Bouamrane, Faycal

    1998-09-01

    Deep x-ray lithography/LIGA has proven to be a well established framework of x-ray based technologies for the fabrication of microstructures and pseudo three-dimensional objects. Inherently, x-ray lithography/LIGA is not fully three-dimensional because of the principle of simple shadow printing onto resists of constant thickness. Thus, it would be impossible to obtain 3D spheres, but series of stacked monolithic 2D cylinders. Hence, until recently, LIGA was mainly concerned with simple uni-level (1D) monolithic structures, using optically opaque mask-membranes like Be, Si or Ti with grown-on Au absorbers. In the course for mastering pseudo three-dimensional microstructures like micro-coils or electromagnetic applications, an alignment in between the lithographic steps becomes necessary which requires optically transparent membrane materials, if optical alignment is chosen. Diamond or SiC membranes are the actual suitable materials for such purposes, but their pricing and/or process robustness inhibit their frequent use in simple projects. We would like to report on a new promising material: a glued-on thin glass membrane. The advantages are incomparably lower costs compared to Diamond or SiC technologies, a considerable ease of fabrication, handling, quite favorable mechanical/optical properties, sufficient for lithographic purposes and multi-level deep x-ray lithography/LIGA activities.

  17. A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

    Directory of Open Access Journals (Sweden)

    Andrea D. Furlan

    2012-01-01

    Full Text Available Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

  18. A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

    Science.gov (United States)

    Furlan, Andrea D.; Yazdi, Fatemeh; Tsertsvadze, Alexander; Gross, Anita; Van Tulder, Maurits; Santaguida, Lina; Gagnier, Joel; Ammendolia, Carlo; Dryden, Trish; Doucette, Steve; Skidmore, Becky; Daniel, Raymond; Ostermann, Thomas; Tsouros, Sophia

    2012-01-01

    Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments. PMID:22203884

  19. [The kangaroo mothers' programme: a simple and cost-effective alternative for protecting the premature newborn or low-birth-weight babies].

    Science.gov (United States)

    Lizarazo-Medina, Jenny P; Ospina-Diaz, Juan M; Ariza-Riaño, Nelly E

    2012-06-01

    Describing the efficacy and achievements of the kangaroo mothers' programme (KMP) regarding preterm or low-birth-weight babies' health and development in Hospital San Rafael in Tunja from November 2007 to December 2009. This was a retrospective observational cohort study; 374 infants born prematurely or having low-birth-weight were included to assess household socio-demographic factors, maternal and obstetric history, delivery characteristics and complications and follow-up until 40 weeks post-conception age. There was a high prevalence of teenage pregnancy (17.5 %) and in women older than 35 years (12.6 %), unwanted pregnancy (40.6 %), low quality and poor availability of food in families, complications such as preeclampsia, infection and premature rupture of membranes, 1,969 grams average birth weight, 2,742.9 grams average weight on discharge and 22 grams average weight gain per day. It was found that KMP methodology substantially improved the mothers' psychological aspects and health status and the newborns' prognosis and led to stabilising body temperature and weight gain rate while decreasing risks of complications and nosocomial infection. It also lowered health care costs and shortened hospital stay.

  20. Wireless data communication alternatives for small public safety agencies: how one community cost-effectively solved its expanding field data requirements

    Science.gov (United States)

    Canning, Ryan M.; Lefebvre, Eric

    2005-06-01

    A growing number of Public Safety agencies have begun leveraging wireless data communication technology to improve tactical response capabilities as well as overall productivity. For years police departments subscribed to CDPD (Cellular Digital Packet Data) services to provide officers with basic dispatch data and criminal database access. Now as cellular carriers have deactivated CDPD and shifted to 2.5G and 3G data services such as 1xRTT, GPRS and EDGE, police departments are scrambling to fill the void. Not surprisingly, the extraordinary investments cellular carriers made to upgrade their infrastructures have been transferred to the customer, with monthly fees running as high as $80 a month per user. It's no wonder public safety agencies have been reluctant to adopt these services. Lost in the fray are those smaller police departments which account for nearly 90% of the nation's total. This group has increasingly sought out alternative data communication solutions that are not predicated on budget-busting monthly access fees. One such example is the Marco Island Police Department (MIPD) in Southwestern Florida that received a Federal grant to augment its existing voice communications with data. After evaluating several different technologies and vendors, MIPD chose a 900 MHz ad hoc mesh network solution based on its ability to provide reliable, high-speed and secure IP-based data communications over extensive distances. This paper will discuss technical details of Marco Island's mobile mesh network implementation; including: coverage area with 900 MHz spread spectrum radios, strategic repeater tower placement, interference, throughput performance, and the necessity for application-persistence software.

  1. Alternating Hemiplegia

    Science.gov (United States)

    ... such as alternating hemiplegia, with the goals of learning more about these disorders and finding ways to prevent, treat and, ultimately cure them. Show More Show Less Search Disorders SEARCH SEARCH Definition Treatment Prognosis Clinical Trials Organizations Publications Definition Alternating ...

  2. GenMed 010: a one day workshop on generic medicines

    Directory of Open Access Journals (Sweden)

    Shankar PR

    2011-03-01

    Full Text Available This report outlines the content of a one-day workshop onGeneric Medicines that was held at KIST Medical College,Lalitpur, Nepal on 13th December 2010, which was attendedby 32 delegates from different institutions in Nepal, includingpharmacists, pharmacologists and medical doctors. Rightmedicine, right patient, right dose, right frequency andduration, right information and right monitoring areconditions to be fulfilled for the rational use of medicine(RUM. The World Health Organization (WHO defines genericmedicine as ‘a pharmaceutical product, usually intended to beinterchangeable with the innovator product, marketed afterthe expiry of patent or other exclusivity rights’. Economicfactors, supportive legislation and regulation, public andprofessional acceptance and quality assurance are keyenabling factors promoting use of generics. Increased patentprotection for medicines and removing process patents is akey feature of new trade agreements and newer medicines fordiseases like HIV/AIDS, tuberculosis and infectious diseasesare likely to be more expensive. The Medicine andTherapeutics Committee (MTC can play a key role inpromoting generic medicine use in institutions.Nepal being among the Least Developed Countries (LDCsneed not provide patent protection for medicines until 31stDecember 2015. Only a few ‘true’ generics are available inNepal and there is huge cost variation in the price of differentbranded generics. Clinicians have concerns about the qualityof medicines in general, substitution of poor quality brands bypharmacists and about therapeutic substitution. Genericshave to meet the same regulatory requirements and bebioequivalent to reference preparations assuring their quality.

  3. A Novel Generic Ball Recognition Algorithm Based on Omnidirectional Vision for Soccer Robots

    Directory of Open Access Journals (Sweden)

    Hui Zhang

    2013-11-01

    Full Text Available It is significant for the final goal of RoboCup to realize the recognition of generic balls for soccer robots. In this paper, a novel generic ball recognition algorithm based on omnidirectional vision is proposed by combining the modified Haar-like features and AdaBoost learning algorithm. The algorithm is divided into offline training and online recognition. During the phase of offline training, numerous sub-images are acquired from various panoramic images, including generic balls, and then the modified Haar-like features are extracted from them and used as the input of the AdaBoost learning algorithm to obtain a classifier. During the phase of online recognition, and according to the imaging characteristics of our omnidirectional vision system, rectangular windows are defined to search for the generic ball along the rotary and radial directions in the panoramic image, and the learned classifier is used to judge whether a ball is included in the window. After the ball has been recognized globally, ball tracking is realized by integrating a ball velocity estimation algorithm to reduce the computational cost. The experimental results show that good performance can be achieved using our algorithm, and that the generic ball can be recognized and tracked effectively.

  4. Compact Green's Function for a Generic Rijke Burner

    Directory of Open Access Journals (Sweden)

    P. R. Murray

    2011-09-01

    Full Text Available A theoretical examination is made of the thermo-acoustic properties of a Rijke burner of large aspect ratio rectangular cross-section. Such a generic device has been proposed by Kok et al. (2009 paper presented at the 16th International Congress on Sound & Vibration to make canonical studies of combustion instabilities. An aeroacoustic Green's function is derived which permits the sound pressure produced by arbitrary thermal and vortex sources within the burner to be calculated by convolution. The Green's function corresponds to the potential flow sound field produced by an impulsive point source; its calculation taking account of flame-holder geometry is facilitated by use of the Schwarz-Christoffel transformation. The transformation is performed numerically to accommodate complex burner geometry and validated by comparison with an alternative procedure involving the direct numerical integration of Laplace's equation.

  5. Is the "in situ" simulation for teaching anesthesia residents a lower cost, feasible and satisfying alternative to simulation center ? A 24 months prospective observational study in a university hospital.

    Science.gov (United States)

    Lois, F J; Pospiech, A L; Van Dyck, M J; Kahn, D A; De Kock, M F

    2014-01-01

    The value of simulation in medical education is increasingly obvious. Nevertheless, the high cost of running a simulation center and the time's availability for students to get to simulation center remain a major problem. Technological developments and miniaturization of computer systems now allow handling of simulation manikins. Therefore, "in situ" simulation seems a valuable alternative to center simulation. To identify the costs and feasibility of "in situ" simulation. To conduct an evaluation of the sessions by participants in order to adapt the educational objectives. Observational study. 118 "in situ" simulation sessions were organized between March 2011 and February 2013 in the university hospital of Université Catholique de Louvain. Sessions took place in OR facilities. At the end of each session, a questionnaire was given to each participant. 357 of 368 participants completed a questionnaire. For each session, one or two nurses and 2 residents in anesthesia were invited. Total costs for organizing the sessions. Number of realized sessions. Global satisfaction of participants. Total cost for organizing the sessions is 18 414 Euro. One hundred and one among the 118 scheduled sessions were performed, which corresponds to a rate of 85%. Three hundred and sixty-five people participated in training simulations. During the sessions, 357 questionnaires were completed. The global satisfaction was high with a median Likert scale of 5 (5-5) to the question "I would like to participate in other sessions in the future". The "in situ" simulation in anesthesia is feasible in a university hospital using the available facilities of the operating theater during the working hours of both participants and trainers. However, the number of annual sessions may be limited by the availability of the simulation room or staff.

  6. Removing hydrocarbons from soil more cost effectively than other conventional thermal technologies is now further enhanced when you can create viable recycling alternatives

    Energy Technology Data Exchange (ETDEWEB)

    MacLean, B.B.F.; Harper, C.H. [CHH Consulting, Red Deer, AB (Canada)

    2008-07-01

    The need for quick and accurate land remediation technology has become an important issue, as regulations and public opinion have placed pressure on industry leaders to find environmentally benign and less invasive solutions for handling and processing hazardous waste streams. This paper described the merging of two distinct and proven technologies used to remove and recover valuable liquids from the soil. The remaining soil can then be made into an environmentally friendly construction product. The technologies included the Earth Brick Press Model TB250 developed by Earth Brick International and the KAB-1000 PTDU thermal desorption unit developed by Terra-Tech Remediation. The thermal desorption process puts heated air into soil faster than conventional thermal treatment methods. A water wash process affects the chemistry of the remaining liquids and enhances the ability to reuse and recycle them. The Earth Brick Press takes the soils and additives and creates benign bricks. The blending of these two technologies has the potential to address cost, speed and future liability issues. The paper provided information on the project permits and licensing; product registration; and operational issues such as characteristics of the target soil; course versus fine soils; moisture levels; distribution of hydrocarbon content; and co-contaminant levels. The paper also discussed the technical support team, including inventors and partners; consultants and business development team; and third party consultants. It was concluded that the economic benefits of blending the two technologies may be enhanced by the benefit of positive public perceptions and the ability to give back to society. 4 refs., 7 figs.

  7. On generic representation of implicit induction procedures

    NARCIS (Netherlands)

    D. Naidich

    1996-01-01

    textabstractWe develop a generic representation of implicit induction proof procedures within the cover set induction framework. Our work further develops the approach of cover set induction on propositional orderings. We show that in order to represent a substantially wide range of implicit

  8. Crystallization Kinetics within a Generic Modelling Framework

    DEFF Research Database (Denmark)

    Meisler, Kresten Troelstrup; von Solms, Nicolas; Gernaey, Krist

    2013-01-01

    An existing generic modelling framework has been expanded with tools for kinetic model analysis. The analysis of kinetics is carried out within the framework where kinetic constitutive models are collected, analysed and utilized for the simulation of crystallization operations. A modelling...... procedure is proposed to gain the information of crystallization operation kinetic model analysis and utilize this for faster evaluation of crystallization operations....

  9. Matatti’s generic names for fungi

    NARCIS (Netherlands)

    Donk, M.A.

    1975-01-01

    The generic names for fungi used by Maratti in his ‘Flora romana’ must be accepted as validly published. Notes are given on the validly re-published names. Of these Agaricum and Coralloides may cause some difficulties. Conservation of Fomes (Fr.) Fr. against Agaricum [Mich.] Maratti is proposed. To

  10. 40 CFR 721.545 - Polyalkenylalkylphenol (generic).

    Science.gov (United States)

    2010-07-01

    ....545 Section 721.545 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC... subject to reporting. (1) The chemical substance identified generically as a Polyalkenylalkylphenol (PMN P... subpart A of this part apply to this section except as modified by this paragraph. (1) Recordkeeping...

  11. 40 CFR 721.450 - Hydrofluorochloroalkene (generic).

    Science.gov (United States)

    2010-07-01

    ....450 Section 721.450 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC... subject to reporting. (1) The chemical substance identified generically as a hydrofluorochloroalkene (PMN... subpart A of this part apply to this section except as modified by this paragraph. (1) Recordkeeping. The...

  12. Intermediates and Generic Convergence to Equilibria

    DEFF Research Database (Denmark)

    Marcondes de Freitas, Michael; Wiuf, Carsten; Feliu, Elisenda

    2017-01-01

    Known graphical conditions for the generic and global convergence to equilibria of the dynamical system arising from a reaction network are shown to be invariant under the so-called successive removal of intermediates, a systematic procedure to simplify the network, making the graphical condition...

  13. On the genericity of spacetime singularities

    Indian Academy of Sciences (India)

    We consider here the genericity aspects of spacetime singularities that occur in cosmology and in gravitational collapse. The singularity theorems (that predict the occurrence of singularities in general relativity) allow the singularities of gravitational collapse to be either visible to external observers or covered by an event ...

  14. Generic Hypermedia Structure and Presentation Specification

    NARCIS (Netherlands)

    L. Rutledge (Lloyd); J.R. van Ossenbruggen (Jacco); L. Hardman (Lynda); D.C.A. Bulterman (Dick)

    1997-01-01

    textabstractWe consider the generic hypermedia structure of a document to be a means of representing the document that allows it to be processed into a wide variety of presentations. Representing a document in this manner requires additional specification and resources to render it into any

  15. Comparing Generic Parameter Controllers for EAs

    NARCIS (Netherlands)

    Karafotias, G.; Hoogendoorn, M.

    2014-01-01

    Parameter controllers for Evolutionary Algorithms (EAs) deal with adjusting parameter values during an evolutionary run. Many ad hoc approaches have been presented for parameter control, but few generic parameter controllers exist and, additionally, no comparisons or in depth analyses of these

  16. A Generic Solution Approach to Nurse Rostering

    DEFF Research Database (Denmark)

    Hansen, Anders Dohn; Mason, Andrew; Ryan, David

    In this report, we present a solution approach to the nurse rostering problem. The problem is defined by a generic model that is able to capture close to all of the problem characteristics that we have seen in the literature and in the realistic problems at hand. The model is used directly in the...

  17. Towards Generic Models of Player Experience

    DEFF Research Database (Denmark)

    Shaker, Noor; Shaker, Mohammad; Abou-Zleikha, Mohamed

    2015-01-01

    -dependent and their applicability is usually limited to the system and the data used for model construction. Establishing models of user experience that are highly scalable while maintaing the performance constitutes an important research direction. In this paper, we propose generic models of user experience in the computer games...

  18. Baldrige Theory into Practice: A Generic Model

    Science.gov (United States)

    Arif, Mohammed

    2007-01-01

    Purpose: The education system globally has moved from a push-based or producer-centric system to a pull-based or customer centric system. Malcolm Baldrige Quality Award (MBQA) model happens to be one of the latest additions to the pull based models. The purpose of this paper is to develop a generic framework for MBQA that can be used by…

  19. First-class rules and generic traversal

    NARCIS (Netherlands)

    Dolstra, E.; Visser, Eelco

    2001-01-01

    In this paper we present a functional language supporting first-class rules and generic traversal. This is achieved by generalizing the pattern matching constructs of standard functional languages. The case construct that ties rules together and prevents their reuse, is replaced by separate,

  20. Developing A Generic Optical Avionic Network

    DEFF Research Database (Denmark)

    Zhang, Jiang; An, Yi; Berger, Michael Stübert

    2011-01-01

    We propose a generic optical network design for future avionic systems in order to reduce the weight and power consumption of current networks on board. A three-layered network structure over a ring optical network topology is suggested, as it can provide full reconfiguration flexibility and supp...

  1. Quality of generic medicines in South Africa

    DEFF Research Database (Denmark)

    Patel, Aarti; Gauld, Robin; Norris, Pauline

    2012-01-01

    must be addressed to ensure that people use them with confidence. Campaigns to increase the uptake of generic medicines by consumers and providers of healthcare need to be informed by local norms and practices. This study sought to compare South African consumers' and healthcare providers' perceptions...

  2. Comparison of Generic Accelerated Nursing Students

    Science.gov (United States)

    Kaddorura, Mahmood; Williams, Collette

    2012-01-01

    Case study pedagogy is a teaching strategy in which teachers hope to help students develop and use critical thinking (CT) abilities. This study compared CT skills of 75 second year generic accelerated baccalaureate nursing students during their Fundamentals of Nursing course before and after being educated using case study pedagogical method.…

  3. Climate Change: Generic Implications for Agriculture

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Climate Change: Generic Implications for Agriculture. Increasing carbon dioxide: Good for most crops. Increase in mean temperature: orter crop durations, higher evapotranspiration, other effects on growth and yield. Intermittent periods of extreme heat stress: highly ...

  4. Generic spin model on a pyrochlore lattice

    Science.gov (United States)

    Sim, Gibaik; Lee, Sungbin

    Motivated by several pyrochlores, we discuss generic spin model considering nearest and next nearest neighbors. Both Luttinger-Tisza analysis and simulated annealing, we analyze the phase diagram of classical spin model and discuss new types of non-coplanar order induced by anisotropic interactions. KAIST startup funding.

  5. Alternative granular media for the metal casting industry. Final report, September 30, 1994

    Energy Technology Data Exchange (ETDEWEB)

    Guichelaar, P.J.; Ramrattan, S.N.; Tieder, R.E. [Michigan Technological Univ., Houghton, MI (United States)

    1995-09-01

    Silica sand for foundry use is inexpensive to purchase, readily transported and widely available. As a result, it is universally used. However, three factors are becoming increasingly significant as more environmental regulations are promulgated. First, the disposal of waste foundry sand has become an excessively burdensome cost. Second, the phase changes which occur in the silica structure on heating and cooling cause thermal breakdown of the sand into smaller unusable fractions. Third, silica is a relatively weak mineral. Alternatives to silica sand which can withstand the rigors of repetitive reuse must be seriously evaluated as a way to control production costs of the domestic metal casting industry. Chromite sands, olivine sands and carbon sands have each been successfully used to solve operating problems and thus have developed their specific niches in the foundry materials inventory. However, there are several other materials that are candidates for replacing silica sand, such as fused alumina, sintered bauxite and sintered oil well proppants. These media, and others that are generically similar, are manufactured for specific purposes. Compositions and shapes could be readily tailored for used in a metal casting environment of total recycling and materials conservation. This study examines materials that are readily available as alternatives to silica sand from a functionality perspective and a cost perspective. Some of the alternative materials are natural and others are synthetic and thus referring to them as ``sands`` has the potential to cause confusion; the generic term ``granular medium`` is used in this study to mean any material that could functionally substitute for silica sand in the foundry process.

  6. Considerations for the Placement of Youth with EBD in Alternative Education Programs

    Science.gov (United States)

    Atkins, Trent; Bartuska, Jamie

    2010-01-01

    Alternative education programs (also called alternative schools) first appeared on the American landscape in the 1960s. Despite the proliferation of these programs, a generic description of what constitutes an alternative education program, historically, has been elusive. Most alternative education programs have the general criteria of serving…

  7. The formation of CuInSe{sub 2}-based thin-film solar cell absorbers from alternative low-cost precursors

    Energy Technology Data Exchange (ETDEWEB)

    Jost, S.

    2008-01-18

    This work deals with real-time investigations concerning the crystallisation process of CuInSe{sub 2}-based thin-film solar cell absorbers while annealing differently produced and composed ''low-cost'' precursors. Various types of precursors have been investigated concerning their crystallisation behaviour. Three groups of experiments have been performed: (i) Investigations concerning the crystallisation process of the quaternary chalcopyrite Cu(In,Al)Se{sub 2} and Cu(In,Al)S{sub 2}, (ii) investigations concerning the formation process of the compound semiconductor CuInSe{sub 2} from electroplated precursors, and (iii) investigations concerning the crystallisation of Cu(In,Ga)Se{sub 2} using precursors with thermally evaporated indium. A specific sample surrounding has been constructed, which enables to perform time-resolved angle-dispersive X-ray powder diffraction experiments during the annealing process of precursor samples. A thorough analysis of subsequently recorded diffraction patterns using the Rietveld method provides a detailed knowledge about the semiconductor crystallisation process while annealing. Based on these fundamental investigations, conclusions have been drawn concerning an adaptation of the precursor deposition process in order to optimise the final solar cell results. The investigations have shown, that one class of electroplated precursors shows a crystallisation behaviour identical to the one known for vacuum-deposited precursors. The investigations concerning the crystallisation process of the quaternary chalcopyrite Cu(In,Al)Se{sub 2} revealed, that the chalcopyrite forms from the ternary selenide (Al,In){sub 2}Se{sub 3} and Cu{sub 2}Se at elevated process temperatures. This result is used to explain the separation of the absorber layer into an aluminum-rich and an indium-rich chalcopyrite phase, which has been observed at processed Cu(In,Al)Se{sub 2} absorbers from several research groups. In addition, differences

  8. Evaluation of Saccharomyces cerevisiae fermentation product as an alternative to monensin on growth performance, cost of gain, and carcass characteristics of heavy-weight yearling beef steers.

    Science.gov (United States)

    Swyers, K L; Wagner, J J; Dorton, K L; Archibeque, S L

    2014-06-01

    Two hundred fifty-two cross-bred yearling steers (406 ± 24 kg BW) were used in a completely randomized block design with a 2 × 2 factorial arrangement of treatments (7 pens/treatment) to evaluate the effects of dietary Saccharomyces cerevisiae fermentation product (SFP) and monensin (MON) on growth performance and carcass characteristics. Dietary treatments arranged as a 2 × 2 factorial were 1) with or without SFP and 2) with or without MON. Finishing diets contained 19.7% of DM as dried distiller's grains with solubles. Both SFP and MON were added in the total mixed ration in place of an equal amount of cornmeal (DM basis; target intake = 2.8 g of SFP and 33 mg of MON/kg of dietary DM). Each treatment group was offered ad libitum access to a transition ration from d 1 to 8 and then to the finishing ration from d 9 to 125. Body weights were collected on d 0, 28, 56, 84, 110, and 125. Initial and final BW was an average of 2-d weights (d -1 and 0 and d 124 and 125, respectively). Steers were shipped for harvest on d 125. Overall ADG was decreased (P = 0.03) in steers supplemented with SFP, but final BW was similar among treatments. Feeding SFP was associated with lighter (P < 0.01) HCW and a greater (P = 0.01) number of carcasses grading USDA Choice. Twelfth rib fat thickness was not affected by SFP (P = 0.82) or MON (P = 0.35), but numerical decreases in 12th rib fat thickness among cattle receiving SFP or MON alone contributed to a tendency (P = 0.07) for greater 12 rib fat thickness when SFP and MON were provided. There was no effect of treatment on cost of gain (P ≥ 0.21). The effects of SFP in the current study may have been limited in heavy yearling steers due to consumption of a finishing diet containing 19.7% dried distiller's grains with solubles.

  9. Prescribing generic drugs using a generic name: Are we teaching it right?

    Science.gov (United States)

    Kamath, Ashwin

    2016-01-01

    The Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, state that "Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.". Undergraduate medical students are introduced to drug nomenclature early on during their pharmacology course. They are told that generic name or, more appropriately, non-proprietary name (usually international non-proprietary name INN), is to be used while writing prescriptions.

  10. A Generic Topology Derivation Method for Single-phase Converters with Active Capacitive DC-links

    DEFF Research Database (Denmark)

    Wang, Haoran; Wang, Huai; Zhu, Guorong

    2016-01-01

    capacitive DCDC- link solutions, but important aspects of the topology assess-ment, such as the total energy storage, overall capacitive energy buffer ratio, cost, and reliability are still not available. This paper proposes a generic topology derivation method of single-phase power converters...... with capacitive DC-links, which derives all existing topologies to our best knowledge, and identify a few new topologies. A reliability-oriented design process is applied to compare the cost of different solutions with the lifetime target of 10 years and 35 years, respectively. It reveals that the most cost...

  11. Cost-benefit analysis of wetland restoration

    DEFF Research Database (Denmark)

    Dubgaard, Alex

    2004-01-01

    of environmental services. Costs typically depend on the level of ambitions regarding the magnitude and multitude of benefits. Decision makers are therefore confronted with the questions: how can generically different benefits be measured in comparable terms and how should different levels of project costs...

  12. Generic penetration in the retail atypical antipsychotic market.

    Science.gov (United States)

    Lenderts, Susan; Kalali, Amir H; Buckley, Peter

    2010-03-01

    In this article, we explore the penetration of generic atypical antipsychotics in the United States market before and after the availability of generic risperidone in July 2008. Analysis suggests that, overall, generic penetration into the atypical antipsychotic market has grown from approximately three percent in January 2008 to more than 25 percent in December 2009. Similar trends are uncovered when branded and generic prescriptions are analyzed by specialty.

  13. Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States.

    Science.gov (United States)

    Cicero, Theodore J; Inciardi, James A; Surratt, Hilary

    2007-12-01

    A great deal of previous work on the pharmacoeconomics of alcohol, tobacco and illicit drug abuse indicates that as cost decreases, abuse increases and vice versa. The application of these cost principles to the abuse of prescribed medications is largely unknown. In this paper we assessed whether the introduction of generic products in the U.S. increased the therapeutic use and illicit abuse of extended release oxycodone products and the fentanyl patch. As an index of therapeutic use, we purchased prescription data for each of the ZIP codes in which we had corresponding abuse data. To gather information about prescription drug abuse, we elicited cases with quarterly questionnaires completed by a key informant network. The introduction of generic extended release (ER) oxycodone and fentanyl patch did not significantly change the total prescriptions written for these products, but markedly altered the composition of sales: branded sales dropped precipitously over a very short time and this was compensated for by a corresponding increase in sales of generics. Surprisingly, the introduction of generic products did not increase the abuse of ER oxycodone or fentanyl products; the branded version was the drug of choice for at least 2 years. Our data suggest that drug costs alone do not increase the overall likelihood that a prescription opioid analgesic will be used therapeutically or abused. However, while generics are rapidly endorsed by insurance companies as a prescribed entity, abuse of the branded versions of ER oxycodone and fentanyl remains predominant for some time.

  14. 40 CFR 721.9959 - Polyurethane polymer (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Polyurethane polymer (generic). 721... Substances § 721.9959 Polyurethane polymer (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as a polyurethane polymer (PMN P-01...

  15. 40 CFR 721.10113 - Thioether epoxy (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Thioether epoxy (generic). 721.10113... Substances § 721.10113 Thioether epoxy (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as thioether epoxy (PMN P-04-547) is subject to...

  16. Generic personality and emotion simulation for conversational agents

    NARCIS (Netherlands)

    Egges, A.; Kshirsagar, S.; Magnenat-Thalmann, N.

    2004-01-01

    This paper describes a generic model for personality, mood and emotion simulation for conversational virtual humans. We present a generic model for updating the parameters related to emotional behaviour, as well as a linear implementation of the generic update mechanisms. We explore how existing

  17. Generic Drugs: The Same Medicine for Less Money

    Science.gov (United States)

    Generic Drugs: The Same Medicine for Less Money What is a generic drug? A generic is a copy of a brand-name drug. A brand- name drug has a patent. When ... benefit to your health, and you will save money. 7KH IHGHUDO )RRG DQG 'UXJ $GPLQLVWUDWLRQ )'$ UHJXODWHV ERWK ...

  18. 40 CFR 721.10069 - Ether amine phosphonate (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Ether amine phosphonate (generic). 721... Substances § 721.10069 Ether amine phosphonate (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as ether amine phosphonate (PMN P...

  19. 40 CFR 721.5908 - Modified phenolic resin (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Modified phenolic resin (generic). 721... Substances § 721.5908 Modified phenolic resin (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as modified phenolic resin (PMN P...

  20. 40 CFR 721.5905 - Modified phenolic resin (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Modified phenolic resin (generic). 721... Substances § 721.5905 Modified phenolic resin (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as a modified phenolic resin (PMN...

  1. 40 CFR 721.2755 - Cycloaliphatic epoxy resin (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Cycloaliphatic epoxy resin (generic... Substances § 721.2755 Cycloaliphatic epoxy resin (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as cycloaliphatic epoxy resin (PMN...

  2. 40 CFR 721.2673 - Aromatic epoxide resin (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Aromatic epoxide resin (generic). 721... Substances § 721.2673 Aromatic epoxide resin (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as aromatic epoxide resin (PMN P...

  3. 'Generic substitution' in New Jersey, 1979-87.

    Science.gov (United States)

    Culkin, T T; Mendell, S

    1989-02-01

    A total of 76,385 prescription orders from 543 randomly selected New Jersey community pharmacies were reviewed from 1979 to 1987 to ascertain the overall extent of drug product selection, or generic substitution. Also assessed were factors affecting generic substitution such as extent of ordering generically, prescribers' and patients' disapproval of generic substitution, the limitations of a formulary, and pharmacists' compliance with the generic substitution law. Over the study period generic substitution more than doubled, from an average of 6.6% to an average of 14.2% of all new prescription orders. Prescribers disallowed generics on 32% of all eligible prescription orders in 1979 and on 42% in 1987. Patients disallowed generics on 3.7% of all eligible prescription orders in 1979 and on 5.7% in 1987. Pharmacists' compliance with state law mandating generic substitution rose from 47% in 1979 to 74% in 1987. A companion analysis of 4.64 million prescription payment records (2 million of which were for generics) from two state prescription reimbursement programs demonstrated an average savings of $5.73 and $8.74 per generic prescription order when compared to their branded counterparts. Prescribers and pharmacists were found to be the major impediments to more extensive generic substitution.

  4. 40 CFR 721.5917 - Phenyl azo dye (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Phenyl azo dye (generic). 721.5917... Substances § 721.5917 Phenyl azo dye (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as a phenyl azo dye (PMN P-02-17) is subject to...

  5. 40 CFR 721.988 - Pyrazolone azomethine dye (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Pyrazolone azomethine dye (generic... Substances § 721.988 Pyrazolone azomethine dye (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as a pyrazolone azomethine dye...

  6. 40 CFR 721.10172 - Alkylamide derivative (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Alkylamide derivative (generic). 721... Substances § 721.10172 Alkylamide derivative (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as alkylamide derivative (PMN P-03...

  7. 40 CFR 721.646 - Aminofluoran derivative (generic name).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Aminofluoran derivative (generic name... Substances § 721.646 Aminofluoran derivative (generic name). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as aminofluoran derivative (PMN P...

  8. 40 CFR 721.10006 - Mixed metal oxide (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Mixed metal oxide (generic). 721.10006... Substances § 721.10006 Mixed metal oxide (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as mixed metal oxide (PMN P-99-511...

  9. 40 CFR 721.4610 - Mixed metal oxides (generic).

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Mixed metal oxides (generic). 721.4610... Substances § 721.4610 Mixed metal oxides (generic). (a) Chemical substance and significant new uses subject to reporting. (1) The chemical substance identified generically as mixed metal oxides (PMN P-98-0002...

  10. Making sense of a generic label

    DEFF Research Database (Denmark)

    Lassen, Inger

    2016-01-01

    and discourse analysis as part of a course in Management and Communication. In the exam question, students were introduced to two apparently different genres. These included a genre that was so far unfamiliar to the students, viz. a ‘Suppliers Code of Conduct’, and a second genre (a job advertisement......Making sense of a generic label through linguistic context analysis: A study of genre (re)cognition among novices’ Considerable work has been done on written and spoken genres characterized by a high degree of ritualization with “predictable elements occurring in a predictable order” (Fairclough...... 2003: 72; Swales 1990). In such studies, analysis of generic structure (moves/ stages) has been predominant and highly relevant for understanding institutionalized motives and the rhetorical objectives carried by each move (Lassen 2006). In a similar vein, Bhatia (2004: 22) has suggested that “genre...

  11. [The patents game. Generic and biosimilar drugs].

    Science.gov (United States)

    Villamañán, E; González, D; Armada, E; Ruano, M; Álvarez-Sala, R; Herrero, A

    2016-01-01

    The protection provided by patents on medicines has a limited duration. The expiry of patents expiration allows copies of the drugs to be released, competing with original. At first, they were identical to the original, known as generic drugs, but in recent years, due to the marketing of biological therapies and the expiry of many of their patents, biosimilar drugs have also emerged. These are not exact copies of the original, but, like generic drugs, biosimilar drugs have to demonstrate equivalence to the reference drugs in quality, safety and efficacy. Nevertheless, despite their importance and contribution to sustainability of health system, doctors are sometimes unaware of differences between them, and their impact in terms of clinical and economic effects. An attempt is made to review and clarify certain aspects often unknown by physicians, despite their involvement in their use. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  12. Generic Structure Potential of Christian Apologetics

    Directory of Open Access Journals (Sweden)

    Onwu Inya

    2012-01-01

    Full Text Available Religious texts have been examined by scholars from different theoretical standpoints. However, a close survey of the literature reveals that little attention has been paid to Christian apologetics from a linguistic perspective. Also, an examination of studies along the lines of Generic Structure Potential (henceforth GSP shows that the genre status of Christian apologetics has not been indicated. This gap provides the motivation for this paper, which investigates the GSP of Christian apologetics. Twenty texts written by various key contemporary apologetic writers were purposively selected for the study. The following generic structure potential catalogue was generated:The paper reveals that the elements of the GSP concertedly work to advance, argue for or defend the Christian belief system. The paper also suggests that the model could be applied to other forms of apologetic instances.

  13. Generic Properties of Stochastic Entropy Production

    Science.gov (United States)

    Pigolotti, Simone; Neri, Izaak; Roldán, Édgar; Jülicher, Frank

    2017-10-01

    We derive an Itô stochastic differential equation for entropy production in nonequilibrium Langevin processes. Introducing a random-time transformation, entropy production obeys a one-dimensional drift-diffusion equation, independent of the underlying physical model. This transformation allows us to identify generic properties of entropy production. It also leads to an exact uncertainty equality relating the Fano factor of entropy production and the Fano factor of the random time, which we also generalize to non-steady-state conditions.

  14. Savannah River Site generic data base development

    Energy Technology Data Exchange (ETDEWEB)

    Blanchard , A.

    2000-01-04

    This report describes the results of a project to improve the generic component failure database for the Savannah River Site (SRS). Additionally, guidelines were developed further for more advanced applications of database values. A representative list of components and failure modes for SRS risk models was generated by reviewing existing safety analyses and component failure data bases and from suggestions from SRS safety analysts. Then sources of data or failure rate estimates were identified and reviewed for applicability. A major source of information was the Nuclear Computerized Library for Assessing Reactor Reliability, or NUCLARR. This source includes an extensive collection of failure data and failure rate estimates for commercial nuclear power plants. A recent Idaho National Engineering Laboratory report on failure data from the Idaho Chemical Processing Plant was also reviewed. From these and other recent sources, failure data and failure rate estimates were collected for the components and failure modes of interest. For each component failure mode, this information was aggregated to obtain a recommended generic failure rate distribution (mean and error factor based on a lognormal distribution). Results are presented in a table in this report. A major difference between generic database and previous efforts is that this effort estimates failure rates based on actual data (failure events) rather than on existing failure rate estimates. This effort was successful in that over 75% of the results are now based on actual data. Also included is a section on guidelines for more advanced applications of failure rate data. This report describes the results of a project to improve the generic component failure database for the Savannah River site (SRS). Additionally, guidelines were developed further for more advanced applications of database values.

  15. Generic Superweak Chaos Induced by Hall Effect

    OpenAIRE

    Ben-Harush, Moti; Dana, Itzhack

    2016-01-01

    We introduce and study the "kicked Hall system" (KHS), i.e., charged particles periodically kicked in the presence of uniform magnetic ($\\mathbf{B}$) and electric ($\\mathbf{E}$) fields that are perpendicular to each other and to the kicking direction. We show that for resonant values of $B$ and $E$ and in the weak-chaos regime of sufficiently small nonintegrability parameter $\\kappa$ (the kicking strength), there exists a \\emph{generic} family of periodic kicking potentials for which the Hall...

  16. Generic Architecture for Mobile Check System

    OpenAIRE

    KARIMA MAAZOUZ; HABIB.BENLAHMER; NACEUR.ACHTAICH

    2013-01-01

    the explosion of the market of Smartphone has rapidly changed the way of m-commerce transactions, especially the m-payment systems which are knowing a wide acceptance due to their diversity and the new mobile technologies. In this work we have introduced the system m-check as a mobile payment system, we have presented a generic architecture of the system and the different protocols for the implementation of the system m-check

  17. Alternative energies updates on progress

    CERN Document Server

    Ferreira, Germán

    2013-01-01

    This book examines the key pillars of alternative energy, including biomass, hydrogen, solar and geothermal. It features life cycle assessment and thermoeconomic analysis as tools for evaluating and optimising environmental and cost subjects.

  18. Impact of a Novel Cost-Saving Pharmacy Program on Pregabalin Use and Health Care Costs.

    Science.gov (United States)

    Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia

    2016-02-01

    Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di

  19. Physicians’ generic drug prescribing behavior in district hospitals: a case of Phitsanulok, Thailand

    Directory of Open Access Journals (Sweden)

    Plianbangchang P

    2010-09-01

    Full Text Available Generic prescribing is a sound approach to contain health care costs. However, little is known about physicians’ prescribing patterns in the Thai context. Objective: To explore physicians’ generic prescription patterns in district hospitals.Methods: Data was collected from three of the eight district hospitals between January and December 2008 (final response rate 37.5%. All participating hospitals were between 30 and 60-bed capacity. The researchers reviewed 10% of total outpatient prescriptions in each hospital. Results: A total of 14,500 prescriptions were evaluated. The majority of patients were under universal health coverage (4,367; 30.1%, followed by senior citizens’ health insurance (2,734; 18.9%, and civil servant medical benefit schemes (2,419; 16.7%. Ten thousand six hundred and seventy-one prescriptions (73.6% of total prescriptions had at least one medication. Among these, each prescription contained 2.85 (SD=1.69 items. The majority of prescriptions (7,886; 73.9% were prescribed by generic name only. Drugs prescribed by brand names varied in their pharmacological actions. They represented both innovator and branded-generic items. Interestingly, a large number of them were fixed-dose combination drugs. All brand name prescriptions were off patented. In addition, none of the brand-name drugs prescribed were categorized as narrow therapeutic range or any other drug that had been reported to have had problems with generic substitution. Conclusion: The majority of prescriptions in this sample were written by generic names. There is room for improvement in brand name prescribing patterns.

  20. Do users of risperidone who switch brands because of generic reference pricing fare better or worse than non-switchers? A New Zealand natural experiment.

    Science.gov (United States)

    Lessing, Charon; Ashton, Toni; Davis, Peter

    2015-11-01

    This study evaluated patient health outcomes and any impact on healthcare costs consequent to the implementation of generic reference-pricing of risperidone in New Zealand using national datasets. Reference pricing risperidone reduced the price of the originator brand by 50 % as well as overall expenditure on risperidone tablets. Half of all patients made a single switch to generic risperidone, with the remainder making multiple switches between brands. 1.5 % made a switch-back to the originator brand. No difference was found in use of healthcare services between switchers and non-switchers of the originator brand or versus the comparator group. This refutes the available literature on brand-to-generic and generic-to-generic switching.