WorldWideScience

Sample records for cost-effective battery-powered aspirator

  1. A Battery Power Bank with Series-Connected Buck–Boost-Type Battery Power Modules

    Directory of Open Access Journals (Sweden)

    Tsung-Hsi Wu

    2017-05-01

    Full Text Available The operation of a battery power bank with series-connected buck–boost-type battery power modules (BPMs was investigated in this study. Each BPM consisted of a battery pack with an associated buck–boost converter for individually controlling battery currents. With a proposed discharging scenario, load voltage regulation with charge equalization among batteries was performed by controlling the battery currents in accordance with their state-of-charges (SOCs estimated by real-time battery-loaded voltages detected under the same operating condition. In addition, the fault tolerance was executed to isolate exhausted or faulty batteries from the battery power bank without interrupting the system operation. Experiments were conducted to verify the effectiveness of the discharging scenario for a laboratory battery power bank with four series buck–boost BPMs.

  2. Fuel Cell and Battery Powered Forklifts

    DEFF Research Database (Denmark)

    Zhang, Zhe; Mortensen, Henrik H.; Jensen, Jes Vestervang

    2013-01-01

    A hydrogen-powered materials handling vehicle with a fuel cell combines the advantages of diesel/LPG and battery powered vehicles. Hydrogen provides the same consistent power and fast refueling capability as diesel and LPG, whilst fuel cells provide energy efficient and zero emission Electric...... propulsion similar to batteries. In this paper, the performance of a forklift powered by PEM fuel cells and lead acid batteries as auxiliary energy source is introduced and investigated. In this electromechanical propulsion system with hybrid energy/power sources, fuel cells will deliver average power...

  3. Fuel Cell and Battery Powered Forklifts

    DEFF Research Database (Denmark)

    Zhang, Zhe; Mortensen, Henrik H.; Jensen, Jes Vestervang

    2013-01-01

    A hydrogen-powered materials handling vehicle with a fuel cell combines the advantages of diesel/LPG and battery powered vehicles. Hydrogen provides the same consistent power and fast refueling capability as diesel and LPG, whilst fuel cells provide energy efficient and zero emission Electric...... propulsion similar to batteries. In this paper, the performance of a forklift powered by PEM fuel cells and lead acid batteries as auxiliary energy source is introduced and investigated. In this electromechanical propulsion system with hybrid energy/power sources, fuel cells will deliver average power......, whilst batteries will handle all the load dynamics, such as acceleration, lifting, climbing and so on. The electrical part of the whole propulsion system for forklift has been investigated in details. The energy management strategy is explained and verified through simulation. Finally, experimental...

  4. Combined {sup 99m}Tc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Wale, Anita [Brighton and Sussex University Hospitals NHS Trust, Department of Nuclear Medicine, Brighton (United Kingdom); Royal Sussex County Hospital, Department of Nuclear Medicine, Brighton (United Kingdom); Miles, Kenneth A. [University College London, London (United Kingdom); Young, Barnaby [Tan Tock Seng Hospital, Novena (Singapore); Zammit, Charles [Brighton and Sussex University Hospitals NHS Trust, Department of Surgery, Brighton (United Kingdom); Williams, Anthony [Brighton and Sussex University Hospitals NHS Trust, Department of Pathology, Brighton (United Kingdom); Quin, John [Brighton and Sussex University Hospitals NHS Trust, Department of Endocrinology and Diabetes, Brighton (United Kingdom); Dizdarevic, Sabina [Brighton and Sussex University Hospitals NHS Trust, Department of Nuclear Medicine, Brighton (United Kingdom)

    2014-01-15

    Fine-needle aspiration (FNA) has revolutionised the care of patients with thyroid nodules and is the initial investigation of choice. However, as a result of nondiagnostic (Thy1) and nonneoplastic (Thy2) specimens, it remains an imperfect sole solution with a range of sensitivities and a high inadequate ratio. Therefore the British Thyroid Association (BTA) guidelines recommend a second FNA immediately for Thy1 specimens and 3-6 months later for Thy2 specimens. Patients must be followed up to exclude malignancy. In this study we assessed the performance of MIBI scintigraphy for diagnosing thyroid malignancy and the cost-effectiveness of a combined FNA/MIBI investigative strategy for the management of thyroid nodules. The diagnostic performance of MIBI scintigraphy was calculated from a retrospective review of local data combined with a meta-analysis of the published literature. Decision tree analysis was used to calculate the cost-effectiveness of a combined FNA/MIBI investigative strategy compared to the BTA guidelines. From 712 patients, the sensitivity, specificity, PPV and NPV of MIBI scintigraphy for the diagnosis of malignancy were 96 %, 46 %, 34 % and 97 %, respectively. MIBI-based strategies were more accurate and associated with lower cost per patient (pound 1,855/EUR2,125 vs. pound 2,445/EUR2,801) and lower cost per cancer diagnosed (pound 1,902/EUR2,179 vs. pound 2,469/EUR2,828) with negligible change in life expectancy. Due to its high NPV, MIBI scintigraphy can usefully exclude malignancy for Thy1 and Thy2 lesions. Its low specificity means MIBI scintigraphy cannot be recommended as a first-line investigation, but as a second-line investigation MIBI scintigraphy may lead to a lower rate of unnecessary thyroidectomies. Combined FNA/MIBI strategies are potentially cost-effective in the management of solitary or dominant thyroid nodules. (orig.)

  5. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape.

    Science.gov (United States)

    Masood, Shahla; Rosa, Marilin; Kraemer, Dale F; Smotherman, Carmen; Mohammadi, Amir

    2015-08-01

    Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis. After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined. Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most

  6. 21 CFR 874.3375 - Battery-powered artificial larynx.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Battery-powered artificial larynx. 874.3375 Section 874.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... intended for use in the absence of the larynx to produce sound. When held against the skin in the area...

  7. 78 FR 33849 - Battery-Powered Medical Devices Workshop: Challenges and Opportunities; Public Workshop; Request...

    Science.gov (United States)

    2013-06-05

    ... No. FDA-2013-N-0580] Battery-Powered Medical Devices Workshop: Challenges and Opportunities; Public... entitled ``Battery-Powered Medical Devices Workshop: Challenges and Opportunities''. The purpose of this workshop is to create awareness of the challenges related to battery-powered medical devices and...

  8. MEMS wing technology for a battery-powered ornithopter

    OpenAIRE

    2000-01-01

    The objective of this project is to develop a battery-powered ornithopter (flapping-wing) Micro Aerial Vehicle (MAV) with MEMS wings. In this paper, we present a novel MEMS-based wing technology that we developed using titanium-alloy metal as wingframe and parylene C as wing membrane. MEMS technology enables systematic research in terms of repeatablility, size control, and weight minimization. We constructed a high quality low-speed wind tunnel with velocity uniformity of 0.5% and speeds from...

  9. Study of hydrogen-powered versus battery-powered automobiles

    Energy Technology Data Exchange (ETDEWEB)

    Donnelly, J.J. Jr.; Greayer, W.C.; Nichols, R.J.; Escher, W.J.D.

    1979-05-01

    A study conducted to compare the technological status and the resultant potential vehicle characteristics for hydrogen- and battery-powered automobiles that could be produced from 1985 to 2000 is documented in 3 volumes. The primary objectives of the study were: the assessments of applicable energy storage and propulsion technology for the two basic vehicle types (applied to four-passenger cars); a rigorous comparison of vehicle weight, size, and usefulness versus design range; and an investigation of the relative efficiencies of expending energy from various primary sources to power the subject vehicle. Another important objective, unique to hydrogen powered vehicles, was the assessment of the technology, logistics, and cost implications of a hydrogen production and delivery capability. This volume, Volume III, contains three major sections: the assessment of battery electric vehicle technology for energy storage and the drivetrain system; the technical and economic comparison of hydrogen- and battery-powered vehicles derived primarily from data in the previous vehicle technology assessments, with consideration of alternative energy sources; and a series of appendices that support the vehicle definitions and comparisons.

  10. A new controller for battery-powered electric vehicles

    Science.gov (United States)

    Belsterling, C. A.; Stone, J.

    1980-01-01

    This paper describes the development, under a NASA/DOE contract, of a new concept for efficient and reliable control of battery-powered vehicles. It avoids the detrimental effects of pulsed-power controllers like the SCR 'chopper' by using rotating machines to meter continuous currents to the traction motor. The concept is validated in a proof-of-principle demonstration system and a complete vehicle is simulated on an analog computer. Test results show exceptional promise for a full-scale system. Optimum control strategies to minimize controller weight are developed by means of the simulated vehicle. The design for an Engineering Model is then prepared in the form of a practical, compact two-bearing package with forced air cooling. Predicted performance is outstanding, with controller efficiency of over 90% at high speed.

  11. Aspiration pneumonia

    Science.gov (United States)

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  12. CT Guided Bone Biopsy Using a Battery Powered Intraosseous Device

    Energy Technology Data Exchange (ETDEWEB)

    Schnapauff, Dirk, E-mail: dirk.schnapauff@charite.de; Marnitz, Tim, E-mail: tim.marnitz@charite.de; Freyhardt, Patrick, E-mail: Patrick.freyhardt@charite.de; Collettini, Federico, E-mail: Federico.collettini@charite.de [Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Department of Radiology (Germany); Hartwig, Kerstin, E-mail: kerstin.hartwig@charite.de [Charite Universitaetsmedizin Berlin, Campus Charite Mitte, Department of Haematology and Oncology (Germany); Joehrens, Korinna, E-mail: korinna.joehrens@charite.de [Charite Universitaetsmedizin Berlin, Campus Charite Mitte, Department of Pathology (Germany); Hamm, Bernd, E-mail: bernd.hamm@charite.de; Kroencke, Thomas, E-mail: thomas.kroencke@charite.de; Gebauer, Bernhard, E-mail: Bernhard.gebauer@charite.de [Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Department of Radiology (Germany)

    2013-10-15

    Purpose: To evaluate the feasibility of a battery powered intraosseous device to perform CT-fluoroscopy guided bone biopsy. Methods: Retrospective analysis of 12 patients in whom bone specimen were acquired from different locations under CT-fluoroscopy guidance using the OnControl bone marrow biopsy system (OBM, Vidacare, Shavano Park, TX, USA). Data of the 12 were compared to a historic cohort in whom the specimen were acquired using the classic Jamshidi Needle, as reference needle using manual force for biopsy. Results: Technical success was reached in 11 of 12 cases, indicated by central localisation of the needle within the target lesion. All specimen sampled were sufficient for histopathological workup. Compared to the historical cohort the time needed for biopsy decreased significantly from 13 {+-} 6 to 6 {+-} 4 min (P = 0.0001). Due to the shortened intervention time the radiation dose (CTDI) during CT-fluoroscopy was lowered significantly from 169 {+-} 87 to 111 {+-} 54 mGy Multiplication-Sign cm (P = 0.0001). Interventional radiologists were confident with the performance of the needle especially when using in sclerotic or osteoblastic lesions. Conclusion: The OBM is an attractive support for CT-fluoroscopy guided bone biopsy which is safe tool and compared to the classical approach using the Jamshidi needle leading to significantly reduced intervention time and radiation exposure.

  13. Bone marrow aspiration

    Science.gov (United States)

    Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

  14. Strategic Aspirations

    DEFF Research Database (Denmark)

    Christensen, Lars Thøger; Morsing, Mette; Thyssen, Ole

    2016-01-01

    Strategic aspirations are public announcements designed to inspire, motivate, and create expectations about the future. Vision statements or value declarations are examples of such talk, through which organizations announce their ideal selves and declare what they (intend to) do. While aspirations...... aspirations, in other words, have exploratory and inspirational potential—two features that are highly essential in complex areas such as sustainability and CSR. This entry takes a communicative focus on strategic aspirations, highlighting the value of aspirational talk, understood as ideals and intentions...

  15. Smart Power Supply for Battery-Powered Systems

    Science.gov (United States)

    Krasowski, Michael J.; Greer, Lawrence; Prokop, Norman F.; Flatico, Joseph M.

    2010-01-01

    A power supply for battery-powered systems has been designed with an embedded controller that is capable of monitoring and maintaining batteries, charging hardware, while maintaining output power. The power supply is primarily designed for rovers and other remote science and engineering vehicles, but it can be used in any battery alone, or battery and charging source applications. The supply can function autonomously, or can be connected to a host processor through a serial communications link. It can be programmed a priori or on the fly to return current and voltage readings to a host. It has two output power busses: a constant 24-V direct current nominal bus, and a programmable bus for output from approximately 24 up to approximately 50 V. The programmable bus voltage level, and its output power limit, can be changed on the fly as well. The power supply also offers options to reduce the programmable bus to 24 V when the set power limit is reached, limiting output power in the case of a system fault detected in the system. The smart power supply is based on an embedded 8051-type single-chip microcontroller. This choice was made in that a credible progression to flight (radiation hard, high reliability) can be assumed as many 8051 processors or gate arrays capable of accepting 8051-type core presently exist and will continue to do so for some time. To solve the problem of centralized control, this innovation moves an embedded microcontroller to the power supply and assigns it the task of overseeing the operation and charging of the power supply assets. This embedded processor is connected to the application central processor via a serial data link such that the central processor can request updates of various parameters within the supply, such as battery current, bus voltage, remaining power in battery estimations, etc. This supply has a direct connection to the battery bus for common (quiescent) power application. Because components from multiple vendors may have

  16. Hover performance estimation and validation of battery powered vertical takeoff and landing aircraft

    Institute of Scientific and Technical Information of China (English)

    王波; 侯中喜; 鲁亚飞; 朱雄峰

    2016-01-01

    Battery powered vertical takeoff and landing (VTOL) aircraft attracts more and more interests from public, while limited hover endurance hinders many prospective applications. Based on the weight models of battery, motor and electronic speed controller, the power consumption model of propeller and the constant power discharge model of battery, an efficient method to estimate the hover endurance of battery powered VTOL aircraft was presented. In order to understand the mechanism of performance improvement, the impacts of propulsion system parameters on hover endurance were analyzed by simulations, including the motor power density, the battery capacity, specific energy and Peukert coefficient. Ground experiment platform was established and validation experiments were carried out, the results of which showed a well agreement with the simulations. The estimation method and the analysis results could be used for optimization design and hover performance evaluation of battery powered VTOL aircraft.

  17. Solar battery powered bicycle lamp SKL050. Final report; Solar/Akkufahrradleuchte SKL050. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Lang, O.

    2001-06-01

    Up to now there are no functional or high quality mobile solar powered chargers and lamps available for the outdoor and bicycle consumer. Hence the project SKL050 was concerned with the development of a novel combination of battery powered multi-functional lamp and solar charger. All components such as solar module, bulb, electronics and housing were supposed to be involved in the development. The goal was a ready-for-production development well placed in the field of high quality bicycle, camping and household appliances by efficient, well matched components and an exclusive and functional design. Another issue in the development was a cost effective production by automated assembling in order to maintain the maximum customer price of 129,- DM (incl. VAT). Most of the stated goals were reached at the end of the project. Only the detailed construction of the housing parts and final approvals have to be carried out by a bicycle accessories company which is interested to produce and market the SKL050 in licence. Apart from the product SKL050 several important results regarding automation processes of small solar modules have been collected and are supposed to be integrated in future products of the SOLARC GmbH. (orig.) [German] Im Bereich mobiler solarbetriebener Ladegeraete und Leuchten fuer den Outdoor- und Fahrradkonsumenten sind bislang keine funktionell oder aesthetisch brauchbaren Produkte verfuegbar. Das Vorhaben SKL050 umfasste daher gezielt die Entwicklung einer neuartigen Kombination aus akkubetriebener Mehrzweckleuchte und Solar-Akkulader. Saemtliche Basiskomponenten wie Solarmodul, Leuchtmittel, Elektronik und Gehaeuse sollten mit in die Entwicklung einbezogen werden. Ziel des Vorhabens war ein zur Serienreife entwickeltes Produkt, welches durch leistungsfaehige, optimal aufeinander abgestimmte Komponenten sowie durch ein exklusives und funktionelles Design einen Platz im Bereich der hochwertigen Fahrrad-, Camping-, und Haushaltsaccessoires findet. Bei

  18. 14 CFR 382.127 - What procedures apply to stowage of battery-powered mobility aids?

    Science.gov (United States)

    2010-01-01

    ...-powered mobility aids? 382.127 Section 382.127 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT... DISABILITY IN AIR TRAVEL Stowage of Wheelchairs, Other Mobility Aids, and Other Assistive Devices § 382.127 What procedures apply to stowage of battery-powered mobility aids? (a) Whenever baggage...

  19. Battery Management Systems: Accurate State-of-Charge Indication for Battery-Powered Applications

    NARCIS (Netherlands)

    Pop, V.; Bergveld, H.J.; Danilov, D.; Regtien, P.P.L.; Notten, P.H.L.

    2008-01-01

    Battery Management Systems – Universal State-of-Charge indication for portable applications describes the field of State-of-Charge (SoC) indication for rechargeable batteries. With the emergence of battery-powered devices with an increasing number of power-hungry features, accurately estimating the

  20. Optimizing MEMS-Based Storage Devices for Mobile Battery-Powered Systems

    NARCIS (Netherlands)

    Khatib, Mohammed G.; Hartel, Pieter H.

    2010-01-01

    An emerging storage technology, called MEMS-based storage, promises nonvolatile storage devices with ultrahigh density, high rigidity, a small form factor, and low cost. For these reasons, MEMS-based storage devices are suitable for battery-powered mobile systems such as PDAs. For deployment in such

  1. Optimizing MEMS-Based Storage Devices for Mobile Battery-Powered Systems

    NARCIS (Netherlands)

    Khatib, M.G.; Hartel, Pieter H.

    An emerging storage technology, called MEMS-based storage, promises nonvolatile storage devices with ultrahigh density, high rigidity, a small form factor, and low cost. For these reasons, MEMS-based storage devices are suitable for battery-powered mobile systems such as PDAs. For deployment in such

  2. Battery Management Systems: Accurate State-of-Charge Indication for Battery-Powered Applications

    NARCIS (Netherlands)

    Pop, V.; Bergveld, H.J.; Danilov, D.; Regtien, Paulus P.L.; Notten, P.H.L.

    2008-01-01

    Battery Management Systems – Universal State-of-Charge indication for portable applications describes the field of State-of-Charge (SoC) indication for rechargeable batteries. With the emergence of battery-powered devices with an increasing number of power-hungry features, accurately estimating the

  3. A battery-powered high-current power supply for superconductors

    CERN Document Server

    Wake, M; Suda, K

    2002-01-01

    Since superconductors do not require voltages, a high-current power supply could run with low power if the voltage is sufficiently reduced. Even a battery-powered power supply could give as much as 2,000A for a superconductor. To demonstrate this hypothesis, a battery-powered 2,000A power supply was constructed. It uses an IGBT chopper and Schottky diode together with a specially arranged transformer to produce a high current with low voltage. Testing of 2,000A operation was performed for about 1.5 hr using 10 car batteries. Charging time for this operation was 8 hr. Ramping control was smooth and caused no trouble. Although the IGBT frequency ripple of 16.6 kHz was easily removed using a passive filter, spike noise remained in the output voltage. This ripple did not cause any trouble in operating a pancake-type inductive superconducting load. (author)

  4. Lithium-Ion Battery Power Degradation Modelling by Electrochemical Impedance Spectroscopy

    DEFF Research Database (Denmark)

    Stroe, Daniel-Ioan; Swierczynski, Maciej Jozef; Stroe, Ana-Irina

    2017-01-01

    This paper investigates the use of the electrochemical impedance spectroscopy (EIS) technique as an alternative to the DC pulses technique for estimating the power capability decrease of Lithium-ion batteries during calendar ageing. Based on results obtained from calendar ageing tests performed...... at different conditions during one to two years, a generalized model that estimates the battery power capability decrease as function of the resistance Rs increase (obtained from EIS) was proposed and successfully verified....

  5. Cost effective solar Inverter

    Directory of Open Access Journals (Sweden)

    Nagarathna M

    2015-06-01

    Full Text Available Solar energy the most efficient, eco-friendly and abundantly available energy source in the nature. It can be converted into electrical energy in cost effective manner. In recent years, the interest in solar energy has risen due to surging oil prices and environmental concern. In many remote or underdeveloped areas, direct access to an electric grid is impossible and a photovoltaic inverter system would make life much simpler and more convenient. With this in mind, it is aimed to design, build, and test a solar panel inverter. This inverter system could be used as backup power during outages, battery charging, or for typical household applications. The main components of this solar system are solar cell, dc to dc boost converters, and inverter. Sine wave push pull inverter topology is used for inverter. In this topology only two MOSFETs are used and isolation requirement between control circuit and power circuit is also less which helps to decrease the cost of solar inverter.

  6. Management of pulmonary aspiration

    NARCIS (Netherlands)

    Janda, Matthias; Scheeren, Thomas W L; Nöldge-Schomburg, Gabriele F E

    2006-01-01

    Pulmonary aspiration of gastric contents in the perioperative phase is associated with increased postoperative morbidity and mortality. For the management of aspiration, differentiation between acid-associated aspiration pneumonitis and aspiration pneumonia as a consequence of a secondary bacterial

  7. Life-cycle cost analysis of conventional and fuel cell/battery powered urban passenger vehicles

    Science.gov (United States)

    1992-11-01

    This Final Report summarizes the work on the life cycle cost (LCC) analysis of conventional and fuel cell/battery powered urban passenger vehicles. The purpose of the work is to support the Division in making sound economic comparisons between conventional and fuel cell/battery powered buses, passenger vans, and cars for strategic analysis of programmatic R&D goals. The LCC analysis can indicate whether paying a relatively high initial capital cost for advanced technology with low operating and/or environmental costs is advantageous over paying a lower initial cost for conventional technology with higher operating and/or environmental costs. While minimizing life cycle cost is an important consideration, it does not always result in technology penetration in the marketplace. The LCC analysis model developed under this contract facilitates consideration of all perspectives. Over 100 studies have been acquired and analyzed for their applicability. Drawing on prior work by JPL and Los Alamos National Laboratory as primary sources, specific analytical relationships and cost/performance data relevant to fuel cell/battery and intemal combustion engine (ICE) powered vehicles were selected for development of an LCC analysis model. The completed LCC model is structured around twelve integrated modules. Comparative analysis is made between conventional gasoline and diesel vehicles and fuel cell/battery vehicles using either phosphoric acid fuel cells or proton-exchange membrane fuel cells. In all, seven base vehicle configuration cases with a total of 21 vehicle class/powertrain/fuel combinations are analyzed. The LCC model represents a significant advance in comparative economic analysis of conventional and fuel cell/battery powered vehicle technologies embodying several unique features which were not included in prior models.

  8. Optimal Dispatch of Unreliable Electric Grid-Connected Diesel Generator-Battery Power Systems

    Science.gov (United States)

    Xu, D.; Kang, L.

    2015-06-01

    Diesel generator (DG)-battery power systems are often adopted by telecom operators, especially in semi-urban and rural areas of developing countries. Unreliable electric grids (UEG), which have frequent and lengthy outages, are peculiar to these regions. DG-UEG-battery power system is an important kind of hybrid power system. System dispatch is one of the key factors to hybrid power system integration. In this paper, the system dispatch of a DG-UEG-lead acid battery power system is studied with the UEG of relatively ample electricity in Central African Republic (CAR) and UEG of poor electricity in Congo Republic (CR). The mathematical models of the power system and the UEG are studied for completing the system operation simulation program. The net present cost (NPC) of the power system is the main evaluation index. The state of charge (SOC) set points and battery bank charging current are the optimization variables. For the UEG in CAR, the optimal dispatch solution is SOC start and stop points 0.4 and 0.5 that belong to the Micro-Cycling strategy and charging current 0.1 C. For the UEG in CR, the optimal dispatch solution is of 0.1 and 0.8 that belongs to the Cycle-Charging strategy and 0.1 C. Charging current 0.1 C is suitable for both grid scenarios compared to 0.2 C. It makes the dispatch strategy design easier in commercial practices that there are a few very good candidate dispatch solutions with system NPC values close to that of the optimal solution for both UEG scenarios in CAR and CR.

  9. Battery-powered bone drill: caution needed in densely blastic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Simeone, F.J.; Huang, Ambrose J. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

    2015-12-15

    Image-guided biopsies play an important role for pathologic diagnosis of bone tumors. Recently, motorized, battery powered bone marrow biopsy devices have been used to biopsy focal bone lesions with high accuracy. We present here two cases of densely blastic metastases where the biopsy sample could not be removed from the needle. These two cases suggest that if the lesion is densely blastic, then the sample should be small (<5 mm) to ensure that the biopsy specimen will not be stuck within the biopsy needle. (orig.)

  10. Power Constrained High-Level Synthesis of Battery Powered Digital Systems

    DEFF Research Database (Denmark)

    Nielsen, Sune Fallgaard; Madsen, Jan

    2003-01-01

    We present a high-level synthesis algorithm solving the combined scheduling, allocation and binding problem minimizing area under both latency and maximum power per clock-cycle constraints. Our approach eliminates the large power spikes, resulting in an increased battery lifetime, a property...... of utmost importance for battery powered embedded systems. Our approach extends the partial-clique partitioning algorithm by introducing power awareness through a heuristic algorithm which bounds the design space to those of power feasible schedules. We have applied our algorithm on a set of dataflow graphs...

  11. Method of electric powertrain matching for battery-powered electric cars

    Science.gov (United States)

    Ning, Guobao; Xiong, Lu; Zhang, Lijun; Yu, Zhuoping

    2013-05-01

    The current match method of electric powertrain still makes use of longitudinal dynamics, which can't realize maximum capacity for on-board energy storage unit and can't reach lowest equivalent fuel consumption as well. Another match method focuses on improving available space considering reasonable layout of vehicle to enlarge rated energy capacity for on-board energy storage unit, which can keep the longitudinal dynamics performance almost unchanged but can't reach lowest fuel consumption. Considering the characteristics of driving motor, method of electric powertrain matching utilizing conventional longitudinal dynamics for driving system and cut-and-try method for energy storage system is proposed for passenger cars converted from traditional ones. Through combining the utilization of vehicle space which contributes to the on-board energy amount, vehicle longitudinal performance requirements, vehicle equivalent fuel consumption level, passive safety requirements and maximum driving range requirement together, a comprehensive optimal match method of electric powertrain for battery-powered electric vehicle is raised. In simulation, the vehicle model and match method is built in Matlab/simulink, and the Environmental Protection Agency (EPA) Urban Dynamometer Driving Schedule (UDDS) is chosen as a test condition. The simulation results show that 2.62% of regenerative energy and 2% of energy storage efficiency are increased relative to the traditional method. The research conclusions provide theoretical and practical solutions for electric powertrain matching for modern battery-powered electric vehicles especially for those converted from traditional ones, and further enhance dynamics of electric vehicles.

  12. A Score Function for Optimizing the Cycle-Life of Battery-Powered Embedded Systems

    DEFF Research Database (Denmark)

    Wognsen, Erik Ramsgaard; Haverkort, Boudewijn; Jongerden, Marijn

    2015-01-01

    An ever increasing share of embedded systems is powered by rechargeable batteries. These batteries deteriorate with the number of charge/discharge cycles they are subjected to, the so-called cycle life. In this paper, we propose the wear score function to compare and evaluate the relative impact...... of usage (charge and discharge) profiles on cycle life. The wear score function can not only be used to rank different usage profiles, these rankings can also be used as a criterion for optimizing the overall lifetime of a battery-powered system. We perform such an optimization on a nano-satellite case...... checking and reinforcement learning to synthesize near-optimal scheduling strategies subject to possible hard timing-constaints. We use this to study the trade-off between optimal short-term dynamic payload selection and the operational life of the satellite....

  13. CT-guided radiofrequency ablation of osteoid osteoma using a novel battery-powered drill

    Energy Technology Data Exchange (ETDEWEB)

    Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Collettini, Federico; Hamm, Bernd; Gebauer, Bernhard [Charite Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Joehrens, Korinna [Charite Universitaetsmedizin Berlin, Department of Pathology, Berlin (Germany)

    2015-05-01

    To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drilling, in radiofrequency ablation of osteoid osteoma as an alternative to conventional orthopedic drills. Between 2009 and 2013, altogether 33 patients underwent CT-guided radiofrequency ablation of an osteoid osteoma at our institution. To access the nidus of the clinically and radiologically suspected osteoid osteoma, a channel was drilled using the OnControl Bone Marrow Biopsy System (OBM, Arrow OnControl, Teleflex, Shavano Park, TX, USA) and a biopsy was taken. Procedure time (i.e., drilling including local anesthesia), amount of scans (i.e., single-shot fluoroscopy), radiation exposure, and the results of biopsy were investigated and compared retrospectively to a classical approach using either a manual bone biopsy system or a conventional orthopedic drill (n = 10) after ethical review board approval. Drilling the tract into the nidus was performed without problems in 22 of the 23 OBM cases. Median procedure time was 7 min compared to 13 min using the classical approach (p < 0.001). Median amount CT scans, performed to control correct positioning of the drill was comparable with 26 compared to 24.5 (p = NS) scans. Histologically, the diagnosis of osteoid osteomas could be determined in all 17 cases where a biopsy was taken. Radiofrequency ablation could be performed without problems in any case. The use of the battery-powered drill was feasible and facilitated the access to the osteoid osteoma's nidus offering the possibility to extract a specimen in the same step. (orig.)

  14. Adaptive Driving Equipment: Selection and Major Considerations [and] Battery Powered Scooters and 3-Wheelers. Information Support Packets #1 and #2.

    Science.gov (United States)

    Stevens, John H.

    Two brief guides offer suggestions for persons with physical disabilities who are considering the purchase of adaptive driving equipment, battery-powered scooters, or three wheelers. The first guide offers guidelines for individuals considering purchase of special hand controls or other modifications or a van lift to enhance their independence in…

  15. Design and commissioning test results for the hypervelocity launcher research complex battery power supply

    Science.gov (United States)

    Cornette, James B.; Sterrett, John D.; Lippert, Jack R.; Williams, Robert W.

    1989-08-01

    The preliminary design of the battery power supply (BPS) was reported to the 6th IEEE Pulsed Power conference. In 1987, the final design was completed, assembled, and sequentially verified during approximately 1750 operational verification tests. These experiments consisted of single string verifications at 1000 amperes to a system discharge of 2,150,000 amperes. Final system design is very similar to the preliminary design previously presented. System fabrication is complete and at the present time consists of 858, 16 battery series strings resulting in 13,728 operational batteries. The final switching design has evolved into several levels of redundancy at varying current levels. These include 36 pneumatic, 100,000 ampere switches that control 24, 16 battery strings in parallel. These switches are used for the primary make and break of system current to charge the inductor. There are also 18 pneumatic crowbar switches at the 24 string level that are used to short the inductor from the BPS prior to system opening. At the string level there are 2000 ampere dc contactors that are used as a secondary current break and to pre-set the BPS in the appropriate parallel/series configuration prior to a discharge sequence. Explosively driven opening and closing switches are also employed at the interface junction to any Hypervelocity launcher test article.

  16. Electricity consumption by battery-powered consumer electronics: A household-level survey

    Energy Technology Data Exchange (ETDEWEB)

    McAllister, J. Andrew; Farrell, Alexander E. [Energy and Resources Group, University of California, 310 Barrows Hall, Berkeley, CA 94720-3050 (United States)

    2007-07-15

    The rapid proliferation of battery-powered consumer electronics and their reliance on inefficient linear transformers has been suggested to be an important part of the rapid growth in 'miscellaneous' electricity consumption in recent years, but detailed data are scarce. We conducted a survey of 34 randomly selected households (HHs) in Northern California about the number, type, and usage of consumer electronics. We also measured the energy consumption of 85 typical consumer electronic devices through various parts of the charge cycle. These primary data were supplemented by national sales information for consumer electronics. Results indicate that typical HHs own 8.4 rechargeable devices, which have a total average demand of 12-17 W per HH. Statewide, this amounts to 160-220 MW of demand, with the peak occurring in the late evening, and about 1600 GWh per year. Only about 15% of this energy is used for battery charging, the rest is lost as waste heat during no-load and charge maintenance periods. Technical options to increase the efficiency of these devices, and the research and policy steps needed to realize these savings are discussed. (author)

  17. Data base on batteries, power-conditioning equipment, and photovoltaic arrays. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Podder, A; Kapner, M; Morse, T

    1981-02-01

    The objective of this study was to compile an up-to-date comprehensive data base for research, design, and development of photovoltaic systems, primarily in the areas of applications and battery technology, and secondarily in the area of power conditioning and photovoltaic array technology. This volume contains the data base used to develop the end-use scenarios and identify the R and D needed for batteries to be used in photovoltaic power systems. In addition to its specific application to the present study, this data base is intended to provide state-of-the-art information to manufacturers of the various components of photovoltaic power systems, system designers, and researchers in this field. An extensive literature search was conducted to obtain technical data on batteries, power conditioners, and photovoltaic arrays. The data obtained from published technical literature and direct communication with manufacturers and developers are compiled. Principles of operation, types of systems, performance characteristics, test data, and cost data are included for each of the components. (WHK)

  18. Energy Efficient Monitoring for Intrusion Detection in Battery-Powered Wireless Mesh Networks

    KAUST Repository

    Hassanzadeh, Amin

    2011-07-18

    Wireless Mesh Networks (WMN) are easy-to-deploy, low cost solutions for providing networking and internet services in environments with no network infrastructure, e.g., disaster areas and battlefields. Since electric power is not readily available in such environments battery-powered mesh routers, operating in an energy efficient manner, are required. To the best of our knowledge, the impact of energy efficient solutions, e.g., involving duty-cycling, on WMN intrusion detection systems, which require continuous monitoring, remains an open research problem. In this paper we propose that carefully chosen monitoring mesh nodes ensure continuous and complete detection coverage, while allowing non-monitoring mesh nodes to save energy through duty-cycling. We formulate the monitoring node selection problem as an optimization problem and propose distributed and centralized solutions for it, with different tradeoffs. Through extensive simulations and a proof-of-concept hardware/software implementation we demonstrate that our solutions extend the WMN lifetime by 8%, while ensuring, at the minimum, a 97% intrusion detection rate.

  19. Performance Characterization of a Lithium-ion Gel Polymer Battery Power Supply System for an Unmanned Aerial Vehicle

    Science.gov (United States)

    Reid, Concha M.; Manzo, Michelle A.; Logan, Michael J.

    2004-01-01

    Unmanned aerial vehicles (UAVs) are currently under development for NASA missions, earth sciences, aeronautics, the military, and commercial applications. The design of an all electric power and propulsion system for small UAVs was the focus of a detailed study. Currently, many of these small vehicles are powered by primary (nonrechargeable) lithium-based batteries. While this type of battery is capable of satisfying some of the mission needs, a secondary (rechargeable) battery power supply system that can provide the same functionality as the current system at the same or lower system mass and volume is desired. A study of commercially available secondary battery cell technologies that could provide the desired performance characteristics was performed. Due to the strict mass limitations and wide operating temperature requirements of small UAVs, the only viable cell chemistries were determined to be lithium-ion liquid electrolyte systems and lithium-ion gel polymer electrolyte systems. Two lithium-ion gel polymer cell designs were selected as candidates and were tested using potential load profiles for UAV applications. Because lithium primary batteries have a higher specific energy and energy density, for the same mass and volume allocation, the secondary batteries resulted in shorter flight times than the primary batteries typically provide. When the batteries were operated at lower ambient temperatures (0 to -20 C), flight times were even further reduced. Despite the reduced flight times demonstrated, for certain UAV applications, the secondary batteries operated within the acceptable range of flight times at room temperature and above. The results of this testing indicate that a secondary battery power supply system can provide some benefits over the primary battery power supply system. A UAV can be operated for hundreds of flights using a secondary battery power supply system that provides the combined benefits of rechargeability and an inherently safer

  20. High-performance combination method of electric network frequency and phase for audio forgery detection in battery-powered devices.

    Science.gov (United States)

    Savari, Maryam; Abdul Wahab, Ainuddin Wahid; Anuar, Nor Badrul

    2016-09-01

    Audio forgery is any act of tampering, illegal copy and fake quality in the audio in a criminal way. In the last decade, there has been increasing attention to the audio forgery detection due to a significant increase in the number of forge in different type of audio. There are a number of methods for forgery detection, which electric network frequency (ENF) is one of the powerful methods in this area for forgery detection in terms of accuracy. In spite of suitable accuracy of ENF in a majority of plug-in powered devices, the weak accuracy of ENF in audio forgery detection for battery-powered devices, especially in laptop and mobile phone, can be consider as one of the main obstacles of the ENF. To solve the ENF problem in terms of accuracy in battery-powered devices, a combination method of ENF and phase feature is proposed. From experiment conducted, ENF alone give 50% and 60% accuracy for forgery detection in mobile phone and laptop respectively, while the proposed method shows 88% and 92% accuracy respectively, for forgery detection in battery-powered devices. The results lead to higher accuracy for forgery detection with the combination of ENF and phase feature.

  1. Analysis of environmental factors impacting the life cycle cost analysis of conventional and fuel cell/battery-powered passenger vehicles. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-01-31

    This report presents the results of the further developments and testing of the Life Cycle Cost (LCC) Model previously developed by Engineering Systems Management, Inc. (ESM) on behalf of the U.S. Department of Energy (DOE) under contract No. DE-AC02-91CH10491. The Model incorporates specific analytical relationships and cost/performance data relevant to internal combustion engine (ICE) powered vehicles, battery powered electric vehicles (BPEVs), and fuel cell/battery-powered electric vehicles (FCEVs).

  2. Aspirations of Life

    Institute of Scientific and Technical Information of China (English)

    Zhou; Ningxin

    2012-01-01

    After entering Senior Three, besides strenuous revisions and examinations, what the students think most and discuss most is aspirations of life. As far as I know, most of my classmates have already specified their choices of majors and their aspirations of life. Some classmates excel in science subjects, so they have chosen science and engineering subjects, hoping that they will become scientists or engineers.

  3. Poverty and Aspirations Failure

    NARCIS (Netherlands)

    Dalton, P.S.; Ghosal, S.; Mani, A.

    2011-01-01

    We develop a theoretical framework to study the psychology of poverty and 'aspirations failure'. In our framework, the rich and the poor share the same preferences - and also a behavioral bias in setting aspirations. Greater downside risks imposed by poverty exacerbates the effects of this behaviora

  4. Aspiration and leadership

    NARCIS (Netherlands)

    Jagersma, P.K.

    2007-01-01

    Management needs an aspiration as to how the company will work in the future. It needs a guide for corporate priorities. Any company - local or global - must be driven by an aspiration that energizes and motivates the company from top to bottom. Yet very few managers and executives know how a corpor

  5. Aspiration in Jaffna Tamil

    Science.gov (United States)

    Thananjayarajasingham, S.

    1975-01-01

    The article accounts for the phenomenon of aspiration in Jaffna Tamil, a dialect distinct form South Indian dialects of Tamil. Not being distinctive orphonologically determined, aspiration is dealt with as a prosodic feature affecting voiceless stops in various positions. Distribution and symbolic representation are handled; kymographic evidence…

  6. Aspirations of Rural Youth.

    Science.gov (United States)

    Bajema, Duane H.; Miller, W. Wade; Williams, David L.

    2002-01-01

    Of 883 Iowa high school seniors, 60% lived in towns, 40% on farms. Both groups had a high level of congruence between educational and occupational aspirations and perceived minimal barriers to goal achievement. Farm and town students had equally diverse aspirations. (Contains 23 references.) (SK)

  7. Poverty and Aspirations Failure

    NARCIS (Netherlands)

    Dalton, P.S.; Ghosal, S.; Mani, A.

    2011-01-01

    We develop a theoretical framework to study the psychology of poverty and 'aspirations failure'. In our framework, the rich and the poor share the same preferences - and also a behavioral bias in setting aspirations. Greater downside risks imposed by poverty exacerbates the effects of this behaviora

  8. Cost-effectiveness thresholds: pros and cons.

    Science.gov (United States)

    Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

    2016-12-01

    Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

  9. A Departmental Cost-Effectiveness Model.

    Science.gov (United States)

    Holleman, Thomas, Jr.

    In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…

  10. CT colonography and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Mavranezouli, Ifigeneia [University College London, National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-department of Clinical Health Psychology, London (United Kingdom); East, James E. [St Marks Hospital, Imperial College London, Wolfson Unit for Endoscopy, London (United Kingdom); Taylor, Stuart A. [University College Hospital, Specialist X-Ray, London (United Kingdom); University College Hospital, Department of Imaging, London (United Kingdom)

    2008-11-15

    CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

  11. Green Infrastructure Siting and Cost Effectiveness Analysis

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Parcel scale green infrastructure siting and cost effectiveness analysis. You can find more details at the project's website.

  12. Cost-Effective Stress Management Training.

    Science.gov (United States)

    Shea, Gordon F.

    1980-01-01

    Stress management training can be a cost effective way to improve productivity and job performance. Among many relaxation techniques, the most effective in terms of teachability, participant motivation, and profitability are self-hypnosis, progressive relaxation, and transcendental meditation. (SK)

  13. Research development and demonstration of a fuel cell/battery powered bus system. Interim report, August 1, 1991--April 30, 1992

    Energy Technology Data Exchange (ETDEWEB)

    Romano, S.; Wimmer, R.

    1992-04-30

    This report describes the progress in the Georgetown University research, development and demonstration project of a fuel cell/battery powered bus system. The topics addressed in the report include vehicle design and application analysis, technology transfer activities, coordination and monitoring of system design and integration contractor, application of fuel cells to other vehicles, current problems, work planned, and manpower, cost and schedule reports.

  14. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

    Full Text Available Steven SimoensResearch Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, BelgiumAbstract: Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical, the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events and effectiveness of a biosimilar, the cost-effectiveness

  15. Bone Marrow Aspiration and Biopsy

    Science.gov (United States)

    ... Advertising & Sponsorship: Policy | Opportunities Bone Marrow Aspiration and Biopsy Share this page: Was this page helpful? Also ... Examination Formal name: Bone Marrow Aspiration; Bone Marrow Biopsy Related tests: Complete Blood Count ; WBC Differential ; Reticulocyte ...

  16. Small intestine aspirate and culture

    Science.gov (United States)

    ... ency/article/003731.htm Small intestine aspirate and culture To use the sharing features on this page, please enable JavaScript. Small intestine aspirate and culture is a lab test to check for infection ...

  17. Rising Aspirations Dampen Satisfaction

    Science.gov (United States)

    Clark, Andrew E.; Kamesaka, Akiko; Tamura, Teruyuki

    2015-01-01

    It is commonly believed that education is a good thing for individuals. Yet, its correlation with subjective well-being is most often only weakly positive, or even negative, despite the many associated better individual-level outcomes. We here square the circle using novel Japanese data on happiness aspirations. If reported happiness comes from a…

  18. Rising Aspirations Dampen Satisfaction

    Science.gov (United States)

    Clark, Andrew E.; Kamesaka, Akiko; Tamura, Teruyuki

    2015-01-01

    It is commonly believed that education is a good thing for individuals. Yet, its correlation with subjective well-being is most often only weakly positive, or even negative, despite the many associated better individual-level outcomes. We here square the circle using novel Japanese data on happiness aspirations. If reported happiness comes from a…

  19. Aspirated High Pressure Compressor

    Science.gov (United States)

    2006-08-01

    of Technology Aamir Shabbir Cambridge, Massachusetts 02139, USA University of Toledo Toledo , Ohio 43606, USA ABSTRACT transport engine aspirated...special thanks to Jack Costa, James Letendre, and Victor Dubrowski for their tireless work in the lab. The instruments were partially the result of

  20. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS COST-EFFECTIVENESS FOR GENERALIZED ANALYSIS 1. 2. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 Undertaking...

  1. Electrochemical Journals, AIP's Scitation, Cost-Effectiveness

    OpenAIRE

    Roth, Dana L

    2004-01-01

    A review of the relative subscription costs, page & article counts of Electrochemical Society journals compared with commercial counterparts. A description of the AIP's Scitation database. The relative cost-effectiveness (normalized cost/article/Impact Factor) of society and commercial journals related to electrochemistry.

  2. Cost-effectiveness in reproductive medicine

    NARCIS (Netherlands)

    L.M. Moolenaar

    2013-01-01

    This thesis reports on cost-effectiveness in reproductive medicine. Firstly, we evaluated the methodologic quality of studies in reproductive medicine. Insight into the quality of economical analysis in reproductive medicine is important for valuing the performed studies and to assess whether these

  3. Cost-effectiveness analysis and innovation.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

  4. Pulmonary aspiration in hospitalized adults.

    Science.gov (United States)

    Elpern, E H

    1997-02-01

    Until recent years, pulmonary aspiration attracted remarkably little clinical investigation. Although aspiration was considered a common occurrence in hospitalized individuals, with serious and even fatal consequences, clinicians had limited scientific data to guide practice. Consequently, approaches to this problem were based largely on unsystematic observations, intuition, and tradition. Recent investigations on the subjects of aspiration have increased our understanding of patients at risk for aspiration, the value of diagnostic methods, and the efficacy of interventions to prevent or limit aspirations. Results of these studies call to question many time-honored adages and practices. Considerable uncertainty remains and more investigation is necessary before management decisions can be characterized clearly and clinical strategies defined. This review focuses on pulmonary aspiration and enteral feeding in the critically ill adult. Factors implicated in aspiration in this population are highlighted and evidence to support the application of interventions prescribed commonly is presented.

  5. Development of power storage system. Advanced battery power storage system. (The development results and research plan in 1988 fiscal year)

    Energy Technology Data Exchange (ETDEWEB)

    Kouda, Atsushi; Yazawa, Tetsuo

    1988-07-01

    The research and trial manufacture of 1kW battery on the electrode and battery construction, development of 10kW battery module, capacity enlarging and trial manufacturing as to four type batteries, that is, Na-S battery, Zn-Cl battery, Zn-Br battery and redox flow type battery were forwarded as the items to be developed in Japan for the advanced battery power storage system. The research and development of system technology was started in 1980 to verify the operating and controlling characteristics and the protection system. The technology of the 60kW class module for 1,000kW class battery system was established in 1987 and the total system research and development is forwarding. The 1,000kW class system test is continued; the 60kW class module batteries of Na-S battery and Zn-Br battery are operated; the fabrication of 1,000kW class pilot plant is initiated; and the reliability and safety of the power system are verified in 1988. (1 fig, 2 tabs)

  6. Optimal integration of a hybrid solar-battery power source into smart home nanogrid with plug-in electric vehicle

    Science.gov (United States)

    Wu, Xiaohua; Hu, Xiaosong; Teng, Yanqiong; Qian, Shide; Cheng, Rui

    2017-09-01

    Hybrid solar-battery power source is essential in the nexus of plug-in electric vehicle (PEV), renewables, and smart building. This paper devises an optimization framework for efficient energy management and components sizing of a single smart home with home battery, PEV, and potovoltatic (PV) arrays. We seek to maximize the home economy, while satisfying home power demand and PEV driving. Based on the structure and system models of the smart home nanogrid, a convex programming (CP) problem is formulated to rapidly and efficiently optimize both the control decision and parameters of the home battery energy storage system (BESS). Considering different time horizons of optimization, home BESS prices, types and control modes of PEVs, the parameters of home BESS and electric cost are systematically investigated. Based on the developed CP control law in home to vehicle (H2V) mode and vehicle to home (V2H) mode, the home with BESS does not buy electric energy from the grid during the electric price's peak periods.

  7. Durability patch and damage dosimeter: a portable battery-powered data acquisition computer and durability patch design process

    Science.gov (United States)

    Haugse, Eric D.; Johnson, Patrick E.; Smith, David L.; Rogers, Lynn C.

    2000-05-01

    Repairs of secondary structure can be accomplished by restoring structural integrity at the damaged area and increasing the structure's damping in the repair region. Increased damping leads to a reduction in resonant response and a repair that will survive for the life of the aircraft. In order to design a repair with effective damping properties, the in-service structural strains and temperatures must be known. A rugged, small and lightweight data acquisition unit called the Damage Dosimeter has been developed to accomplish this task with minimal impact to the aircraft system. Running autonomously off of battery power, the Damage Dosimeter measures three channels of strain at sample rates as high as 15 kilo-samples per second and a single channel of temperature. It merges the functionality of both analog signal conditioning and a digital single board computer on one 3.5 by 5 inch card. The Damage Dosimeter allows an engineer to easily instrument an in-service aircraft to assess the structural response characteristics necessary to properly select damping materials. This information in conjunction with analysis and design procedures can be used to design a repair with optimum effectiveness. This paper will present the motivation behind the development of the Damage Dosimeter along with an overview of its functional capabilities and design. In-service flight data and analysis results will be discussed for two applications. The paper will also describe how the Damage Dosimeter is used to enable the Durability Patch design process.

  8. A dual-beam dual-camera method for a battery-powered underwater miniature PIV (UWMPIV) system

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Binbin; Liao, Qian [University of Wisconsin-Milwaukee, Department of Civil Engineering and Mechanics, Milwaukee, WI (United States); Bootsma, Harvey A. [University of Wisconsin-Milwaukee, School of Freshwater Sciences, Milwaukee, WI (United States); Wang, Pei-Fang [Space and Naval Warfare Systems Center, Advanced Systems and Applied Sciences, Envrionmental Sciences, San Diego, CA (United States)

    2012-06-15

    A battery-powered in situ Underwater Miniature PIV (UWMPIV) has been developed and deployed for field studies. Instead of generating high-energy laser pulses as in a conventional PIV system, the UWMPIV employs a low-power Continuous Wave (CW) laser (class IIIb) and an oscillating mirror (galvanometer) to generate laser sheets. In a previous version of the UWMPIV, the time between exposures of a pair of particle images, {delta}t, could not be reduced without loss of illumination strength. This limitation makes it unsuitable for high-speed flows. In this paper, we present a technique to solve this problem by adopting two CW lasers with different wavelength and two CCD cameras in a second-generation UWMPIV system. Several issues including optical alignment, non-uniform distribution of {delta}t due to the varying speed of the scanning beam and local flow velocities are discussed. The timing issue is solved through a simple calibration procedure that involves the reconstruction of maps of laser beam arrival time. Comparison of the performance between the new method and a conventional PIV system is presented. Measurements were performed in a laboratory open-channel flume. Excellent agreement was found between the new method and the standard PIV measurement in terms of the extracted vertical profiles of mean velocity, RMS fluctuation, Reynolds stress and dissipation rate of turbulent kinetic energy. (orig.)

  9. Compact, battery powered, wireless digitizers for in situ data acquisitions in the sino-united spherical tokamak

    Science.gov (United States)

    Liu, Yangqing; Tan, Yi; Ke, Rui; Yang, Hao; Wang, Wenhao; Gao, Zhe

    2015-07-01

    Potential isolation and long cable drive are very important in acquiring certain signals from tokamak diagnostics. Compact, battery powered, wireless digitizers for in situ data acquisition have been developed and routinely used in the sino-united spherical tokamak to solve the problems of isolation and long cables. The wireless digitizers utilize the integrated analog to digital converters and the static random access memory of microcontrollers but transfer data wirelessly. They consist of simple and concise circuits but have considerable performances of 12-16 bit in resolution and 500-1000 kS/s in sample rate. Wireless triggering and energy saving are two major challenges of the wireless digitizers. Wireless transceivers in the data link layer are used as trigger and can reduce the trigger jitters to be smaller than 1 μs. In order to reduce the energy consumption, the wireless digitizers are waken only when the tokamak is about to discharge. After discharges, they turn to a periodic checking mode with current consumption smaller than 200 μA. Because of low duty cycle, the wireless digitizers have a battery life of up to four weeks. In general, the wireless digitizers have better performance than normal isolation amplifiers and can greatly simplify the cable connections. They are very suitable for the data acquisition of dangerous and/or susceptible analog signals in tokamaks.

  10. CSR as Aspirational Talk

    DEFF Research Database (Denmark)

    Christensen, Lars Thøger; Morsing, Mette; Thyssen, Ole

    2013-01-01

    Most writings on corporate social responsibility (CSR) treat lack of consistency between organizational CSR talk and action as a serious problem that needs to be eliminated. In this article, we argue that differences between words and action are not necessarily a bad thing and that such discrepan......Most writings on corporate social responsibility (CSR) treat lack of consistency between organizational CSR talk and action as a serious problem that needs to be eliminated. In this article, we argue that differences between words and action are not necessarily a bad thing...... and that such discrepancies have the potential to stimulate CSR improvements. We draw on a research tradition that regards communication as performative to challenge the conventional assumption that CSR communication is essentially superficial, as opposed to CSR action. In addition, we extend notions of organizational...... hypocrisy to argue that aspirational CSR talk may be an important resource for social change, even when organizations do not fully live up to their aspirations....

  11. Cost effectiveness of a medical digital library.

    Science.gov (United States)

    Roussel, F; Darmoni, S J; Thirion, B

    2001-01-01

    The rapid increase in the price of electronic journals has made the optimization of collection management an urgent task. As there is currently no standard procedure for the evaluation of this problem, we applied the Reading Factor (RF), an electronically computed indicator used for consultation of individual articles. The aim of our study was to assess the cost effective impact of modifications in our digital library (i.e. change of access from the Intranet to the Internet or change in editorial policy). The digital OVID library at Rouen University Hospital continues to be cost-effective in comparison with the interlibrary loan costs. Moreover, when electronic versions are offered alongside a limited amount of interlibrary loans, a reduction in library costs was observed.

  12. Sampling: Making Electronic Discovery More Cost Effective

    Directory of Open Access Journals (Sweden)

    Milton Luoma

    2011-06-01

    Full Text Available With the huge volumes of electronic data subject to discovery in virtually every instance of litigation, time and costs of conducting discovery have become exceedingly important when litigants plan their discovery strategies.  Rather than incurring the costs of having lawyers review every document produced in response to a discovery request in search of relevant evidence, a cost effective strategy for document review planning is to use statistical sampling of the database of documents to determine the likelihood of finding relevant evidence by reviewing additional documents.  This paper reviews and discusses how sampling can be used to make document review more cost effective by considering issues such as an appropriate sample size, how to develop a sampling strategy, and taking into account the potential value of the litigation in relation to the costs of additional discovery efforts. 

  13. Comparative efficacy of the Colgate Actibrush battery-powered toothbrush vs Oral-B CrossAction toothbrush on established plaque and gingivitis: a 6-week clinical study.

    Science.gov (United States)

    Nathoo, S; Rustogi, K N; Petrone, M E; DeVizio, W; Zhang, Y P; Volpe, A R; Proskin, H M

    2000-01-01

    The objective of this clinical program was to compare the efficacy of the Colgate Actibrush battery-powered toothbrush and the Oral-B CrossAction Toothbrush (full head, soft bristle) for the control of supragingival plaque and gingivitis. Two independent clinical studies were conducted: Study 1 (repeated 3 times) was a single-use, examiner-blind clinical study designed to measure the removal of plaque after 24 hours of no oral hygiene. Study 2 was a definitive 6-week, examiner-blind clinical study designed to determine plaque and gingivitis efficacy at 3 and 6 weeks. Sixty-one men and women, who had refrained from using oral hygiene procedures for 24 hours, were entered into the study and stratified into 2 balanced groups according to baseline (prebrushing) plaque and gingivitis scores. For Study 1, Modified Navy Plaque Index (Rustogi Refinement) scores were obtained prebrushing and after a 1-minute supervised brushing with the assigned toothbrush and a commercially available toothpaste. On 3 separate occasions, after 24 hours of no oral hygiene, the Colgate Actibrush battery-powered toothbrush removed significantly more plaque than did the CrossAction Toothbrush. For Study 2, subjects were instructed to brush their teeth twice daily for 1 minute with the assigned toothbrush. Plaque Index scores and Löe-Silness Gingival Index scores were assessed after 3 and 6 weeks. At the 6-week examination, the group using the Colgate Actibrush battery-powered toothbrush exhibited a statistically significant reduction in both supragingival plaque and gingivitis, compared with the group that used the CrossAction Toothbrush. The results of these clinical studies support the conclusion that the Colgate Actibrush battery-powered toothbrush is clinically superior for the control of both supragingival plaque and gingivitis, as compared with the Oral-B CrossAction manual toothbrush.

  14. Hip Fracture Prevention: Cost-Effective Strategies

    OpenAIRE

    Peter Vestergaard; Lars Rejnmark; Leif Mosekilde

    2001-01-01

    The available literature on cost benefit, cost effectiveness and cost utility of different drug and non-drug regimens in preventing hip fractures was reviewed. The cost of a hip fracture and of the different treatment regimens varied considerably from one country to another. In primary prevention, potential savings only exceeded costs in women over the age of 70 years treated with hormonal replacement therapy (HRT). In the case of HRT, treating those with low bone mineral density levels (seco...

  15. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

    Omidvari, Amir-Houshang; Meester, Reinier G S; Lansdorp-Vogelaar, Iris

    2016-12-01

    Gastrointestinal (GI) diseases are among the leading causes of death in the world. To reduce the burden of GI diseases, surveillance is recommended for some diseases, including for patients with inflammatory bowel diseases, Barrett's oesophagus, precancerous gastric lesions, colorectal adenoma, and pancreatic neoplasms. This review aims to provide an overview of the evidence on cost-effectiveness of surveillance of individuals with GI conditions predisposing them to cancer, specifically focussing on the aforementioned conditions. We searched the literature and reviewed 21 studies. Despite heterogeneity of studies in terms of settings, study populations, surveillance strategies and outcomes, most reviewed studies suggested at least some surveillance of patients with these GI conditions to be cost-effective. For some high-risk conditions frequent surveillance with 3-month intervals was warranted, while for other conditions, surveillance may only be cost-effective every 10 years. Further studies based on more robust effectiveness evidence are needed to inform and optimise surveillance programmes for GI cancers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. [Cost effectiveness and health sector reform].

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.

  17. Cost effectiveness of new roadway lighting systems

    Directory of Open Access Journals (Sweden)

    Yi Jiang

    2015-06-01

    Full Text Available Appropriate and adequate lighting at select locations on roadways is essential for roadway safety. As the lighting technologies advance, many types of new lighting devices have been developed for roadway lightings. The most promising new lighting technologies for roadway lighting include light emitting diode, induction, plasma, and metal halide lighting systems. A study was conducted to compare the new systems with the conventional high pressure sodium systems that are currently used on the Indiana roadway systems. In this study, the engineering issues, were analyzed such as illuminance, color rendering, power usage, cost effectiveness, and approval procedures for new roadway lighting systems. This paper, however, presents only the study findings related to cost effectiveness of the evaluated roadway lighting systems. Illustrated in this paper are the main features of the roadway lighting systems under evaluations, installations of the new lighting systems, measurements of power consumptions, and life cycle cost analyses of the lighting systems. Through this study, experience and knowledge have been obtained on the installations, power measurements, and cost effectiveness of the new types of the roadway lighting devices. The actual power values of various luminaires were obtained by measuring the electric current with a multi-meter. It was found that the differences between the rated and measured power values could be significant. The results of the life cycle cost analysis indicate that the lower life cycle costs of some of the alternative lighting devices are attributed to their relatively lower electricity usages and longer lamp/emitter replacement cycles.

  18. Comparative efficacy of Colgate Actibrush battery-powered toothbrush and Colgate Plus (manual) toothbrush on established plaque and gingivitis: a 30-day clinical study in New Jersey.

    Science.gov (United States)

    Sowinski, J A; Battista, G W; Petrone, D M; Petrone, M E; Rustogi, K N; Chaknis, P; DeVizio, W; Volpe, A R

    2000-01-01

    The objective of this 30-day clinical study, conducted in harmony with American Dental Association guidelines, was to evaluate the efficacy of a new battery-powered toothbrush (Colgate Actibrush) relative to a manual toothbrush (Colgate Plus Diamond Head Toothbrush, Full Head, Soft Bristle) in the control of supragingival plaque and gingivitis. A total of 110 adult men and women from the Northern New Jersey area were entered into the study and stratified into 2 balanced groups according to baseline plaque and gingivitis scores. Participants were instructed to brush twice daily (morning and evening) for 1 minute with their assigned toothbrush and a commercially available toothpaste (Colgate Cavity Protection Great Regular Flavor Fluoride Toothpaste). Examinations for plaque and gingivitis were conducted by the same dental examiner at baseline, after 15 days, and again after 30 days of product use. All 110 participants complied with the protocol and completed the 30-day clinical study. At the 30-day examinations, the group using the Colgate Actibrush battery-powered toothbrush exhibited a statistically significant greater reduction in plaque (26.7%) and in gingivitis (25.8%) than did the group who used the Colgate Plus Diamond Head Toothbrush. The results of this 30-day clinical study support the conclusion that the Colgate Actibrush battery-powered toothbrush provides a clinically superior level of efficacy for the control of supragingival plaque and for the control of gingivitis when compared with a manual toothbrush.

  19. [Fine-needle Aspiration of Thyroid Nodules: Is it Worth Repeating?

    Science.gov (United States)

    Fernandes, Vera; Pereira, Tânia; Eloy, Catarina

    2017-06-30

    The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results. Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule. The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3. The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases. The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.

  20. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    by the Ministry of Transport, with the Technical University of Denmark as one of the main contributors. The CO2-strategy was to be based on the principle of cost-effectiveness. A model was set up to assist in the assessment. The model consists of a projection of CO2-emissions from road and rail modes from 2020...... are evaluated according to CO2 reduction potential and according to the ‘shadow price’ on a reduction of one ton CO2. The shadow price reflects the costs (and benefits) of the different measures. Comparing the measures it is possible to identify cost effective measures, but these measures are not necessarily......, a scenario-part and a cost-benefit part. Air and sea modes are not analyzed. The model adopts a bottom-up approach to allow a detailed assessment of transport policy measures. Four generic areas of intervention were identified and the likely effect on CO2 emissions, socioeconomic efficiency and other...

  1. GEAR UP Aspirations Project Evaluation

    Science.gov (United States)

    Trimble, Brad A.

    2013-01-01

    The purpose of this study was to conduct a formative evaluation of the first two years of the Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP) Aspirations Project (Aspirations) using a Context, Input, Process, and Product (CIPP) model so as to gain an in-depth understanding of the project during the middle school…

  2. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Jensen Beck, Søren; Houlind, Kim;

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  3. Workload, Aspiration, and Fun

    DEFF Research Database (Denmark)

    Muhr, Sara Louise; Pedersen, Michael; Alvesson, Mats

    2012-01-01

    Contemporary working life highlights the challenge between exploitation and exploration both on a general and a more individual level. Here, we focus on the latter, and connect the critical debate regarding selfmanagement to March’s exploitation/exploration trade-off, as this forms a useful...... study of a large group of management consultants, we explore how they perform and make sense of selfexploitation and self-exploration through three specific discourses: the discourse of workload, the discourse of aspiration, and the discourse of fun. Through these, the consultants try to identify...... optimal amounts of work, play, and ambition, all while handling the trade-off between selfexploitation and self-exploration. We show how this keeps failing, but how it reappears as a necessary condition for avoiding future failures. In all three discourses, the trade-off therefore presents itself...

  4. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  5. Aspirated Compressors for High Altitude Engines Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Aurora Flight Sciences proposes to incorporate aspirated compressor technology into a high altitude, long endurance (HALE) concept engine. Aspiration has been proven...

  6. [Intensified insulin treatment is cost-effective].

    Science.gov (United States)

    Reichard, P; Alm, C; Andersson, E; Wärn, I; Rosenqvist, U

    1999-01-20

    Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.

  7. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    Friedman, S. N.

    The possibility to combine various technologies, such as Bi-Polar linear and CMOS/Digital makes it feasible to create systems with a tailored performance not available on a single monolithic circuit. The custom LSI 'BLOCK', especially if it is universal in nature, is proving to be a cost effective way for the developer to improve his product. The custom LSI represents a low price part in contrast to the discrete components it will replace. In addition, the hybrid assembly can realize a savings in labor as a result of the reduced parts handling and associated wire bonds. The possibility of the use of automated system manufacturing techniques leads to greater reliability as the human factor is partly eliminated. Attention is given to reliability predictions, cost considerations, and a product comparison study.

  8. Cost-effective ultrasound PACS solution

    Science.gov (United States)

    Honeyman-Buck, Janice C.; Frost, Meryll M.; Staab, Edward V.

    1995-05-01

    Picture archiving and communication systems (PACS) have been quite successful at the University of Florida in the areas of CT, MR, and nuclear medicine. In each case, although we have not always been able to provide the optimal level of performance, we have been able to solve a problem and the systems are used extensively. Ultrasound images are required in a number of locations and the multiformat camera print capability was no longer adequate for the growing volume in the ultrasound section. Although we were certain we could successfully implement PACS for ultrasound, new forces in health care dictate that we justify our system in terms of cost. We analyzed the feasibility of a PACS solution for ultrasound and designed a system that meets our needs and is cost effective. We evaluated the ultrasound operation in terms of image acquisition patterns and throughput requirements. An inventory of existing and PACS equipment was made to determine the feasibility of interfacing the two systems. Commercial systems were evaluated for functionality and cost and a system was designed to meet our needs. The only way to achieve our goal of installing a cost effective ultrasound PACS was to eliminate film and use the cost savings to offset the cost of new equipment and development. We designed a system that could be produced using inexpensive components and existing hardware and software to meet our needs. A commercial vendor was chosen to provide the ultrasound acquisition. The Radiology Information System interface used at the University provides the necessary data to build a DICOM header, and an existing DICOM server routes the images to the appropriate workstations, archives, and printers. Additional storage is added to an existing archive to accommodate the ultrasound images and two existing workstations are evaluated for use in ultrasound.

  9. Using Cost-Effectiveness Tests to Design CHP Incentive Programs

    Energy Technology Data Exchange (ETDEWEB)

    Tidball, Rick [ICF International, Fairfax, VA (United States)

    2014-11-01

    This paper examines the structure of cost-effectiveness tests to illustrate how they can accurately reflect the costs and benefits of CHP systems. This paper begins with a general background discussion on cost-effectiveness analysis of DER and then describes how cost-effectiveness tests can be applied to CHP. Cost-effectiveness results are then calculated and analyzed for CHP projects in five states: Arkansas, Colorado, Iowa, Maryland, and North Carolina. Based on the results obtained for these five states, this paper offers four considerations to inform regulators in the application of cost-effectiveness tests in developing CHP programs.

  10. Cost effectiveness of robotic mitral valve surgery

    Science.gov (United States)

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  11. A New Combined Boost Converter with Improved Voltage Gain as a Battery-Powered Front-End Interface for Automotive Audio Amplifiers

    Directory of Open Access Journals (Sweden)

    Ching-Ming Lai

    2017-08-01

    Full Text Available High boost DC/DC voltage conversion is always indispensable in a power electronic interface of certain battery-powered electrical equipment. However, a conventional boost converter works for a wide duty cycle for such high voltage gain, which increases power consumption and has low reliability problems. In order to solve this issue, a new battery-powered combined boost converter with an interleaved structure consisting of two phases used in automotive audio amplifier is presented. The first phase uses a conventional boost converter; the second phase employs the inverted type. With this architecture, a higher boost voltage gain is able to be achieved. A derivation of the operating principles of the converter, analyses of its topology, as well as a closed-loop control designs are performed in this study. Furthermore, simulations and experiments are also performed using input voltage of 12 V for a 120 W circuit. A reasonable duty cycle is selected to reach output voltage of 60 V, which corresponds to static voltage gain of five. The converter achieves a maximum measured conversion efficiency of 98.7% and the full load efficiency of 89.1%.

  12. Cost-effectiveness of narlaprevir in the chronic hepatitis C (genotype 1) therapy in treatment-naïve patients and relapsers

    OpenAIRE

    D. A. Gusev; A. V. Rudakova; A. N. Uskov; L. N. Konovalova; Yu. V. Lobzin

    2016-01-01

    In the treatment of chronic hepatitis C (CHC) protease inhibitors (PI) are actively used. The aim of this analysis was to evaluate the cost-effectiveness of narlaprevir and simeprevir in the CHC (genotype 1) therapy in treatment-naïve patients and relapsers.Material and methods. Analysis of the cost-effectiveness of simeprevir and narlaprevir was conducted from the perspective of the health care system based on QUEST-1, QUEST-2, ASPIRE and PIONEER clinical trials. The relative risk of achievi...

  13. A decision model for cost effective design of biomass based green energy supply chains.

    Science.gov (United States)

    Yılmaz Balaman, Şebnem; Selim, Hasan

    2015-09-01

    The core driver of this study is to deal with the design of anaerobic digestion based biomass to energy supply chains in a cost effective manner. In this concern, a decision model is developed. The model is based on fuzzy multi objective decision making in order to simultaneously optimize multiple economic objectives and tackle the inherent uncertainties in the parameters and decision makers' aspiration levels for the goals. The viability of the decision model is explored with computational experiments on a real-world biomass to energy supply chain and further analyses are performed to observe the effects of different conditions. To this aim, scenario analyses are conducted to investigate the effects of energy crop utilization and operational costs on supply chain structure and performance measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Cost-effective nursing practice: cost-awareness and empowerment.

    Science.gov (United States)

    Fisher, P

    1993-12-01

    Cost-effective nursing practice is essential to succeed today as resources allocated to health care are declining. Realizing that any change poses a threat to our security, it is imperative that stakeholders be permitted to participate in decision-making processes affecting their work. An honest, open exchange of ideas towards cost-effective practices should be encouraged. Cost-effective behaviours are influenced significantly by negative attitudes with regard to loss of human resources, increased workload, and potential pay cuts. This article describes innovative strategies which could promote successful cost-effective nursing practice, including working smarter, not working harder. Topics addressed are attitude, awareness and empowerment.

  15. BSCC Code of Practice--fine needle aspiration cytology.

    Science.gov (United States)

    Kocjan, G; Chandra, A; Cross, P; Denton, K; Giles, T; Herbert, A; Smith, P; Remedios, D; Wilson, P

    2009-10-01

    The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue (Cytopathology 2009;20:211-23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.

  16. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

    A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of…

  17. Cost-effectiveness of vaccination against herpes zoster.

    Science.gov (United States)

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.

  18. Cost-effectiveness of online positive psychology: Randomized controlled trial

    NARCIS (Netherlands)

    Bolier, Linda; Majo, Cristina; Smit, Filip; Westerhof, Gerben Johan; Haverman, Merel; Walburg, J.A.; Riper, Heleen; Bohlmeijer, Ernst Thomas

    2014-01-01

    As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a rand

  19. Research and development of a phosphoric acid fuel cell/battery power source integrated in a test-bed bus. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-30

    This project, the research and development of a phosphoric acid fuel cell/battery power source integrated into test-bed buses, began as a multi-phase U.S. Department of Energy (DOE) project in 1989. Phase I had a goal of developing two competing half-scale (25 kW) brassboard phosphoric acid fuel cell systems. An air-cooled and a liquid-cooled fuel cell system were developed and tested to verify the concept of using a fuel cell and a battery in a hybrid configuration wherein the fuel cell supplies the average power required for operating the vehicle and a battery supplies the `surge` or excess power required for acceleration and hill-climbing. Work done in Phase I determined that the liquid-cooled system offered higher efficiency.

  20. Aspiration of biological viscoelastic drops

    CERN Document Server

    Guevorkian, Karine; Durth, Mélanie; Dufour, Sylvie; Brochard-Wyart, Françoise

    2010-01-01

    Spherical cellular aggregates are in vitro systems to study the physical and biophysical properties of tissues. We present a novel approach to characterize the mechanical properties of cellular aggregates using micropipette aspiration technique. We observe an aspiration in two distinct regimes, a fast elastic deformation followed by a viscous flow. We develop a model based on this viscoelastic behavior to deduce the surface tension, viscosity, and elastic modulus. A major result is the increase of the surface tension with the applied force, interpreted as an effect of cellular mechanosensing.

  1. ASPIRE: Added-value Sensing

    DEFF Research Database (Denmark)

    Anggorojati, Bayu; Cetin, Kamil; Mihovska, Albena D.

    2010-01-01

    FP7 ICT project ASPIRE is one of the coordinated European efforts to further the advancement of this technology, in the areas of enabling technology development for RFID. The focus of ASPIRE is on the design, development and adoption of an innovative, programmable, royalty-free, lightweight...... and privacy friendly RFID middleware. Advances in active RFID integration with WSNs allow for more RFID-based applications to be developed. In order to fill the gap between the active RFID system and the existing middleware, a HAL for active reader and ALE server extension to support sensing data from active...

  2. Aspiration of Nasopore nasal packing.

    Science.gov (United States)

    Smith, Jonathan; Reddy, Ekambar

    2017-10-04

    We present a case of postoperative Nasopore aspiration in an otherwise fit and well 11-year-old. An endoscopic adenoidectomy had been performed without incident and Nasopore packing placed into each nasal cavity. Immediately after extubation, there was marked hypoxia, tachypnoea and high clinical suspicion of pack aspiration. The patient returned to theatre for emergency rigid bronchoscopy and retrieval of nasal packing. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Applying a Typology to Vocational Aspirations.

    Science.gov (United States)

    Holland, John L.; Gottfredson, Gary D.

    The psychological meaning and predictive value of a person's vocational aspirations were examined by applying Holland's typology to the vocational aspirations of high school juniors (N=1,005), college juniors (N=692), employed adults (N=140), and a second sample of college students studied over a 1 year interval (N=624). The aspirational data were…

  4. Aspirations of Latina Adolescent Suicide Attempters

    Science.gov (United States)

    Hausmann-Stabile, Carolina; Gulbas, Lauren; Zayas, Luis H.

    2013-01-01

    Parents' aspirations and expectations are communicated to their offspring. Children internalize their parents' aspirations and accept some of the expectations while rejecting others, all part of the developmental process and identity-consolidation. When the aspirations and expectations of youth and parents are incongruent, the outcomes…

  5. Cost-effectiveness of Lung Cancer Screening in Canada.

    Science.gov (United States)

    Goffin, John R; Flanagan, William M; Miller, Anthony B; Fitzgerald, Natalie R; Memon, Saima; Wolfson, Michael C; Evans, William K

    2015-09-01

    The US National Lung Screening Trial supports screening for lung cancer among smokers using low-dose computed tomographic (LDCT) scans. The cost-effectiveness of screening in a publically funded health care system remains a concern. To assess the cost-effectiveness of LDCT scan screening for lung cancer within the Canadian health care system. The Cancer Risk Management Model (CRMM) simulated individual lives within the Canadian population from 2014 to 2034, incorporating cancer risk, disease management, outcome, and cost data. Smokers and former smokers eligible for lung cancer screening (30 pack-year smoking history, ages 55-74 years, for the reference scenario) were modeled, and performance parameters were calibrated to the National Lung Screening Trial (NLST). The reference screening scenario assumes annual scans to age 75 years, 60% participation by 10 years, 70% adherence to screening, and unchanged smoking rates. The CRMM outputs are aggregated, and costs (2008 Canadian dollars) and life-years are discounted 3% annually. The incremental cost-effectiveness ratio. Compared with no screening, the reference scenario saved 51,000 quality-adjusted life-years (QALY) and had an incremental cost-effectiveness ratio of CaD $52,000/QALY. If smoking history is modeled for 20 or 40 pack-years, incremental cost-effectiveness ratios of CaD $62,000 and CaD $43,000/QALY, respectively, were generated. Changes in participation rates altered life years saved but not the incremental cost-effectiveness ratio, while the incremental cost-effectiveness ratio is sensitive to changes in adherence. An adjunct smoking cessation program improving the quit rate by 22.5% improves the incremental cost-effectiveness ratio to CaD $24,000/QALY. Lung cancer screening with LDCT appears cost-effective in the publicly funded Canadian health care system. An adjunct smoking cessation program has the potential to improve outcomes.

  6. The clinical utility and cost effectiveness of routine thyroid screening ...

    African Journals Online (AJOL)

    depression, cognitive impairment, and psychosis, while ... the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at .... Antidepressants were prescribed to 302 (28%) of patients,.

  7. Cost-effectiveness analysis of Mectizan treatment Programmes for ...

    African Journals Online (AJOL)

    Cost-effectiveness analysis of Mectizan treatment Programmes for Onchocerciasis Control: Operational Experiences in two districts of Southwestern Nigeria. ... Vol 8, No 1 (2009) >. Log in or Register to get access to full text downloads.

  8. Exploring cost-effective maize integrated weed management ...

    African Journals Online (AJOL)

    Exploring cost-effective maize integrated weed management approaches under intensive farming systems. ... Log in or Register to get access to full text downloads. ... Kamuliand Iganga districts with one hand-hoe weeding (1hh) as the control.

  9. Improving cost-effectiveness of hypertension management at a ...

    African Journals Online (AJOL)

    Improving cost-effectiveness of hypertension management at a community health centre. ... Log in or Register to get access to full text downloads. ... drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

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

    African Journals Online (AJOL)

    Costs and cost-effectiveness of alternative tuberculosis management strategies in South ... important national implications, supporting the goals of the new tuberculosis control programme. ... DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT ...

  11. Cost-effective conservation of an endangered frog under uncertainty.

    Science.gov (United States)

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

  12. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.

    Science.gov (United States)

    Dilley, Sarah E; Havrilesky, Laura J; Bakkum-Gamez, Jamie; Cohn, David E; Michael Straughn, J; Caughey, Aaron B; Rodriguez, Maria I

    2017-08-01

    Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy. Copyright © 2017. Published by

  13. Ingested and Aspirated Foreign Bodies.

    Science.gov (United States)

    Green, S Sarah

    2015-10-01

    Esophageal and aspirated foreign bodies have important clinical significance, and both should be considered carefully when the history or physical examination findings raise sufficient suspicion. The published evidence regarding the diagnosis and management of foreign body ingestion or aspiration is weighted disproportionately with observational studies, case controls, expert opinion, and systematic reviews. Most of the publications would receive a categorization of C (observational studies including case-control and cohort design) and D (expert opinion, case reports, and clinical reasoning). One of the few prospective studies examining the diagnostic evaluation of foreign body aspiration in children could be considered level B evidence (randomized clinical trials, systematic reviews, or diagnostic studies with minor limitations). This study found that the medical history is the most important predictive part of the evaluation. There is evidence for considering bronchoscopy if there is significant history suggestive of foreign body aspiration, even in the setting of normal physical examination findings. (28). Most ingested foreign bodies spontaneously pass without incident. However, special attention should be paid to objects in the esophagus as well as to batteries and magnets. Based on a systematic review of the literature (level B evidence) and the potential for rapid and life-threatening damage, batteries in the esophagus should be removed immediately. (10) Other objects, such as coins, may be observed for passage in an asymptomatic patient. In addition, given the high risk of significant complications, ingestion of high-powered magnets should be quickly and carefully evaluated. Although single magnets are likely to pass without complication, multiple magnets or magnets ingested with other metal objects can cause significant damage and should be removed if there is any concern for mural entrapment, bowel perforation, or failure to progress. (10

  14. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    Science.gov (United States)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  15. Cost-effectiveness analysis of sandhill crane habitat management

    Science.gov (United States)

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  16. Dengue dynamics and vaccine cost-effectiveness in Brazil.

    Science.gov (United States)

    Durham, David P; Ndeffo Mbah, Martial L; Medlock, Jan; Luz, Paula M; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

    2013-08-20

    Recent Phase 2b dengue vaccine trials have demonstrated the safety of the vaccine and estimated the vaccine efficacy with further trials underway. In anticipation of vaccine roll-out, cost-effectiveness analysis of potential vaccination policies that quantify the dynamics of disease transmission are fundamental to the optimal allocation of available doses. We developed a dengue transmission and vaccination model and calculated, for a range of vaccination costs and willingness-to-pay thresholds, the level of vaccination coverage necessary to sustain herd-immunity, the price at which vaccination is cost-effective and is cost-saving, and the sensitivity of our results to parameter uncertainty. We compared two vaccine efficacy scenarios, one a more optimistic scenario and another based on the recent lower-than-expected efficacy from the latest clinical trials. We found that herd-immunity may be achieved by vaccinating 82% (95% CI 58-100%) of the population at a vaccine efficacy of 70%. At this efficacy, vaccination may be cost-effective for vaccination costs up to US$ 534 (95% CI $369-1008) per vaccinated individual and cost-saving up to $204 (95% CI $39-678). At the latest clinical trial estimates of an average of 30% vaccine efficacy, vaccination may be cost-effective and cost-saving at costs of up to $237 (95% CI $159-512) and $93 (95% CI $15-368), respectively. Our model provides an assessment of the cost-effectiveness of dengue vaccination in Brazil and incorporates the effect of herd immunity into dengue vaccination cost-effectiveness. Our results demonstrate that at the relatively low vaccine efficacy from the recent Phase 2b dengue vaccine trials, age-targeted vaccination may still be cost-effective provided the total vaccination cost is sufficiently low.

  17. Comparative efficacy on supragingival plaque and gingivitis of a manual toothbrush (Colgate Plus) and a battery-powered toothbrush (Colgate Actibrush) over a 30-day period.

    Science.gov (United States)

    Sharma, N; Galustians, H J; Qaqish, J G; Rustogi, K N; Petrone, M E; Volpe, A R

    2000-01-01

    This clinical study compared the effect of Colgate Actibrush, a battery-powered toothbrush, and Colgate Plus Diamond Head, a full-head, soft-bristled manual toothbrush, on established supragingival plaque and gingivitis over a 30-day period. Sixty-two healthy adult men and women were entered in the study. The subjects were stratified into two balanced groups according to their mean baseline plaque and gingivitis scores. Each group was randomly assigned to the use of one of the two toothbrushes. Subjects were instructed to brush their teeth at home twice daily (morning and evening) for 1 minute with their assigned toothbrush and a commercially available tooth-paste for the 30-day duration of the study. Gingivitis and plaque examinations, as well as a soft-tissue evaluation, were conducted by the same dental examiner at baseline and after 15 and 30 days of toothbrush use. Plaque and gingivitis scores were reduced significantly from baseline after the use of both toothbrushes for 30 days. However, improvement in both supragingival plaque and gingivitis scores was significantly greater in the group using Colgate Actibrush. In conclusion, although both toothbrushes provided a significant plaque and gingivitis benefit when used as part of a normal oral hygiene regimen, the efficacy of the Colgate Actibrush was demonstrated to be superior to that of the Colgate Plus Toothbrush after 30 days of use.

  18. Low-cost photodynamic therapy devices for global health settings: Characterization of battery-powered LED performance and smartphone imaging in 3D tumor models

    Science.gov (United States)

    Hempstead, Joshua; Jones, Dustin P.; Ziouche, Abdelali; Cramer, Gwendolyn M.; Rizvi, Imran; Arnason, Stephen; Hasan, Tayyaba; Celli, Jonathan P.

    2015-05-01

    A lack of access to effective cancer therapeutics in resource-limited settings is implicated in global cancer health disparities between developed and developing countries. Photodynamic therapy (PDT) is a light-based treatment modality that has exhibited safety and efficacy in the clinic using wavelengths and irradiances achievable with light-emitting diodes (LEDs) operated on battery power. Here we assess low-cost enabling technology to extend the clinical benefit of PDT to regions with little or no access to electricity or medical infrastructure. We demonstrate the efficacy of a device based on a 635 nm high-output LED powered by three AA disposable alkaline batteries, to achieve strong cytotoxic response in monolayer and 3D cultures of A431 squamous carcinoma cells following photosensitization by administering aminolevulinic acid (ALA) to induce the accumulation of protoporphyrin IX (PpIX). Here we characterize challenges of battery-operated device performance, including battery drain and voltage stability specifically over relevant PDT dose parameters. Further motivated by the well-established capacity of PDT photosensitizers to serve as tumour-selective fluorescence contrast agents, we demonstrate the capability of a consumer smartphone with low-cost add-ons to measure concentration-dependent PpIX fluorescence. This study lays the groundwork for the on-going development of image-guided ALA-PDT treatment technologies for global health applications.

  19. A 1.5-to-5 V converter for a battery-powered activity-dependent intracortical microstimulation SoC.

    Science.gov (United States)

    Azin, Meysam; Mohseni, Pedram

    2012-01-01

    This paper reports on the design, analysis, implementation, and testing of a 1.5-to-5 V converter as part of a battery-powered activity-dependent intracortical microstimulation (ICMS) system-on-chip (SoC) that converts extracellular neural spikes recorded from one cortical area to electrical stimuli delivered to another cortical area in real time. The highly integrated voltage converter is intended to generate a 5-V supply for the stimulating back-end on the SoC from a miniature primary battery that powers the entire system. It is implemented in AMS 0.35 µm two-poly four-metal (2P/4M) complementary metal-oxide-semiconductor (CMOS) technology, employs only one external capacitor (1 µF) for storage, and delivers a maximum dc load current of ~88 µA with power efficiency of 31% with its output voltage adjusted to 5.05 V. This current drive capability affords simultaneous stimulation on all eight channels of the SoC with current amplitude up to ~100 µA and average stimulus rate >500 Hz, which is comfortably higher than firing rate of cortical neurons (<150 spikes per second). The measurement results also agree favorably with theoretical derivations from the analysis of converter operation.

  20. Groundwater remediation and the cost effectiveness of phytoremediation.

    Science.gov (United States)

    Compernolle, T; Van Passel, S; Weyens, N; Vangronsveld, J; Lebbe, L; Thewys, T

    2012-10-01

    In 1999, phytoremediation was applied at the site of a Belgian car factory to contain two BTEX plumes. This case study evaluates the cost effectiveness of phytoremediation compared to other remediation options, applying a tailored approach for economic evaluation. Generally, when phytoremediation is addressed as being cost effective, the cost effectiveness is only determined on an average basis. This study however, demonstrates that an incremental analysis may provide a more nuanced conclusion. When the cost effectiveness is calculated on an average basis, in this particular case, the no containment strategy (natural attenuation) has the lowest cost per unit mass removed and hence, should be preferred. However, when the cost effectiveness is determined incrementally, no containment should only be preferred if the value of removing an extra gram of contaminant mass is lower than 320 euros. Otherwise, a permeable reactive barrier should be adopted. A similar analysis is provided for the effect determined on the basis of remediation time. Phytoremediation is preferred compared to 'no containment' if reaching the objective one year earlier is worth 7 000 euros.

  1. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of 'value', which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. © 2015 The Authors. Chemical Biology & Drug Design Published by John Wiley & Sons Ltd.

  2. Cost effectiveness of type 2 diabetes screening: A systematic review.

    Science.gov (United States)

    Najafi, Behzad; Farzadfar, Farshad; Ghaderi, Hossein; Hadian, Mohammad

    2016-01-01

    Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically. We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond's checklist for appraising the quality of studies. The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies. A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening.

  3. An Aspirational Community Theory of the Firm

    DEFF Research Database (Denmark)

    Li, Xin

    contractual labor and aspirational labor, the former being defined as services provided by a laborer in fulfillment of a contract while the latter as services provided by a laborer in pursuit of an aspiration; and argue that firms exist because while the market may be effective and efficient for allocating...... propose an aspirational community theory of the firm (ACT) as a candidate theory by conceptualizing the firm as an aspirational community, the core of which is a group of like-minded people sharing similar or same aspiration/vision. To explain the existence of the firm, we make a distinction between...... contractual labor it is less effective and efficient than the firms for allocating aspirational labor....

  4. Tracheobronchial Foreign Body Aspiration: Dental Prosthesis

    Directory of Open Access Journals (Sweden)

    Ataman Köse

    2014-01-01

    Full Text Available It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.

  5. Endometrial aspiration cytology in gynecological disorders

    OpenAIRE

    Jadhav, Meenal V.; Anjali S Phatke; Nalini Vinayak Kadgi; Sharda R Rane; Kulkarni, Kalpana K.

    2016-01-01

    Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histo...

  6. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

    Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

    2016-01-01

    . Objective: To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants: This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness...... of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age....... Interventions: Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures: Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results: Standard management yielded 9.6 QALYs...

  7. A Layered Decision Model for Cost-Effective System Security

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

  8. Bayesian cost-effectiveness analysis with the R package BCEA

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

    The book provides a description of the process of health economic evaluation and modelling for cost-effectiveness analysis, particularly from the perspective of a Bayesian statistical approach. Some relevant theory and introductory concepts are presented using practical examples and two running case studies. The book also describes in detail how to perform health economic evaluations using the R package BCEA (Bayesian Cost-Effectiveness Analysis). BCEA can be used to post-process the results of a Bayesian cost-effectiveness model and perform advanced analyses producing standardised and highly customisable outputs. It presents all the features of the package, including its many functions and their practical application, as well as its user-friendly web interface. The book is a valuable resource for statisticians and practitioners working in the field of health economics wanting to simplify and standardise their workflow, for example in the preparation of dossiers in support of marketing authorisation, or acade...

  9. Cost effectiveness and efficiency in assistive technology service delivery.

    Science.gov (United States)

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  10. Thrombus aspiration catheter is a Dottering balloon.

    Science.gov (United States)

    Sheshagiri Rao, D; Barik, Ramachandra; Prasad, Akula Siva

    2016-01-01

    Coronary angiogram in a young man with history of STEMI with delayed presentation revealed subtotal occlusion of left anterior descending artery (LAD) with large thrombotic filling defect distal to the critical lesion. PCI was preferred without delay because of ongoing chest pain. Several runs of thrombus aspiration failed to detect any visible thrombus. However, the immediate angiogram after thrombus aspiration showed complete distal embolization of the thrombus which could have been achieved by Dottering or balloon dilatation. In contrary to the general perception, does thrombus aspiration push more thrombus than it can aspirate?

  11. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

    Full Text Available The need for more cost-effective and pedagogically acceptable combinations of teaching and learning methods to sustain increasing student numbers means that the use of innovative methods, using technology, is accelerating. There is an expectation that economies of scale might provide greater cost-effectiveness whilst also enhancing student learning. The difficulties and complexities of these expectations are considered in this paper, which explores the challenges faced by those wishing to evaluate the costeffectiveness of computer-based assessment (CBA. The paper outlines the outcomes of a survey which attempted to gather information about the costs and benefits of CBA.

  12. Cost Effectiveness Analysis of Optimal Malaria Control Strategies in Kenya

    Directory of Open Access Journals (Sweden)

    Gabriel Otieno

    2016-03-01

    Full Text Available Malaria remains a leading cause of mortality and morbidity among the children under five and pregnant women in sub-Saharan Africa, but it is preventable and controllable provided current recommended interventions are properly implemented. Better utilization of malaria intervention strategies will ensure the gain for the value for money and producing health improvements in the most cost effective way. The purpose of the value for money drive is to develop a better understanding (and better articulation of costs and results so that more informed, evidence-based choices could be made. Cost effectiveness analysis is carried out to inform decision makers on how to determine where to allocate resources for malaria interventions. This study carries out cost effective analysis of one or all possible combinations of the optimal malaria control strategies (Insecticide Treated Bednets—ITNs, Treatment, Indoor Residual Spray—IRS and Intermittent Preventive Treatment for Pregnant Women—IPTp for the four different transmission settings in order to assess the extent to which the intervention strategies are beneficial and cost effective. For the four different transmission settings in Kenya the optimal solution for the 15 strategies and their associated effectiveness are computed. Cost-effective analysis using Incremental Cost Effectiveness Ratio (ICER was done after ranking the strategies in order of the increasing effectiveness (total infections averted. The findings shows that for the endemic regions the combination of ITNs, IRS, and IPTp was the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment and IRS; for seasonal areas is the use of ITNs plus treatment; and for the low risk areas is the use of treatment only. Malaria transmission in Kenya can be minimized through tailor-made intervention strategies for malaria control

  13. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... and privacy challenges that emerge when designing a system architecture and infrastructure. The resulting architecture is a consumer-centric and agent-based design and uses open Internet-based communication protocols for enabling interoperability while being cost-effective. Finally, the PhD report present...

  14. The role of aspiration in corporate fiduciary duties

    National Research Council Canada - National Science Library

    Velasco, Julian

    2012-01-01

    ... duty standards of conduct are aspirational and unenforceable. This theory, which I will call the "aspirational view," is misguided. The use of the term "aspirational" is especially problematic. Whatever else "aspirational" may mean, it does not mean obligatory or mandatory. Whether by design or only by effect, the aspirational view has the ...

  15. Cost-Effectiveness Analysis of Family Planning Services Offered by ...

    African Journals Online (AJOL)

    USER

    Keywords: Mobile clinics; Staic clinic; Family planning; Cost-effectiveness. Résumé ... revealed surprisingly low use of mobile clinic services ... provider point of view. Cost data ..... this is an even more attractive strategy than tying free IUDs to ...

  16. Cost-effectiveness of hepatitis a vaccination in indonesia

    NARCIS (Netherlands)

    Suwantika, A.A.; Beutels, P.; Postma, M.J.

    2014-01-01

    Objectives: This study aims to assess the cost-effectiveness of hepatitis A vaccination in Indonesia, including an explicit comparison between one-dose and twodose vaccines. Methods: An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the

  17. Cost-effectiveness of hepatitis A vaccination in Indonesia

    NARCIS (Netherlands)

    Suwantika, Auliya A.; Beutels, Philippe; Postma, Maarten J.

    2014-01-01

    Objective: This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. Methods: An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the

  18. Cost-effectiveness of varenicline for smoking cessation

    DEFF Research Database (Denmark)

    Keiding, Hans

    2009-01-01

    Smoking cessation therapies are among the most cost-effective preventive healthcare measures. Varenicline is a relatively new drug developed especially for this purpose, and it has been shown to achieve better quit rates than nicotine replacement therapies and the non-nicotine-based drug, bupropion...

  19. The Cost Effectiveness of Hepatitis Immunization for US College Students

    Science.gov (United States)

    Jacobs, R. Jake; Saab, Sammy; Meyerhoff, Allen S.

    2003-01-01

    Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to…

  20. Cost-effectiveness of private umbilical cord blood banking.

    Science.gov (United States)

    Kaimal, Anjali J; Smith, Catherine C; Laros, Russell K; Caughey, Aaron B; Cheng, Yvonne W

    2009-10-01

    To investigate the cost-effectiveness of private umbilical cord blood banking. A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.04% chance of requiring an autologous stem cell transplant, a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and a 50% reduction in risk of graft-versus-host disease if a sibling uses banked umbilical cord blood. Private cord blood banking is not cost-effective because it cost an additional $1,374,246 per life-year gained. In sensitivity analysis, if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than 1 in 110, private umbilical cord blood banking becomes cost-effective. Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant. Patients considering private blood banking should be informed of the remote likelihood that a unit will be used for a child or another family member. III.

  1. Methods for analyzing cost effectiveness data from cluster randomized trials

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2007-09-01

    Full Text Available Abstract Background Measurement of individuals' costs and outcomes in randomized trials allows uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomizing clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. Methods We used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1 joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2 joint modeling of costs and effects with Bayesian hierarchical models and 3 linear regression of net benefits at different willingness to pay levels using a least squares regression with Huber-White robust adjustment of errors, b a least squares hierarchical model and c a Bayesian hierarchical model. Results All five methods produced similar results, with greater uncertainty than if cluster randomization was not accounted for. Conclusion Cost effectiveness analyses alongside cluster randomized trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.

  2. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  3. The Cost-Effectiveness of Atypicals in the UK

    NARCIS (Netherlands)

    Heeg, Bart; Buskens, Erik; Botteman, Marc; Caleo, Sue; Ingham, Mike; Damen, Joep; de Charro, Frank; van Hout, Ben

    2008-01-01

    Background: In 2002, the National Institute for Health and Clinical Excellence (NICE), recommended atypical antipsychotics over conventional ones for first-line schizophrenia treatment, based on their lower risk of extrapyramidal symptoms. Objective: To estimate the incremental cost-effectiveness of

  4. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  5. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Lawson, Lartey Godwin; Lund, Mogens

    2015-01-01

    stage are considered. Cost analyses are conducted for different risk reduction targets and for three alternative scenarios concerning the acceptable range of interventions. Results demonstrate that using a system-wide policy approach to risk reduction can be more cost-effective than a policy focusing...

  6. Cost-effectiveness of colorectal cancer screening - An overview

    NARCIS (Netherlands)

    I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)

    2010-01-01

    textabstractThere are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysi

  7. Is population screening for abdominal aortic aneurysm cost-effective?

    Directory of Open Access Journals (Sweden)

    Jensen Lotte

    2008-11-01

    Full Text Available Abstract Background Ruptured abdominal aortic aneurysm (AAA is responsible for 1–2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA. Methods We performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU. All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care. Results The search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions. Conclusion Further analyses of cost-effectiveness of AAA screening are recommended.

  8. Cost-effectiveness modelling in diagnostic imaging: a stepwise approach

    NARCIS (Netherlands)

    Sailer, A.M.; Zwam, W.H. van; Wildberger, J.E.; Grutters, J.P.C.

    2015-01-01

    Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this ar

  9. Cost-Effective School Alarm Systems. Security Topics Series.

    Science.gov (United States)

    Kaufer, Steve

    This document outlines considerations in the selection of a cost-effective school-alarm system. Steps in the planning process include: conducting a district needs assessment; gathering input from all staff levels; consulting technical expertise; and selecting a security system that can be integrated with other site needs. It further describes the…

  10. Cost-effectiveness of periconceptional supplementation of folic acid

    NARCIS (Netherlands)

    Postma, MJ; Londeman, J; Veenstra, M; de Walle, HEK; de Jong-van den Berg, LTW

    2002-01-01

    Background: Supplementation of folic acid prior to and in the beginning of pregnancy may prevent neural tube defects (NTDs) in newborns - such as spina bifida - and possibly other congenital malformations. Objective. To estimate cost effectiveness of periconceptional supplementation of folk: acid us

  11. Cost-effective utilisation of basic biochemical laboratory ...

    African Journals Online (AJOL)

    Cost-effective use of laboratory investigations is vital in primary care. Tahir Pillay, MB ChB, ... He is passionate about strengthening the role of the generalist in healthcare in South Africa. Correspondence to: .... Laboratories can bill for this extra ...

  12. Cost-Effectiveness Affirmative Reading Skills Program, 1984-85.

    Science.gov (United States)

    Gallagher, Michael P.

    The 1984-85 cost-effects study represents the third annual analysis of the components of Cleveland's Affirmative Reading Skills Plan, which offers three instructional strands--developmental (regular reading/language arts), support (additional enrichment, corrective or remedial), and compensatory (instruction for students having reading scores in…

  13. Priority Setting, Cost-Effectiveness, and the Affordable Care Act.

    Science.gov (United States)

    Persad, Govind

    2015-01-01

    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  14. Cost Effectiveness of Current Awareness Sources in the Pharmaceutical Industry

    Science.gov (United States)

    Ashmole, R. F.; And Others

    1973-01-01

    The cost effectiveness of several commercial data bases, journal scanning by information scientists, and the impact of private communication are compared in this study. A previously developed technique for measuring the usefulness of commercial data bases is utilized. (21 references) (Author/KE)

  15. Final report: Compiled MPI. Cost-Effective Exascale Application Development

    Energy Technology Data Exchange (ETDEWEB)

    Gropp, William Douglas [Univ. of Illinois, Urbana-Champaign, IL (United States)

    2015-12-21

    This is the final report on Compiled MPI: Cost-Effective Exascale Application Development, and summarizes the results under this project. The project investigated runtime enviroments that improve the performance of MPI (Message-Passing Interface) programs; work at Illinois in the last period of this project looked at optimizing data access optimizations expressed with MPI datatypes.

  16. [Cost-effectiveness analysis of professional oral hygiene].

    Science.gov (United States)

    Olesov, E E; Shaĭmieva, N I; Kononenko, V I; Bersanov, R U; Monakova, N E

    2014-01-01

    Periodontal status and oral hygiene indexes were studied in 125 young employee of Kurchatov Institute. Oral hygiene values dynamic was assessed after professional oral hygiene in persons with unsatisfactory oral hygiene at baseline examination. When compared with the same values in the absence of professional oral hygiene procedures the results allowed calculating cost-effectiveness rate for biannual professional oral hygiene.

  17. Cost-effectiveness of PET and PET/Computed Tomography

    DEFF Research Database (Denmark)

    Gerke, Oke; Hermansson, Ronnie; Hess, Søren

    2015-01-01

    measure by means of incremental cost-effectiveness ratios when considering the replacement of the standard regimen by a new diagnostic procedure. This article discusses economic assessments of PET and PET/computed tomography reported until mid-July 2014. Forty-seven studies on cancer and noncancer...

  18. Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

    Directory of Open Access Journals (Sweden)

    Doug Coyle

    2012-01-01

    Full Text Available INTRODUCTION: Rotavirus is the main cause of gastroenteritis in Canadian children younger than five years of age, resulting in significant morbidity and cost. The present study provides evidence on the cost effectiveness of two alternative rotavirus vaccinations (RotaTeq [Merck Frosst Canada Ltd, Canada] and Rotarix [GlaxoSmithKline, Canada] available in Canada.

  19. Hepatocellular carcinoma: cost-effectiveness of screening. A systematic review

    Directory of Open Access Journals (Sweden)

    Ruggeri M

    2012-06-01

    Full Text Available Matteo RuggeriFacoltà di Economia, Università Cattolica del Sacro Cuore – sede di Roma, Rome, ItalyAbstract: Hepatocellular carcinoma (HCC is one of the most common tumors worldwide. HCC is a potential target for cancer surveillance (or screening as it occurs in well-defined, at-risk populations. Curative therapy is possible only for small tumors and screening strategy has been recommended by the US, Italian, and other international liver societies and is practiced widely, but its benefits are not clearly established. The objective of this study was to review the available evidence with respect to the cost-effectiveness of key technologies in the prevention HCC. The literature search was conducted with the support of PubMed. Firstly we selected articles by reading the abstracts. Secondly, we read the articles and the revision was further restricted, with the following as inclusion criteria: (1 full economic evaluation of HCC screening programs; (2 comparison between HCC techniques; (3 outcome measures expressed in terms of quality adjusted life years (QALY; (4 full text availability. The initial review of the literature yielded 346 articles. Of those, 288 were excluded at the first stage. Of those excluded, 108 did not meet the target, 106 did not present the cost analysis, 33 did not analyze the treatment of the disease, and in 41 the abstract was not available. Of the 58 included in the first step, seven examined the cost-effectiveness of different HCC screening techniques, seven investigated the cost-effectiveness of HCC screening versus no screening, and one looked at the cost-effectiveness of timing for HCC surveillance and monitoring, while 43 were about HBV vaccination and screening. We included only the seven articles examining the cost-effectiveness of different HCC screening techniques. In general, incidence is the key parameter which determines the cost-effectiveness of HCC screening. Discrepancies in the results exist when

  20. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

    Full Text Available Abstract Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention. Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates

  1. A multi-port power electronics interface for battery powered electric vehicles: Application of inductively coupled wireless power transfer and hybrid energy storage system

    Science.gov (United States)

    McDonough, Matthew Kelly

    Climate change, pollution, and geopolitical conflicts arising from the extreme wealth concentrations caused by fossil fuel deposits are just a few of the side-effects of the way that we fuel our society. A new method to power our civilization is becoming more and more necessary. Research for new, more sustainable fuel sources is already underway due to research in wind, solar, geothermal, and hydro power. However this focus is mainly on stationary applications. A large portion of fossil fuel usage comes from transportation. Unfortunately, the transition to cleaner transportation fuels is being stunted by the inability to store adequate amounts of energy in electro-chemical batteries. The idea of charging while driving has been proposed by many researchers, however several challenges still exist. In this work some of these challenges are addressed. Specifically, the ability to route power from multiple sources/loads is investigated. Special attention is paid to adjusting the time constant of particular converters, namely the battery and ultra-capacitor converters to reduce the high frequency and high magnitude current components applied to the battery terminals. This is done by developing a closed loop model of the entire multi-port converter, including the state of charge of the ultra-capacitors. The development of closed loop models and two experimental testbeds for use as stationary vehicle charging platforms with their unique set of sources/loads are presented along-side an on-board charger to demonstrate the similarities and differences between stationary charging and mobile charging. Experimental results from each are given showing that it is not only possible, but feasible to utilize Inductively Coupled Wireless Power Transfer (ICWPT) to charge a battery powered electric vehicle while driving and still protect the life-span of the batteries under the new, harsher conditions generated by the ICWPT system.

  2. Fine needle aspiration cytology of rectal masses.

    Science.gov (United States)

    Kochhar, R; Rajwanshi, A; Wig, J D; Gupta, N M; Kesiezie, V; Bhasin, D K; Malik, A K; Gupta, S K; Mehta, S K

    1990-01-01

    This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure. Images Figure 1 Figure 2 Figure 3 PMID:2323600

  3. Endometrial aspiration cytology in gynecological disorders

    Directory of Open Access Journals (Sweden)

    Meenal V Jadhav

    2016-01-01

    Full Text Available Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histology. Endometrial aspiration was performed by infant feeding tube in 10 cases and intra cath cannula in 45 cases. The slides were stained with rapid Papanicolaou (PAP stain and Leishman stain. Results: Endometrial aspiration cytology showed 90% and 94.6% sampling adequacy with infant feeding tube and intra cath cannula, respectively. Intra cath cannula was very convenient to handle and superior to infant feeding tube in aspirating the endometrium. Of the two stains used, rapid PAP stain was less time-consuming and superior to Leishman stain in studying the nuclear details. Leishman stain was helpful in detecting cytoplasmic vacuoles of secretory endometrium. Overall diagnostic accuracy of endometrial cytology was 90.4% while that for morphological hormonal evaluation was 97.6%. It enjoyed a sensitivity of 91.66%, a specificity of 88.23%, positive predictive value of 94.28%, and negative predictive value of 83.33%. Conclusion: Intra cath cannula emerged as an inexpensive, effective, and convenient device for endometrial aspiration. Endometrial aspiration proved to be a fairly effective, simple, and informative diagnostic modality.

  4. Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid

    Science.gov (United States)

    ... Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid An ultrasound-guided thyroid biopsy uses sound waves ... Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid? During a fine needle aspiration biopsy of the ...

  5. Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid ... Needle Aspiration Biopsy of the Thyroid? What is Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid? ...

  6. Vacuum aspiration for induced abortion could be safely and legally performed by nurses and midwives.

    Science.gov (United States)

    Sheldon, Sally; Fletcher, Joanne

    2017-01-18

    Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors. This study aimed to provide a detailed reassessment of the relevant law and the clinical evidence that supports this assumption. A close reading of relevant law reveals that this assumption is unfounded. On the contrary, it would be lawful for appropriately trained nurses or midwives, acting as part of a multidisciplinary team, to carry out vacuum aspiration procedures. This interpretation of the law offers the potential for developing more streamlined, cost-effective abortion services, which would be both safe and highly acceptable to patients. 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/.

  7. Cost-effectiveness of automated external defibrillators on airlines.

    Science.gov (United States)

    Groeneveld, P W; Kwong, J L; Liu, Y; Rodriguez, A J; Jones, M P; Sanders, G D; Garber, A M

    2001-09-26

    Installation of automated external defibrillators (AEDs) on passenger aircraft has been shown to improve survival of cardiac arrest in that setting, but the cost-effectiveness of such measures has not been proven. To examine the costs and effectiveness of several different options for AED deployment in the US commercial air transportation system. Decision and cost-effectiveness analysis of a strategy of full deployment on all aircraft as well as several strategies of partial deployment only on larger aircraft, compared with a baseline strategy of no AEDs on aircraft (but training flight attendants in basic life support) for a hypothetical cohort of persons experiencing cardiac arrest aboard US commercial aircraft. Estimates for costs and outcomes were obtained from the medical literature, the Federal Aviation Administration, the Air Transport Association of America, a population-based cohort of Medicare patients, AED manufacturers, and the Bureau of Labor Statistics. Quality-adjusted survival after cardiac arrest; costs of AED deployment on aircraft and of medical care for cardiac arrest survivors. Adding AEDs on passenger aircraft with more than 200 passengers would cost $35 300 per quality-adjusted life-year (QALY) gained. Additional AEDs on aircraft with capacities between 100 and 200 persons would cost an additional $40 800 per added QALY compared with deployment on large-capacity aircraft only, and full deployment on all passenger aircraft would cost an additional $94 700 per QALY gained compared with limited deployment on aircraft with capacity greater than 100. Sensitivity analyses indicated that the quality of life, annual mortality rate, and the effectiveness of AEDs in improving survival were the most influential factors in the model. In 85% of Monte Carlo simulations, AED placement on large-capacity aircraft produced cost-effectiveness ratios of less than $50 000 per QALY. The cost-effectiveness of placing AEDs on commercial aircraft compares favorably

  8. Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity.

    Science.gov (United States)

    Klebanoff, Matthew J; Chhatwal, Jagpreet; Nudel, Jacob D; Corey, Kathleen E; Kaplan, Lee M; Hur, Chin

    2017-02-01

    Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited. To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study. A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed. Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses. Bariatric surgery incurs

  9. Scalp Melanoma Diagnosed by Fine Needle Aspiration Cytology in a Tertiary Health Center

    Directory of Open Access Journals (Sweden)

    A. B. Zarami

    2015-01-01

    Full Text Available Melanoma is one of the most aggressive malignant skin neoplasms worldwide with more than 20% of world melanoma seen in black Africa and Asia. Late presentation due to ignorance, poverty, and lack of adequate health facility in Nigeria is always the norms. We present this case report because of precision in diagnosis, using fine needle aspiration cytology (FNAC to reemphasize that the technique is cheap, cost effective, and quick that can reduce the burden of incisional biopsy before definitive surgery and improve early detection of the disease especially in developing countries.

  10. The Basic Science of Bone Marrow Aspirate Concentrate in Chondral Injuries

    Science.gov (United States)

    Holton, James; Imam, Mohamed; Ward, Jonathan; Snow, Martyn

    2016-01-01

    There has been great interest in bone marrow aspirate concentrate (BMAC) as a cost effective method in delivering mesenchymal stem cells (MSCs) to aid in the repair and regeneration of cartilage defects. Alongside MSCs, BMAC contains a range of growth factors and cytokines to support cell growth following injury. However, there is paucity of information relating to the basic science underlying BMAC and its exact biological role in supporting the growth and regeneration of chondrocytes. The focus of this review is the basic science underlying BMAC in relation to chondral damage and regeneration.

  11. Battery powered BION FES network.

    Science.gov (United States)

    Schulman, J H; Mobley, J P; Wolfe, J; Regev, E; Perron, C Y; Ananth, R; Matei, E; Glukhovsky, A; Davis, R

    2004-01-01

    The Alfred Mann Foundation is completing development of a coordinated network of BION microstimulator/sensor (hereinafter implant) that has broad stimulating, sensing and communication capabilities. The network consists of a master control unit (MCU) in communication with a group of BION implants. Each implant is powered by a custom lithium-ion rechargeable 10 mW-hr battery. The charging, discharging, safety, stimulating, sensing, and communication circuits are designed to be highly efficient to minimize energy use and maximize battery life and time between charges. The stimulator can be programmed to deliver pulses in any value in the following range: 5 microA to 20 mA in 3.3% constant current steps, 7 micros to 2000 micros in 7 micros pulse width steps, and 1 to 4000 Hz in frequency. The preamp voltage sensor covers the range 10 microV to 1.0 V with bandpass filtering and several forms of data analysis. The implant also contains sensors that can read out pressure, temperature, DC magnetic field, and distance (via a low frequency magnetic field) up to 20 cm between any two BION implants. The MCU contains a microprocessor, user interface, two-way communication system, and a rechargeable battery. The MCU can command and interrogate in excess of 800 BlON implants every 10 ms, i.e., 100 times a second.

  12. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt

    2017-01-01

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring....... Telemonitoring consisted of two tele-consultations in the patient's own home and one consultation at the outpatient clinic; standard monitoring consisted of three outpatient clinic consultations. Total healthcare costs were estimated over a 6-month period at individual patient level, from a healthcare sector...... perspective. The bootstrap method was used to calculate the incremental cost-effectiveness ratio, and one-way sensitivity analyses were performed. Telemonitoring costs were found to be €2039 less per patient compared to standard monitoring; however, this difference was not statistically significant...

  13. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients.

    Science.gov (United States)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt; Yderstræde, Knud Bonnet; Kidholm, Kristian; Pedersen, Kjeld Møller

    2016-09-16

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring. Telemonitoring consisted of two tele-consultations in the patient's own home and one consultation at the outpatient clinic; standard monitoring consisted of three outpatient clinic consultations. Total healthcare costs were estimated over a 6-month period at individual patient level, from a healthcare sector perspective. The bootstrap method was used to calculate the incremental cost-effectiveness ratio, and one-way sensitivity analyses were performed. Telemonitoring costs were found to be €2039 less per patient compared to standard monitoring; however, this difference was not statistically significant. Amputation rate was similar in the two groups. In conclusion, a telemonitoring service in this form had similar costs and effects as standard monitoring. © The Author(s) 2016.

  14. [Cost-effectiveness of breast cancer screening policies in Mexico].

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Sánchez-González, Gilberto; Bautista-Arredondo, Sergio; Torres-Mejía, Gabriela; Bertozzi, Stefano M

    2009-01-01

    Generate cost-effectiveness information to allow policy makers optimize breast cancer (BC) policy in Mexico. We constructed a Markov model that incorporates four interrelated processes of the disease: the natural history; detection using mammography; treatment; and other competing-causes mortality, according to which 13 different strategies were modeled. Strategies (starting age, % of coverage, frequency in years)= (48, 25, 2), (40, 50, 2) and (40, 50, 1) constituted the optimal method for expanding the BC program, yielding 75.3, 116.4 and 171.1 thousand pesos per life-year saved, respectively. The strategies included in the optimal method for expanding the program produce a cost per life-year saved of less than two times the GNP per capita and hence are cost-effective according to WHO Commission on Macroeconomics and Health criteria.

  15. An fMRI study on sunk cost effect.

    Science.gov (United States)

    Zeng, Jianmin; Zhang, Qinglin; Chen, Changming; Yu, Rongjun; Gong, Qiyong

    2013-06-26

    Sunk cost effect (also called escalation of commitment, etc) is a pervasive, interesting and famous decision bias, which has been intensively discussed in psychology, economics, management, political science, zoology, etc. To date, little has been known about the neural basis of this phenomenon. We investigated it by using functional magnetic resonance imaging (fMRI) to monitor healthy subjects' brain activities when they made decisions in a task wherein sunk cost and incremental cost were systematically manipulated. Higher sunk cost only increased activity of some brain areas (mainly lateral frontal and parietal cortices, which are involved in risk-taking), whereas lower incremental cost mainly increased activity of some brain areas (including striatum and medial prefrontal cortex, which are sensitive to rewards). No overlapping brain areas were found to respond to both sunk cost and incremental cost. These results favor certainty effect over self-justification or diminishing sensitivity as account of sunk cost effect.

  16. Cost-effectiveness analysis in Chagas' disease vectors control interventions

    Directory of Open Access Journals (Sweden)

    A. M. Oliveira Filho

    1989-01-01

    Full Text Available After a large scale field trial performed in central Brazil envisaging the control of Chagas' disease vectors in an endemic area colonized by Triatoma infestans and T. sordida the cost-effectiveness analysis for each insecticide/formulation was performed. It considered the operational costs and the prices of insecticides and formulations, related to the activity and persistence of each one. The end point was considered to be less than 90% of domicilliary unitis (house + annexes free of infestation. The results showed good cost-effectiveness for a slow-release emulsifiable suspension (SRES based on PVA and containing malathion as active ingredient, as well as for the pyrethroids tested in this assay-cyfluthrin, cypermethrin, deltamethrin and permethrin.

  17. Power and sample size in cost-effectiveness analysis.

    Science.gov (United States)

    Laska, E M; Meisner, M; Siegel, C

    1999-01-01

    For resource allocation under a constrained budget, optimal decision rules for mutually exclusive programs require that the treatment with the highest incremental cost-effectiveness ratio (ICER) below a willingness-to-pay (WTP) criterion be funded. This is equivalent to determining the treatment with the smallest net health cost. The designer of a cost-effectiveness study needs to select a sample size so that the power to reject the null hypothesis, the equality of the net health costs of two treatments, is high. A recently published formula derived under normal distribution theory overstates sample-size requirements. Using net health costs, the authors present simple methods for power analysis based on conventional normal and on nonparametric statistical theory.

  18. Cost-effectiveness of Voriconasole in treatment of invasive aspregillosis

    Directory of Open Access Journals (Sweden)

    N. N. Climko

    2009-01-01

    Full Text Available Invasive aspergillosis (IA is widespread infectious implication in immunodeficient patients, characterized by severe clinical manifestations and high mortality. This article presents the first case of pharmacoeconomical analysis of Voriconasole in treatment of IA compared with alternative therapies in Russia. Using mathematic modeling methods, we evalued total costs (including costs of IA treatment, clinical effectiveness and IA-related mortality in each therapy group. Obtained results showed the dominating of Voriconasole because of its high effectiveness and lower costs compared with caspofungine or amphotericine B. Total costs of therapy with Voricinasole were up to 30% lower compared with caspofungine and up to 70% lower compared with amphotericine B. Performed univariate sensitivity analysis showed that cost-effectiveness of anti-IA treatment depends mostly on clinical effectiveness of antimycotics rather than drug costs. Thus, treatment with Voriconasole is cost-effective in IA patients.

  19. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

  20. Methodological considerations in the analysis of cost effectiveness in dentistry.

    Science.gov (United States)

    Antczak-Bouckoms, A A; Tulloch, J F; White, B A; Capilouto, E I

    1989-01-01

    Cost-effectiveness analysis is a technique applied with increasing frequency to help make rational decisions in health care resource allocation. This article reviews the ten general principles of cost-effectiveness analysis outlined by the Office of Technology Assessment of the US Congress and describes a model for such analyses used widely in medicine, but only recently applied in dentistry. The imperative for the formulation of the best current information on both the effectiveness of dental practices and their costs is made more urgent because of the now universally recognized belief that resources available to meet the demands for health care are limited. Today's environment requires critical allocation decisions within categorical health problems, across diseases, or relative to other health problems. If important health benefits or cost savings are to be realized, then these analytic approaches must become widely understood, accepted, and appropriately applied by key decision makers in the dental health sector.

  1. Selecting cost-effective areas for restoration of ecosystem services.

    Science.gov (United States)

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services.

  2. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

    Background Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. Methods Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplem...

  3. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

    Background: Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. Methods: Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc suppl...

  4. Cost-effectiveness of early treatment for retinopathy of prematurity.

    Science.gov (United States)

    Kamholz, Karen L; Cole, Cynthia H; Gray, James E; Zupancic, John A F

    2009-01-01

    The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments. To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management. We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses. The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving. Early treatment of retinopathy of prematurity is both

  5. Modified Transverse Thoracosternotomy and Cost-Effective Reinforced Sternal Closure.

    Science.gov (United States)

    Costa, Joseph; Sonett, Joshua R; D'Ovidio, Frank

    2015-12-01

    The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method.

  6. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

    Science.gov (United States)

    Broide, Efrat; Matalon, Shay; Kriger-Sharabi, Ofra; Richter, Vered; Shirin, Haim; Leshno, Moshe

    2016-01-01

    AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results. METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed. RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status. PMID:27678365

  7. Cost-effectiveness of the Norwegian breast cancer screening program.

    Science.gov (United States)

    van Luijt, P A; Heijnsdijk, E A M; de Koning, H J

    2017-02-15

    The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained. © 2016 UICC.

  8. Assessing cost-effectiveness in the management of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Ceri J Phillips

    2009-11-01

    Full Text Available Ceri J Phillips, Ioan HumphreysInstitute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UKAbstract: Multiple sclerosis (MS is one of the most common causes of neurological disability in young and middle-aged adults, with current prevalence rates estimated to be 30 per 100,000 populations. Women are approximately twice as susceptible as males, but males are more likely to have progressive disease. The onset of the disease normally occurs between 20 and 40 years of age, with a peak incidence during the late twenties and early thirties, resulting in many years of disability for a large proportion of patients, many of whom require wheelchairs and some nursing home or hospital care. The aim of this study is to update a previous review which considered the cost-effectiveness of disease-modifying drugs (DMDs, such as interferons and glatiramer acetate, with more up to date therapies, such as mitaxantrone hydrochloride and natalizumab in the treatment of MS. The development and availability of new agents has been accompanied byan increased optimism that treatment regimens for MS would be more effective; that the number, severity and duration of relapses would diminish; that disease progression would be delayed; and that disability accumulation would be reduced. However, doubts have been expressed about the effectiveness of these treatments, which has only served to compound the problems associated with endeavors to estimate the relative cost-effectiveness of such interventions.Keywords: multiple sclerosis, disease management, immunomodulatory drugs, cost-effectiveness, cost-effectiveness analysis, cost-utility analysis

  9. Cost Effective Evaluation of Companies’ Storytelling on the Web

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

    In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies’ self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts, initiate the customers’ imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies’ self-presentation as future work places for stude...

  10. Cost Effective Evaluation of Companies’ Storytelling on the Web

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

    Abstract: In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies’ self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts, initiate the customers’ imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies’ self-presentation as future work places...

  11. Cost-effectiveness of asthma therapy: a comprehensive review.

    Science.gov (United States)

    Domínguez-Ortega, Javier; Phillips-Anglés, Elsa; Barranco, Pilar; Quirce, Santiago

    2015-01-01

    Asthma has an important impact in terms of both direct and indirect costs. In Europe, the disease costs € 19 000 million a year. Moreover, the cost is greater among patients with severe uncontrolled asthma and is even higher when the work productivity is also taken into account. Improved control of the disease results in cost savings. In this context, cost-effectiveness and cost-utility studies offer important information for clinicians in deciding the best treatment options for asthmatic patients and contribute to ensure an efficient use of the available healthcare resources. An English and Spanish literature search using electronic search engines (PubMed and EMBASE) was conducted in peer-review journals, from 2009 to June 2014. In order to perform the search for the most suitable and representative articles, key words were selected ("asthma", "cost-effectiveness", "cost-utility", "QALY", "cost-benefit", "economic impact of asthma" "healthcare cost", "asthma treatment" and "work productivity with asthma"). Two-hundred forty-three titles and abstracts were identified by the primary literature search. The full text of the potentially 76 eligible papers was reviewed, and 22 articles were qualified to be finally included. This article provides a comprehensive review on the evidence of cost-effectiveness of asthma treatments derived from the published literature and offers an overall summary of the socioeconomic burden of asthma and its relationship with the degree of disease control. Management alternatives, such as the use of combination therapy with ICS/LABA or omalizumab, when administered according to their current therapeutic indications, have been shown to be cost-effective.

  12. Cost-effective wearable sensor to detect EMF

    OpenAIRE

    Paradiso, Joseph A.; Vaucelle, Catherine Nicole; Ishii, Hiroshi

    2009-01-01

    In this paper we present the design of a cost-effective wearable sensor to detect and indicate the strength and other characteristics of the electric field emanating from a laptop display. Our Electromagnetic Field Detector Bracelet can provide an immediate awareness of electric fields radiated from an object used frequently. Our technology thus supports awareness of ambient background emanation beyond human perception. We discuss how detection of such radiation mig...

  13. Data Center Storage Cost-Effective Strategies, Implementation, and Management

    CERN Document Server

    Smith, Hubbert

    2011-01-01

    We overspend on data center storage ! yet, we fall short of business requirements. It's not about the technologies. It's about the proper application of technologies to deliver storage services efficiently and affordably. It's about meeting business requirements dependent on data center storage. Spend less, deliver more. Data Center Storage: Cost-Effective Strategies, Implementation, and Management provides an industry insider's insight on how to properly scope, plan, evaluate, and implement storage technologies to maximize performance, capacity, reliability, and power savings. It provides bus

  14. Cost-effectiveness of Family-Based Obesity Treatment.

    Science.gov (United States)

    Quattrin, Teresa; Cao, Ying; Paluch, Rocco A; Roemmich, James N; Ecker, Michelle A; Epstein, Leonard H

    2017-09-01

    We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. We reported greater reductions in child and parent weight at 6 and 24 months compared with an attention-controlled information control (IC) group. This article reports the cost-effectiveness of long-term weight change for FBT compared with IC. Ninety-six children 2 to 5 years of age with overweight or obesity and with parents who had a BMI ≥25 were randomly assigned to FBT or IC, and both received diet and activity education (12-month treatment and 12-month follow-up). Weight loss and cost-effectiveness were assessed at 24 months. Intention-to-treat, completers, and sensitivity analyses were performed. The average societal cost per family was $1629 for the FBT and $886 for the IC groups at 24 months. At 24 months, child percent over BMI (%OBMI) change decreased by 2.0 U in the FBT group versus an increase of 4.4 U in the IC group. Parents lost 6.0 vs 0.2 kg at 24 months in the FBT and IC groups, respectively. The incremental cost-effectiveness ratios (ICERs) for children and parents' %OBMI were $116.1 and $83.5 per U of %OBMI, respectively. Parental ICERs were also calculated for body weight and BMI and were $128.1 per 1, and $353.8/ per kilogram, respectively. ICER values for child %OBMI were similar in the intention-to-treat group ($116.1/1 U decrease) compared with completers ($114.3). For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group. Copyright © 2017 by the American Academy of Pediatrics.

  15. Cost-Effectiveness of Health Coaching: An Integrative Review.

    Science.gov (United States)

    Hale, Rachel; Giese, Jeannie

    The purpose of this review was to evaluate published literature to distinguish how health coaching influences the cost of chronic disease management in insured adults with chronic conditions. An integrated literature review was conducted. MEDLINE, Business Source Complete, and OneSearch were searched for the years 2001-2016 utilizing the following key words: health coaching, health coaching AND insurance companies, health coaching AND cost, health coaching AND health insurance, and health coaching AND insurance cost. A total of 67 articles met inclusion criteria and were assessed for applicability. Of those, 27 articles were found to be relevant to the research question. The practice settings of these articles are mostly primary care and wellness programs. Throughout the literature, health coaching has been found effective in chronic disease management such as hypertension, diabetes, and hyperlipidemia. Studies evaluating the cost-effectiveness of health coaching are limited. The current literature does not clearly demonstrate that health coaching lowers expenditures and patient copayments in the short term but projects future savings. Health coaching has the potential to improve chronic disease management and lower health care expenditures. Further long-term research is needed to evaluate the cost-effectiveness of health coaching. It has been projected that the cost-effectiveness of health coaching will be long-term or over 12 months after initiating the health coaching program.

  16. Clinical profile of children with kerosene aspiration.

    Science.gov (United States)

    Venkatesh, C; Sriram, P; Adhisivam, B; Mahadevan, S

    2011-07-01

    Accidental aspiration of kerosene is a common problem among children in developing countries. This descriptive study involved the retrospective analysis of children admitted with kerosene aspiration in a tertiary care hospital in South India for a year. Kerosene aspiration contributed to 60.4% of poisoning cases. Boys aged less than three years and from a rural background formed a significant proportion. Tachypnoea, cough and crepitations were the predominant clinical findings. Male gender and malnutrition (weight for age <80%) were significantly associated with prolonged hospital stay.

  17. Coronary air embolism treated with aspiration catheter.

    Science.gov (United States)

    Patterson, M S; Kiemeneij, F

    2005-05-01

    Coronary air embolism remains a recognised complication of coronary catheterisation despite a strong emphasis on prevention. Current treatment consists of supportive measures with 100% oxygen and analgesia. Recent case reports describe the use of mechanical treatments aimed at dispersing or removing the air embolus with variable success. A case of coronary air embolism causing an acute coronary syndrome is described that was definitively treated with an aspiration system. The effectiveness of the aspiration system in the distal section of an obtuse marginal artery indicates that such dedicated aspiration systems may prove useful in the standard treatment of air embolism.

  18. Cost-effectiveness analysis of rotavirus vaccination in Argentina.

    Science.gov (United States)

    Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Hernández, Laura; Giglio, Norberto; Gentile, Ángela; Diosque, Máximo; Vizzotti, Carla

    2015-05-07

    Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. Compared to no

  19. Cost-effectiveness of hepatitis A vaccination in Indonesia.

    Science.gov (United States)

    Suwantika, Auliya A; Beutels, Philippe; Postma, Maarten J

    2014-01-01

    This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the model, we made a comparison on the use of two-dose and one-dose vaccines. The model involved a 70-year time horizon with 1-month cycles for children less than 2 years old and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of the hepatitis A vaccination. Vaccination would save US$ 3,795,148 and US$ 2,892,920 from the societal perspective, for the two-dose and one-dose vaccine schedules, respectively, in the context of hepatitis A treatment. It also would save 8917 and 6614 discounted quality-adjusted-life-years (QALYs), respectively. With the vaccine price of US$ 3.21 per dose, the implementation of single dose vaccine would yield an incremental cost-effectiveness ratio (ICER) of US$ 4933 per QALY gained versus no vaccination, whereas the two-dose versus one-dose schedule would cost US$ 14 568 per QALY gained. Considering the 2012 gross-domestic-product (GDP) per capita in Indonesia of US$ 3557, the results indicate that hepatitis A vaccination would be a cost-effective intervention, both for the two-dose and one-dose vaccine schedules in isolation, but two-dose vaccination would no longer be cost-effective if one-dose vaccination is a feasible option. Vaccination would be 100% affordable at budgets of US$ 71,408 000 and US$ 37,690,000 for the implementation of the two-dose and one-dose vaccine schedules, respectively. The implementation of hepatitis A vaccination in Indonesia would be a cost-effective health intervention under the market vaccine price. Given the budget limitations, the use of a one-dose-vaccine schedule would be more realistic to be applied than a two-dose schedule. The vaccine price, mortality rate and

  20. Acceptance of health technology assessment submissions with incremental cost-effectiveness ratios above the cost-effectiveness threshold

    Directory of Open Access Journals (Sweden)

    Griffiths EA

    2015-08-01

    Full Text Available Elizabeth A Griffiths, Janek K Hendrich, Samuel DR Stoddart, Sean CM Walsh HERON™ Commercialization, PAREXEL International, London, UK Objectives: In health technology assessment (HTA agencies where cost-effectiveness plays a role in decision-making, an incremental cost-effectiveness ratio (ICER threshold is often used to inform reimbursement decisions. The acceptance of submissions with ICERs higher than the threshold was assessed across different agencies and across indications, in order to inform future reimbursement submissions. Methods: All HTA appraisals from May 2000 to May 2014 from National Institute for Health and Care Excellence (NICE, Scottish Medicines Consortium (SMC, Pharmaceutical Benefits Advisory Committee (PBAC, and Canadian Agency for Drugs and Technologies in Health (CADTH were assessed. Multiple technology appraisals, resubmissions, vaccination programs, and requests for advice were excluded. Submissions not reporting an ICER, or for which an ICER could not be determined were also excluded. The remaining appraisals were reviewed, and the submitted ICER, recommendation, and reasoning behind the recommendation were extracted. Results: NICE recommended the highest proportion of submissions with ICERs higher than the threshold (34% accepted without restrictions; 20% with restrictions, followed by PBAC (16% accepted without restrictions; 4% with restrictions, SMC (11% accepted without restrictions; 14% accepted with restrictions, and CADTH (0% accepted without restrictions; 26% with restrictions. Overall, the majority of higher-than-threshold ICER submissions were classified into the "malignant disease and immunosuppression" therapeutic category; however, there was no notable variation in acceptance rates by disease area. Reasons for accepting submissions reporting ICERs above the threshold included high clinical benefit over the standard of care, and addressing an unmet therapeutic need. Conclusion: Acceptance of submissions

  1. 矿用锂离子蓄电池电源安全性能试验要求变化浅析%Requirements change mine lithium-ion battery power supply of the safety performance test

    Institute of Scientific and Technical Information of China (English)

    许明英

    2015-01-01

    Lithium-ion batteries as a reliable power supply equipment has been widely used in coal mine, but the security implications due to the improper use of lithium and its application in the coal field has been largely restricted. Large-capacity lithium-ion battery power coal mine safety issues in the application is the top priority, Mine was the good lithium-ion batteries power products access and in the field, countries have to develop new requirements to stringent production and inspection.Some Changes article describes the mine lithium-ion battery power supply safety performance test requirements, analysis of the reasons for the change and assessment for substance. To implement the new requirements have a positive effect.%锂离子蓄电池电源作为可靠的供电设备已经广泛的应用于煤矿井下,但由于锂离子电池存在的安全问题,使其在煤矿领域的应用受到很大限制。大容量锂离子电池电源在煤矿井下应用的安全性问题更是重中之重。为把好矿用锂离子蓄电池电源产品在该领域的准入关,国家相继制定新相关要求,来严格生产和检验。文章阐述了矿用锂离子蓄电池电源安全性能试验要求的几点变化,分析了变化的原因和考核针对物质。对落实新要求有着积极作用。

  2. Cost effectiveness of adopted quality requirements in hospital laboratories.

    Science.gov (United States)

    Hamza, Alneil; Ahmed-Abakur, Eltayib; Abugroun, Elsir; Bakhit, Siham; Holi, Mohamed

    2013-01-01

    The present study was designed in quasi-experiment to assess adoption of the essential clauses of particular clinical laboratory quality management requirements based on international organization for standardization (ISO 15189) in hospital laboratories and to evaluate the cost effectiveness of compliance to ISO 15189. The quality management intervention based on ISO 15189 was conceded through three phases; pre - intervention phase, Intervention phase and Post-intervention phase. In pre-intervention phase the compliance to ISO 15189 was 49% for study group vs. 47% for control group with P value 0.48, while the post intervention results displayed 54% vs. 79% for study group and control group respectively in compliance to ISO 15189 and statistically significant difference (P value 0.00) with effect size (Cohen's d) of (0.00) in pre-intervention phase and (0.99) in post - intervention phase. The annual average cost per-test for the study group and control group was 1.80 ± 0.25 vs. 1.97 ± 0.39, respectively with P value 0.39 whereas the post-intervention results showed that the annual average total costs per-test for study group and control group was 1.57 ± 0.23 vs 2.08 ± 0.38, P value 0.019 respectively, with cost-effectiveness ratio of (0.88) in pre -intervention phase and (0.52) in post-intervention phase. The planned adoption of quality management requirements (QMS) in clinical laboratories had great effect to increase the compliance percent with quality management system requirement, raise the average total cost effectiveness, and improve the analytical process capability of the testing procedure.

  3. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Directory of Open Access Journals (Sweden)

    J Lennert Veerman

    Full Text Available AIMS: Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. METHODS: We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs below A$50 000 per Disability Adjusted Life Year (DALY averted are considered good value for money. RESULTS: The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000 for sibutramine and A$230 000/DALY (170 000-340 000 for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. CONCLUSIONS: Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

  4. Cost-effectiveness of HPV vaccination in Belize.

    Science.gov (United States)

    Walwyn, Leslie; Janusz, Cara Bess; Clark, Andrew David; Prieto, Elise; Waight, Eufemia; Largaespada, Natalia

    2015-05-07

    Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Comprehensive overview: efficacy, tolerability, and cost-effectiveness of irbesartan

    Directory of Open Access Journals (Sweden)

    Gialama F

    2013-10-01

    Full Text Available Fotini Gialama, Nikos ManiadakisHealth Services Organisation and Management, National School of Public Health, Athens, GreeceBackground: Hypertension represents a major health problem, affecting more than one billion adults worldwide. Irbesartan, an angiotensin II receptor blocker, is considered to be a highly effective treatment in the management of hypertension. The purpose of this review is to evaluate the efficacy, safety and tolerability profile, and cost-effectiveness of treatment with irbesartan in hypertension.Methods: A review of the literature was conducted using the electronic PubMed and Cochrane Library databases and the Health Economic Evaluations Database of search terms relating to irbesartan efficacy, tolerability, and cost-effectiveness, and the results were utilized.Results: Findings from the present analysis show that irbesartan either as monotherapy or in combination with other antihypertensive agents can achieve significant reductions in blood pressure, both systolic and diastolic, compared with alternative treatment options. Irbesartan was also found to have a renoprotective effect independent of its blood pressure-lowering in patients with type 2 diabetes and nephropathy. Furthermore, irbesartan demonstrated an excellent safety and tolerability profile, with either lower or equal adverse events compared with placebo and other alternative treatments. In terms of economic analyses, compared with other antihypertensive therapy alternatives, irbesartan was found to be a preferred option, that is less costly and more effective.Conclusion: The evidence indicates that treating patients with hypertension alone or with type 2 diabetes and nephropathy using irbesartan can control hypertension, prolong life, and reduce costs in relation to existing alternatives.Keywords: irbesartan, tolerability, safety, efficacy, cost-effectiveness, economic evaluation

  6. Cost-effective framework for basic surgical skills training.

    Science.gov (United States)

    Jiang, Deng-Jin; Wen, Chan; Yang, Ai-Jun; Zhu, Zhi-Li; Lei, Yan; Lan, Yang-Jun; Huang, Qing-Yuan; Hou, Xiao-Yu

    2013-06-01

    The importance of basic surgical skills is entirely agreed among surgical educators. However, restricted by ethical issues, finance etc, the basic surgical skills training is increasingly challenged. Increasing cost gives an impetus to the development of cost-effective training models to meet the trainees' acquisition of basic surgical skills. In this situation, a cost-effective training framework was formed in our department and introduced here. Each five students were assigned to a 'training unit'. The training was implemented weekly for 18 weeks. The framework consisted of an early, a transitional, an integrative stage and a surgical skills competition. Corresponding training modules were selected and assembled scientifically at each stage. The modules comprised campus intranet databases, sponge benchtop, nonliving animal tissue, local dissection specimens and simulating reality operations. The training outcomes used direct observation of procedural skills as an assessment tool. The training data of 50 trainees who were randomly selected in each year from 2006 to 2011 year, were retrospectively analysed. An excellent and good rate of the surgical skills is from 82 to 88%, but there is no significant difference among 6 years (P > 0.05). The skills scores of the contestants are markedly higher than those of non-contestants (P < 0.05). The average training cost per trainee is about $21.85-34.08. The present training framework is reliable, feasible, repeatable and cost-effective. The skills competition can promote to improve the surgical skills level of trainees. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  7. Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty.

    Science.gov (United States)

    Mather, Richard C; Watters, Tyler S; Orlando, Lori A; Bolognesi, Michael P; Moorman, Claude T

    2010-04-01

    Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA. A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits. In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy. Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  8. Using Cost-Effectiveness Analysis to Address Health Equity Concerns.

    Science.gov (United States)

    Cookson, Richard; Mirelman, Andrew J; Griffin, Susan; Asaria, Miqdad; Dawkins, Bryony; Norheim, Ole Frithjof; Verguet, Stéphane; J Culyer, Anthony

    2017-02-01

    This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.

  9. The cost-effectiveness of rotavirus vaccination in Armenia.

    Science.gov (United States)

    Jit, Mark; Yuzbashyan, Ruzanna; Sahakyan, Gayane; Avagyan, Tigran; Mosina, Liudmila

    2011-11-01

    The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted.

  10. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Science.gov (United States)

    Veerman, J Lennert; Barendregt, Jan J; Forster, Megan; Vos, Theo

    2011-01-01

    Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money. The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000) for sibutramine and A$230 000/DALY (170 000-340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

  11. Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan.

    Science.gov (United States)

    Freiesleben de Blasio, Birgitte; Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children vaccine cost at vaccination program costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study.

  12. Cost-effectiveness of hepatitis B vaccination of prison inmates.

    Science.gov (United States)

    Pisu, Maria; Meltzer, Martin Isaac; Lyerla, Rob

    2002-12-13

    The purpose of this paper is to determine the cost-effectiveness of vaccinating inmates against hepatitis B. From the prison perspective, vaccinating inmates at intake is not cost-saving. It could be economically beneficial when the cost of a vaccine dose is 1.6 and 50%, respectively. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them.

  13. Development and Manufacture of Cost Effective Composite Drill Pipe

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie, II; Lee Truong; James T. Heard

    2006-09-29

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2005 through September 30, 2006 and contains the following discussions: Qualification Testing; Prototype Development and Testing of ''Smart Design'' Configuration; Field Test Demonstration; Development of Ultra-Short Radius Composite Drill Pipe (USR-CDP); and Development of Smart USR-CDP.

  14. Cost effectiveness of a protocol using palivizumab in preterm infants

    Directory of Open Access Journals (Sweden)

    Yolanda Hernández-Gago

    2017-03-01

    Full Text Available Objective: The main objective was to evaluate the cost-effectiveness of protocol use of palivizumab in premature established by consensus in our Hospital comparing it based on the recommendations of various Scientific Societies. As a secondary objective risk factors and severity of hospitalized patients attending the established protocol in our Hospital were analyzed. Methods: The study period was 4 seasons with the expanded protocol (retrospective data versus 2 with restricted or agreed protocol (prospective data. The perspective of the study was the Health System, including the costs of hospitalization and palivizumab our center. The calculation of the effectiveness was determined with the admission rate of premature patients stratified by weeks of gestational age <29, <32; and <35. For the analysis of risk factors and severity in patients admitted seasons with the new protocol are collected prospectively clinical data and environmental and social factors. Results: In the range of gestational age <29 years old and <32 greater effectiveness of the extended protocol was not demonstrated against the consensus. Only more effective for EG <35 in the accumulated data and comparing seasons 12/13 and 08/09 to 13/14 for individual data was observed. This range has an associated incremental cost effectiveness ratio of € 53 250,07 (range: € 14 793,39 to € 90 446,47 for singles data and € 50 525,53 (€ 28 688.22 to € 211 575,65 for accumulated. The establishment of this protocol in our center meant an average saving per season € 169 911,51. A cost- effectiveness of the extended protocol appropriate relationship is found if the cost of palivizumab per patient was less than € 1 206,67 (calculated for maximum use of the vial and a higher rate of hospitalization of 9.21%. Children entering the season with the new protocol (season 12/13 and 13/14 are 63.4% in children under 3 months and 90% are term infants who do not belong to any population at

  15. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

    Weile, Louise K K; Kahn, James G; Marseille, Elliot

    2015-01-01

    and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...... and varying results in the existing body of evidence, we find it unreasonable to outline any global recommendations. For future economic studies, we recommend inclusion of long-term outcomes and adaptation to local preferences, as well as examination of the impact of the diagnostic criteria recently proposed...

  16. Cost-effective wound management: a survey of 1717 nurses.

    Science.gov (United States)

    Newton, Heather

    2017-06-22

    Delivering high-quality wound care requires a mix of knowledge and skills, which nurses aim to update by attending educational events such as conferences and study days. This article describes the data obtained from 30 educational study days, which took place across England, Scotland and Wales. It will explore nurses' knowledge in relation to the cost-effectiveness and clinical efficacy of current wound care practices, based on the answers of 1717 delegates that attended the events. It will also outline the results in relation to reducing expenditure on wound dressings and the importance of performing an accurate wound assessment.

  17. Cost Effective Polymer Solar Cells Research and Education

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Sam-Shajing [Norfolk State Univ, Norfolk, VA (United States)

    2015-10-13

    The technical or research objective of this project is to investigate and develop new polymers and polymer based optoelectronic devices for potentially cost effective (or cost competitive), durable, lightweight, flexible, and high efficiency solar energy conversion applications. The educational objective of this project includes training of future generation scientists, particularly young, under-represented minority scientists, working in the areas related to the emerging organic/polymer based solar energy technologies and related optoelectronic devices. Graduate and undergraduate students will be directly involved in scientific research addressing issues related to the development of polymer based solar cell technology.

  18. Key aspects of cost effective collector and solar field design

    Science.gov (United States)

    von Reeken, Finn; Nicodemo, Dario; Keck, Thomas; Weinrebe, Gerhard; Balz, Markus

    2016-05-01

    A study has been performed where different key parameters influencing solar field cost are varied. By using levelised cost of energy as figure of merit it is shown that parameters like GoToStow wind speed, heliostat stiffness or tower height should be adapted to respective site conditions from an economical point of view. The benchmark site Redstone (Northern Cape Province, South Africa) has been compared to an alternate site close to Phoenix (AZ, USA) regarding site conditions and their effect on cost-effective collector and solar field design.

  19. Operating Dedicated Data Centers - Is It Cost-Effective?

    Science.gov (United States)

    Ernst, M.; Hogue, R.; Hollowell, C.; Strecker-Kellog, W.; Wong, A.; Zaytsev, A.

    2014-06-01

    The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.

  20. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... for the residential domain in the envisaged smart grid. The PhD project is funded and associated to the EU project “Energy Demand Aware Open Services for Smart Grid Intelligent Automation” (Smart HG) and therefore introduces the project on a system-level. Based on this, we present some of the integration, security...

  1. Cost-effectiveness studies as part of an ALARA program

    Energy Technology Data Exchange (ETDEWEB)

    Baum, J.W.

    1986-01-01

    Recent studies of cost effectiveness of engineering modifications for dose reduction at nuclear power plants conducted at BNL will be considered in this report. Since each of these items has the potential for a 50% to 60% reduction in collective dose, it appears there is large potential for dose reduction from engineering type modifications. The question that must be answered for each plant is ''which modifications or improvements are required for optimization (ALARA). The purpose of this paper is to illustrate that quantified optimization need not be costly and can often be highly beneficial.

  2. Cost-Effective Helicopter Options for Partner Nations

    Science.gov (United States)

    2015-01-01

    elevation feature MGTOW maximum gross takeoff weight MOB main operating base MoD Ministry of Defense MoI Ministry of Interior nm nautical miles NSRW...we provided a main operat- ing base ( MOB ) or forward operating base (FOB) from which operations would be conducted. In these instances, the...RAND RR141z1-2.2 MOB /FOB MOB /FOB X Y Z LZs Alternate LZs 23 nmPrimary LZ Bor der Bor der 120º 120º 10 Cost-Effective Helicopter Options for Partner

  3. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

    Full Text Available Daniel J Cher,1 Melissa A Frasco,2 Renée JG Arnold,2,3 David W Polly4,5 1Clinical Affairs, SI-BONE, Inc., San Jose, CA, USA; 2Division of Health Economics and Outcomes Research, Quorum Consulting, Inc., San Francisco, CA, USA; 3Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA; 5Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA Background: Sacroiliac joint (SIJ disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective: To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods: Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results: SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085. SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion: Compared to traditional non-surgical treatments

  4. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Peter Manekas

    2005-03-18

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2003 through September 30, 2004 and contains the following discussions: (1) Direct Electrical Connection for Rotary Shoulder Tool Joints; (2) Conductors for inclusion in the pipe wall (ER/DW-CDP); (3) Qualify fibers from Zoltek; (4) Qualify resin from Bakelite; (5) First commercial order for SR-CDP from Integrated Directional Resources (SR-CDP); and (6) Preparation of papers for publication and conference presentations.

  5. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2011-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  6. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2016-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  7. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

    Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

    2017-09-15

    To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Cost-effectiveness of a ROPS retrofit education campaign.

    Science.gov (United States)

    Myers, M L; Cole, H P; Westneat, S C

    2004-05-01

    A community educational campaign implemented in two Kentucky counties was effective in influencing farmers to retrofit their tractors with rollover protective structures (ROPS) to protect tractor operators from injury in the event of an overturn. This article reports on the cost-effectiveness of this program in the two counties when compared to no program in a control county. A decision analysis indicated that it would be effective at averting 0.27 fatal and 1.53 nonfatal injuries over a 20-year period, and when this analysis was extended statewide, 7.0 fatal and 40 nonfatal injuries would be averted in Kentucky. Over the 20-year period, the cost-per-injury averted was calculated to be $172,657 at a 4% annual discount rate. This cost compared favorably with a national cost of $489,373 per injury averted despite the additional program cost in Kentucky. The principle reason for the increased cost-effectiveness of the Kentucky program was the three-fold higher propensity for tractors to overturn in Kentucky. The cost-per-injury averted in one of the two counties was $112,535. This lower cost was attributed principally to incentive awards financed locally for farmers to retrofit their tractors with ROPS.

  9. Strengthening Cost-Effectiveness Analysis for Public Health Policy.

    Science.gov (United States)

    Russell, Louise B; Sinha, Anushua

    2016-05-01

    Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs.

  10. Cost-effectiveness analysis in markets with high fixed costs.

    Science.gov (United States)

    Cutler, David M; Ericson, Keith M Marzilli

    2010-01-01

    We consider how to conduct cost-effectiveness analysis when the social cost of a resource differs from the posted price. From the social perspective, the true cost of a medical intervention is the marginal cost of delivering another unit of a treatment, plus the social cost (deadweight loss) of raising the revenue to fund the treatment. We focus on pharmaceutical prices, which have high markups over marginal cost due to the monopoly power granted to pharmaceutical companies when drugs are under patent. We find that the social cost of a branded drug is approximately one-half the market price when the treatment is paid for by a public insurance plan and one-third the market price for mandated coverage by private insurance. We illustrate the importance of correctly accounting for social costs using two examples: coverage for statin drugs and approval for a drug to treat kidney cancer (sorafenib). In each case, we show that the correct social perspective for cost-effectiveness analysis would be more lenient than researcher recommendations.

  11. Can aging in place be cost effective? A systematic review.

    Science.gov (United States)

    Graybill, Erin M; McMeekin, Peter; Wildman, John

    2014-01-01

    To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to 'age in place' and highlight what further research is needed to inform decisions regarding aging in place. People aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement. Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style. Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered. The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.

  12. Can aging in place be cost effective? A systematic review.

    Directory of Open Access Journals (Sweden)

    Erin M Graybill

    Full Text Available PURPOSE OF THE STUDY: To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs that specifically enable older people to 'age in place' and highlight what further research is needed to inform decisions regarding aging in place. DESIGN: People aged 65+ and their live-in carers (where applicable, using an ALT to age in place at home opposed to a community-dwelling arrangement. METHODS: Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style. RESULTS: Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered. IMPLICATIONS: The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.

  13. [Cost-effectiveness analysis on colorectal cancer screening program].

    Science.gov (United States)

    Huang, Q C; Ye, D; Jiang, X Y; Li, Q L; Yao, K Y; Wang, J B; Jin, M J; Chen, K

    2017-01-10

    Objective: To evaluate the cost-effectiveness of colorectal cancer screening program in different age groups from the view of health economics. Methods: The screening compliance rates, detection rates in different age groups were calculated by using the data from colorectal cancer screening program in Jiashan county, Zhejiang province. The differences in indicator among age groups were analyzed with χ(2) test or trend χ(2) test. The ratios of cost to the number of case were calculated according to cost statistics. Results: The detection rates of immunochemical fecal occult blood test (iFOBT) positivity, advanced adenoma and colorectal cancer and early stage cancer increased with age, while the early diagnosis rates were negatively associated with age. After exclusion the younger counterpart, the cost-effectiveness of individuals aged >50 years could be reduced by 15%-30%. Conclusion: From health economic perspective, it is beneficial to start colorectal cancer screening at age of 50 years to improve the efficiency of the screening.

  14. ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF MALE INFERTILITY

    Directory of Open Access Journals (Sweden)

    Prasad

    2015-03-01

    Full Text Available BACKGROUND: Male infertility is a common problem and needs a minimally invasive method to arrive at the appropriate diagnosis . Alternative to open testicular biopsy the fine needle aspiration cytology of the testis is being increasingly used as a minimally invasive method of evaluating testicular function . AIM OF THE STUDY: To know whether FNAC of testes is as informative as biopsy in cases of male infertility . To establish that FNAC is cost effective , safe , out p atient investigation with no complications . METHODOLOGY: Fifty patients with primary male infertility in the age group of 20 - 40 years were included in the study . All the cases with oligospermia and azoospermia were subjected for Doppler study to rule out varicocele . Cord block was achieved with 1% lignocaine and aspiration was done with 23 gauge 1 . 5 inch needle . Smears were made on albuminised slides and stained with Leishman Stain . Forresta et al scoring system was adopted to analyse the smears . In the same sitting testicular biopsy was taken , fixed in Bouins fluid , routinely processed and stained with H&E stain . RESULTS: The commonest group with infertility were in the age group 21 - 30 years . On semen analysis 78% were azoospermic and 22% were oligozoospermic . The testicular size was normal in 90 % of subjects and 10% had small testis . Out of fifty subjects with infertility , 40% subjects had varicocele . Varicocele was commonly associated with duct obstruction . The commonest patterns observed on cytology were; normal spermatogenesis ( 14/50 , 28 % , duct obstruction ( 8/50 , 16 % , maturation arre st ( 7/50 , 14 % and testicular atrophy ( 7/50 , 14 % . In the present study diagnostic accuracy was 93 . 4% . CONCLUSION: Fine needle aspiration cytology is as informative as biopsy and can be done as a routine procedure . It is a simple and cost effective . In cases where FNAC shows normal spermatogenesis with azoospermia and oligospermia , biopsy and doppler study

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Wyoming

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Wyoming. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Wyoming.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for South Dakota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in South Dakota. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in South Dakota.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for West Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in West Virginia. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in West Virginia.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Texas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Texas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Texas.

  19. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Wisconsin

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Wisconsin. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Wisconsin.

  20. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Utah

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Utah. Moving to the 2015 IECC from the 2012 Utah State Code base code is cost-effective for residential buildings in all climate zones in Utah.

  1. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Tennessee. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Tennessee.

  2. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Rhode Island

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Rhode Island. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Rhode Island.

  3. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Oklahoma

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Oklahoma. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Oklahoma.

  4. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Vermont

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Vermont. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Vermont.

  5. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Pennsylvania

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Pennsylvania. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Pennsylvania.

  6. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for South Carolina

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in South Carolina. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in South Carolina.

  7. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Virginia. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Virginia.

  8. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Illinois

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Illinois. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Illinois.

  9. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Mississippi

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Mississippi. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Mississippi.

  10. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Colorado. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Colorado.

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Missouri

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Missouri. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Missouri.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Nevada

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Nevada. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Nevada.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Idaho

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Idaho. Moving to the 2015 IECC from the 2015 Idaho State Code base code is cost-effective for residential buildings in all climate zones in Idaho.

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Montana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Montana. Moving to the 2015 IECC from the 2014 Montana State Code base code is cost-effective for residential buildings in all climate zones in Montana.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Delaware

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Delaware. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Delaware.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Louisiana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Louisiana. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Louisiana.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Kansas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Kansas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Kansas.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Minnesota. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Minnesota.

  19. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Mexico. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in New Mexico.

  20. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Indiana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V.; Zhao, Mingjie; Taylor, Zachary T.; Poehlman, Eric A.

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Indiana. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Indiana.

  1. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Arkansas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Arkansas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Arkansas.

  2. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Michigan

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Michigan. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Michigan.

  3. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Kentucky

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Kentucky. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Kentucky.

  4. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Hawaii

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Hawaii. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Hawaii.

  5. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Nebraska

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Nebraska. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Nebraska.

  6. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Massachusetts. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Massachusetts.

  7. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Florida

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Florida. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Florida.

  8. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Connecticut

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Connecticut. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Connecticut.

  9. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Alaska

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Alaska. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Alaska.

  10. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Georgia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Georgia. Moving to the 2015 IECC from the 2011 Georgia State Code base code is cost-effective for residential buildings in all climate zones in Georgia.

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Arizona

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Arizona. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Arizona.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New York

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New York. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in New York.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for North Dakota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in North Dakota. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in North Dakota.

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Maine

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Maine. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Maine.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Ohio

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Ohio. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Ohio.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Iowa

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Iowa. Moving to the 2015 IECC from the 2014 Iowa State Code base code is cost-effective for residential buildings in all climate zones in Iowa.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Maryland. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Maryland.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Alabama

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Alabama. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Alabama.

  19. REVASCULARIZATION FOR FEMOROPOPLITEAL DISEASE - A DECISION AND COST-EFFECTIVENESS ANALYSIS

    NARCIS (Netherlands)

    HUNINK, MGM; WONG, JB; DONALDSON, MC; MEYEROVITZ, MF; DEVRIES, J; HARRINGTON, DP

    1995-01-01

    Objective.-To evaluate the relative benefits and cost-effectiveness of revascularization for femoropopliteal disease using percutaneous transluminal angioplasty or bypass surgery. Design.-Decision analysis using a multistate transition simulation model (Markov process) and cost-effectiveness analysi

  20. Cost-effective therapy in patients with idiopathic hirsutism.

    Science.gov (United States)

    Lumachi, Franco; Zulian, Elisa; Scaroni, Carla

    2004-06-01

    Hirsutism affects 10% of women. Hirsute women with normal circulating androgen levels and normal ovarian function (i.e., regular and ovulatory menstrual cycles) are defined as having idiopathic hirsutism, which may affect more than 20% of all hirsute women. In the treatment of idiopathic hirsutism, different medical therapies, alone or in combination, have been reported. The drugs currently available are oral contraceptives, cyproterone acetate androgen receptors blockers (i.e., spironolactone and flutamide), 5alpha-reductase inhibitors (e.g., finasteride [Proscar, Aventis]) and gonadotrophin-releasing hormone analogs. After 1 year of treatment, each drug may improve hirsutism and reduce the Ferriman-Gallwey score by 35-40%. This review analyses the causes of hirsutism and provides information on each therapy and the cost-effective results in patients with idiopathic hirsutism.

  1. Cost Effective Evaluation of Companies' Storytelling on the Web

    DEFF Research Database (Denmark)

    Clemmensen, Torkil; Vendelø, Morten Thanning

    2004-01-01

    Abstract: In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies' self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts......, initiate the customers' imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies' self-presentation as future work places for students. The results demonstrate that the students choose the company that has a web site with rich...... narrative qualities above the company that has a web site with good graphical appearance, but poor narrative qualities. In conclusion, we suggest that user centred evaluation of commercial web sites by using the suggested method can pay attention to deep, narrative structures in both the company's self...

  2. Cost-effective design of economic instruments in nutrition policy.

    Science.gov (United States)

    Jensen, Jørgen D; Smed, Sinne

    2007-04-04

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.

  3. Cost-effective design of economic instruments in nutrition policy

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may....... The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range...... of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn....

  4. Development of a Cost Effective Power Generation System: An Overview

    Directory of Open Access Journals (Sweden)

    Shiv Prakash Bihari

    2016-03-01

    Full Text Available This paper presents an overview on development of cost effective power generation system and motivates for development of a model for hybrid system with wind to investigate the combined operation of wind with different sources to cater to wind’s stochastic nature for imbalance minimization and optimal operation. Development of model for trading power in competitive electricity market and development of strategies for trading in electricity markets (wind energy and reserves markets to investigate the effects of real time pricing tariffs on electricity market operation has been illustrated in this paper. Dynamic modelling related studies to investigate the wind generator’s kinetic energy for primary frequency support using simulink and simulation studies on doubly fed induction generator to study its capability during small disturbances / fluctuations on power system have been described.

  5. Cost-effective design of economic instruments in nutrition policy

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may...... be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively....... The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range...

  6. A Cost- Effective Design of Reversible Programmable Logic Array

    CERN Document Server

    Singla, Pradeep; 10.5120/5619-7911

    2012-01-01

    In the recent era, Reversible computing is a growing field having applications in nanotechnology, optical information processing, quantum networks etc. In this paper, the authors show the design of a cost effective reversible programmable logic array using VHDL. It is simulated on xilinx ISE 8.2i and results are shown. The proposed reversible Programming logic array called RPLA is designed by MUX gate [10] & Feynman gate for 3- inputs, which is able to perform any reversible 3- input logic function or Boolean function. Furthermore the quantized analysis with camparitive finding is shown for the realized RPLA against the existing one. The result shows improvement in the quantum cost and total logical caculation in proposed RPLA.

  7. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    support (e.g. 10 million €/year) for the respective instruments, and in turn assess the geographically distributed effects on farm income and employment, on production, value-added and employment in related upstream and downstream industries, on income and employment in the municipalities, and on a number......The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

  8. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...... time incorporating economic interactions between different geographical areas, via inter-regional trade, commuting and influences via prices and wages. In order to make results for different policy instruments comparable, we use the simulation models to assess the effects of a given amount of public...

  9. Simple and cost-effective fluorescent labeling of 5-hydroxymethylcytosine

    Science.gov (United States)

    Shahal, Tamar; Green, Ori; Hananel, Uri; Michaeli, Yael; Shabat, Doron; Ebenstein, Yuval

    2016-12-01

    The nucleobase 5-hydroxymethylcytosine (5-hmC), a modified form of cytosine, is an important epigenetic mark related to regulation of gene expression. 5-hmC levels are highly dynamic during early development and are modulated during the progression of neurodegenerative disease and cancer. We describe a spectroscopic method for the global quantification of 5-hmC in genomic DNA. This method relies on the enzymatic glucosylation of 5-hmC, followed by a glucose oxidation step that results in the formation of aldehyde moieties that are covalently linked to a fluorescent reporter by oxime ligation. The fluorescence intensity of the labeled sample is directly proportional to its 5-hmC content. We show that this simple and cost-effective technique is suitable for quantification of 5-hmC content in different mouse tissues.

  10. Cost effectiveness of ergonomic redesign of electronic motherboard.

    Science.gov (United States)

    Sen, Rabindra Nath; Yeow, Paul H P

    2003-09-01

    A case study to illustrate the cost effectiveness of ergonomic redesign of electronic motherboard was presented. The factory was running at a loss due to the high costs of rejects and poor quality and productivity. Subjective assessments and direct observations were made on the factory. Investigation revealed that due to motherboard design errors, the machine had difficulty in placing integrated circuits onto the pads, the operators had much difficulty in manual soldering certain components and much unproductive manual cleaning (MC) was required. Consequently, there were high rejects and occupational health and safety (OHS) problems, such as, boredom and work discomfort. Also, much labour and machine costs were spent on repairs. The motherboard was redesigned to correct the design errors, to allow more components to be machine soldered and to reduce MC. This eliminated rejects, reduced repairs, saved US dollars 581495/year and improved operators' OHS. The customer also saved US dollars 142105/year on loss of business.

  11. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard

    2003-03-30

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents accomplishments made from October 1, 2002 through September 30, 2003. The following have been accomplished and are reported in detail herein: Metal-to-Composite Interface (MCI) redesign and testing; Successful demonstration of MCI connection for both SR and ER/DW CDP; Specifications for a 127mm (5 inch) ID by 152.4 mm (6 inch) OD composite drill pipe have been finalized for Extended Reach/Deep Water applications (ER/DW); Field testing of Short Radius CDP (SR); Sealing composite laminate to contain high pressure; Amendments; Amendment for ''Smart'' feature added to ER/DW development along with time and funding to complete battery of qualification tests with option for field demonstration; and Preparation of papers for publication and conference presentations.

  12. Development of a cost effective microscope heater stage

    Science.gov (United States)

    Dugre, Joshua; Prayaga, Chandra; Wade, Aaron

    Utilizing 3D printing technology, a heater stage has been developed and implemented for microscopic systems. Due to the flexibility of 3D printing,the heater stage can be easily modified to fit any sample size with only slight modifications to the heating element being required. The sample in contact with the heating element can also easily be secured in a thermal insulator, such as aluminum foil. The thermal gradient of the heater stage has been recorded to be less than 1°C and has been compared to more expensive designs, and the cost effectiveness of the system has been determined. The system has been tested with a sample of the liquid crystal 8CB in order to determine the exact temperatures of the phase transitions of the crystal to verify that the system is applicable to a wide range of experimental physics. UWF Quality Enhancement Plan Award.

  13. Cost-effective design of economic instruments in nutrition policy

    Directory of Open Access Journals (Sweden)

    Smed Sinne

    2007-04-01

    Full Text Available Abstract This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.

  14. Cost-effective unilateral climate policy design: Size Matters

    Energy Technology Data Exchange (ETDEWEB)

    Boehringer, Christoph; Fischer, Carolyn; Rosendahl, Knut Einar

    2011-07-01

    Given the bleak prospects for a global agreement on mitigating climate change, pressure for unilateral abatement is increasing. A major challenge is emissions leakage. Border carbon adjustments and output-based allocation of emissions allowances can increase effectiveness of unilateral action but introduce distortions of their own. We assess antileakage measures as a function of abatement coalition size. We first develop a partial equilibrium analytical framework to see how these instruments affect emissions within and outside the coalition. We then employ a computable general equilibrium model of international trade and energy use to assess the strategies as the coalition grows. We find that full border adjustments rank first in global cost-effectiveness, followed by import tariffs and output-based rebates. The differences across measures and their overall appeal decline as the abatement coalition grows. In terms of cost, the coalition countries prefer border carbon adjustments; countries outside the coalition prefer output-based rebates.(Author)

  15. An Improved, Efficient and Cost Effective Software Inspection Meeting Process

    Directory of Open Access Journals (Sweden)

    Dilawar Ali

    2013-02-01

    Full Text Available Normally, the inspection process is seemed to be just finding defects in software during software development process lifecycle. Software inspection is considered as a most cost effective technique, but if these defects are not properly corrected or handled it would cost you more than double later in the project. This paper focus on the last phase of inspection meeting process showing the importance of Follow-Up Stage in software inspection meeting process. This paper also suggests a set of activities that should be performed during the Rework and Follow-Up Stages so to get inspection meeting results productive and efficient. In this paper we focus on the over the shoulder reviews so to ensure the software quality having less impact on the total software cost.

  16. Guideline Standardisation, Cost Effectiveness, Industry Needs and Conflict of Interest

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

    Full Text Available 1. A Conference on Guideline Standardization (COGS was convened in April 2002 'to define a standard for guideline reporting that would promote guideline quality and facilitate implementation'. It includes items for standardization, conceptual issues, up gradation, conflict of interest, patient interest and systematization. Even items for individual preferences, choice or values are not neglected. Special mention must be made of items which specify disclosure of conflict of interest both in the Developer (including the organization that develops and the individuals involved in the guideline's formulation, as well as in the sponsor or funding source (and its role in developing and/or reporting the guideline. 2. Recommendations of CPGs and CDR panels are conflicting. One considers effectiveness, the other considers cost-effectiveness. However, CPGs do not adhere to established methodological standards, critical information that would attest to validity is regularly absent, explicit criteria to grade the scientific evidence that supports their recommendations is absent from 82% of guidelines, 87% are not in a position to report whether a systematic literature search was performed, 67% do not describe the type of professionals used in guidelines development, there is such marked variation in the quality of guidelines. Moreover, CPG guideline layers often are conflicted in their interests. The problem can be resolved to a large extent by taking a simple step: making CPG panelists go into cost effectiveness along with recommending Guidelines. What then happens is that they have to consider not only effectiveness but also costs. Now effectiveness can be fudged, cost cannot. Why? Because, what is the cost is well known. Therapies in Guidelines should be recommended and graded according to whether they are Most, Moderately or Least Cost Effective. For that CPGs will have to perform economic analysis as well. This will meet with resistance for obvious

  17. RTM: Cost-effective processing of composite structures

    Science.gov (United States)

    Hasko, Greg; Dexter, H. Benson

    1991-01-01

    Resin transfer molding (RTM) is a promising method for cost effective fabrication of high strength, low weight composite structures from textile preforms. In this process, dry fibers are placed in a mold, resin is introduced either by vacuum infusion or pressure, and the part is cured. RTM has been used in many industries, including automotive, recreation, and aerospace. Each of the industries has different requirements of material strength, weight, reliability, environmental resistance, cost, and production rate. These requirements drive the selection of fibers and resins, fiber volume fractions, fiber orientations, mold design, and processing equipment. Research is made into applying RTM to primary aircraft structures which require high strength and stiffness at low density. The material requirements are discussed of various industries, along with methods of orienting and distributing fibers, mold configurations, and processing parameters. Processing and material parameters such as resin viscosity, perform compaction and permeability, and tool design concepts are discussed. Experimental methods to measure preform compaction and permeability are presented.

  18. Cost-effective lightweight mirrors for aerospace and defense

    Science.gov (United States)

    Woodard, Kenneth S.; Comstock, Lovell E.; Wamboldt, Leonard; Roy, Brian P.

    2015-05-01

    The demand for high performance, lightweight mirrors was historically driven by aerospace and defense (A&D) but now we are also seeing similar requirements for commercial applications. These applications range from aerospace-like platforms such as small unmanned aircraft for agricultural, mineral and pollutant aerial mapping to an eye tracking gimbaled mirror for optometry offices. While aerospace and defense businesses can often justify the high cost of exotic, low density materials, commercial products rarely can. Also, to obtain high performance with low overall optical system weight, aspheric surfaces are often prescribed. This may drive the manufacturing process to diamond machining thus requiring the reflective side of the mirror to be a diamond machinable material. This paper summarizes the diamond machined finishing and coating of some high performance, lightweight designs using non-exotic substrates to achieve cost effective mirrors. The results indicate that these processes can meet typical aerospace and defense requirements but may also be competitive in some commercial applications.

  19. Cost Effectiveness Ratio: Evaluation Tool for Comparing the Effectiveness of Similar Extension Programs

    Science.gov (United States)

    Jayaratne, K. S. U.

    2015-01-01

    Extension educators have been challenged to be cost effective in their educational programming. The cost effectiveness ratio is a versatile evaluation indicator for Extension educators to compare the cost of achieving a unit of outcomes or educating a client in similar educational programs. This article describes the cost effectiveness ratio and…

  20. Cost-Effectiveness Analysis in Practice: Interventions to Improve High School Completion

    Science.gov (United States)

    Hollands, Fiona; Bowden, A. Brooks; Belfield, Clive; Levin, Henry M.; Cheng, Henan; Shand, Robert; Pan, Yilin; Hanisch-Cerda, Barbara

    2014-01-01

    In this article, we perform cost-effectiveness analysis on interventions that improve the rate of high school completion. Using the What Works Clearinghouse to select effective interventions, we calculate cost-effectiveness ratios for five youth interventions. We document wide variation in cost-effectiveness ratios between programs and between…

  1. Comparing the Cost-Effectiveness of Simulation Modalities: A Case Study of Peripheral Intravenous Catheterization Training

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-01-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three…

  2. Costs, health effects and cost-effectiveness of alcohol and tobacco control strategies in Estonia.

    NARCIS (Netherlands)

    Lai, T.; Habicht, J.; Reinap, M.; Chisholm, D.; Baltussen, R.M.P.M.

    2007-01-01

    OBJECTIVE: To assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia. DESIGN: A WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian Kroo

  3. Cost-Effectiveness of Decision Support Strategies in Acute Bronchitis.

    Science.gov (United States)

    Michaelidis, Constantinos I; Kern, Melissa S; Smith, Kenneth J

    2015-10-01

    A recent clinical trial suggests that printed (PDS) and computer decision support (CDS) interventions are safe and effective in reducing antibiotic use in acute bronchitis relative to usual care (UC). Our aim was to evaluate the cost-effectiveness of decision support interventions in reducing antibiotic use in acute bronchitis. We conducted a clinical trial-based cost-effectiveness analysis comparing UC, PDS and CDS for management of acute bronchitis. We assumed a societal perspective, 5-year program duration and 30-day time horizon. The U.S. population aged 13-64 years presenting with acute bronchitis in the ambulatory setting. Printed and computer decision support interventions relative to usual care. Cost per antibiotic prescription safely avoided. In the base case, PDS dominated UC and CDS, with lesser total costs (PDS: $2,574, UC: $2,768, CDS: $2,805) and fewer antibiotic prescriptions (PDS: 3.79, UC: 4.60, CDS: 3.95) per patient over 5 years. In one-way sensitivity analyses, PDS dominated UC across all parameter values, except when antibiotics reduced work loss by ≥ 1.9 days or the probability of hospitalization within 30 days was ≥ 0.9 % in PDS (base case: 0.2 %) or ≤ 0.4 % in UC (base case: 1.0 %). The dominance of PDS over CDS was sensitive both to probability of hospitalization and plausible variation in the adjusted odds of antibiotic use in both strategies. A PDS strategy to reduce antibiotic use in acute bronchitis is less costly and more effective than both UC and CDS strategies, although results were sensitive to variation in probability of hospitalization and the adjusted odds of antibiotic use. This simple, low-cost, safe, and effective intervention would be an economically reasonable component of a multi-component approach to address antibiotic overuse in acute bronchitis.

  4. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

    Full Text Available Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control, with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation

  5. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    Science.gov (United States)

    Takura, Tomoyuki; Nakanishi, Takeshi; Kawanishi, Hideki; Nitta, Kosaku; Akizawa, Tadao; Hiramatsu, Makoto; Kawasaki, Tadayuki; Kukita, Kazutaka; Soejima, Hidehisa; Hirakata, Hideki; Yoshida, Toyohiko; Miyamoto, Takashi; Takahashi, Susumu

    2015-10-01

    The cost-effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro-QOL 5-dimensions (EQ-5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost-effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ-5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P MHD is a treatment that could improve the socioeconomic state of elderly patients with end-stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis.

  6. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Science.gov (United States)

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  7. Specialty-specific admission: a cost-effective intervention?

    LENUS (Irish Health Repository)

    Slattery, E

    2012-02-01

    INTRODUCTION: Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions. METHODS: All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs. RESULTS: Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to 17,342 noted. Specialty-specific admission was associated with shorter LOS for most GI admissions. CONCLUSION: Significant disparity exists for both LOS and PLC for most GI diagnoses. Specialty-specific admissions are associated with reduced LOS. Specialty-specific admission would appear to be cost-effective which may also lead to improved clinical outcomes.

  8. Evaluation of ventilatory therapy for acid aspiration.

    Science.gov (United States)

    Flint, L; Gosdin, G; Carrico, C J

    1975-10-01

    Aspiration of hydrochloric acid in experimental animals results in severe, progressive hypoxia which is due to intrapulmonary shunting and depressed cardiac output. This preparation is useful therefore in studying the therapy of hypoxia. Mongrel dogs were subjected to acid aspiration and the effects of several ventilatory patterns on intrapulmonary shunt fractions and lung water accumulation observed. The combination of large tidal volumes (30 c.c. per kilogram) with positive end-expiratory pressure was effective in preventing intrapulmonary shunting and other ventilatory patterns were ineffective. Pulmonary edema uniformly followed acid aspiration and was not affected by ventilatory therapy. When ventilatory therapy was delayed for 4 hours, the progression of shunting apparently was limited, but the existing shunt was not reduced.

  9. CT detection and aspiration of abdominal abscesses.

    Science.gov (United States)

    Haaga, J R; Alfidi, R J; Havrilla, T R; Cooperman, A M; Seidelmann, F E; Reich, N E; Weinstein, A J; Meaney, T F

    1977-03-01

    Computed tomography (CT) is effective in detecting intraabdominal abscesses. Loculations of fluid and extraluminal gas are clearly localized in relation to other organs. Of 22 abscess in this series, CT successfully detected 20; comparative information with gallium, techneticum, and ultrasound scans is presented. In addition to localizing these collections, CT can be used to guide needle aspiration and drainage procedures. Three sizes of needles were used to aspirate specimens and/or provide drainage. This was accomplished successfully in 12 of 14 CT-guided procedures.

  10. Health Economic Assessment: Cost-Effectiveness Thresholds and Other Decision Criteria

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2010-04-01

    Full Text Available An article published in this Journal argued that New Zealand does not apply a cost-effectiveness threshold because medicines are funded within a fixed budget and because cost-effectiveness is only one of nine criteria that inform decisions. This Comment has explained that, from a theoretical perspective, the cost-effectiveness threshold model is not inconsistent with these two arguments. The observed annual variation in incremental cost-effectiveness ratios in New Zealand may originate from yearly differences in new medicines that request reimbursement and in the budget size, and from the fact that decision makers take into account other decision criteria in addition to cost-effectiveness.

  11. Critical Research for Cost-Effective Photoelectrochemical Production of Hydrogen

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Liwei [Midwest Optoelectronics, LLC, Toledo, OH (United States); Deng, Xunming [Univ. of Toledo, OH (United States); Abken, Anka [Midwest Optoelectronics, LLC, Toledo, OH (United States); Cao, Xinmin [Midwest Optoelectronics, LLC, Toledo, OH (United States); Du, Wenhui [Midwest Optoelectronics, LLC, Toledo, OH (United States); Vijh, Aarohi [Xunlight Corporation, Toledo, OH (United States); Ingler, William [Univ. of Toledo, OH (United States); Chen, Changyong [Univ. of Toledo, OH (United States); Fan, Qihua [Univ. of Toledo, OH (United States); Collins, Robert [Univ. of Toledo, OH (United States); Compaan, Alvin [Univ. of Toledo, OH (United States); Yan, Yanfa [Univ. of Toledo, OH (United States); Giolando, Dean [Univ. of Toledo, OH (United States); Turner, John [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2014-10-29

    The objective of this project is to develop critical technologies required for cost-effective production of hydrogen from sunlight and water using a-Si triple junction solar cell based photo-electrodes. In this project, Midwest Optoelectronics, LLC (MWOE) and its collaborating organizations utilize triple junction a-Si thin film solar cells as the core element to fabricate photoelectrochemical (PEC) cells. Triple junction a-Si/a-SiGe/a-SiGe solar cell is an ideal material for making cost-effective PEC system which uses sun light to split water and generate hydrogen. It has the following key features: 1) It has an open circuit voltage (Voc ) of ~ 2.3V and has an operating voltage around 1.6V. This is ideal for water splitting. There is no need to add a bias voltage or to inter-connect more than one solar cell. 2) It is made by depositing a-Si/a-SiGe/aSi-Ge thin films on a conducting stainless steel substrate which can serve as an electrode. When we immerse the triple junction solar cells in an electrolyte and illuminate it under sunlight, the voltage is large enough to split the water, generating oxygen at the Si solar cell side (for SS/n-i-p/sunlight structure) and hydrogen at the back, which is stainless steel side. There is no need to use a counter electrode or to make any wire connection. 3) It is being produced in large rolls of 3ft wide and up to 5000 ft long stainless steel web in a 25MW roll-to-roll production machine. Therefore it can be produced at a very low cost. After several years of research with many different kinds of material, we have developed promising transparent, conducting and corrosion resistant (TCCR) coating material; we carried out extensive research on oxygen and hydrogen generation catalysts, developed methods to make PEC electrode from production-grade a-Si solar cells; we have designed and tested various PEC module cases and carried out extensive outdoor testing; we were able to obtain a solar to hydrogen conversion efficiency (STH

  12. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perović Saša

    2009-01-01

    Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs

  13. Cost effective processes by using negative-tone development application

    Science.gov (United States)

    Yamamoto, Kei; Kato, Keita; Ou, Keiyu; Shirakawa, Michihiro; Kamimura, Sou

    2015-03-01

    The high volume manufacturing with extreme ultraviolet (EUV) lithography is delaying due to its light source issue. Therefore, ArF-immersion lithography has still been the most promising technology for down scaling of device pitch. As the limitation of ArF-immersion single patterning is considered to be nearly 40nm half pitch (hp), ArF-immersion lithography has necessity to be extended by combining processes to achieve sub- 20nm hp patterning. Recently, there are many reports about the extension of ArF-immersion lithography, e.g., self-aligned multiple patterning (SAMP) and litho-etch-litho-etch (LELE) process. These methods have been realized by the combination of lithography, deposition, and etching. On the other aspect, 1-D layout is adopted for leading devices, which contains additional cut or block litho and etch processes to form 2-D like layout. Thus, according to the progress of down scaling technologies, number of processes increases and the cost of ownership (CoO) can not be neglected. Especially, the number of lithography steps and etching steps has been expanded by the combination of processes, and it has come to occupy a large portion of total manufacturing cost. We have reported that negative tone development (NTD) system using organic solvent developer have enough resolution to achieve fine narrow trench or contact hole patterning, since negative tone imaging enables to apply bright mask for these pattern with significantly high optical image contrast compared to positive tone imaging, and it has contributed high throughput multiple patterning. On the other hand, NTD system is found to be useful not only for leading device node, but also for cost effective process. In this report, we propose the cost effective process using NTD application. In the viewpoint of cost down at exposure tool, we have developed KrF-NTD resist which is customized for organic solvent developer. Our KrF-NTD resist has resolution comparable with ArF positive tone development

  14. Cost-Effectiveness Analysis of Infrapopliteal Drug-Eluting Stents

    Energy Technology Data Exchange (ETDEWEB)

    Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Karnabatidis, Dimitris; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Siablis, Dimitris [Patras University Hospital, Department of Interventional Radiology, School of Medicine (Greece)

    2013-02-15

    IntroductionThere are no cost-utility data about below-the-knee placement of drug-eluting stents. The authors determined the cost-effectiveness of infrapopliteal drug-eluting stents for critical limb ischemia (CLI) treatment. The event-free individual survival outcomes defined by the absence of any major events, including death, major amputation, and target limb repeat procedures, were reconstructed on the basis of two published infrapopliteal series. The first included spot Bail-out use of Sirolimus-eluting stents versus bare metal stents after suboptimal balloon angioplasty (Bail-out SES).The second was full-lesion Primary Everolimus-eluting stenting versus plain balloon angioplasty and bail-out bare metal stenting as necessary (primary EES). The number-needed-to-treat (NNT) to avoid one major event and incremental cost-effectiveness ratios (ICERs) were calculated for a 3-year postprocedural period for both strategies. Overall event-free survival was significantly improved in both strategies (hazard ratio (HR) [confidence interval (CI)]: 0.68 [0.41-1.12] in Bail-out SES and HR [CI]: 0.53 [0.29-0.99] in Primary EES). Event-free survival gain per patient was 0.89 (range, 0.11-3.0) years in Bail-out SES with an NNT of 4.6 (CI: 2.5-25.6) and a corresponding ICER of 6,518 Euro-Sign (range 1,685-10,112 Euro-Sign ). Survival gain was 0.91 (range 0.25-3.0) years in Primary EES with an NNT of 2.7 (CI: 1.7-5.8) and an ICER of 11,581 Euro-Sign (range, 4,945-21,428 Euro-Sign ) per event-free life-year gained. Two-way sensitivity analysis showed that stented lesion length >10 cm and/or DES list price >1000 Euro-Sign were associated with the least economically favorable scenario in both strategies. Both strategies of bail-out SES and primary EES placement in the infrapopliteal arteries for CLI treatment exhibit single-digit NNT and relatively low corresponding ICERs.

  15. Occupational Aspirations and Expectations of Australian Adolescents

    Science.gov (United States)

    Patton, Wendy; Creed, Peter

    2007-01-01

    Adolescents across the five years of high school (169 females and 164 males) completed a survey that identified occupational status aspirations and expectations coded into six types-- realistic, investigative, artistic, social, enterprising, or conventional--according to the RIASEC model (Holland, 1997). As the focus of the study was to explore…

  16. Income Aspirations and Cooperation : Experimental Evidence

    NARCIS (Netherlands)

    Dalton, P.S.

    2010-01-01

    This article is the first attempt to study the empirical link between income aspirations and cooperation in a one shot public good game. By combining experimental with survey data, we find evidence that the more frustrated people are with their income, the lower is their propensity to cooperate with

  17. Aspiring Girls: Great Expectations or Impossible Dreams?

    Science.gov (United States)

    Richards, Gill; Posnett, Carol

    2012-01-01

    This study explores girls' aspirations for their future. The context was an ex-coalmining area where concerns had been raised by the local authority about the levels of girls' achievement. The focus of the research was the views of Year 6 girls as they prepared for their transition to secondary school and Year 11 girls as they prepared for their…

  18. FOREIGN BODY ASPIRATION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Nafia Ozlem Kazanci

    2013-03-01

    Full Text Available Foreign body aspiration (FBA is common under 3 years of age. FBA can cause sudden respiratory failure. Furthermore, it leads to many respiratory system complications. Therefore, FBA is an important cause of mortality and morbidity for this age group. FBA cases are usually followed by diagnoses like pneumonia, bronchitis or bronchial asthma in the late period that history, clinical and laboratory findings suggesting foreign body aspiration can not be detected. We reported a 2-year-old male patient with pneumonia, who were administered various treatments. In thorax CT of this case, an image compatible with foreign body was seen in the right middle lobe-upper lobe separation area. Granulation tissue was detected in the entrance of the right main bronchus by rigid bronchoscopy and marked improvement occured in lung aeration after bronchoscopy. This case was reported to emphasize the importance of early diagnosis of foreign body aspiration because of high mortality and morbidity and the necessity of considering the foreign body aspiration in children with recurrent pulmonary infections. [J Contemp Med 2013; 3(1.000: 58-61

  19. Uitwerking en implementatie Aspire voor witte asperges

    NARCIS (Netherlands)

    Kruistum, van G.; Wilms, J.A.M.

    2008-01-01

    In vervolg op het afgesloten project ‘Valideren van het AspireNZ systeem voor asperges in Nederland’ is medio 2006 dit vervolgproject gestart. Doelstelling is de ontwikkeling van een werkend Beslissing Ondersteunend Systeem (BOS) op basis van regelmatige meting van suikergehalten van de wortels en b

  20. Turban pin aspiration: new fashion, new syndrome.

    Science.gov (United States)

    Ilan, Ophir; Eliashar, Ron; Hirshoren, Nir; Hamdan, Kasem; Gross, Menachem

    2012-04-01

    Turban pin aspiration syndrome is a new clinical entity afflicting young Islamic girls wearing a turban.The goal of this study was to present our experience in diagnosis and treatment of this new entity, define its clinical and epidemiologic features, and shed a new light on the role of fashion in the increased incidence. A retrospective study in a tertiary university hospital. Review of clinical parameters and epidemiologic features of 26 patients diagnosed with turban pin aspiration syndrome admitted to the Hadassah-Hebrew University Hospitals in Jerusalem from 1990 to 2010. All patients were Muslim females with an average age of 16 years. In all cases, the history was positive for accidental aspiration. Most of the pins were located in the trachea (42%). In 20 cases, the pins were extracted by rigid bronchoscopy without major complications. Fluoroscopy-assisted rigid bronchoscopy was used successfully in three cases. In one case, the object was self-ejected by coughing before the bronchoscopy, and two patients were referred to the chest unit for thoracotomy. Clinicians should be aware of this distinct form of foreign body aspiration, its method of diagnosis, and extraction techniques. A cultural investigation showed a difference in the turban-fastening technique of young girls as compared with their mothers. Removal by rigid bronchoscopy is a safe method with a high success rate and should be considered as the preferred extraction method of choice. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  1. Occupational Aspirations and Expectations of Australian Adolescents

    Science.gov (United States)

    Patton, Wendy; Creed, Peter

    2007-01-01

    Adolescents across the five years of high school (169 females and 164 males) completed a survey that identified occupational status aspirations and expectations coded into six types-- realistic, investigative, artistic, social, enterprising, or conventional--according to the RIASEC model (Holland, 1997). As the focus of the study was to explore…

  2. Factors Influencing High School Students' Career Aspirations

    Science.gov (United States)

    Tang, Mei; Pan, Wei; Newmeyer, Mark D.

    2008-01-01

    This article explores the factors influencing high school students' career aspirations with a study analyzing 141 high school students. The Social Cognitive Career Development Model was utilized to examine the interactive relationships among learning experiences, career self-efficacy, outcome expectations, career interests, and career choices. The…

  3. The Gap between Aspiration and Practice

    Science.gov (United States)

    Tuckett, Alan

    2013-01-01

    At the time of the fifth UNESCO international conference on adult education (CONFINTEA V) in Hamburg in 1997, it seemed that a resilient alliance of governments and civil society organizations had been created. This alliance would have the commitment and cooperation needed to pursue the ambitious aspirations captured in the 10 themes of the…

  4. DIAGNOSTIC UTILITY OF CELL BLOCKS IN THYROID ASPIRATES

    Directory of Open Access Journals (Sweden)

    Zarika

    2015-09-01

    False Positive in our series. CONCLUSION: Cell block technique showed to be highly effective with high sensitivity and specificity and could be utilized as a cost effective diagnostic tool in the armamentarium of diagnostic work up in the patients with thyroid lesions.

  5. Cost-Effective Marine Protection--A Pragmatic Approach.

    Directory of Open Access Journals (Sweden)

    Soile Oinonen

    Full Text Available This paper puts forward a framework for probabilistic and holistic cost-effectiveness analysis to provide support in selecting the least-cost set of measures to reach a multidimensional environmental objective. Following the principles of ecosystem-based management, the framework includes a flexible methodology for deriving and populating criteria for effectiveness and costs and analyzing complex ecological-economic trade-offs under uncertainty. The framework is applied in the development of the Finnish Programme of Measures (PoM for reaching the targets of the EU Marine Strategy Framework Directive (MSFD. The numerical results demonstrate that substantial cost savings can be realized from careful consideration of the costs and multiple effects of management measures. If adopted, the proposed PoM would yield improvements in the state of the Baltic Sea, but the overall objective of the MSFD would not be reached by the target year of 2020; for various environmental and administrative reasons, it would take longer for most measures to take full effect.

  6. Hospitalization for pelvic inflammatory disease: a cost-effectiveness analysis.

    Science.gov (United States)

    Smith, Kenneth J; Ness, Roberta B; Roberts, Mark S

    2007-02-01

    Nulliparous women are frequently hospitalized for treatment of pelvic inflammatory disease (PID). The goal of this study was to determine the economic feasibility of hospitalizing adolescents and young women for PID. The authors conducted a Markov decision model, estimating the cost-effectiveness of hospitalization compared with outpatient therapy for mild to moderate PID for adolescents and young women, calculating costs per quality-adjusted life-year (QALY) gained under various assumptions about hospitalization effects on complications. If hospitalization decreases PID complications by 10%, 20%, or 30%, the cost/QALY gained is 145,000 dollars, 67,400 dollars, or 42,400 dollars, respectively, compared with outpatient therapy. Assumptions about hospitalization effects on the development of chronic pelvic pain heavily weight the analysis; costs/QALY gained by hospitalization increase considerably if chronic pain is unaffected. Hospitalization for PID treatment to possibly preserve fertility in nulliparous young women and adolescents is unlikely to be economically reasonable even if substantial improvements in PID complication rates are assumed.

  7. A more cost-effective method of preoperative computerized imaging.

    Science.gov (United States)

    Webber, W B

    1989-07-01

    Stimulated by the explosive expansion of the computerized desk top publishing industry during the past few years, microcomputer hardware and software are evolving at a staggering rate. Memory is rapidly increasing, and prices are declining. I have found that with the hardware and software described in this paper, I was able to obtain, in a much more cost-effective manner, as useful preoperative information for my practice as I could obtain with more expensive "turnkey" (only one use) computerized imaging systems. This type of microcomputer, of course, is not limited to just the imaging system, but can be used for a variety of other programs as well, such as word processing, slide labeling and production, spreadsheet functions, billing and filing, and numerous business and other applications. The ease of use with readily available 35-mm slides of my patients has greatly enhanced the appeal of this system. Computerized imaging, when used as an educational tool, can be very helpful in preoperative planning, resident teaching, and for illustration and discussion of a patient's proposed surgery. The electronic imaging disclaimer compiled by the American Society of Plastic and Reconstructive Surgeons has been extremely helpful in clarifying the limits of computerized imaging and reducing any false expectations that my patients might have. All of us are experiencing the dawn of a very exciting evolution.

  8. The High Value CVT Concept--Cost Effective and Powerful

    Institute of Scientific and Technical Information of China (English)

    A. Englisch,; A. Teubert; A. Gotz; E. Muller; E. Simon; B. Walter; A. Baumgartner

    2011-01-01

    Based on the comprehensive comparison of vehicle performance in economy,engine power,driving smoothness,and efficiency cost as well as pollutant emission etc,the paper discussed the high value CVT concept from an angle of the cost effective and powerful for vehicle.In the paper,it researched the related technical detail in CVT.By means of realizing the continuous change in transmission ratio,it could obtain the optimal matching between transmission system and engine operating mode,and enhance the characteristic of fuel oil in economy,and also improve the convenience in manipulation for driver and make passenger comfortable.For easy to understand the concept,the paper made the comparison analysis in many aspects such as performance,transmission specification,high value CVT hybrid,orifice torque sensor,hydraulic system,high value CVT em,new chain portfolio and assessment of the high value CVT on the NEDC.Finally it showed the potential advantages of CVT technology development,and proposed future developing trends to realize technical scheme of high value CVT.

  9. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; Jeffrey R. Jean; Hans Neubert; Lee Truong

    2001-10-30

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report discusses and illustrates all progress in the first two years of this NETL/DOE supported program. The following have been accomplished and are reported in detail herein: (1) Specifications for both 5 5/16 inch and 3 3/8 inch composite drill pipe have been finalized. (2) All basic laboratory testing has been completed and has provide sufficient data for the selection of materials for the composite tubing, adhesives, and abrasion coatings. (3) Successful demonstration of composite/metal joint interfacial connection. (4) Upgrade of facilities to provide a functional pilot plant manufacturing facility. (5) Arrangements to have the 3 3/8 inch CDP used in a drilling operation early in C.Y. 2002. (6) Arrangements to have the 5 5/16 inch CDP marketed and produced by a major drill pipe manufacturer.

  10. Good practices on cost - effective road infrastructure safety investments.

    Science.gov (United States)

    Yannis, George; Papadimitriou, Eleonora; Evgenikos, Petros; Dragomanovits, Anastasios

    2016-12-01

    The paper presents the findings of a research project aiming to quantify and subsequently classify several infrastructure-related road safety measures, based on the international experience attained through extensive and selected literature review and additionally on a full consultation process including questionnaire surveys addressed to experts and relevant workshops. Initially, a review of selected research reports was carried out and an exhaustive list of road safety infrastructure investments covering all types of infrastructure was compiled. Individual investments were classified according to the infrastructure investment area and the type of investment and were thereafter analysed on the basis of key safety components. These investments were subsequently ranked in relation to their safety effects and implementation costs and on the basis of this ranking, a set of five most promising investments was selected for an in-depth analysis. The results suggest that the overall cost effectiveness of a road safety infrastructure investment is not always in direct correlation with the safety effect and is recommended that cost-benefit ratios and safety effects are always examined in conjunction with each other in order to identify the optimum solution for a specific road safety problem in specific conditions and with specific objectives.

  11. The challenge of paying for cost-effective cures.

    Science.gov (United States)

    Zettler, Patricia J; Fuse Brown, Erin C

    2017-01-01

    In this article, we consider the problem of financing highly effective and cost-effective prescription drugs within a value-based pricing system. Precisely because these drugs are highly effective, their value-based prices may be quite expensive; and moreover, the value-based price of a cure ought to be set high enough to create incentives for innovation, otherwise these beneficial therapies may be underdeveloped. However, in our fragmented health insurance system, where patients move frequently between payers, these payers generally lack the incentives to pay value-based prices for cures because they cannot ensure that they will reap the long-term economic benefits. Therefore, we argue that there is a need for mechanisms to spread the burden of financing of cures across payers to maximize patient access and the public good. We suggest that risk adjustment, reinsurance, and risk corridors are familiar policy options that merit consideration to address the problem and create incentives for value-based pricing.

  12. Climate targets and cost-effective climate stabilization pathways

    Science.gov (United States)

    Held, H.

    2015-08-01

    Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

  13. Cost effectiveness of Aedes aegypti control programmes: participatory versus vertical.

    Science.gov (United States)

    Baly, A; Toledo, M E; Boelaert, M; Reyes, A; Vanlerberghe, V; Ceballos, E; Carvajal, M; Maso, R; La Rosa, M; Denis, O; Van der Stuyft, P

    2007-06-01

    We conducted an economic appraisal of two strategies for Aedes aegypti control: a vertical versus a community-based approach. Costs were calculated for the period 2000-2002 in three pilot areas of Santiago de Cuba where a community intervention was implemented and compared with three control areas with routine vertical programme activities. Reduction in A. aegypti foci was chosen as the measure of effectiveness. The pre-intervention number of foci (614 vs. 632) and economical costs for vector control (US$243746 vs. US$263486) were comparable in the intervention and control areas. During the intervention period (2001-2002), a 13% decrease in recurrent costs for the health system was observed. Within the control areas, these recurrent relative costs remained stable. The number of A. aegypti foci in the pilot areas and the control areas fell by 459 and 467, respectively. The community-based approach was more cost effective from a health system perspective (US$964 vs. US$1406 per focus) as well as from society perspective (US$1508 vs. US$1767 per focus).

  14. Time Overrun and Cost Effectiveness in the Construction Industry

    Directory of Open Access Journals (Sweden)

    T.Subramani

    2014-06-01

    Full Text Available The project management technique of planning and scheduling using tools and devices are helpful in comparing the project with stipulated cost, time and quality. Resource tracking, Minimize the uncertainty and Cost Effectiveness is focused in this project. The software tool used for planning and scheduling is Primavera project planner enterprise for construction. The study covers three case studies of the process of planning, scheduling the activities and monitoring. A general re sequencing model had been proposed to overcome the delay factor from the critical area, to minimize the delay of the construction and to reduce the time, cost and it also helpful to concentrate on the major areas in the project. Re sequencing model leads the management to cost savings and make entire project success. Resource planning is one aspect, which decides the systematic execution of the project at worksite. This study is to have hands- on experience in an ongoing project, and evaluation of schedule of equipment, staff, Labor and Materials. It helps to plan and evaluate the resources for the Construction of the building project. This study also compares the cost variation due to the delay of the project and re scheduling the project by crashing process. KEYWORDS:

  15. (Correcting misdiagnoses of asthma: a cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Vandemheen Katherine

    2011-05-01

    Full Text Available Abstract Background The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective. Method Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars. Results Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37% did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278. Conclusion Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

  16. Reliable and cost-effective serodiagnosis of rheumatoid arthritis.

    Science.gov (United States)

    Meyer, Pieter W A; Ally, Mahmood M T M; Anderson, Ronald

    2016-06-01

    Early diagnosis of patients with rheumatoid arthritis (RA) optimises therapeutic benefit and the probability of achieving disease remission. Notwithstanding clinical acumen, early diagnosis is dependent on access to reliable serodiagnostic procedures, as well as on the discerning application and interpretation of these. In the case of RA, however, no disease-specific serodiagnostic procedure is available due to the multi-factorial and polygenic nature of this autoimmune disorder. This has resulted in the development of an array of serodiagnostic procedures based on the detection of autoantibodies reactive with various putative autoantigens. Other procedures based on measurement of elevations in the concentrations of systemic biomarkers of inflammation, most commonly acute phase reactants and cytokines/chemokines, are used as objective indices of disease activity. Following a brief overview of RA research in African populations, the current review is focused on those autoantibodies/biomarkers, specifically rheumatoid factor, anti-citrullinated peptide antibodies and C-reactive protein, which are currently recognised as being the most reliable and cost-effective with respect to disease prediction and diagnosis, as well as in monitoring activity and outcome.

  17. Cost-Effective Marine Protection--A Pragmatic Approach.

    Science.gov (United States)

    Oinonen, Soile; Hyytiäinen, Kari; Ahlvik, Lassi; Laamanen, Maria; Lehtoranta, Virpi; Salojärvi, Joona; Virtanen, Jarno

    2016-01-01

    This paper puts forward a framework for probabilistic and holistic cost-effectiveness analysis to provide support in selecting the least-cost set of measures to reach a multidimensional environmental objective. Following the principles of ecosystem-based management, the framework includes a flexible methodology for deriving and populating criteria for effectiveness and costs and analyzing complex ecological-economic trade-offs under uncertainty. The framework is applied in the development of the Finnish Programme of Measures (PoM) for reaching the targets of the EU Marine Strategy Framework Directive (MSFD). The numerical results demonstrate that substantial cost savings can be realized from careful consideration of the costs and multiple effects of management measures. If adopted, the proposed PoM would yield improvements in the state of the Baltic Sea, but the overall objective of the MSFD would not be reached by the target year of 2020; for various environmental and administrative reasons, it would take longer for most measures to take full effect.

  18. Gender and Leadership Aspiration : The Impact of the Organizational Environment

    NARCIS (Netherlands)

    C. Erlemann

    2016-01-01

    markdownabstractSummary The aim of this dissertation is to examine gender differences in leadership aspiration. Although some important work regarding gender-specific aspiration has been done already, conditions fostering leadership aspiration – particularly among women – are not completely

  19. Thin-needle aspiration biopsy of the prostate.

    Science.gov (United States)

    Koss, L G; Woyke, S; Schreiber, K; Kohlberg, W; Freed, S Z

    1984-05-01

    The authors summarize the current status of thin-needle aspiration biopsy of the prostate and evaluate the accomplishments and limitations of this method of diagnosis. Historical developments, indications, technique, contraindications, complications, cytology of aspirates, diagnostic efficacy of aspirates, and grading of prostatic carcinomas are discussed.

  20. Risk of aspiration in care home residents and associated factors

    NARCIS (Netherlands)

    Maarel-Wierink, C.D. van der; Putten, G.J. van der; Visschere, L.M. De; Bronkhorst, E.M.; Baat, C. de; Schols, J.M.

    2015-01-01

    Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experi

  1. Gender and Leadership Aspiration : The Impact of the Organizational Environment

    NARCIS (Netherlands)

    C. Erlemann

    2016-01-01

    markdownabstractSummary The aim of this dissertation is to examine gender differences in leadership aspiration. Although some important work regarding gender-specific aspiration has been done already, conditions fostering leadership aspiration – particularly among women – are not completely under

  2. 锂离子动力电池的性能选择及安全性保护%Lithium ion battery power of choice and safety protection performance

    Institute of Scientific and Technical Information of China (English)

    郭芙琴

    2012-01-01

    The lithium ion battery is a widely used rechargeable batteries, relative performance is good, especially the lithium ion battery power has become the new energy industrial environment. Along with the expanding the use of lithium ion power battery performance selection, the charging and discharging safety protection is becoming ever more important.%锂离子电池是一种应用广泛的可充电电池,相对性能比较好,特别是锂离子动力电池已成为工业化环境中的新能源。随着其使用面的扩大,对锂离子动力电池的性能选择、充放电的安全保护显得愈发重要。

  3. Mobile source emission control cost-effectiveness: Issues, uncertainties, and results

    Energy Technology Data Exchange (ETDEWEB)

    Wang, M.Q. [Argonne National Lab., IL (United States). Center for Transportation Research

    1994-12-01

    Emissions from mobile sources undoubtedly contribute to US urban air pollution problems. Consequently, mobile source control measures, ranging from vehicle emission standards to reducing vehicle travel, have been adopted or proposed to help attain air quality standards. To rank various mobile source control measures, various government agencies and private organizations calculate cost-effectiveness in dollars per ton of emissions reduced. Arguments for or against certain control measures are often made on the basis of the calculated cost-effectiveness. Yet, different studies may yield significantly different cost-effectiveness results, because of the various methodologies used and assumptions regarding the values of costs and emission reductions. Because of the methodological differences, the cost-effectiveness results may not be comparable between studies. Use of incomparable cost-effectiveness results may result in adoption of ineffective control measures. This paper first discusses some important methodological issues involved in cost-effectiveness calculation for mobile sources and proposes appropriate, systematic methods for dealing with these issues. Various studies have been completed recently to evaluate the cost-effectiveness of mobile source emission control measures. These studies resulted in wide variations in the cost-effectiveness for same control measures. Methodological assumptions used in each study are presented and, based on the proposed methods for cost-effectiveness calculation, adjustments are applied to the original estimates in each study to correct inappropriate methodological assumptions and to make the studies comparable. Finally, mobile source control measures are ranked on the basis of the adjusted cost-effectiveness estimates.

  4. The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

    Directory of Open Access Journals (Sweden)

    Justin Ji-Yuen Siu MD

    2016-10-01

    Full Text Available Additional intervention and medical treatment of complications may follow the primary treatment of a ureteral stone. We investigated the cost of the treatment of ureteral stone(s within 45 days after initial intervention by means of retrospective analysis of the National Health Insurance Research Database of Taiwan. All patients of ages ≥20 years diagnosed with ureteral stone(s( International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-9-CM: 592.1 from January 2001 to December 2011 were enrolled. We included a comorbidity code only if the diagnosis appeared in at least 2 separate claims in a patient’s record. Treatment modalities (code included extracorporeal shock-wave lithotripsy (SWL; 98.51, ureteroscopic lithotripsy (URSL; 56.31, percutaneous nephrolithotripsy (PNL; 55.04, (open ureterolithotomy (56.20, and laparoscopy (ie, laparoscopic ureterolithotomy; 54.21. There were 28 513 patients with ureteral stones (13 848 men and 14 665 women in the randomized sample of 1 million patients. The mean cost was 526.4 ± 724.1 United States Dollar (USD. The costs of treatment were significantly increased in patients with comorbidities. The costs of treatment among each primary treatment modalities were 1212.2 ± 627.3, 1146.7 ± 816.8, 2507.4 ± 1333.5, 1533.3 ± 1137.1, 2566.4 ± 2594.3, and 209.8 ± 473.2 USD in the SWL, URSL, PNL, (open ureterolithotomy, laparoscopy (laparoscopic ureterolithotomy, and conservative treatment group, respectively. In conclusion, URSL was more cost-effective than SWL and PNL as a primary treatment modality for ureteral stone(s when the possible additional costs within 45 days after the initial operation were included in the calculation.

  5. A cost-effective climastrategy; En omkostningseffektiv klimastrategi

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-02-01

    As a consequence of the 1997 Kyoto Protocol and the subsequent 1998 EU Burden Sharing Agreement, Denmark is committed to reducing its average annual greenhouse gas emissions in the period 2008-2012 by 21% in relation to the basis year, 1990. Excess emissions in relation to the reduction commitments are expected to be 25 million tonnes CO{sub 2} equivalents per year, corresponding to approximately 30% of expected emissions in the period 2008-2012, if calculations are based on Denmark's legal commitment under the EU Burden Sharing Agreement, which is significantly more than previously estimated. The legal commitment is based on figures not corrected for the especially large import of electricity in the basis year, 1990. At the Council meeting in connection with ratification of the Kyoto Protocol on 4 March 2002, Denmark did however achieve agreement on a political declaration. According to the declaration, Denmark's claim for adjusted electricity imports for the basis year, 1990, will be considered when individual Member State reductions in tonnes are finally determined in 2006. If the claimed correction is fully taken account of, Danish excess emissions will be reduced by 5 million tonnes CO{sub 2} equivalents per year. Flexible mechanisms, i.e. trading in the so-called credits from CO{sub 2} reduction projects in developing countries and in Central and Eastern Europe as well as trading in CO{sub 2} quotas, may contribute to fulfilling Denmark's reduction commitments. This reflects the fact that greenhouse gas emissions are a global problem that must be solved by ensuring the most cost-effective reduction at global level. Furthermore, flexible mechanisms can contribute to developing the countries in question through the transfer of know-how and capital. (ba)

  6. Chromogenic media for urine cultures can be cost-effective

    Directory of Open Access Journals (Sweden)

    Matjaž J. Retelj

    2007-03-01

    Full Text Available Background: Chromogenic media for diagnostic urinary bacteriology have several advantages over traditional media, such as cysteine-lactose-electrolyte deficient (CLED medium. Chromogenic media allow for easier recognition of mixed growth, save time, reduce workload and provide higher detection rates. However, the cost of chromogenic media is significantly higher compared to CLED and performance of chromogenic media varies depending on the manufacturer. In the present study, performance, turn-around time and cost of Uriselect4 chromogenic medium was compared to CLED.Methods: For performance analysis, 351 midstream urine (MSU samples from September 2005 to December 2005 were directly plated in parallel on Uriselect4 and CLED agar using the calibrated loop technique. Isolates on Uriselect4 were presumptively identified according to the product insert. For cost-effectiveness analysis, we included 1,972 consecutive MSU samples from May 2005 to July 2006. We compared the cost of required materials as well as technologists’ or specialists’ time for each medium examined.Results: No significant differences were found between the isolation rates of urinary pathogens on the studied media. The procedure using chromogenic media for uropathogens is slightly cheaper than the procedure using CLED, considering the proportion of bacteriuria positive samples (50.5 % and the distribution of taxa among isolates (namely Escherichia coli with 59.6 % observed in our laboratory. At the current isolation proportion in MSU samples processed in our laboratory, the average time to reporting results could be decreased by 0.3 days.Conclusions: Use of chromogenic media for urine investigations offers multiple advantages without increasing costs compared to procedures using CLED.

  7. Cost-effective electric vehicle charging infrastructure siting for Delhi

    Science.gov (United States)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6-7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ˜10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  8. Ultrasonic gas alloy atomization under near-zero aspiration pressure

    Science.gov (United States)

    Yan, Pengfei; Wang, Deping; Yan, Biao

    2015-04-01

    In this paper, ultrasonic gas atomization (USGA) of Zn-Al under near-zero aspiration pressure was discussed. The protrusion length of delivery tube was modified to adjust the aspiration pressure. Under near-zero aspiration pressure, melt filming was observed by camera and more fine powders were produced. While under larger subambient aspiration pressure, melt filming was unavailable, corresponding to less fine powders. The results suggest that the position of the wake near the delivery tube can be optimized under near-zero aspiration. Less protrusion of delivery tube reduces the energy loss in gas flow deflection. Both facilitate to produce finer powders.

  9. Repeated nondiagnostic result of thyroid fine-needle aspiration biopsy.

    Science.gov (United States)

    Ziemiańska, Klaudia; Kopczyński, Janusz; Kowalska, Aldona

    2016-01-01

    Fine-needle aspiration biopsy (FNAB) is the most accurate and cost-effective method to evaluate the risk of malignancy of thyroid nodules, but approximately 1-24% of FNABs generate a nondiagnostic result (ND-FNAB). The aim of this study was to determine the predictive factors of a repeated nondiagnostic result of FNAB. A total of 4018 FNABs performed in a territorial referral centre were analysed, of which 288 (7.17%) were nondiagnostic. Medical records were available for 245 biopsies performed in 228 patients. The retrospective analysis of factors that may influence a repeat ND-FNAB, including demographic, clinical and ultrasound characteristics, was performed. A repeat FNAB was performed in 159 nodules giving a diagnostic result in 79.2% of cases. The time between the biopsies ranged from 1 to 611 days (mean 154.4, median 119). The timing of a repeat FNAB did not significantly alter the diagnostic output (p = 0.29). In the univariate analysis, significant predictors of a repeat ND-FNAB were older patient age (p = 0.02), L-thyroxine supplementation (p = 0.05), and a history of (131)I therapy (p < 0.0001). In the multivariate analysis, only a history of (131)I therapy was a statistically significant risk factor for a repeat ND-FNAB (p = 0.002). Patients with a history of (131)I therapy and ND-FNAB should undergo periodic ultrasonographic assessment rather than a repeat biopsy. The interval between repeated FNABs recommended by guidelines does not affect the diagnostic output.

  10. Cost-Effectiveness of Old and New Technologies for Aneuploidy Screening.

    Science.gov (United States)

    Sinkey, Rachel G; Odibo, Anthony O

    2016-06-01

    Cost-effectiveness analyses allow assessment of whether marginal gains from new technology are worth increased costs. Several studies have examined cost-effectiveness of Down syndrome (DS) screening and found it to be cost-effective. Noninvasive prenatal screening also appears to be cost-effective among high-risk women with respect to DS screening, but not for the general population. Chromosomal microarray (CMA) is a genetic sequencing method superior to but more expensive than karyotype. In light of CMAs greater ability to detect genetic abnormalities, it is cost-effective when used for prenatal diagnosis of an anomalous fetus. This article covers methodology and salient issues of cost-effectiveness. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B

    2008-01-01

    (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural...... approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior...... cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting. Udgivelsesdato: 2008-Feb...

  12. Cost-effectiveness of early intervention in first-episode psychosis

    DEFF Research Database (Denmark)

    Hastrup, Lene Halling; Kronborg, Christian; Bertelsen, Mette

    2013-01-01

    BACKGROUND: Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. AIMS: To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive...... community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. METHOD: An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. RESULTS...

  13. The sweet lung: Chewing gummi bear aspiration

    Science.gov (United States)

    Tavladaki, Theonimfi; Fitrolaki, Michaela-Diana; Spanaki, Anna-Maria; Ilia, Staurula; Geromarkaki, Elissabet; Briassoulis, George

    2012-01-01

    Inhalation of foreign bodies, a leading cause of accidental death, is most common in preschool children. In this article we report our experience with a 5-year-old Greek girl who presented with a 24-hour history of sore throat, chest pain, and shortness of breath. Emergency bronchoscopy was performed and multiple small chewing gummi bear (HARIBO) particles impacted in the orifices of the right main bronchus and right lobar and segmentalinic bronchi were successfully removed and aspirated. Aspiration of gummi bears, which is for the first time reported, may cause a silent choking episode leading to life-threatening bronchi obstruction at multiple sites, even in children older than 4 years. PMID:22919167

  14. Air Bag Momentum Force Including Aspiration

    Directory of Open Access Journals (Sweden)

    Guy Nusholtz

    1995-01-01

    Full Text Available A gas-jet momentum force drives the air bag into position during a crash. The magnitude of this force can change as a result of aspiration. To determine the potential magnitude of the effect on the momentum force and mass flow rate in an aspirated system, a series of experiments and simulations of those experiments was conducted. The simulation consists of a two-dimensional unsteady isentropic CFD model with special “infinite boundaries”. One of the difficulties in simulating the gas-jet behavior is determining the mass flow rate. To improve the reliability of the mass flow rate input to the simulation, a sampling procedure involving multiple tests was used, and an average of the tests was adopted.

  15. Fine needle aspiration biopsy of ophthalmic tumors☆

    Science.gov (United States)

    Singh, Arun D.; Biscotti, Charles V.

    2012-01-01

    A majority of intraocular tumors can be diagnosed based on clinical examination and ocular imaging studies, which obviate the need for diagnostic ophthalmic fine needle aspiration biopsy (FNAB). Overall, diagnostic accuracy of ophthalmic FNAB is high but limited cellularity can compromise the diagnostic potential of ophthalmic aspirate samples. The role of ophthalmic FNAB is limited in retinal tumors. Orbital FNAB should be considered in the evaluation of lacrimal gland tumors, orbital metastasis, and lymphoproliferative lesions. Negative cytologic diagnosis of malignancy should not be considered unequivocal proof that an intraocular malignancy does not exist. With improved understanding of genetic prognostic factors of uveal melanoma, ophthalmic FNAB is gaining popularity for prognostic purposes in combination with eye conserving treatment of the primary tumor. In special clinical indications, ancillary studies such as immunohistochemistry and FISH can be performed on ophthalmic FNAB samples. Assistance of an experienced cytopathologist cannot be overemphasized. PMID:23960981

  16. Coronary air embolism treated with aspiration catheter

    OpenAIRE

    Patterson, M S; Kiemeneij, F.

    2005-01-01

    Coronary air embolism remains a recognised complication of coronary catheterisation despite a strong emphasis on prevention. Current treatment consists of supportive measures with 100% oxygen and analgesia. Recent case reports describe the use of mechanical treatments aimed at dispersing or removing the air embolus with variable success. A case of coronary air embolism causing an acute coronary syndrome is described that was definitively treated with an aspiration system. The effectiveness of...

  17. Palm oil: a healthful and cost-effective dietary component.

    Science.gov (United States)

    Ong, A S H; Goh, S H

    2002-03-01

    Palm oil is an excellent choice for food manufacturers because of its nutritional benefits and versatility. The oil is highly structured to contain predominantly oleic acid at the sn2-position in the major triacylglycerols to account for the beneficial effects described in numerous nutritional studies. Oil quality and nutritional benefits have been assured for the variety of foods that can be manufactured from the oil directly or from blends with other oils while remaining trans-free. The oxidative stability coupled with the cost-effectiveness is unparalleled among cholesterol-free oils, and these values can be extended to blends of polyunsaturated oils to provide long shelf-life. Presently the supply of genetic-modification-free palm oil is assured at economic prices, since the oil palm is a perennial crop with unparalleled productivity. Numerous studies have confirmed the nutritional value of palm oil as a result of the high monounsaturation at the crucial 2-position of the oil's triacylglycerols, making the oil as healthful as olive oil. It is now recognized that the contribution of dietary fats to blood lipids and cholesterol modulation is a consequence of the digestion, absorption, and metabolism of the fats. Lipolytic hydrolysis of palm oil glycerides containing predominantly oleic acid at the 2 position and palmitic and stearic acids at the 1 and 3 positions allows for the ready absorption of the 2-monoacrylglycerols while the saturated free fatty acids remain poorly absorbed. Dietary palm oil in balanced diets generally reduced blood cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides while raising the high-density lipoprotein (HDL) cholesterol. Improved lipoprotein(a) and apo-A1 levels were also demonstrated from palm oil diets; an important benefits also comes from the lowering of blood triglycerides (or reduced fat storage) as compared with those from polyunsaturated fat diets. Virgin palm oil also provides carotenes apart from

  18. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults.

    Science.gov (United States)

    Carson-Chahhoud, Kristin V; Wakai, Abel; van Agteren, Joseph Em; Smith, Brian J; McCabe, Grainne; Brinn, Malcolm P; O'Sullivan, Ronan

    2017-09-07

    difference (MD) -1.66, 95% CI -2.28 to -1.04; 387 participants, 5 studies; moderate-quality evidence). A narrative synthesis of evidence revealed that simple aspiration led to fewer adverse events (245 participants, 3 studies; low-quality evidence), but data suggest no differences between groups in terms of one-year success rate (RR 1.07, 95% CI 0.96 to 1.18; 318 participants, 4 studies; moderate-quality evidence), hospitalization rate (RR 0.60, 95% CI 0.25 to 1.47; 245 participants, 3 studies; very low-quality evidence), and patient satisfaction (median between-group difference of 0.5 on a scale from 1 to 10; 48 participants, 1 study; low-quality evidence). No studies provided data on cost-effectiveness. Available trials showed low to moderate-quality evidence that intercostal tube drainage produced higher rates of immediate success, while simple aspiration resulted in a shorter duration of hospitalization. Although adverse events were reported more commonly for patients treated with tube drainage, the low quality of the evidence warrants caution in interpreting these findings. Similarly, although this review observed no differences between groups when early failure rate, one-year success rate, or hospital admission rate was evaluated, this too needs to be put into the perspective of the quality of evidence, specifically, for evidence of very low and low quality for hospitalization rate and patient satisfaction, respectively. Future adequately powered research is needed to strengthen the evidence presented in this review.

  19. Role of AgNORs in thyroid lesions on fine needle aspiration cytology smears

    Directory of Open Access Journals (Sweden)

    Asotra Sarita

    2008-01-01

    Full Text Available Background: Fine needle aspiration has an important role in diagnosis of thyroid neoplasm. However, it is difficult to differentiate between follicular adenoma and follicular carcinoma by cytology alone. Recently, silver staining has been performed for nucleolar organizer regions (AgNORs to differentiate various tumors. Aims: The present study was undertaken to see if the AgNOR technique could distinguish between benign and malignant lesions, particularly, follicular neoplasm. Materials and Methods: One hundred forty cases of thyroid lesions were examined, which included colloid goiter (n = 36, multinodular goiter (n = 38, subacute thyroiditis (n = 6, Hashimoto′s thyroiditis (n = 17, lymphocytic thyroiditis (n = 3, follicular neoplasm (n = 18, Hurthle cell neoplasm (n = 3, papillary carcinoma (n = 16, and medullary carcinoma (n = 3. Diagnosis was confirmed by histopathology in 80 cases. The usual one-step silver colloidal reaction was performed at room temperature for 35 minutes and intranuclear dots of silver deposits were counted in 100 cells. Results: AgNOR counts of benign and malignant lesions were compared and were found to be statistically significant (P < 0.001. The mean AgNOR counts were higher in neoplastic lesions. Conclusions: AgNOR counting in fine needle aspiration smears is a simple, sensitive, and cost-effective method for differentiating benign from malignant thyroid follicular neoplasms.

  20. Diagnosis and reporting of follicular-patterned thyroid lesions by fine needle aspiration.

    Science.gov (United States)

    Faquin, William C

    2009-03-01

    Over the past 3 decades, fine needle aspiration (FNA) has developed as the most accurate and cost-effective initial method for guiding the clinical management of patients with thyroid nodules. Thyroid FNA specimens containing follicular-patterned lesions are the most commonly encountered and include various forms of benign thyroid nodules, follicular carcinomas, and the follicular variant of papillary thyroid carcinoma. Based primarily upon the cytoarchitectural pattern, FNA is used as a screening test for follicular-patterned lesions to identify the majority of patients with benign nodules who can be managed without surgical intervention. The terminology and reporting of thyroid FNA results have been problematic due to significant variation between laboratories, but the recent multidisciplinary NCI Thyroid FNA State of the Science Conference has provided a seven-tiered diagnostic solution. A key element of this approach is the category "atypical cells of undetermined significance" (ACUS) which is used for those aspirates which cannot be easily classified as benign, suspicious, or malignant. Lesions in this category represent approximately 3-6% of thyroid FNAs and have a risk of malignancy intermediate between the "benign" category and the "suspicious for a follicular neoplasm" category. The recommended follow-up for an ACUS diagnosis is clinical correlation and in most cases, repeat FNA sampling.

  1. Technology strategy for cost-effective drilling and intervention; Technology Target Areas; TTA4 - Cost effective drilling and intervention

    Energy Technology Data Exchange (ETDEWEB)

    2007-07-01

    The main goals of the OG21 initiative are to (1) develop new technology and knowledge to increase the value creation of Norwegian oil and gas resources and (2) enhance the export of Norwegian oil and gas technology. The OG21 Cost-effective Drilling and Intervention (CEDI) Technology Target Area (TTA) has identified some key strategic drilling and well intervention needs to help meet the goals of OG21. These key strategic drilling and well intervention needs are based on a review of present and anticipated future offshore-Norway drilling and well intervention conditions and the Norwegian drilling and well intervention industry. A gap analysis has been performed to assess the extent to which current drilling and well intervention research and development and other activities will meet the key strategic needs. Based on the identified strategic drilling and well intervention needs and the current industry res each and development and other activities, the most important technology areas for meeting the OG21 goals are: environment-friendly and low-cost exploration wells; low-cost methods for well intervention/sidetracks; faster and extended-reach drilling; deep water drilling, completion and intervention; offshore automated drilling; subsea and sub-ice drilling; drilling through basalt and tight carbonates; drilling and completion in salt formation. More specific goals for each area: reduce cost of exploration wells by 50%; reduce cost for well intervention/sidetracks by 50%; increase drilling efficiency by 40%; reduce drilling cost in deep water by 40 %; enable offshore automated drilling before 2012; enable automated drilling from seabed in 2020. Particular focus should be placed on developing new technology for low-cost exploration wells to stem the downward trends in the number of exploration wells drilled and the volume of discovered resources. The CEDI TTA has the following additional recommendations: The perceived gaps in addressing the key strategic drilling and

  2. On the potential cost effectiveness of scientific audits.

    Science.gov (United States)

    Click, J L

    1989-09-01

    inefficient process for uncovering scientific fraud (5, 6, 9). Data from a survey of university scientists was also presented, indicating ". . . a reluctance to take prompt, corrective action not only when an investigator suspects another of misconduct but also should the investigator discover flaws in his or her own published reports-whether the flaws were the result of honest error or fraud"; (10). The uncritical acceptance by established scientists that the self-correcting process works compounds the problem. The Editor of Science has written that";. . . 99.9999 percent of reports are accurate and truthful. . ."; (8). If indeed only 0.0001% of published reports were inaccurate or untruthful, there would be little justification for scientific audits. However, congressional testimony from the National Institutes of Health (NIH) revealed that";. . . the NIH Director's office has handled an average of 15-20 allegations and reports of misconduct annually in its extramural programs, which supports the work of approximately 50,000 scientists"; (11). As I shall attempt to demonstrate, since NIH alone receives fraud-related complaints concerning the work of at least 0.03% of scientists it supports in other institutions, and since evidence indicates that the incidence of fraud is considerably greater than 0.03% (10, 12), the need to audit data is justifiable on the basis of being cost effective.

  3. New tools for cost-effective delivery of breast imaging.

    Science.gov (United States)

    Kolb, Gerald R

    2002-01-01

    Breast imaging has a deserved reputation as a very difficult financial proposition for hospitals. Regulation, low reimbursement, costly new technologies and staff shortages all combine to create an operational environment that is difficult, at best. While it may not be possible for every hospital to make breast imaging profitable, it is the obligation of every hospital to make this and all service lines as cost-effective as possible. While the typical care episode in a hospital will include several different services or procedures, the breast-imaging patient is typically in the department or breast center for a single procedure. Consequently, all of the administrative and facility costs of the patient encounter must be borne by the reimbursement for the single procedure. Breast imaging involves relatively expensive technology and highly-trained, and costly, technologists in its delivery. The costs of these inputs are relatively fixed; therefore material improvement can only be realized through the redesign of process. Analysis of the process of care delivery is critical to any discussion of the economics of breast imaging. Breast imaging can basically be divided into two categories: screening mammography and diagnostic procedures. This is a very important distinction, because screening mammography requires only general supervision, while the balance of breast imaging requires the direct supervision of the physician. Decoupling the physician from the examination allows the organization of screening delivery programs in highly efficient, high-throughput systems. On the diagnostic side of breast imaging, the primary economic enhancement that can be realized is from the delivery of more than one procedure during the patient visit. Mammography has high fixed costs (technology and technologist) and, where high fixed costs are found, profitability is determined by process and volume. Where process can be optimized to a level that will allow a positive return for each

  4.  Cost-effectiveness of medicine vs. endoscopy for dyspeptic patients

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Lauritzen, Torsten; Christensen, Bo

      Background: Decision analyses conclude that empirical anti-secretory therapy is more cost-effective than endoscopy for managing patients with dyspepsia however RCTs including economic evaluation come to diverging results Aim: to compare the cost-effectiveness of two strategies for management of...

  5. Cost-effectiveness of HIV screening of patients attending clinics for sexually transmitted diseases in Amsterdam

    NARCIS (Netherlands)

    Bos, JM; Fennema, JSA; Postma, MJ

    2001-01-01

    Objective: To estimate the cost-effectiveness of universal HIV screening of patients attending a clinic for sexually transmitted diseases (STD) in Amsterdam. Design: Cost effectiveness analysis. Methods: A Bernoulli model for the secondary transmission of HIV was linked with epidemiological data on

  6. Cost-effectiveness of a randomised trial of physical activity in Alzheimer's disease

    DEFF Research Database (Denmark)

    Sopina, Elizaveta; Sørensen, Jan; Beyer, Nina

    2017-01-01

    Objectives To explore the cost-effectiveness of a supervised moderate-To-high intensity aerobic exercise programme in people diagnosed with Alzheimer's disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health...

  7. 10 CFR 436.42 - Evaluation of Life-Cycle Cost Effectiveness.

    Science.gov (United States)

    2010-01-01

    ...) ENERGY STAR qualified and FEMP designated products may be assumed to be life-cycle cost-effective. (b) In... 10 Energy 3 2010-01-01 2010-01-01 false Evaluation of Life-Cycle Cost Effectiveness. 436.42... PROGRAMS Agency Procurement of Energy Efficient Products § 436.42 Evaluation of Life-Cycle...

  8. Universal HIV screening of pregnant women in England : cost effectiveness analysis

    NARCIS (Netherlands)

    Postma, Maarten; Beck, E J; Mandalia, S; Sherr, L; Walters, M D; Houweling, H; Jager, Johannes C

    1999-01-01

    OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital

  9. Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Johns Benjamin P

    2010-03-01

    Full Text Available Abstract Background Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others. In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario would not be cost effective. In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage.

  10. Cost-effectiveness of HIV screening of patients attending clinics for sexually transmitted diseases in Amsterdam

    NARCIS (Netherlands)

    Bos, JM; Fennema, JSA; Postma, MJ

    2001-01-01

    Objective: To estimate the cost-effectiveness of universal HIV screening of patients attending a clinic for sexually transmitted diseases (STD) in Amsterdam. Design: Cost effectiveness analysis. Methods: A Bernoulli model for the secondary transmission of HIV was linked with epidemiological data on

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for North Carolina

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in North Carolina. Moving to the 2015 IECC from the 2012 North Carolina State Code base code is cost-effective for residential buildings in all climate zones in North Carolina.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Hampshire

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Hampshire. Moving to the 2015 IECC from the 2010 New Hampshire State Code base code is cost-effective for residential buildings in all climate zones in New Hampshire.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Jersey

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Jersey. Moving to the 2015 IECC from the 2015 New Jersey State Code base code is cost-effective for residential buildings in all climate zones in New Jersey.

  14. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands

    NARCIS (Netherlands)

    Henry, Thea L.; de Brouwer, Bonnie F.E.; van Keep, Marjolein M.L.; Blankestijn, Peter J.; Bots, Michiel L.; Koffijberg, Hendrik

    2015-01-01

    Objectives: Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the

  15. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in the Netherlands

    NARCIS (Netherlands)

    Henry, Thea L.; De Brouwer, Bonnie F E; Van Keep, Marjolijn M L; Blankestijn, Peter J.; Bots, Michiel L.; Koffijberg, Hendrik

    2015-01-01

    Objectives: Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the

  16. Cost-effectiveness of cervical cancer screening: Cytology versus human papillomavirus DNA testing

    NARCIS (Netherlands)

    J.M. van Rosmalen (Joost); I.M.C.M. de Kok (Inge); M. van Ballegooijen (Marjolein)

    2012-01-01

    textabstractObjective To determine the most cost-effective screening programme for cervical cancer. Design Cost-effectiveness analysis from a societal perspective. Setting The Netherlands. Population Dutch women who have not been invited for human papillomavirus (HPV) vaccination. Methods We calibra

  17. Cost-effectiveness of cervical cancer screening: Cytology versus human papillomavirus DNA testing

    NARCIS (Netherlands)

    J.M. van Rosmalen (Joost); I.M.C.M. de Kok (Inge); M. van Ballegooijen (Marjolein)

    2012-01-01

    textabstractObjective To determine the most cost-effective screening programme for cervical cancer. Design Cost-effectiveness analysis from a societal perspective. Setting The Netherlands. Population Dutch women who have not been invited for human papillomavirus (HPV) vaccination. Methods We calibra

  18. Cost-Effectiveness Analysis of Early Reading Programs: A Demonstration with Recommendations for Future Research

    Science.gov (United States)

    Hollands, Fiona M.; Kieffer, Michael J.; Shand, Robert; Pan, Yilin; Cheng, Henan; Levin, Henry M.

    2016-01-01

    We review the value of cost-effectiveness analysis for evaluation and decision making with respect to educational programs and discuss its application to early reading interventions. We describe the conditions for a rigorous cost-effectiveness analysis and illustrate the challenges of applying the method in practice, providing examples of programs…

  19. Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial)

    NARCIS (Netherlands)

    Broekmans, FJM; Mol, F.; Mello, N.M.; Strandell, Annika; Strandell, Karin; Jurkovic, Davor; Ross, Jackie; Barnhart, K.; Yalcinkaya, Tamer; Verhoeve, H.R.; Graziosi, G.C.M.; Koks, Carolien A M; Klinte, Ingmar; Hogstrom, Lars; Janssen, Ineke; Kragt, Harry; Hoek, Annemieke; Trimbos-Kemper, Trudy; Willemsen, Wim; Ankum, W.M.; Mol, Benwillem; Wely, M.; van der Veen, Fulco; Hajenius, Petra J

    2015-01-01

    STUDY QUESTION: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? SUMMARY ANSWER: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoi

  20. Cost-effectiveness of HIV screening of blood donations in Accra (Ghana)

    NARCIS (Netherlands)

    van Hulst, Marinus; Sagoe, Kwamena W. C.; Vermande, Jacobien E.; van der Schaaf, Ido P.; Adriani, Willem P. A. van der Tuuk; Torpey, Kwasi; Ansah, Justina; Mingle, Julius A. A.; Sibinga, Cees Th. Smit; Postma, Maarten J.

    2008-01-01

    Objectives: Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP-NAT),

  1. Implementing a Cost Effectiveness Analyzer for Web-Supported Academic Instruction: A Campus Wide Analysis

    Science.gov (United States)

    Cohen, Anat; Nachmias, Rafi

    2009-01-01

    This paper describes the implementation of a quantitative cost effectiveness analyzer for Web-supported academic instruction that was developed in Tel Aviv University during a long term study. The paper presents the cost effectiveness analysis of Tel Aviv University campus. Cost and benefit of 3,453 courses were analyzed, exemplifying campus-wide…

  2. Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management

    NARCIS (Netherlands)

    Zwerink, Marlies; Effing, Tanja; Kerstjens, Huib A. M.; van der Valk, Paul; Brusse-Keizer, Marjolein; van der Palen, Job

    2016-01-01

    Introduction: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. Methods: A

  3. Living renal donors: optimizing the imaging strategy--decision- and cost-effectiveness analysis

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina); M.C.J.M. Kock (Marc); W. Weimar (Willem); K. Visser (Karen); M.G.M. Hunink (Myriam); J.N.M. IJzermans (Jan)

    2003-01-01

    textabstractPURPOSE: To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors. MATERIALS AND METHODS: In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced

  4. Cost effectiveness of guideline advice for children with asthma : a literature review

    NARCIS (Netherlands)

    Feenstra, Talitha L; Rutten-Van Mölken, Maureen P M H; Jager, Johannes C; Van Essen-Zandvliet, Liesbeth E M

    2002-01-01

    Asthma is an important chronic disease among children. This study reviews the cost effectiveness of interventions in the long-term care of asthmatic children and compares these results with treatment advice in four current guidelines. Cost-effectiveness studies were searched for in Medline, Embase,

  5. Universal HIV screening of pregnant women in England : cost effectiveness analysis

    NARCIS (Netherlands)

    Postma, Maarten; Beck, E J; Mandalia, S; Sherr, L; Walters, M D; Houweling, H; Jager, Johannes C

    1999-01-01

    OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital

  6. Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data

    NARCIS (Netherlands)

    Ploeg, C.P.B. van der; Akker-van Marle, M.E. van den; Vernooij-van Langen, A.M.M.; Elvers, L.H.; Gille, J.J.P.; Verkerk, P.H.; Dankert-Roelse, J.E.; Loeber, J.G.; Triepels, R.H.; Pal, S.M. van der; Dompeling, E.; Pals, G.; Gulmans, V.A.M.; Oey-Spauwen, M.J.W.; Wijnands, Y.H.H.M.; Castricum, L.M.; Arets, H.G.M.; Ent, C.K. van der; Tiddens, H.A.W.M.; Rijke, Y.B. de; Yntema, J.B.

    2015-01-01

    BACKGROUND: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. METHODS: We used primary data to compare cost-effectiveness of four screening strategie

  7. Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data

    NARCIS (Netherlands)

    van der Ploeg, C. P B; van den Akker-van Marle, M. E.; Vernooij-van Langen, A. M M; Elvers, L. H.; Gille, J. J P; Verkerk, P. H.; Dankert-Roelse, J. E.; Dankert-Roelse, J. E.; Vernooij-van Langen, A. M M; Loeber, J. G.; Elvers, L. H.; Triepels, R. H.; Gille, J. J P; Van der Ploeg, C. P B; van der Pal, S. M.; Dompeling, E.; Pals, G.; van den Akker van Marle, M. E.; Gulmans, V. A M; Oey-Spauwen, M. J W; Wijnands, Y. H H M; Castricum, L. M.; Arets, H. G M; van der Ent, C. K.; Tiddens, H. A W M; de Rijke, Y. B.; Yntema, J. B.

    2015-01-01

    Background: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. Methods: We used primary data to compare cost-effectiveness of four screening strategie

  8. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    Science.gov (United States)

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  9. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands

    NARCIS (Netherlands)

    Henry, Thea L.; Brouwer, de Bonnie F.E.; Keep, van Marjolein M.L.; Blankestijn, Peter J.; Bots, Michiel L.; Koffijberg, Hendrik

    2015-01-01

    Objectives: Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the per

  10. Cost-Effectiveness Analysis of Various Methods of Instruction in Developmental Mathematics.

    Science.gov (United States)

    Carman, Robert A.

    This paper examined in a critical fashion the existing applications of cost-effectiveness analysis in education, particularly the study of instructional effectiveness in the community college. Various schemes for measuring costs of instruction such as cost benefit analysis, cost-effectiveness analysis and planning programming budgeting systems…

  11. Manual on Cost-Effectiveness of Training Modalities in Population Education. Population Education Programme Service Series.

    Science.gov (United States)

    United Nations Educational, Scientific and Cultural Organization, Bangkok (Thailand). Principal Regional Office for Asia and the Pacific.

    This manual is the result of a regional training workshop on the cost-effectiveness of different training strategies in population education by Unesco in Kathmandu, Nepal, June 1-8, 1987. The purpose of the manual is to enable project staff to initiate studies to determine cost-effective training strategies in population growth control education.…

  12. Cost-effectiveness and evidence-based policy : Steering on social Impact

    NARCIS (Netherlands)

    van Yperen, Tom

    2016-01-01

    Introduction - The cost-effectiveness of many services is unknown. Because the demand for services is growing, whereas budgets are cut, the issue how to enhance the cost-effectiveness of Child and Youth Care is urgent in day to day politics and practice. The NJi developed a working model that helps

  13. Practical implications of differential discounting in cost-effectiveness analyses with varying numbers of cohorts

    NARCIS (Netherlands)

    O'Mahony, J.F.; de Kok, I.M.; van Rosmalen, Joost; Habbema, J.D.; Brouwer, Werner; van Ballegooijen, Marjolein

    2011-01-01

    OBJECTIVE: To call attention to the influence of the number of birth-cohorts used in cost-effectiveness analysis (CEA) models on incremental cost-effectiveness ratios (ICERs) under differential discounting. METHODS: The consequences of increasing the number of birth-cohorts are demonstrated using a

  14. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laustsen, Jesper; Lindholt, Jes Sanddal

    2012-01-01

    To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.......To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service....

  15. Cost effectiveness of treatments for wet age-related macular degeneration.

    Science.gov (United States)

    Mitchell, Paul; Annemans, Lieven; White, Richard; Gallagher, Meghan; Thomas, Simu

    2011-02-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged ≥50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination and Cochrane Library databases were searched for all wet AMD health technology assessments (HTAs). Overall, 44 publications were evaluated in full and included in this review. A broad range of cost-effectiveness analyses were identified for the most commonly used therapies for wet AMD (pegaptanib, ranibizumab and photodynamic therapy [PDT] with verteporfin). Three studies evaluated the cost effectiveness of bevacizumab in wet AMD. A small number of analyses of other treatments, such as laser photocoagulation and antioxidant vitamins, were also found. Ranibizumab was consistently shown to be cost effective for wet AMD in comparison with all the approved wet AMD therapies (four of the five studies identified showed ranibizumab was cost effective vs usual care, PDT or pegaptanib); however, there was considerable variation in the methodology for cost-effectiveness modelling between studies. Findings from the HTAs supported those from the PubMed and EMBASE searches; of the seven HTAs that included ranibizumab, six (including HTAs for Australia, Canada and the UK) concluded that ranibizumab was cost effective for the treatment of wet AMD; most compared ranibizumab with PDT and/or pegaptanib. By contrast, HTAs at best generally recommended pegaptanib or PDT for restricted use in subsets of patients with wet AMD. In the literature analyses, pegaptanib was found to be cost effective versus usual/best supportive care (including PDT) or no treatment in one of five studies; the other four

  16. Long-term cost-effectiveness of single indirect restorations in selected dental practices.

    Science.gov (United States)

    Kelly, P G; Smales, R J

    2004-05-22

    To determine the relative cost-effectiveness of alternative methods for restoring large tooth substance loss in adults. Long-term survival estimates and discounted costs for 245 large indirect restorations were used to calculate their incremental cost-effectiveness over 15 years when compared with direct placement Class II cusp-overlay amalgams and Class IV multisurface resin composites, placed in 100 patients from three private dental practices. The direct placement restorations were more cost-effective than the indirect restorations at all time intervals over the 15-year study period. The full gold crown and the ceramometal crown were the most cost-effective indirect posterior and anterior restorations respectively. The cast gold onlay and the porcelain jacket crown were the least cost-effective indirect posterior and anterior restorations respectively. When clinically practicable, large direct placement restorations should be placed initially in preference to indirect restorations.

  17. Fine Needle Aspiration Cytology of Thyroid Nodules: Correlation with Surgical Histopathology Histopathology

    Directory of Open Access Journals (Sweden)

    Nargess Ghazaleh

    2008-01-01

    Full Text Available Objective: Approximately 7% of people have thyroid nodules. The most important consideration in evaluating patients with thyroid nodules is whether the nodule is malignant. Fine needle aspiration (FNA biopsy is the best, safest, and most cost-effective measure for distinguishing malignancy, thus preventing unnecessary surgeries. In this survey, adequacy of smears, cytologic findings, histologic findings, and their concordance, have been studied. Materials and Methods: FNA biopsy was performed in 200 patients with palpable thyroid nodules in 2004-2005. Cytologic findings and adequacy of specimens were recorded. Of the 200 patients, 39 had surgery; postoperative histological results were compared with FNA biopsy results.Results: Of FNA smears, 88% were adequate; of these adequate smears, 57.2% were benign, 34.2% were suspicious for malignancy, and 8.6% were reported as malignant. When results of surgical pathology were compared with FNA cytology results, all benign surgical specimens also had benign cytology results, and all malignant surgical specimens had malignant results on cytology evaluation. In nodules with suspicious cytology, histopathology showed that 50% were malignant and 50% were benign.Conclusions: FNA is a simple and cost-effective procedure for identifying benign and malignant nodules. The incidence of malignant pathology in nodules with suspicious cytology was higher than other studies.Turk Jem 2008; 12: 73-4

  18. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.

    Science.gov (United States)

    Taylor, Penny; Pezzullo, Lynne; Grant, Suzanne J; Bensoussan, Alan

    2014-09-01

    Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta-analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost-effectiveness analysis were the incremental cost-effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability-adjusted life-year (DALY) saved. The WHO benchmark for a very highly cost-effective intervention is one that costs less than gross domestic product per capita per quality-adjusted life-year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP.

  19. Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

    Science.gov (United States)

    Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

    2016-01-01

    Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a

  20. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer☆

    Science.gov (United States)

    Duarte, A.; Walker, J.; Walker, S.; Richardson, G.; Holm Hansen, C.; Martin, P.; Murray, G.; Sculpher, M.; Sharpe, M.

    2015-01-01

    Objectives Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. Methods Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained. Results DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses. Conclusions Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings. PMID:26652589

  1. Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-05-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

  2. Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

    Science.gov (United States)

    Emmett, Susan D; Tucci, Debara L; Bento, Ricardo F; Garcia, Juan M; Juman, Solaiman; Chiossone-Kerdel, Juan A; Liu, Ta J; de Muñoz, Patricia Castellanos; Ullauri, Alejandra; Letort, Jose J; Mansilla, Teresita; Urquijo, Diana P; Aparicio, Maria L; Gong, Wenfeng; Francis, Howard W; Saunders, James E

    2016-09-01

    Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

  3. When Aspirations Exceed Expectations: Quixotic Hope Increases Depression among Students.

    Directory of Open Access Journals (Sweden)

    Katharine H Greenaway

    Full Text Available A paradox exists in modern schooling: students are simultaneously more positive about the future and more depressed than ever. We suggest that these two phenomena may be linked. Two studies demonstrated that students are more likely to be depressed when educational aspirations exceed expectations. In Study 1 (N = 85 aspiring to a thesis grade higher than one expected predicted greater depression at the beginning and end of the academic year. In Study 2 (N = 2820 aspiring to a level of education (e.g., attending college higher than one expected to achieve predicted greater depression cross-sectionally and five years later. In both cases the negative effects of aspiring high while expecting low persisted even after controlling for whether or not students achieved their educational aspirations. These findings highlight the danger of teaching students to aspire higher without also investing time and money to ensure that students can reasonably expect to achieve their educational goals.

  4. Correlation of gastroesophageal reflex with aspiration pneumonia after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hirashima, Tokuji; Hashimoto, Hajime; Noro, Toshio; Takahashi, Tadao; Hino, Yasunori; Kuroiwa, Kouzirou [Tokyo Metropolitan Geriatric Medical Center (Japan)

    1996-08-01

    In order to elucidate the correlation of gastroesophageal reflex (GER) with aspiration pneumonia after surgery, 48 patients (mean, 75.6 years) with gastric cancer treated at the hospital from March, 1994 to December, 1994 were subjected to this prospective study. The pharyngeal stimulation test, nutritional assessment, radionuclide esophageal scintigraphy (34 cases) were performed before surgery and relationship between those results and aspiration pneumonia were studied. Aspiration pneumonia occurred in 3 cases, and all of them were in, significantly, poor nutritional status, compared with other. A significant increase in the frequency of GER was observed when a naso-gastric tube (NGT) was placed, but surprisingly, all the patients with aspiration pneumonia were 3 out of 4 patients who had continuous GER without NGT. It is noteworthy, continuous GER without NGT was significantly (p<0.001) affected postoperative aspiration pneumonia and impaired phalyngeal reflex was frequently correlated with development of aspiration pneumonia, when malnutritional status existed. (author)

  5. When Aspirations Exceed Expectations: Quixotic Hope Increases Depression among Students.

    Science.gov (United States)

    Greenaway, Katharine H; Frye, Margaret; Cruwys, Tegan

    2015-01-01

    A paradox exists in modern schooling: students are simultaneously more positive about the future and more depressed than ever. We suggest that these two phenomena may be linked. Two studies demonstrated that students are more likely to be depressed when educational aspirations exceed expectations. In Study 1 (N = 85) aspiring to a thesis grade higher than one expected predicted greater depression at the beginning and end of the academic year. In Study 2 (N = 2820) aspiring to a level of education (e.g., attending college) higher than one expected to achieve predicted greater depression cross-sectionally and five years later. In both cases the negative effects of aspiring high while expecting low persisted even after controlling for whether or not students achieved their educational aspirations. These findings highlight the danger of teaching students to aspire higher without also investing time and money to ensure that students can reasonably expect to achieve their educational goals.

  6. Risk Factors for Aspiration Pneumonia in Older Adults

    OpenAIRE

    2015-01-01

    BackgroundsAspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly.Methodology and Principal FindingsWe conducted an observational study using data from a nationwide survey of geri...

  7. Risk Factors for Aspiration Pneumonia in Older Adults

    OpenAIRE

    2015-01-01

    Backgrounds Aspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly. Methodology and Principal Findings We conducted an observational study using data from a nationwide survey of g...

  8. Changing educational aspirations of children living in poverty in Ethiopia

    OpenAIRE

    2010-01-01

    Using both qualitative and quantitative data, this paper examines the changing educational and occupational aspirations and educational achievements of children living in poor communities in Ethiopia. The results suggest that children had high aspirations at an earlier age but that these changed later, with poverty rarely influencing their earlier aspirations but having a strong impact later on. Children with high educational achievement, mostly urban children and some rural girls, maintained...

  9. Foreign Body Aspiration in Children-a Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    Slobodanka Petrovic

    2012-03-01

    Full Text Available The clinical presentation of foreign body aspiration in children is variable. Clinicians should maintain a high index of suspicion in order to make a prompt and correct diagnosis. In this paper,we present a case of foreign body aspiration that had gone unrecognized for 54 days. Foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms usually consistent with airway obstruction which is refractory to medical treatment.

  10. Comparison of Fine Needle Aspiration and Fine Needle Nonaspiration Cytology of Thyroid Nodules: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Hongming Song

    2015-01-01

    Full Text Available Background. Fine needle aspiration cytology (FNAC and fine needle nonaspiration cytology (FNNAC are useful cost-effective techniques for preoperatively assessing thyroid lesions. Both techniques have advantages and disadvantages, and there is controversy over which method is superior. This meta-analysis was performed to evaluate the differences between FNAC and FNNAC for diagnosis of thyroid nodules. Methods. Primary publications were independently collected by two reviewers from PubMed, Web of Science, Google Scholar, EBSCO, OALib, and the Cochrane Library databases. The following search terms were used: fine needle, aspiration, capillary, nonaspiration, sampling without aspiration, thyroid, and cytology. The last search was performed on February 1, 2015. Results. Sixteen studies comprising 1,842 patients and 2,221 samples were included in this study. No statistically significant difference was observed between FNAC and FNNAC groups with respect to diagnostically inadequate smears, diagnostically superior smears, diagnostic performance (accuracy, sensitivity, specificity, negative predictive value, and positive predictive value, area under the summary receiver operating characteristic curve, average score of each parameter (background blood or clot, amount of cellular material, degree of cellular degeneration, degree of cellular trauma, and retention of appropriate architecture, and total score of five parameters. Conclusion. FNAC and FNNAC are equally useful in assessing thyroid nodules.

  11. Image-Guided Fine Needle Cytology with Aspiration Versus Non-Aspiration in Retroperitoneal Masses: Is Aspiration Necessary?

    Directory of Open Access Journals (Sweden)

    Rajiv Kumar Misra

    2015-03-01

    Full Text Available Background: Although using fine needle cytology with aspiration (FNC-A for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Methods: Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. Results: By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%. The diagnostic accuracy of other sites by FNC-A varied from 75.0%–81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%–72.8%. Conclusions: Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.

  12. Screening, prevention and treatment of cervical cancer -- a global and regional generalized cost-effectiveness analysis.

    Science.gov (United States)

    Ginsberg, Gary Michael; Edejer, Tessa Tan-Torres; Lauer, Jeremy A; Sepulveda, Cecilia

    2009-10-09

    The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, treatment and combined interventions for cervical cancer. Using standardised WHO-CHOICE methodology, a cervical cancer model was employed to provide estimates of screening, vaccination and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. In regions characterized by high income, low mortality and high existing treatment coverage, the addition of any screening programme to the current high treatment levels is very cost-effective. However, based on projections of the future price per dose (representing the economic costs of the vaccination excluding monopolistic rents and vaccine development cost) vaccination is the most cost-effective intervention. In regions characterized by low income, low mortality and existing treatment coverage around 50%, expanding treatment with or without combining it with screening appears to be cost-effective or very cost-effective. Abandoning treatment in favour of screening in a no-treatment scenario would not be cost-effective. Vaccination is usually the most cost-effective intervention. Penta or tri-annual PAP smears appear to be cost-effective, though when combined with HPV-DNA testing they are not cost-effective. In regions characterized by low income, high mortality and low treatment levels, expanding treatment with or without adding screening would be very cost-effective. A one off vaccination plus expanding treatment was usually very cost-effective. One-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. From a cost-effectiveness perspective, consideration should be given to implementing

  13. Performing a Better Bone Marrow Aspiration.

    Science.gov (United States)

    Friedlis, Mayo F; Centeno, Christopher J

    2016-11-01

    Bone marrow aspiration (BMA) is increasingly being used to harvest stem cells for use in regenerative medicine. The focus of BMA in interventional orthopedics is to maximize the yield of mesenchymal stem cells. The authors present an improved method for BMA that involves fluoroscope or ultrasound guidance combined with anesthesia; in the authors' experience, it produces the highest possible stem cell yield and is well tolerated by patients. The authors provide a step-by-step guide to the process, along with a discussion of technical and other considerations and quick reference guides for ultrasound- and fluoroscope-guided BMA. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Role of aspiration-induced migration in cooperation

    CERN Document Server

    Yang, Han-Xin; Wang, Bing-Hong

    2011-01-01

    Both cooperation and migration are ubiquitous in human society and animal world. In this Rapid Communication, we propose an aspiration-induced migration in which individuals will migrate to new sites provided that their payoffs are below some aspiration level. It is found that moderate aspiration level can best favor cooperative behavior. In particular, moderate aspiration level enables cooperator clusters to maintain and expand whereas induces defector clusters to disintegrate, thus promoting the diffusion of cooperation among population. Our results provide insights into understanding the role played by migration in the emergence of cooperative behavior.

  15. Laser-Assisted Removal of Aspirated Thumbtacks by Flexible Bronchoscopy

    Directory of Open Access Journals (Sweden)

    Oren Fruchter

    2010-01-01

    Objectives. To describe a technique for removal of sharp aspirated metal objects employing laser through flexible bronchoscopy. Methods. We report two patients in whom a new technique for removal of sharp aspirated metal objects utilizing Nd-Yag laser flexible bronchoscopy was used. Results. Successful and uncomplicated removal of the aspirated thumbpack by flexible bronchoscopy under conscious sedation was accomplished in the two patients described. Both patients were discharged within 24 hours. Conclusions. In patients with aspirated thumbtack laser-assisted breakage of the object through flexible bronchoscopy may obviate the need for rigid bronchoscopy or thoracotomy.

  16. Silent aspiration: results of 2,000 video fluoroscopic evaluations.

    Science.gov (United States)

    Garon, Bernard R; Sierzant, Tess; Ormiston, Charles

    2009-08-01

    The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as "red-flag" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.

  17. Predictive factors for early aspiration in liver abscess

    Institute of Scientific and Technical Information of China (English)

    Rustam Khan; Saeed Hamid; Shahab Abid; Wasim Jafri; Zaigham Abbas; Mohammed Islam; Hasnain Shah; Shaalan Beg

    2008-01-01

    AIM: To determine the predictive factors for early aspiration in liver abscess.METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess.RESULTS: A total of 966 patients, 738 (76%) male, mean age 43 ± 17 years, were evaluated: 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were: age ≥ 55 years, size of abscess ≥ 5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group.CONCLUSION: Patients with advanced age, abscess size > 5 cm, both lobes of the liver involvement and duration of symptoms > 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.

  18. Gender, aspirations, and achievements : Relating work and family aspirations to occupational outcomes

    NARCIS (Netherlands)

    van der Horst, Mariska

    2014-01-01

    Although women have increased their labour market participation and educational level they still lag behind men in their occupational achievements. An important discussion in the literature as well as in popular media is whether this is due to a gender difference in aspirations. In this study the im

  19. Using propensity scores to estimate the cost-effectiveness of medical therapies.

    Science.gov (United States)

    Indurkhya, Alka; Mitra, Nandita; Schrag, Deborah

    2006-05-15

    The cost-effectiveness ratio is a popular statistic that is used by policy makers to decide which programs are cost-effective in the public health sector. Recently, the net monetary benefit has been proposed as an alternative statistical summary measure to overcome the limitations associated with the cost-effectiveness ratio. Research on using the net monetary benefit to assess the cost-effectiveness of therapies in non-randomized studies has yet to be done. Propensity scores are useful in estimating adjusted effectiveness of programs that have non-randomized or quasi-experimental designs. This article introduces the use of propensity score adjustment in cost-effectiveness analyses to estimate net monetary benefits for non-randomized studies. The uncertainty associated with the net monetary benefit estimate is evaluated using cost-effectiveness acceptability curves. Our method is illustrated by applying it to SEER-Medicare data for muscle invasive bladder cancer to determine the most cost-effective treatment protocol.

  20. A cost-effectiveness analysis of two different antimicrobial stewardship programs.

    Science.gov (United States)

    Okumura, Lucas Miyake; Riveros, Bruno Salgado; Gomes-da-Silva, Monica Maria; Veroneze, Izelandia

    2016-01-01

    There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective.

  1. Cost-effectiveness of interventions to prevent HIV and STDs among women: a randomized controlled trial.

    Science.gov (United States)

    Ruger, Jennifer Prah; Abdallah, Arbi Ben; Ng, Nora Y; Luekens, Craig; Cottler, Linda

    2014-10-01

    Injection drug use is a leading transmission route of HIV and STDs, and disease prevention among drug users is an important public health concern. This study assesses cost-effectiveness of behavioral interventions for reducing HIV and STDs infections among injection drug-using women. Cost-effectiveness analysis was conducted from societal and provider perspectives for randomized trial data and Bernoullian model estimates of infections averted for three increasingly intensive interventions: (1) NIDA's standard intervention (SI); (2) SI plus a well woman exam (WWE); and (3) SI, WWE, plus four educational sessions (4ES). Trial results indicate that 4ES was cost-effective relative to WWE, which was dominated by SI, for most diseases. Model estimates, however, suggest that WWE was cost-effective relative to SI and dominated 4ES for all diseases. Trial and model results agree that WWE is cost-effective relative to SI per hepatitis C infection averted ($109 308 for in trial, $6 016 in model) and per gonorrhea infection averted ($9 461 in trial, $14 044 in model). In sensitivity analysis, trial results are sensitive to 5 % change in WWE effectiveness relative to SI for hepatitis C and HIV. In the model, WWE remained cost-effective or cost-saving relative to SI for HIV prevention across a range of assumptions. WWE is cost-effective relative to SI for preventing hepatitis C and gonorrhea. WWE may have similar effects as the costlier 4ES.

  2. The cost-effectiveness of health communication programs: what do we know?

    Science.gov (United States)

    Hutchinson, Paul; Wheeler, Jennifer

    2006-01-01

    While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

  3. Aspiration Alone, Aspiration Plus Steroid Injection and Aspiration Plus Ethanol Injection for Treatment of Dorsal Wrist Ganglions: A Comparative Study among Three Methods

    Directory of Open Access Journals (Sweden)

    Khandoker Abdur Rahim

    2016-01-01

    Full Text Available Background: There are varieties of treatment modalities to treat dorsal wrist ganglion cysts. But none of these has been the standard. So, we designed this study to compare among different treatment modalities. Objective: To compare the effects of aspiration alone, aspiration plus methylprednisone injection and aspiration plus ethanol injection into the dorsal wrist ganglions. Materials and Methods: This prospective study was performed in Dhaka Medical College Hospital, Dhaka from March 2010 to May 2011. Sixty six patients with dorsal wrist ganglions were treated in three groups –– aspiration alone in 24 patients (Group A, aspiration plus methylprednisolone injection into the cyst in 20 patients (Group B and aspiration plus ethanol injection, then reaspiration of the ethanol from the cyst after 3–5 minutes, in 22 patients (Group C. Elastic compression bandage was applied in all patients and recommended for 3 weeks. Follow-up was done at 1, 3, 6 and 12 months and conclusive assessment was done during final visit. Results: The success rate in Group A was seen in 9 patients (37.5%, in Group B in 11 (55% and in Group C in 14 (63.5% patients. The most frequent side-effect was pain during ethanol injection which was relieved by reaspiration of cyst. Conclusion: Injection of ethanol into the dorsal wrist ganglion was associated with higher success rate compared to aspiration and methylprednisolone injection. Further studies with larger sample size should be performed to assess the effect of ethanol injection in this disease.

  4. The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales.

    Science.gov (United States)

    Atkins, Katherine E; Shim, Eunha; Carroll, Stuart; Quilici, Sibilia; Galvani, Alison P

    2012-11-01

    Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £ 60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58-96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.

  5. GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

    Science.gov (United States)

    Emmett, Susan D; Tucci, Debara L; Smith, Magteld; Macharia, Isaac M; Ndegwa, Serah N; Nakku, Doreen; Mukara, Kaitesi B; Kaitesi, Mukara B; Ibekwe, Titus S; Mulwafu, Wakisa; Gong, Wenfeng; Francis, Howard W; Saunders, James E

    2015-09-01

    Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost-effective threshold reached in all countries using discounted device costs that varied directly with GDP. Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi.

  6. Cost-effective strategies for rural community outreach, Hawaii, 2010-2011.

    Science.gov (United States)

    Pellegrin, Karen L; Barbato, Anna; Holuby, R Scott; Ciarleglio, Anita E; Taniguchi, Ronald

    2014-12-11

    Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event. Leveraging existing community events and employers in rural areas was more cost-effective than formal advertisement for recruiting rural community members.

  7. The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Uttley, Lesley; Stevenson, Matt; Scope, Alison; Rawdin, Andrew; Sutton, Anthea

    2015-07-07

    The majority of mental health problems are non-psychotic (e.g., depression, anxiety, and phobias). For some people, art therapy may be a more acceptable alternative form of psychological therapy than standard forms of treatment, such as talking therapies. This study was part of a health technology assessment commissioned by the National Institute for Health Research, UK and aimed to systematically appraise the clinical and cost-effective evidence for art therapy for people with non-psychotic mental health disorders. Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in May 2013. A quantitative systematic review of clinical effectiveness and a systematic review of studies evaluating the cost-effectiveness of group art therapy were conducted. Eleven randomised controlled trials were included (533 patients). Meta-analysis was not possible due to clinical heterogeneity and insufficient comparable data on outcome measures across studies. The control groups varied between studies but included: no treatment/wait-list, attention placebo controls and psychological therapy comparators. Art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 7 of the 11 studies. A de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control and group art therapy with group verbal therapy. Group art-therapy appeared cost-effective compared with wait-list control with high certainty although generalisability to the target population was unclear; group verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more cost effective. From the limited available evidence art therapy was associated with positive effects compared with

  8. Students' Aspirations, Expectations and School Achievement: What Really Matters?

    Science.gov (United States)

    Khattab, Nabil

    2015-01-01

    Using the Longitudinal Study of Young People in England (LSYPE), this study examines how different combinations of aspirations, expectations and school achievement can influence students' future educational behaviour (applying to university at the age of 17-18). The study shows that students with either high aspirations or high expectations have…

  9. Predictive Value and Psychological Meaning of Vocational Aspirations

    Science.gov (United States)

    Holland, John L.; Gottfredson, Gary D.

    1975-01-01

    The psychological meaning and predictive value of a person's vocational aspirations were examined by applying Holland's typology to the vocational aspirations of high school juniors (N=140), and a second sample of college students studied over a one-year interval (N-624). (Author)

  10. Life Aspirations, Values and Moral Foundations in Mongolian Youth

    Science.gov (United States)

    Bespalov, Alexander; Prudnikova, Marina; Nyamdorj, Bavuu; Vlasov, Mikhail

    2017-01-01

    Life aspirations have aroused much interest in youth studies. Yet, their psychological correlates remain unclear, especially in countries outside the US. The aim of this study was to explore associations among aspirations, values and moral foundations in 157 Mongolian youth, through questionnaires used widely around the world. Correlational and…

  11. 21 CFR 886.4150 - Vitreous aspiration and cutting instrument.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vitreous aspiration and cutting instrument. 886.4150 Section 886.4150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... cutting instrument. (a) Identification. A vitreous aspiration and cutting instrument is an...

  12. Study of Educational Aspirations of Preparatory School Students in Yemen.

    Science.gov (United States)

    Edington, Everett D.

    To identify causes for low enrollment in secondary agricultural schools in Yemen, the United States Agency for International Development and the Yemen Ministry of Education surveyed 990 preparatory (junior high) students, examining their educational aspirations, differences between rural and urban youth, major influences on student aspirations,…

  13. Students' Aspirations, Expectations and School Achievement: What Really Matters?

    Science.gov (United States)

    Khattab, Nabil

    2015-01-01

    Using the Longitudinal Study of Young People in England (LSYPE), this study examines how different combinations of aspirations, expectations and school achievement can influence students' future educational behaviour (applying to university at the age of 17-18). The study shows that students with either high aspirations or high expectations have…

  14. Psychological Empowerment and Adolescent Girls' Aspirations in India

    OpenAIRE

    Roy, Sanchari; Morton, Matthew; Bhattacharya, Shrayana

    2016-01-01

    This paper studies the role of social-emotional or psychological capital in determining the education and employment aspirations of adolescent girls and young women in India. The study finds that girls' self-efficacy and mental health are important determinants of their educational and employment aspirations, suggesting that these hidden forms of human capital may serve as critical targets...

  15. Efficiency and Power Consumption of Aspiration Systems at Woodworking Plants

    Directory of Open Access Journals (Sweden)

    P. I. Diachek

    2008-01-01

    Full Text Available The paper analyzes present state of the equipment and organization of aspiration at wood-working shops. Proposals pertaining to higher efficiency and reduction of power intensity of aspiration systems are given in the paper. Materials presented at the stage of designing make it possible to select a rational system scheme and reduce power expenditure at woodworking industry.

  16. Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness.

    Science.gov (United States)

    Goldfeld, K S

    2014-03-30

    Cost-effectiveness analysis is an important tool that can be applied to the evaluation of a health treatment or policy. When the observed costs and outcomes result from a nonrandomized treatment, making causal inference about the effects of the treatment requires special care. The challenges are compounded when the observation period is truncated for some of the study subjects. This paper presents a method of unbiased estimation of cost-effectiveness using observational study data that is not fully observed. The method-twice-weighted multiple interval estimation of a marginal structural model-was developed in order to analyze the cost-effectiveness of treatment protocols for advanced dementia residents living nursing homes when they become acutely ill. A key feature of this estimation approach is that it facilitates a sensitivity analysis that identifies the potential effects of unmeasured confounding on the conclusions concerning cost-effectiveness.

  17. [Cost-effectiveness of Antipsychotics in the Maintenance Treatment of Schizophrenia in Colombia].

    Science.gov (United States)

    Quitian Reyes, Hoover; Arciniegas Barrera, Jair Alberto; Bohórquez Peñaranda, Adriana; Gómez Restrepo, Carlos

    2016-01-01

    Assess the cost-effectiveness of the antipsychotics for treatment of schizophrenia. A five-year Markov model was built form patients with schizophrenia on the stage of maintenance. Costs were taken from the perspective of the Colombian health care system (Sistema General de Seguridad Social en Salud). The effectiveness was measured in years of life under the same maintenance plan. The Markov model indicated clozapine as the as the most cost-effective alternative between the first line antipsychotics and haloperidol is it when comparing other antipsychotics. Clozapine it's the cost-effectiveness strategy among the first line of antipsychotics and haloperidol is it among the other antipsychotics. Strategies prioritizing the use of cost-effective antipsychotics could improve the resources allocation in the Colombian health care system. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  18. Cost-effectiveness of diagnostic strategies for patients with chest pain

    NARCIS (Netherlands)

    Kuntz, KM; Fleischmann, KE; Hunink, MGM; Douglas, PS

    1999-01-01

    Background: Many noninvasive tests exist to determine whether patients should undergo coronary angiography. The routine use of coronary angiography without previous noninvasive testing is typically not advocated. Objective: To determine the cost-effectiveness of diagnostic strategies for patients wi

  19. Cost effectiveness analysis of strategies for tuberculosis control in developing countries

    NARCIS (Netherlands)

    K. Floyd (Katherine); C. Dye; R.M.P.M. Baltussen (Rob)

    2005-01-01

    textabstractOBJECTIVE: To assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals. DESIGN: Cost effectiveness analysis based on an epidemiological model. SETTING: Analyses undertaken

  20. Cost Effectiveness of Integrated Medicine in Patients With Cancer Receiving Anticancer Chemotherapy

    OpenAIRE

    Coriat, Romain; Boudou-Rouquette, Pascaline; Durand, Jean-Philippe; Forgeot d'Arc, Priscille; Martin, Idalie; Mir, Olivier; Ropert, Stanislas; Alexandre, Jérôme; Goldwasser, François

    2012-01-01

    The hospital-home monitoring program is a cost-effective strategy for offering ambulatory chemotherapy treatment to patients with cancer and has become the authors' standard procedure for ambulatory chemotherapy.

  1. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian Schultz

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...

  2. Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective To define TB control priorities using cost-effectiveness and burden of disease. Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters. Results DOTS reduced 89.19 % of YLL, 78.90% of YLD, and 99.98% of infectivity BOD. One DALY could be saved with 45.70 Yuan by DOTS with 3% discount. Sensitivity analysis showed that discount had effect on CER. Weight of age was insensitive to CER. The higher the DOTS cured rate, the more the cost-effectiveness. Conclusions DOTS is a good cost-effectiveness TB control strategy. Cost-effectiveness and burden of disease can be used to define TB control priorities.

  3. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Mangen, M.J.J.; Giaquinto, C.; Wilschut, J.C.; Hak, E.; Postma, M.J.

    2011-01-01

    Background: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showe

  4. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Mangen, M.J.; Giaquinto, C.; Wilschut, J.C.; Hak, E.; Postma, M.J.; Groot, R. de

    2011-01-01

    BACKGROUND: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showe

  5. Antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease: a cost effectiveness analysis

    NARCIS (Netherlands)

    P. Krijnen (Pieta); C.J. Kaandorp; E.W. Steyerberg (Ewout); D. van Schaardenburg (Dirkjan); H.J. Moens; J.D.F. Habbema (Dik)

    2001-01-01

    textabstractOBJECTIVE: To assess the cost effectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease. METHODS: In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint dise

  6. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Mangen, M.J.J.; Giaquinto, C.; Wilschut, J.C.; Hak, E.; Postma, M.J.

    2011-01-01

    Background: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies

  7. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Mangen, M.J.; Giaquinto, C.; Wilschut, J.C.; Hak, E.; Postma, M.J.; Groot, R. de

    2011-01-01

    BACKGROUND: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies

  8. Economic evaluation of universal 7-valent pneumococcal conjugate vaccination in Taiwan: A cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    David Bin Chia Wu

    2013-03-01

    Conclusion: Taking herd effect and indirect costs into account, PCV7 vaccination is cost-effective in Taiwan. Further pharmacoeconomic model should include herd effect in CEA of infectious disease research.

  9. Costs, effects, and savings of screening for cystic fibrosis gene carriers

    NARCIS (Netherlands)

    M.F. Wildhagen (Mark); H.B. Hilderink; J.G. Verzijl; J.B. Verheij (Joke); L. Kooij (Loes); T. Tijmstra; L.P. ten Kate; J.D.F. Habbema (Dik)

    1998-01-01

    textabstractSTUDY OBJECTIVE: Evaluating the costs, effects, and savings of several strategies for cystic fibrosis (CF) gene carrier screening. DESIGN: A general model for evaluating prenatal, preconceptional, school, and neonatal carrier screening was constructed. For p

  10. A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines.

    Science.gov (United States)

    Lutgens, Maurice; van Oijen, Martijn; Mooiweer, Erik; van der Valk, Mirthe; Vleggaar, Frank; Siersema, Peter; Oldenburg, Bas

    2014-11-01

    Colonoscopic surveillance for neoplasia is recommended for patients with inflammatory bowel disease (IBD)-related colitis. However, data on cost-effectiveness predate current international guidelines. To compare cost-effectiveness based on contemporary data between the surveillance strategies of the American Gastroenterological Association (AGA) and British Society of Gastroenterology (BSG). We constructed a Markov decision model to simulate the clinical course of IBD patients. We compared the 2 surveillance strategies for a base case of a 40-year-old colitis patient who was followed for 40 years. AGA surveillance distinguishes 2 groups: a high-risk group with annual surveillance and an average-risk group with biannual surveillance. BSG surveillance distinguishes 3 risk groups with yearly, 3-year, or 5-year surveillance. Patients could move from a no-dysplasia state with colonoscopic surveillance to 1 of 3 states for which proctocolectomy was indicated: (1) dysplasia/local cancer, (2) regional/metastasized cancer, or (3) refractory disease. After proctocolectomy, a patient moved to a no-colon state without surveillance. Direct costs of medical care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. BSG surveillance dominated AGA surveillance with $9846 per QALY. Both strategies were equally effective with 24.16 QALYs, but BSG surveillance was associated with lower costs because of fewer colonoscopies performed. Costs related to IBD, surgery, or cancer did not affect cost-effectiveness. The model depends on the accuracy of derived data, and the assumptions that were made to reflect real-life situations. Study conclusions may only apply to the U.S. health care system. The updated risk-profiling approach for surveillance of IBD colorectal carcinoma by the BSG guideline appears to be more cost-effective. Copyright © 2014. Published by Elsevier Inc.

  11. Cost-effectiveness of cervical cancer prevention in Central and Eastern Europe and Central Asia.

    Science.gov (United States)

    Berkhof, Johannes; Bogaards, Johannes A; Demirel, Erhan; Diaz, Mireia; Sharma, Monisha; Kim, Jane J

    2013-12-31

    We studied the cost-effectiveness of cervical cancer prevention strategies in the Central and Eastern Europe and Central Asia (CEECA) region. The cost-effectiveness of human papillomavirus (HPV)16/18 vaccination of 12 year-old girls was calculated for 28 countries, under the assumption that vaccination prevents 70% of all cervical cancer cases and that cervical cancer and all-cause mortality rates are stable without vaccination. At three-dose vaccination costs of I$ 100 per vaccinated girl (currency 2005 international dollars), HPV16/18 vaccination was very cost-effective in 25 out of 28 countries using the country's gross domestic product (GDP) per capita as cost-effectiveness threshold (criterion by World Health Organization). A three-dose vaccination cost of I$ 100 is within the current range of vaccine costs in European immunization programs, and therefore our results indicate that HPV vaccination may be good value for money. To evaluate the cost-effectiveness of cervical cancer screening combined with vaccination, we calibrated a published simulation model to HPV genotype data collected in Slovenia, Poland, and Georgia. The screening interval was varied at 3, 6, and 10 years starting at age 25 or 30 and ending at age 60. In Slovenia and Poland, combined vaccination and 10-yearly HPV (DNA) screening (vaccination coverage 70%, screening coverage per round 70%) was very cost-effective when the cost of three-dose vaccination was I$ 100 per vaccinated girl. More intensive screening was very cost-effective when the screening coverage per round was 30% or 50%. In Georgia, 10-yearly Pap screening was very cost-effective in unvaccinated women. Vaccination combined with 10-yearly HPV screening was likely to be cost-effective if the three-dose vaccination cost was I$ 50 per vaccinated girl. To conclude, cervical cancer prevention strategies utilizing both HPV16/18 vaccination and HPV screening are very cost-effective in countries with sufficient resources. In low

  12. Cost-effectiveness analyses of training: a manager?s guide

    OpenAIRE

    O?Malley, Gabrielle; Marseille, Elliot; Weaver, Marcia R

    2013-01-01

    The evidence on the cost and cost-effectiveness of global training programs is sparse. This manager?s guide to cost-effectiveness analysis (CEA) is for professionals who want to recognize and support high quality CEA. It focuses on CEA of training in the context of program implementation or rapid program expansion. Cost analysis provides cost per output and CEA provides cost per outcome. The distinction between these two analyses is essential for making good decisions about value. A hypotheti...

  13. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries

    OpenAIRE

    Linde, Mattias; Steiner, Timothy J.; Chisholm, Dan

    2015-01-01

    Background: Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Methods: Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of cov...

  14. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries

    OpenAIRE

    Linde, Mattias; Steiner, Timothy J.; Chisholm, Dan

    2015-01-01

    Background Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Methods Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of coverage and effi...

  15. Comparing Usage and Cost- Effectiveness Analysis of English Printed and Electronic Books for University of Tehran

    OpenAIRE

    Davoud Haseli; Nader Naghshineh; fatemeh Fahimnia

    2014-01-01

    Libraries operate in a competitive environment, and this is essentially needed to prove its benefits for stockholders, and continuously evaluate and compare advantages for printed and electronic resources. In these cases, economic evaluation methods such as cost- effectiveness analysis, is one of the best methods, because of a comprehensive study of the use and cost of library sources. The purpose of this study is to discovery of use and cost- effectiveness analysis of English printed and ebo...

  16. Cost effectiveness of hepatitis A/B versus hepatitis B vaccination for US prison inmates.

    Science.gov (United States)

    Jacobs, R Jake; Rosenthal, Philip; Meyerhoff, Allen S

    2004-03-12

    Hepatitis B immunization is provided in many US prison systems. We examined the cost effectiveness of substituting bivalent hepatitis A/B vaccine in this setting, considering regional variation in hepatitis A risks and the potential for disease transmission by former prisoners. Where hepatitis A rates are >200, 100-200, and effectiveness would be US$ Prison-based hepatitis A/B immunization would meet accepted standards of cost effectiveness throughout the US.

  17. COST-EFFECTIVENESS ANALYSIS OF ANTI-DIABETIC THERAPY IN A UNIVERSITY TEACHING HOSPITAL

    OpenAIRE

    Giwa Abdulganiyu; Tayo Fola

    2014-01-01

    Purpose: To conduct cost-effectiveness analysis of anti-diabetic therapy in a University Teaching Hospital in 2010. Methods: A retrospective review of selected case-notes was conducted. World Health Organization Defined Daily Dose Method of evaluating drug use and probability method for potential effectiveness of antidiabetic therapeutic options from literature analysis was employed in determining cost-effectiveness of each anti-diabetic therapeutic option identified from anti-diabetic dru...

  18. A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus.

    Directory of Open Access Journals (Sweden)

    Malin Ulfsdotter

    Full Text Available There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC. The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness.A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data.The cost was € 326.3 per parent, of which € 53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and € 272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of € 47 290 per gained QALY. The sensitivity analyses resulted in ratios from € 41 739 to € 55 072. With the common Swedish threshold value of € 55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent.Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation.

  19. Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, António Miguel, E-mail: miguelferreira.md@sapo.pt [Hospital da Luz, Lisboa (Portugal); Hospital Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa (Portugal); Marques, Hugo [Hospital da Luz, Lisboa (Portugal); Hospital Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal); Gonçalves, Pedro Araújo [Hospital da Luz, Lisboa (Portugal); Hospital Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal); Cardim, Nuno [Hospital da Luz, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal)

    2014-04-15

    Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.

  20. Impact of Generic Alendronate Cost on the Cost-Effectiveness of Osteoporosis Screening and Treatment

    OpenAIRE

    Smita Nayak; Roberts, Mark S.; Greenspan, Susan L.

    2012-01-01

    INTRODUCTION: Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women. METHODS: Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorp...

  1. Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model

    Directory of Open Access Journals (Sweden)

    Figar Silvana

    2011-04-01

    Full Text Available Abstract Background Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer. Methods We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA to explore variable uncertainty. Results The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly and, overall, 95% chance of being cost-effective. Discussion Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis. Conclusions The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where

  2. Evaluation of Cost-Effectiveness Criteria in Supply Chain Management: Case Study

    OpenAIRE

    Reza Rostamzadeh; Mahdi Sabaghi; Ahmad Esmaili

    2013-01-01

    The aim of this paper is to evaluate and prioritize the proposed cost-effectiveness criteria in supply chain management using fuzzy multiple attribute decision-making (MADM) approach. Over the past few years, the determination of suitable cost-effectiveness criteria in the supply chain has become a key strategic issue. However, the nature of these kinds of decisions is usually complex and unstructured. Many quantitative and qualitative factors must be considered to determine the suitable crit...

  3. Assessing the value of mepolizumab for severe eosinophilic asthma: a cost-effectiveness analysis.

    Science.gov (United States)

    Whittington, Melanie D; McQueen, R Brett; Ollendorf, Daniel A; Tice, Jeffrey A; Chapman, Richard H; Pearson, Steven D; Campbell, Jonathan D

    2017-02-01

    Adding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown. To estimate the cost effectiveness of mepolizumab. A Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone. The population, adults with severe eosinophilic asthma, was modeled for a lifetime time horizon. A responder scenario analysis was conducted to determine the cost effectiveness for a cohort able to achieve and maintain asthma control. Over a lifetime treatment horizon, 23.96 exacerbations were averted per patient receiving mepolizumab plus SoC. Avoidance of exacerbations and decrease in long-term oral steroid use resulted in more than $18,000 in cost offsets among those receiving mepolizumab, but treatment costs increased by more than $600,000. Treatment with mepolizumab plus SoC vs SoC alone resulted in a cost-effectiveness estimate of $386,000 per QALY. To achieve cost effectiveness of approximately $150,000 per QALY, mepolizumab would require a more than 60% price discount. At current pricing, treating a responder cohort yielded cost-effectiveness estimates near $160,000 per QALY. The estimated cost effectiveness of mepolizumab exceeds value thresholds. Achieving these thresholds would require significant discounts from the current list price. Alternatively, treatment limited to responders improves the cost effectiveness toward, but remains still slightly above, these thresholds. Payers interested in improving the efficiency of health care resources should consider negotiations of the mepolizumab price and ways to predict and assess the response to mepolizumab. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All

  4. Cost effectiveness of treatments for wet age-related macular degeneration

    OpenAIRE

    Mitchell, Paul; Annemans, Lieven; White, Richard; Gallagher, Meghan; Thomas, Simu

    2011-01-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged >= 50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination ...

  5. Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

    OpenAIRE

    Paul Mitchell; Lieven Annemans; Richard White; Meghan Gallagher; Simu Thomas

    2011-01-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged ≥50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination an...

  6. The cost-effectiveness of supportive periodontal care: a global perspective.

    OpenAIRE

    2011-01-01

    Abstract Aim: To evaluate the cost-effectiveness of supportive periodontal care (SPC) provided in generalist and periodontal specialist practices under publicly subsidised or private dental care. Material and Methods: SPC cost data and the costs of replacing teeth were synthesised with estimates of the effectiveness of SPC in preventing attachment and tooth loss and adjusted for differences in clinician?s time. Incremental Cost-Effectiveness Ratios were calculated for both outc...

  7. Levee Setbacks: An Innovative, Cost Effective, and Sustainable Solution for Improved Flood Risk management

    Science.gov (United States)

    2017-06-30

    ER D C/ EL S R- 17 -3 Levee Setbacks: An Innovative, Cost-Effective, and Sustainable Solution for Improved Flood Risk Management En vi...EL SR-17-3 June 2017 Levee Setbacks: An Innovative, Cost-Effective, and Sustainable Solution for Improved Flood Risk Management David L. Smith...describes levee setbacks as alternatives to traditional levees for flood risk management and environmental benefits. It is organized into five sections

  8. Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent.

    Directory of Open Access Journals (Sweden)

    Filip Meheus

    Full Text Available BACKGROUND: Visceral leishmaniasis is a systemic parasitic disease that is fatal unless treated. We assessed the cost and cost-effectiveness of alternative strategies for the treatment of visceral leishmaniasis in the Indian subcontinent. In particular we examined whether combination therapies are a cost-effective alternative compared to monotherapies. METHODS AND FINDINGS: We assessed the cost-effectiveness of all possible mono- and combination therapies for the treatment of visceral leishmaniasis in the Indian subcontinent (India, Nepal and Bangladesh from a societal perspective using a decision analytical model based on a decision tree. Primary data collected in each country was combined with data from the literature and an expert poll (Delphi method. The cost per patient treated and average and incremental cost-effectiveness ratios expressed as cost per death averted were calculated. Extensive sensitivity analysis was done to evaluate the robustness of our estimations and conclusions. With a cost of US$92 per death averted, the combination miltefosine-paromomycin was the most cost-effective treatment strategy. The next best alternative was a combination of liposomal amphotericin B with paromomycin with an incremental cost-effectiveness of $652 per death averted. All other strategies were dominated with the exception of a single dose of 10mg per kg of liposomal amphotericin B. While strategies based on liposomal amphotericin B (AmBisome were found to be the most effective, its current drug cost of US$20 per vial resulted in a higher average cost-effectiveness. Sensitivity analysis showed the conclusion to be robust to variations in the input parameters over their plausible range. CONCLUSIONS: Combination treatments are a cost-effective alternative to current monotherapy for VL. Given their expected impact on the emergence of drug resistance, a switch to combination therapy should be considered once final results from clinical trials are

  9. Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte

    Directory of Open Access Journals (Sweden)

    Jae Jun Lee

    2017-02-01

    Full Text Available A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.

  10. Aspiration of two permanent teeth during maxillofacial injuries.

    Science.gov (United States)

    Xiao, Wen-lin; Zhang, Dai-zun; Wang, Yan-hui

    2009-03-01

    Aspiration of a tooth in maxillofacial injuries is a known complication necessitating prompt recognition and early treatment to minimize potentially serious and, sometimes, even fatal consequences. Here, we report a rare and unusual case in its presentation, the patient having aspirated 2 permanent teeth after maxillofacial, cervical vertebrae, and thoracic region crush injuries due to a motor vehicle accident. The diagnosis of teeth aspiration was delayed until 2 weeks after the event. An aspirated anterior tooth was expectorated by the patient himself, and the other aspirated anterior tooth was removed by flexible bronchoscopy. The paper also emphasizes that clinicians must be aware of dental injury resulting from maxillofacial injuries and account for all teeth as part of their evaluation, keeping an open mind as to where a missing tooth might be located. A rapid diagnosis depends on high clinical suspicion, clinical signs, and radiologic findings.

  11. A commentary review of the cost effectiveness of manual therapies for neck and low back pain.

    Science.gov (United States)

    Harper, Brent; Jagger, Kristen; Aron, Adrian; Steinbeck, Larry; Stecco, Antonio

    2017-07-01

    Neck and low back pain (NLBP) are global health problems, which diminish quality of life and consume vast economic resources. Cost effectiveness in healthcare is the minimal amount spent to obtain acceptable outcomes. Studies on manual therapies often fail to identify which manual therapy intervention or combinations with other interventions is the most cost effective. The purpose of this commentary is to sample the dialogue within the literature on the cost effectiveness of evidence-based manual therapies with a particular focus on the neck and low back regions. This commentary identifies and presents the available literature on the cost effectiveness of manual therapies for NLBP. Key words searched were neck and low back pain, cost effectiveness, and manual therapy to select evidence-based articles. Eight articles were identified and presented for discussion. The lack of homogeneity, in the available literature, makes difficult any valid comparison among the various cost effectiveness studies. Potential outcome bias in each study is dependent upon the lens through which it is evaluated. If evaluated from a societal perspective, the conclusion slants toward "adequate" interventions in an effort to decrease costs rather than toward the most efficacious interventions with the best outcomes. When cost data are assessed according to a healthcare (or individual) perspective, greater value is placed on quality of life, the patient's beliefs, and the "willingness to pay." Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010.

    LENUS (Irish Health Repository)

    Bennett, Kathleen

    2009-01-01

    OBJECTIVE: Coronary heart disease (CHD) is associated with a large burden of disease in Ireland and is responsible for more than 6000 deaths annually. This study examined the cost-effectiveness of specific CHD treatments in Ireland. METHODS: Irish epidemiological data on patient numbers and median survival in specific groups, plus the uptake, effectiveness, and costs of specific interventions, all stratified by age and sex, were incorporated into a previously validated CHD mortality model, the IMPACT model. This model calculates the number of life-years gained (LYGs) by specific cardiology interventions to generate incremental cost-effectiveness ratios (ICERs) per LYG for each intervention. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 1885 CHD deaths in patients aged 25 to 84 years, and thus generated approximately 14,505 extra life-years (minimum 7270, maximum 22,475). In general, all the cardiac interventions investigated were highly cost-effective in the Irish setting. Aspirin, beta-blockers, ACE inhibitors, spironolactone, and warfarin for specific conditions were the most cost-effective interventions (< euro 3000\\/LYG), followed by the statins for secondary prevention (< euro 6500\\/LYG). Revascularization for chronic angina and primary angioplasty for myocardial infarction, although still cost-effective, had the highest ICER (between euro 12,000 and euro 20,000\\/LYG). CONCLUSIONS: Using a comprehensive standardized methodology, cost-effectiveness ratios in this study clearly favored simple medical treatments for myocardial infarction, secondary prevention, angina, and heart failure.

  13. The augmented representation of the cost-effectiveness acceptability curve for economic evaluation of health technology.

    Science.gov (United States)

    Araki, Daiji; Kamae, Isao

    2015-03-24

    New schemes on the cost-effectiveness acceptability curve (CEAC) were developed, which can make the CEAC augmented to be more informative regarding the types of acceptance and statistical inference. Theoretical approaches have been undertaken to address two questions: 1) how the area under the curve (AUC) can be zoned by different types of acceptance displayed on the incremental cost-effectiveness plane, and 2) how the accepted dataset of incremental cost-effectiveness ratios (ICERs), which are generated by simulation runs, can be statistically associated with a threshold of ICER for acceptance. To address the first question, the AUC of a typically sigmoid-shaped CEAC was divided into three zones according to the three segmentations of the scattered plots accepted at South-east, North-east and South-west quadrants on the incremental cost-effectiveness plane. A solution for the second question was "a new CEAC of the mean" (mCEAC), which is defined by plotting a pair of the mean and its occurrence probability of ICER accepted at North-east quadrant on the incremental cost-effectiveness plane. All those schemes were graphically illustrated based on hypothetical examples using the bootstrapping simulation. Our new schemes on CEAC will provide decision makers with useful information on cost-effectiveness assessment beyond the standard presentation of CEAC.

  14. Cost-effectiveness of novel diagnostic tools for the diagnosis of tuberculosis.

    Science.gov (United States)

    Dowdy, D W; O'Brien, M A; Bishai, D

    2008-09-01

    The potential cost-effectiveness of improved diagnostic tests for tuberculosis (TB) in resource-limited settings is unknown. To estimate the incremental cost-effectiveness of a hypothetical new point-of-care TB diagnostic test in South Africa, Brazil and Kenya. Decision-analysis model, adding four diagnostic interventions (sputum smear microscopy, new test, smear plus new test and smear plus TB culture) to a baseline of existing infrastructure without smear. Adding sputum smear was estimated to be more cost-effective (incremental cost per disability-adjusted life year [DALY] of $86 [South Africa], $131 [Brazil], $38 (Kenya]) than a new TB diagnostic with 70% sensitivity, 95% specificity and price of $20 per test ($198 [South Africa], $275 [Brazil], $84 [Kenya]). However, compared to sputum smear, smear plus new test averted 46-49% more DALYs per 1000 TB suspects (321 vs. 215 [South Africa], 243 vs. 166 [Brazil], 790 vs. 531 [Kenya]), at an incremental cost of $170 (Kenya) to $625 (Brazil) per DALY averted. Cost-effectiveness was most sensitive to the specificity and price of the new test, the baseline TB case detection rate and the discount rate. Novel diagnostic tests for TB are potentially highly cost-effective. Cost-effectiveness is maximized by high-specificity, low-cost tests deployed to regions with poor infrastructure.

  15. Acid aspiration-induced airways hyperresponsiveness in mice.

    Science.gov (United States)

    Allen, Gilman B; Leclair, Timothy R; von Reyn, Jessica; Larrabee, Yuna C; Cloutier, Mary E; Irvin, Charles G; Bates, Jason H T

    2009-12-01

    The role of gastroesophageal reflux and micro-aspiration as a trigger of airways hyperresponsiveness (AHR) in patients with asthma is controversial. The role of acid reflux and aspiration as a direct cause of AHR in normal subjects is also unclear. We speculated that aspiration of a weak acid with a pH (1.8) equivalent to the upper range of typical gastric contents would lead to AHR in naive mice. We further speculated that modest reductions in aspirate acidity to a level expected during gastric acid suppression therapy (pH 4.0) would impede aspiration-induced AHR. BALB/c female mice were briefly anesthetized with isoflurane and allowed to aspirate 75 microl of saline with HCl (pH 1.8, 4.0, or 7.4) or underwent sham aspiration. Mice were re-anesthetized 2 or 24 h later, underwent tracheostomy, and were coupled to a mechanical ventilator. Forced oscillations were used to periodically measure respiratory impedance (Zrs) following aerosol delivery of saline and increasing doses of methacholine to measure for AHR. Values for elastance (H), airways resistance (R(N)), and tissue damping (G) were derived from Zrs. Aspirate pH of 1.8 led to a significant overall increase in peak R(N), G, and H compared with pH 4.0 and 7.4 at 2 and 24 h. Differences between pH 7.4 and 4.0 were not significant. In mice aspirating pH 1.8 compared with controls, airway lavage fluid contained more neutrophils, higher protein, and demonstrated higher permeability. We conclude that acid aspiration triggers an acute AHR, driven principally by breakdown of epithelial barrier integrity within the airways.

  16. Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world

    NARCIS (Netherlands)

    C. Knai; M. Sharan; R.M.P.M. Baltussen (Rob)

    2004-01-01

    textabstractIron deficiency is the most common and widespread nutritional disorder in the world, affecting millions of people in both nonindustrialized and industrialized countries. We estimated the costs, effects, and cost-effectiveness of iron supplementation and iron

  17. Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world

    NARCIS (Netherlands)

    C. Knai; M. Sharan; R.M.P.M. Baltussen (Rob)

    2004-01-01

    textabstractIron deficiency is the most common and widespread nutritional disorder in the world, affecting millions of people in both nonindustrialized and industrialized countries. We estimated the costs, effects, and cost-effectiveness of iron supplementation and iron fortificati

  18. The cost-effectiveness of sestamibi scanning compared to bilateral neck exploration for the treatment of primary hyperparathyroidism.

    Science.gov (United States)

    Ruda, James; Stack, Brendan C; Hollenbeak, Christopher S

    2004-08-01

    This article presents a cost-effectiveness analysis to determine whether preoperative imaging with Tc99m-sestamibi for detection and treatment of solitary adenomas associated with primary hyperparathyroidism is cost-effective compared with routine bilateral neck exploration.

  19. Foreign body aspiration masquerading as difficult asthma

    Directory of Open Access Journals (Sweden)

    Rai S

    2007-01-01

    Full Text Available It is important to assess patients of difficult/therapy resistant asthma carefully in order to identify whether there are any correctable factors that may contribute to their poor control. It is critical to make a diagnosis of asthma and to exclude other airway diseases. A 65-years-old lady presented with repeated acute episodes of dyspnoea and wheezing. She was on regular medication for bronchial asthma for 18 years. There was no history of foreign body aspiration or loss of consciousness. Her chest radiograph was normal. She showed poor response to corticosteroids and bronchodilators. Fibreoptic bronchoscopy (FOB showed intracordal cyst of the left vocal cord and 1cm size irregular piece of betel nut in right main bronchus, which was removed endoscopically with the help of dormia basket, following which her condition improved and asthma was controlled on inhaled bronchodilators.

  20. Religiosity and Migration Aspirations among Mexican Youth

    Science.gov (United States)

    Marsiglia, Flavio Francisco; Ayers, Stephanie L.

    2014-01-01

    International migration has become an important topic of discussion from a policy and humanitarian perspective. Part of the debate includes a renewed interest in understanding the factors that influence decisions about migration to the US among Mexican youth still residing in their country of origin. The purpose of this study was to advance knowledge specifically about internal and external religiosity and their influence on youths' migration aspirations. The data for this study were collected in 2007 from students enrolled in an alternative high school program located in the state of Guanajuato, Mexico. The findings indicated that as external religiosity increases, the desire to work or live in the USA decreases. Furthermore, as internal religiosity increases, the desire to work or live in the USA and plans to migrate increase. The results are interpreted and discussed in light of previous research on religious and cultural norm adherence. PMID:25663825

  1. [Fine needle aspiration cytology of mammography screening

    DEFF Research Database (Denmark)

    Engvad, B.; Laenkholm, A.V.; Schwartz, Thue W.

    2009-01-01

    INTRODUCTION: In the year 2000 a quality assurance programme for the preoperative breast diagnostics was introduced in Denmark. The programme was based on the "European guidelines for quality assurance in breast cancer screening and diagnosis" where - among other measures - five cytological...... diagnostic classes were introduced. The aim of this study was to evaluate the quality assurance programme in a screening population to determine whether fine needle aspiration cytology (FNAC) as first choice remains a useful tool in the preoperative diagnostics, or if needle core biopsy should be the first...... of 66% of the 783 FNACs had a malignant cytology diagnosis, which in 99% of the cases turned out to be the correct diagnosis. Four lesions were false positives all of which represented benign proliferative breast diseases. The surgical procedures in these cases were either excisional biopsy...

  2. Transbronchial needle aspiration "by the books"

    Directory of Open Access Journals (Sweden)

    Kupeli Elif

    2011-01-01

    Full Text Available Background : Training for advanced bronchoscopic procedures is acquired during the interventional pulmonology (IP Fellowship. Unfortunately a number of such programs are small, limiting dissemination of formal training. Objective : We studied success of conventional transbronchial needle aspiration (C-TBNA in the hands of physicians without formal IP training. Methods : A technique of C-TBNA was learned solely from the literature, videos and practicing on inanimate models at "Hands-On" courses. Conventional TBNA with 21 and/or 19 gauge Smooth Shot Needles (Olympus® , Japan was performed on consecutive patients with undiagnosed mediastinal lymphadenopathy. Results : Thirty-four patients (male 23, mean age 54.9 ± 11.8 years underwent C-TBNA. Twenty-two patients had nodes larger than 20 mms. Suspected diagnoses were malignancy in 20 and nonmalignant conditions in 14. Final diagnoses were malignancy 17, sarcoidosis 4, reactive lymph nodes 12, and tuberculosis 1. Final diagnosis was established by C-TBNA in 14 (11 malignancy, 3 sarcoidosis; yield 41.1%, mediastinoscopy in 14, transthoracic needle aspiration in 3, peripheral lymph node biopsies in 2 and by endobronchial biopsy in 1. Nodal size had an impact on outcome (P = 0.000 while location did not (P = 0.33. C-TBNA was positive in 11/20 when malignancy was suspected (yield 55%, while 3/14 when benign diagnosis was suspected (yield 21.4% (P = 0.05. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 66.6%, 100%, 100%, 65%, and 79.4%, respectively. There were no complications or scope damage. Conclusion : Conventional-TBNA can be learned by the books and by practicing on inanimate models without formal training and results similar to those published in the literature could be achieved.

  3. Role of fine needle aspiration cytology and cytohistopathological co-relation in thyroid lesions: experience at a tertiary care centre of North India

    Directory of Open Access Journals (Sweden)

    Smita Chandra

    2016-10-01

    Conclusions: The study concludes that although FNAC is safe, cost effective and sensitive technique for diagnosis of thyroid lesions but vigilant cyto-morphological interpretation in association with skilful aspiration and clinic-radiological co-relation is essential to avoid diagnostic pitfalls. This is even more important in cases showing focal neoplastic pathology or presence of dual pathology. Repeat image guided FNAC with clinical follow up is recommended in cases with strong clinical suspicion of malignancy. [Int J Res Med Sci 2016; 4(10.000: 4552-4556

  4. Accounting for the drug life cycle and future drug prices in cost-effectiveness analysis.

    Science.gov (United States)

    Hoyle, Martin

    2011-01-01

    Economic evaluations of health technologies typically assume constant real drug prices and model only the cohort of patients currently eligible for treatment. It has recently been suggested that, in the UK, we should assume that real drug prices decrease at 4% per annum and, in New Zealand, that real drug prices decrease at 2% per annum and at patent expiry the drug price falls. It has also recently been suggested that we should model multiple future incident cohorts. In this article, the cost effectiveness of drugs is modelled based on these ideas. Algebraic expressions are developed to capture all costs and benefits over the entire life cycle of a new drug. The lifetime of a new drug in the UK, a key model parameter, is estimated as 33 years, based on the historical lifetime of drugs in England over the last 27 years. Under the proposed methodology, cost effectiveness is calculated for seven new drugs recently appraised in the UK. Cost effectiveness as assessed in the future is also estimated. Whilst the article is framed in mathematics, the findings and recommendations are also explained in non-mathematical language. The 'life-cycle correction factor' is introduced, which is used to convert estimates of cost effectiveness as traditionally calculated into estimates under the proposed methodology. Under the proposed methodology, all seven drugs appear far more cost effective in the UK than published. For example, the incremental cost-effectiveness ratio decreases by 46%, from £61, 900 to £33, 500 per QALY, for cinacalcet versus best supportive care for end-stage renal disease, and by 45%, from £31,100 to £17,000 per QALY, for imatinib versus interferon-α for chronic myeloid leukaemia. Assuming real drug prices decrease over time, the chance that a drug is publicly funded increases over time, and is greater when modelling multiple cohorts than with a single cohort. Using the methodology (compared with traditional methodology) all drugs in the UK and New

  5. The cost effectiveness of lung transplantation compared with that of heart and liver transplantation in the Netherlands

    NARCIS (Netherlands)

    Ouwens, JP; van Enckevort, PJ; TenVergert, EM; Bonsel, GJ; van der Bij, W; Haagsma, EB; Rutten, FFH; Slooff, MJH; Koeter, GH

    This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost-effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are

  6. A model-based cost-effectiveness analysis of osteoporosis screening and treatment strategy for postmenopausal Japanese women.

    Science.gov (United States)

    Yoshimura, M; Moriwaki, K; Noto, S; Takiguchi, T

    2017-02-01

    Although an osteoporosis screening program has been implemented as a health promotion project in Japan, its cost-effectiveness has yet to be elucidated fully. We performed a cost-effectiveness analysis and found that osteoporosis screening and treatment would be cost-effective for Japanese women over 60 years.

  7. COST-EFFECTIVENESS ANALYSIS OF ANTI-DIABETIC THERAPY IN A UNIVERSITY TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Giwa Abdulganiyu

    2014-03-01

    Full Text Available Purpose: To conduct cost-effectiveness analysis of anti-diabetic therapy in a University Teaching Hospital in 2010. Methods: A retrospective review of selected case-notes was conducted. World Health Organization Defined Daily Dose Method of evaluating drug use and probability method for potential effectiveness of antidiabetic therapeutic options from literature analysis was employed in determining cost-effectiveness of each anti-diabetic therapeutic option identified from anti-diabetic drug utilization studies. Sample Size, n=1200. Subjects’ case-notes were selected by systematic random sampling (Sampling Interval = 1. Results: Glibenclamide (N1.76/unit of effectiveness which was more cost-effective than chlopropamide (N2.97/unit of effectiveness in the management of moderate hyperglycemia in non-obese Type II Diabetes Mellitus was more frequently prescribed (81.5%. Glibenclamide + Metformin (N7.63/unit of effectiveness which was more frequently prescribed (92.5% was not necessarily more cost-effective than Chlopropamide + Metformin (N9.76/unit of effectiveness in the management of moderate hyperglycemia in obese Type II Diabetes- Mellitus. Biphasic Isophane Insulin (N12.65/unit of effectiveness which was more cost-effective than soluble insulin + insulin zinc (N30.37/unit of effectiveness in the management of serve hyperglycemia in non-obese Type II Diabetes Mellitus was less frequently prescribed (42.3%. Biphasic Isophane Insulin + Metformin (N15.91/unit of effectiveness which was more cost-effective than soluble insulin + insulin zinc + metformin (N34.45/ unit of effectiveness in the management of severe hyperglycemia in obese Type II Diabetes Mellitus patients was less frequently prescribed (25%. Conclusions: Prescription of lees cost-effective anti-diabetic drugs was rampant in Hospitals.

  8. The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review

    Directory of Open Access Journals (Sweden)

    Michelle Remme

    2014-11-01

    Full Text Available Introduction: Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. Methods: Effective intervention models were identified from an existing evidence review (“what works for women”. Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. Results: Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. Conclusions: There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.

  9. Cost-effectiveness of Total Knee Arthroplasty in the United States

    Science.gov (United States)

    Losina, Elena; Walensky, Rochelle P.; Kessler, Courtenay L.; Emrani, Parastu S.; Reichmann, William M.; Wright, Elizabeth A.; Holt, Holly L.; Solomon, Daniel H.; Yelin, Edward; Paltiel, A. David; Katz, Jeffrey N.

    2009-01-01

    Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters’ influences on cost-effectiveness. Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers. PMID:19546411

  10. Antihypertensive drugs: a perspective on pharmaceutical price erosion and its impact on cost-effectiveness.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; McGrath, Clare; Herings, Ron; Meerding, Willem-Jan; Rutten, Frans

    2012-01-01

    When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension. Cost-effectiveness at launch was estimated for all antihypertensive drugs launched between 1998 and 2008 in the United Kingdom using hypothetical degrees of incremental clinical effectiveness within the methodologic framework applied by the UK National Institute for Health and Clinical Excellence. Incremental cost-effectiveness ratios were computed and compared with funding thresholds. In addition, the levels of incremental clinical effectiveness required to achieve specific cost-effectiveness thresholds at given prices were estimated. Significant price decreases were observed for existing drugs. This was shown to markedly affect cost-effectiveness of technologies entering the market. The required incremental clinical effectiveness was in many cases greater than physiologically possible so, as a consequence, a number of products might not be available today if current methods of economic appraisal had been applied. We conclude that the definition of cost-effectiveness thresholds is fundamental in promoting efficient innovation. Our findings demonstrate that comparator price attrition has the potential to put pressure in the pharmaceutical research model and presents a challenge to new therapies being accepted for funding. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  11. Cost-effectiveness of Barostim therapy for the treatment of resistant hypertension in European settings.

    Science.gov (United States)

    Borisenko, Oleg; Beige, Joachim; Lovett, Eric G; Hoppe, Uta C; Bjessmo, Staffan

    2014-03-01

    The purpose of this study is to simulate the cost-effectiveness and the long-term clinical performance of the Barostim neo System for the treatment of resistant hypertension when compared to optimal medical treatment. A decision analytic model with a combination of a decision tree and Markov process was used to evaluate the cost-effectiveness of Barostim. The clinical effectiveness of Barostim was based on the results of the randomized, placebo-controlled Rheos trial and the follow-up substudy of the DEBuT-HT trial. The cost-effectiveness was modelled from a German societal perspective over a lifetime horizon. Patients with high SBP levels have an increased risk of myocardial infarction, stroke, heart failure and end-stage renal disease. In a simulated cohort of 50-year-old patients at high risk of end-organ damage, Barostim therapy generated 1.66 additional life-years and 2.17 additional quality-adjusted life years with an incremental cost of &OV0556;16 891 when compared with continuation of medical management. Barostim was estimated to be cost-effective compared with optimal medical treatment with an incremental cost-effectiveness ratio of &OV0556;7 797/QALY. In the model, Barostim reduced over a lifetime the rates of myocardial infarction by 19%, stroke by 35%, heart failure by 12% and end-stage renal disease by 23%. The cost-effectiveness of Barostim can be greater in younger patients with resistant hypertension and in patients with significant risk factors for end-organ damage. Barostim may be a cost-effective treatment when compared with optimal medical management in patients with resistant hypertension.

  12. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV).

  13. Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis.

    Science.gov (United States)

    Grover, Ritwik; Padula, William V; Van Vliet, Michael; Ridgway, Emily B

    2013-11-01

    The purpose of this study was to assess the cost-effectiveness of five standardized procedures for breast reconstruction to delineate the best reconstructive approach in postmastectomy patients in the settings of nonirradiated and irradiated chest walls. A decision tree was used to model five breast reconstruction procedures from the provider perspective to evaluate cost-effectiveness. Procedures included autologous flaps with pedicled tissue, autologous flaps with free tissue, latissimus dorsi flaps with breast implants, expanders with implant exchange, and immediate implant placement. All methods were compared with a "do-nothing" alternative. Data for model parameters were collected through a systematic review, and patient health utilities were calculated from an ad hoc survey of reconstructive surgeons. Results were measured in cost (2011 U.S. dollars) per quality-adjusted life-year. Univariate sensitivity analyses and Bayesian multivariate probabilistic sensitivity analysis were conducted. Pedicled autologous tissue and free autologous tissue reconstruction were cost-effective compared with the do-nothing alternative. Pedicled autologous tissue was the slightly more cost-effective of the two. The other procedures were not found to be cost-effective. The results were robust to a number of sensitivity analyses, although the margin between pedicled and free autologous tissue reconstruction is small and affected by some parameter values. Autologous pedicled tissue was slightly more cost-effective than free tissue reconstruction in irradiated and nonirradiated patients. Implant-based techniques were not cost-effective. This is in agreement with the growing trend at academic institutions to encourage autologous tissue reconstruction because of its natural recreation of the breast contour, suppleness, and resiliency in the setting of irradiated recipient beds.

  14. Chin tuck for prevention of aspiration: effectiveness and appropriate posture.

    Science.gov (United States)

    Ra, Jong Yun; Hyun, Jung Keun; Ko, Kyung Rok; Lee, Seong Jae

    2014-10-01

    Chin tuck has been has been widely used to prevent aspiration in the patients with dysphagia. This study was performed to investigate the effectiveness and the degree of optimal neck flexion of chin tuck. Ninety-seven patients who showed aspiration in the videofluoroscopic swallow study (VFSS). Participants were grouped into the effective (patients who showed effect with chin tuck) and ineffective group (those who did not show effect with chin tuck). VFSS was performed in neutral and chin tuck position and findings were compared between the groups. Severity of aspiration was assessed by the point penetration-aspiration scale. Duration of dysphagic symptoms, history of tracheostomy, and other possible contributing factors were also compared. Neck flexion angle was measured to find appropriate posture in which aspiration was prevented with chin tuck. Aspiration was reduced or eliminated in only 19 patients (19.6 %) with chin tuck. Oral transit time, pharyngeal delayed time and pharyngeal transit time were significantly shortened in both groups (p neck flexion was required to achieve an effect with chin tuck. The effectiveness of chin tuck was less than anticipated. Patients without residue in pyriform sinus were more likely to benefit from chin tuck. Sufficient neck flexion was important in chin tuck to prevent aspiration.

  15. Multi-dimension Aspiration Control Mode in Phacoemulsification

    Institute of Scientific and Technical Information of China (English)

    Xiangqun Wang; Mingguang He; Junwen Zeng

    2005-01-01

    Purpose: Multi-dimension aspiration control mode was put forward in this study.Accuracy of multi-dimension aspiration control model was compared to simple traditional pedal control model.Methods: Induced by high aspiration pressure (200~250 mmHg), hard nucleus (≥Grade Ⅲ ) of senile cataract was chopped before phacoemulsification in 170 patients (174 eyes). Ninety-one patients (94 eyes) accepted multi-dimension aspiration control model in which aspiration direction, distance and targets prevention were adjusted by phaco-tip besides traditional pedal control. Another 79 patients (80 eyes) were compared as reviewed group, aspiration of which was controlled simply by traditional pedal control. Postcapsular rupture rates (PCRR) were compared between two groups.Results: Multi-dimension control model could make the terminal effects cooperate with phacoemulsification more precisely and protect post capsular from damage (x2 =5.41, P < 0.02).Conclusion: Multi-dimension control model could improve the accuracy of aspiration effects and protect postcapsular from damage.

  16. Reliability of fine needle aspiration biopsy in large thyroid nodules.

    Science.gov (United States)

    Bozbıyık, Osman; Öztürk, Şafak; Ünver, Mutlu; Erol, Varlık; Bayol, Ümit; Aydın, Cengiz

    2017-01-01

    Fine needle aspiration biopsy provides one of the most important data that determines the treatment algorithm of thyroid nodules. Nevertheless, the reliability of fine needle aspiration biopsy is controversial in large nodules. The aim of this study was to evaluate the adequacy of fine needle aspiration biopsy in thyroid nodules that are four cm or greater. We retrospectively examined 219 patients files who underwent thyroidectomy for thyroid nodules that were greater than four centimeter between May 2007 and December 2012. Seventy-four patients with hyperthyroidism, and 18 patients without preoperative fine needle aspiration cytology were excluded from the study. Histopathologic results after thyroidectomy were compared with preoperative cytology results, and sensitivity and specificity rates were calculated. False-negativity, sensitivity and specificity rates of fine needle aspiration biopsy of thyroid nodules were found to be 9.7%, 55.5%, and 85%, respectively. Within any nodule of the 127 patients, 28 (22.0%) had thyroid cancer. However, when only nodules of at least 4 cm were evaluated, thyroid cancer was detected in 22 (17.3%) patients. In this study, fine needle aspiration biopsy of large thyroid nodules was found to have a high false-negativity rate. The limitations of fine-needle aspiration biopsy should be taken into consideration in treatment planning of thyroid nodules larger than four centimeters.

  17. Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.

    Directory of Open Access Journals (Sweden)

    Joakim Ramsberg

    Full Text Available OBJECTIVE: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression. DESIGN: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine. The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year. DATA SOURCES: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources. RESULTS: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine. CONCLUSION: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

  18. Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine.

    Science.gov (United States)

    Siegel, J E; Torrance, G W; Russell, L B; Luce, B R; Weinstein, M C; Gold, M R

    1997-02-01

    This article reports the recommendations of the Panel on Cost Effectiveness in Health and Medicine, sponsored by the US Public Health Service, on standardised methods for conducting cost-effectiveness analyses. Although not expressly directed at analyses of pharmaceutical agents, the Panel's recommendations are relevant to pharmacoeconomic studies. The Panel outlines a 'Reference Case' set of methodological practices to improve quality and comparability of analyses. Designed for studies that inform resource-allocation decisions, the Reference Case includes recommendations for study framing and scope, components of the numerator and denominator of cost-effectiveness ratios, discounting, handling uncertainty and reporting. The Reference Case analysis is conducted from the societal perspective, and includes all effects of interventions on resource use and health. Resource use includes 'time' resources, such as for caregiving or undergoing an intervention. The quality-adjusted life-year (QALY) is the common measure of health effect across Reference Case studies. Although the Panel does not endorse a measure for obtaining quality-of-life weights, several recommendations address the QALY. The Panel recommends a 3% discount rate for costs and health effects. Pharmacoeconomic studies have burgeoned in recent years. The Reference Case analysis will improve study quality and usability, and permit comparison of pharmaceuticals with other health interventions.

  19. Pediatric foreign body aspiration: A nidus for Aspergillus colonization.

    Science.gov (United States)

    Mitchell, Candace A; Kreiger, Portia; Goff, Christopher; Shah, Udayan K

    2015-06-01

    We describe an immunocompetent child with bronchial fungus following foreign body aspiration. A two-year-old male presented with cough. Workup revealed air trapping and bronchoscopy showed aspirated foreign material in the right mainstem bronchus. Histopathology revealed fungal organisms suggestive of Aspergillus within an ulcer of the adjacent bronchial mucosa. Foreign body aspiration has been posited as a nidus for aspergilloma formation but is not yet described in the available English-language pediatric literature. Here, the foreign body provided a site for fungal growth in the bronchus of an otherwise healthy child. This case suggests that bronchial foreign body may pose risk of fungal colonization even in immunocompetent children.

  20. Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis.

    Science.gov (United States)

    Tolla, Mieraf Taddesse; Norheim, Ole Frithjof; Memirie, Solomon Tessema; Abdisa, Senbeta Guteta; Ababulgu, Awel; Jerene, Degu; Bertram, Melanie; Strand, Kirsten; Verguet, Stéphane; Johansson, Kjell Arne

    2016-01-01

    The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia's meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper's objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting. Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization's Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results. Combination drug treatment for individuals having >35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000-US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060-US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to > US$7 million, combination drug treatment to individuals having >35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory