WorldWideScience

Sample records for costs comparing depot

  1. HALF-DOSE DEPOT TRIPTORELIN COMPARABLE TO REDUCED DAILY BUSERELIN: A RANDOMIZED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    L. Safdarian

    2007-09-01

    Full Text Available Pituitary suppression by depot GnRH agonist may be excessive for ovarian stimulation. This study compares the efficacy of a single half-dose depot triptorelin and reduced-dose daily buserelin in a long protocol ICSI/ET. METHODS: A total of 182 patients were randomized into two groups using sealed envelopes. Pituitary desensitization was obtained in group 1 (91 patients with half-dose (1.87 mg depot triptorelin in the mid-luteal phase of their menstrual cycle, and in group 2 (91 patients with standard daily dose (0.5 mg buserelin, which was then reduced to 0.25 mg at the start of human menopausal gonadotropin (HMG stimulation. RESULTS: No significant differences were found among those who received HCG in terms of clinical pregnancy rate (34.4% in both groups, implantation rate (14.8% in group 1 versus 11.1% in group 2, fertilization rate (93.3 versus 95.6%, poor response rate (11.1 versus 6.7%, and miscarriage rate (11.1 versus 7.8%. No significant differences were seen in number of HMG ampoules used, follicles at HCG administration, and oocytes retrieved. The number of days of stimulation was significantly reduced in group 2 (11.2 +/- 1.8 in group 1 versus 10.6 +/- 1.9, p = 0.030. CONCLUSION: A half-dose of depot triptorelin can be successfully used in ovarian stimulation instead of reduced-dose daily buserelin, with more patient comfort and reduced stress and cost of injections.

  2. Department of Defense Materiel Distribution System Study. Volume 3, Book 5. Appendix D-3. Depot Cost and Capacity

    Science.gov (United States)

    1978-07-01

    maintenance interface. 2> Variable Cost a. Standard Depot Cost (1) The result of joining the historical depot cost and workload daca as described...79 4 100 50 SO 100 source: „,,«„ StU(Jy Group daca cau respQnse Oepot-specific responses weighted by shipment cub e per depot. V...of floor area which must be dedicated to the travel path, and the necessity for keeping this path clear of standing objects at all ’:i:r..;S. 6.61

  3. Techno-economic analysis of decentralized biomass processing depots.

    Science.gov (United States)

    Lamers, Patrick; Roni, Mohammad S; Tumuluru, Jaya S; Jacobson, Jacob J; Cafferty, Kara G; Hansen, Jason K; Kenney, Kevin; Teymouri, Farzaneh; Bals, Bryan

    2015-10-01

    Decentralized biomass processing facilities, known as biomass depots, may be necessary to achieve feedstock cost, quantity, and quality required to grow the future U.S. bioeconomy. In this paper, we assess three distinct depot configurations for technical difference and economic performance. The depot designs were chosen to compare and contrast a suite of capabilities that a depot could perform ranging from conventional pelleting to sophisticated pretreatment technologies. Our economic analyses indicate that depot processing costs are likely to range from ∼US$30 to US$63 per dry metric tonne (Mg), depending upon the specific technology implemented and the energy consumption for processing equipment such as grinders and dryers. We conclude that the benefits of integrating depots into the overall biomass feedstock supply chain will outweigh depot processing costs and that incorporation of this technology should be aggressively pursued. Copyright © 2015. Published by Elsevier Ltd.

  4. Risperidone (depot) for schizophrenia.

    Science.gov (United States)

    Sampson, Stephanie; Hosalli, Prakash; Furtado, Vivek A; Davis, John M

    2016-04-14

    Risperidone is the first new generation antipsychotic drug made available in a long-acting injection formulation. To examine the effects of depot risperidone for treatment of schizophrenia or related psychoses in comparison with placebo, no treatment or other antipsychotic medication.To critically appraise and summarise current evidence on the resource use, cost and cost-effectiveness of risperidone (depot) for schizophrenia. We searched the Cochrane Schizophrenia Group's Register (December 2002, 2012, and October 28, 2015). We also checked the references of all included studies, and contacted industry and authors of included studies. Randomised clinical trials comparing depot risperidone with other treatments for people with schizophrenia and/or schizophrenia-like psychoses. Two review authors independently selected trials, assessed trial quality and extracted data. For dichotomous data, we calculated the risk ratio (RR), with 95% confidence interval (CI). For continuous data, we calculated mean differences (MD). We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Twelve studies, with a total of 5723 participants were randomised to the following comparison treatments: Risperidone depot versus placebo Outcomes of relapse and improvement in mental state were neither measured or reported. In terms of other primary outcomes, more people receiving placebo left the study early by 12 weeks (1 RCT, n=400, RR 0.74 95% CI 0.63 to 0.88, very low quality evidence), experienced severe adverse events in short term (1 RCT, n=400, RR 0.59 95% CI 0.38 to 0.93, very low quality evidence). There was however, no difference in levels of weight gain between groups (1 RCT, n=400, RR 2.11 95% CI 0.48 to 9.18, very low quality evidence). Risperidone depot versus general oral antipsychotics The outcome of improvement in mental state was not presented due to high levels of attrition, nor were levels of severe adverse events explicitly reported

  5. Cost-Effectiveness of Financial Incentives to Promote Adherence to Depot Antipsychotic Medication: Economic Evaluation of a Cluster-Randomised Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Catherine Henderson

    Full Text Available Offering a modest financial incentive to people with psychosis can promote adherence to depot antipsychotic medication, but the cost-effectiveness of this approach has not been examined.Economic evaluation within a pragmatic cluster-randomised controlled trial. 141 patients under the care of 73 teams (clusters were randomised to intervention or control; 138 patients with diagnoses of schizophrenia, schizo-affective disorder or bipolar disorder participated. Intervention participants received £15 per depot injection over 12 months, additional to usual acute, mental and community primary health services. The control group received usual health services. Main outcome measures: incremental cost per 20% increase in adherence to depot antipsychotic medication; incremental cost of 'good' adherence (defined as taking at least 95% of the prescribed number of depot medications over the intervention period.Economic and outcome data for baseline and 12-month follow-up were available for 117 participants. The adjusted difference in adherence between groups was 12.2% (73.4% control vs. 85.6% intervention; the adjusted costs difference was £598 (95% CI -£4,533, £5,730. The extra cost per patient to increase adherence to depot medications by 20% was £982 (95% CI -£8,020, £14,000. The extra cost per patient of achieving 'good' adherence was £2,950 (CI -£19,400, £27,800. Probability of cost-effectiveness exceeded 97.5% at willingness-to-pay values of £14,000 for a 20% increase in adherence and £27,800 for good adherence.Offering a modest financial incentive to people with psychosis is cost-effective in promoting adherence to depot antipsychotic medication. Direct healthcare costs (including costs of the financial incentive are unlikely to be increased by this intervention.ISRCTN.com 77769281.

  6. Comparative Transcriptome Analysis of Adipose Tissues Reveals that ECM-Receptor Interaction Is Involved in the Depot-Specific Adipogenesis in Cattle.

    Directory of Open Access Journals (Sweden)

    Hyun-Jeong Lee

    Full Text Available Adipocytes mainly function as energy storage and endocrine cells. Adipose tissues showed the biological and genetic difference based on their depots. The difference of adipocytes between depots might be influenced by the inherent genetic programing for adipogenesis. We used RNA-seq technique to investigate the transcriptomes in 3 adipose tissues of omental (O, subcutaneous (S and intramuscular (I fats in cattle. Sequence reads were obtained from Illumina HiSeq2000 and mapped to the bovine genome using Tophat2. Differentially expressed genes (DEG between adipose tissues were detected by EdgeR. We identified 5797, 2156, and 5455 DEGs in the comparison between OI, OS, and IS respectively and also found 5657 DEGs in the comparison between the intramuscular and the combined omental and subcutaneous fats (C (FDR<0.01. Depot specifically up- and down- regulated DEGs were 853 in S, 48 in I, and 979 in O. The numbers of DEGs and functional annotation studies suggested that I had the different genetic profile compared to other two adipose tissues. In I, DEGs involved in the developmental process (eg. EGR2, FAS, and KLF7 were up-regulated and those in the immune system process were down-regulated. Many DEGs from the adipose tissues were enriched in the various GO terms of developmental process and KEGG pathway analysis showed that the ECM-receptor interaction was one of commonly enriched pathways in all of the 3 adipose tissues and also functioned as a sub-pathway of other enriched pathways. However, genes involved in the ECM-receptor interaction were differentially regulated depending on the depots. Collagens, main ECM constituents, were significantly up-regulated in S and integrins, transmembrane receptors, were up-regulated in I. Different laminins were up-regulated in the different depots. This comparative transcriptome analysis of three adipose tissues suggested that the interactions between ECM components and transmembrane receptors of fat cells

  7. Changes Are Needed to the Army Contract with Sikorsky to Use Existing DoD Inventory and Control Costs at the Corpus Christi Army Depot

    Science.gov (United States)

    2011-11-03

    contingency stock for requirements outside the CCAD/Sikorsky contract. 6 The DoD EMALL is a full-service eCommerce site, which strives to be the single...Acquisition System,” DoDI, 4151.21, “Public-Private Partnerships for Depot-Level Maintenance,” and DoD 4140.1-R require full costs and benefits be...LMP, which prevented the Army from achieving the expected benefits from LMP. Furthermore, GAO Report No. GAO-11-139, “Additional Oversight and

  8. Comparative cost of risk survey

    Science.gov (United States)

    2008-06-01

    The objective of this research was to determine the annual cost of risk to the Arizona Department of Transportation (ADOT) and to compare it with that of other state transportation agencies. ADOT is charged with the responsibility of designing, build...

  9. Modeling and Solving the Multi-depot Vehicle Routing Problem with Time Window by Considering the Flexible end Depot in Each Route

    Directory of Open Access Journals (Sweden)

    Mohammad Mirabi

    2016-11-01

    Full Text Available This paper considers the multi-depot vehicle routing problem with time window in which each vehicle starts from a depot and there is no need to return to its primary depot after serving customers. The mathematical model which is developed by new approach aims to minimizing the transportation cost including the travelled distance, the latest and the earliest arrival time penalties. Furthermore, in order to reduce the problem searching space, a novel GA clustering method is developed. Finally, Experiments are run on number problems of varying depots and time window, and customer sizes. The method is compared to two other clustering techniques, fuzzy C means (FCM and K-means algorithm. Experimental results show the robustness and effectiveness of the proposed algorithm.

  10. A comparative study of cross sectional anatomy and computer tomography of perirenal fat depots in New Zealand White rabbits

    International Nuclear Information System (INIS)

    Yonkova, P.; Dimitrov, R.; Toneva, J.; Zapryanova, D.

    2010-01-01

    CT is a contemporary non-invasive imaging technique that gains an increasing importance for in vivo investigations of subcutaneous and visceral fat. The purpose of this investigation was to describe the topography and anatomy imaging features of perirenal fat depots at the level of both kidneys in clinically healthy New Zealand White rabbits that attained slaughter weight. The CT consecutive transverse scans from the last thoracic to the fifth lumbar vertebrae showed that in rabbits, perirenal fat appeared as a homogeneous hypodense structure at the background of denser shadows of lumbar and abdominal muscles, kidneys and abdominal organs. Perirenal fat depot exhibited a soft tissue density with average attenuation of −120.97±4.73 HU. On CT scans, the largest dimensions of the perirenal fat depot were 1.3±0.01 cm at the level of the right kidneys cranial pole; 1.96 cm in the plane where the right renal hilus was visualized; 1.66±0.08 cm at the level of the right kidneys caudal pole; 1.10±0.18 cm in the plane where the left renal hilus was visualized and 1.06±0.15 cm at the level of the left kidneys caudal pole. No subcutaneous fat deposits in the abdominal area were seen. Results obtained in the present study could be used as basic information for various anatomy investigations of rabbits as well as experimental designs for study of obesity in animals and humans. (author)

  11. The role of social cost-benefit analysis in societal decision-making under large uncertainties with application to robbery at a cash depot

    International Nuclear Information System (INIS)

    Jones-Lee, M.; Aven, T.

    2009-01-01

    Social cost-benefit analysis is a well-established method for guiding decisions about safety investments, particularly in situations in which it is possible to make accurate predictions of future performance. However, its direct applicability to situations involving large degrees of uncertainty is less obvious and this raises the question of the extent to which social cost-benefit analysis can provide a useful input to the decision framework that has been explicitly developed to deal with safety decisions in which uncertainty is a major factor, namely risk analysis. This is the main focus of the arguments developed in this paper. In particular, we provide new insights by examining the fundamentals of both approaches and our principal conclusion is that social cost-benefit analysis and risk analysis represent complementary input bases to the decision-making process, and even in the case of large uncertainties social cost-benefit analysis may provide very useful decision support. What is required is the establishment of a proper contextual framework which structures and gives adequate weight to the uncertainties. An application to the possibility of a robbery at a cash depot is examined as a practical example.

  12. A Cost Estimation Model for Commander Naval Air Forces Paicifc's TACAIR F/A-18S Aviation Depot Level Repair Costs

    National Research Council Canada - National Science Library

    Duma, David

    2001-01-01

    .... The first section discusses the methodology used to create a cost estimation model. The second and third sections provide the results of the model's outcomes and compares and analyzes those results to the actual results...

  13. Identification of Relevant Costs in the Decision to Consolidate or Maintain Two Marine Corps Recruit Training Depots

    Science.gov (United States)

    2015-06-01

    personnel, such as the physical fitness advisor, transportation assistant, supervisory training specialist, and the recruit’s administrative branch...the recruits. Recruit Training Regiment (RTR) is a cost that includes items, such as barracks gear, gym equipment, training equipment, and...to provide services, such as family care, behavioral health, Semper Fit , and other community type services (A. Smelko, personal communication, April

  14. Spatial Analysis of Depots for Advanced Biomass Processing

    Energy Technology Data Exchange (ETDEWEB)

    Hilliard, Michael R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Brandt, Craig C. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Webb, Erin [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Sokhansanj, Shahabaddine [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Eaton, Laurence M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Martinez Gonzalez, Maria I. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2014-09-01

    The objective of this work was to perform a spatial analysis of the total feedstock cost at the conversion reactor for biomass supplied by a conventional system and an advanced system with depots to densify biomass into pellets. From these cost estimates, the conditions (feedstock cost and availability) for which advanced processing depots make it possible to achieve cost and volume targets can be identified.

  15. Depot Maintenance: Executed Workload and Maintenance Operations at DOD Depots

    Science.gov (United States)

    2017-02-03

    software. This enclosure provides detailed information about each of the 17 depots on executed workload, personnel, capital investments, process...services’ depots from fiscal year 2012 through 2015, and provides detailed information for each of the 17 depots, on executed workload, personnel...Depot Maintenance: Additional Information Needed to Meet DOD’s Core Capability Reporting Requirements, GAO-13-194 (Washington, D.C.: Feb. 11, 2013

  16. Analysis of Light Armored Vehicle Depot Level Maintenance

    National Research Council Canada - National Science Library

    Mullins, Michael; Adams, Troy; Simms, Robert

    2005-01-01

    An analysis of Light Armored Vehicle (LAV) Depot Level Maintenance is conducted to examine the scheduled maintenance cycle and processes in order to determine potential inefficiencies related to cost or time...

  17. Fatty acid composition of fat depots in wintering Canada geese

    Science.gov (United States)

    Austin, J.E.

    1993-01-01

    I determined the fatty acid composition of subcutaneous, abdominal, visceral, and leg saddle depots in adult female Canada Geese (Branta canadensis) wintering in north-central Missouri during October 1984-March 1985. Mean levels of C14:0, C16:0, C16:1, C18:0, C18:1, C18:2, and C18:3 generally were highest in the subcutaneous and abdominal depots. The ratio of saturated to unsaturated fats was highest in the leg saddle depot and lowest in the abdominal depot. I also assessed the differences among sexes, seasons, and years in fatty acid composition of abdominal fat depots in adult geese collected during October-March, 1985-1987. Adult females had consistently higher levels of C14:0 in abdominal depots than males. Fatty acid composition of the abdominal depot differed among years but not by season. In the abdominal depot, C14:0, C16:0, C16:1, and C18:1 were higher in 1986-1987 compared with the previous two years, whereas C18:3 was highest in 1984-1985. Differences among years reflected changes in winter diet. Fatty acids of wintering geese were similar to those previously found in breeding Canada Geese.

  18. Makahiki+WattDepot

    DEFF Research Database (Denmark)

    Johnson, Philip M.; Xu, Yongwen; Brewer, Robert S.

    2013-01-01

    Satisfying the radically different requirements and operating assumptions of the next generation smart grid requires new kinds of software that enable research and experimentation into the ways that electrical energy production and consumption can be collected, analyzed, visualized, and provided ......, Django, Memcache). In this paper, we detail the novel features of WattDepot and Makahiki, our experiences using them for research and education, and additional ways they can be used for next generation energy research and education....

  19. THE COST OF PRODUCTION UNDER DIRECT COSTING AND ABSORPTION COSTING – A COMPARATIVE APPROACH

    Directory of Open Access Journals (Sweden)

    Bunea-Bontaş Cristina Aurora

    2013-04-01

    Full Text Available Managerial accounting has an important role in strategic management of a company, being designed especially for managers, in order to optimise their decision regarding operating activities. One of the objectives of managerial accounting is the cost calculation, for measuring inventory costs, and the costs and profitability of products and services. Cost calculation systems can vary in terms of which costs are assigned to cost objects, two significant calculation systems being adopted by the costing theory: full cost accounting, which includes all costs of production as product costs, and partial cost accounting, which includes only those costs that vary with output. This article provides a comparative approach regarding the differences between the calculation of the cost of production under direct costing and absorption costing. It also examines the implication of using each of these calculation systems on the financial position and financial performance of the companies reported on the statement of financial position and the income statement. Finally, the advantages of using direct costing for internal reporting are discussed, considering that this method is not acceptable for external reporting to stockholders and other external users.

  20. Function Point Analysis Depot

    Science.gov (United States)

    Muniz, R.; Martinez, El; Szafran, J.; Dalton, A.

    2011-01-01

    The Function Point Analysis (FPA) Depot is a web application originally designed by one of the NE-C3 branch's engineers, Jamie Szafran, and created specifically for the Software Development team of the Launch Control Systems (LCS) project. The application consists of evaluating the work of each developer to be able to get a real estimate of the hours that is going to be assigned to a specific task of development. The Architect Team had made design change requests for the depot to change the schema of the application's information; that information, changed in the database, needed to be changed in the graphical user interface (GUI) (written in Ruby on Rails (RoR and the web service/server side in Java to match the database changes. These changes were made by two interns from NE-C, Ricardo Muniz from NE-C3, who made all the schema changes for the GUI in RoR and Edwin Martinez, from NE-C2, who made all the changes in the Java side.

  1. Comparison of heuristic approaches for the multiple depot vehicle scheduling problem

    NARCIS (Netherlands)

    A.S. Pepin; G. Desaulniers (Guy); A. Hertz (Alain); D. Huisman (Dennis)

    2006-01-01

    textabstractGiven a set of timetabled tasks, the multi-depot vehicle scheduling problem is a well-known problem that consists of determining least-cost schedules for vehicles assigned to several depots such that each task is accomplished exactly once by a vehicle. In this paper, we propose to

  2. Hydrogen Station Cost Estimates: Comparing Hydrogen Station Cost Calculator Results with other Recent Estimates

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Penev, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-09-01

    This report compares hydrogen station cost estimates conveyed by expert stakeholders through the Hydrogen Station Cost Calculation (HSCC) to a select number of other cost estimates. These other cost estimates include projections based upon cost models and costs associated with recently funded stations.

  3. Nuclear vs coal: comparing cost trends

    International Nuclear Information System (INIS)

    Harrer, B.; Nieves, L.

    1981-01-01

    The leading competitors in the new-capacity-addition options, from now to 1990, will be nuclear and coal-fired units. As an alternative viewpoint to the coal vs nuclear economic comparison presented in the October 1981 issue of Electrical World, this study represents an analysis of cost data for generating electricity from the two fuel sources. The economic impacts on nuclear and coal units of varying the levels of several key cost parameters are examined and analyzed. 13 figures

  4. Redistributing Stock in Library Systems with a Depot

    NARCIS (Netherlands)

    van der Heide, Gerlach; Roodbergen, Kees Jan; van Foreest, Nicky

    Public library organizations often utilize depots for carrying out shipments to libraries in case of stock-outs and for storing low demand rental items at low cost. Similar systems may be employed by rental companies for other rental products such as tools, DVDs, and jewelry. Since shipments deplete

  5. Comparative Cost and Strength Analysis of Cement and Aggregate ...

    African Journals Online (AJOL)

    This research presents a comparative cost and strength analysis of cement and aggregate replacement materials which is aimed at reducing the cost of concrete production. Tests were performed to compare the strength and cost of seven various cement replacement materials(rice husk ash, groundnut husk ash, palm oil ...

  6. Thermal Examination of an Orbiting Cryogenic Fuel Depot

    Science.gov (United States)

    Hull, Patrick V.; Canfield, Steven L.; Carrington, Connie; Fikes, John

    2002-01-01

    For many years NASA has been interested in the storage and transfer of cryogenic fuels in space. Lunar, L2 and other chemical propulsive space vehicle missions now have staged refueling needs that a fuel depot would satisfy. The depot considered is located in lower earth orbit. Many considerations must go into designing and building such a station. Multi-layer insulation systems, thermal shielding and low conductive structural supports are the principal means of protecting the system from excessive heat loss due to boiloff. This study focuses on the thermal losses associated with storing LH2 in a passively cooled fuel depot in a lower earth equatorial orbit. The corresponding examination looks at several configurations of the fuel depot. An analytical model has been developed to determine the thermal advantages and disadvantages of three different fuel depot configurations. Each of the systems consists of three Boeing rocket bodies arranged in various configurations. The first two configurations are gravity gradient stabilized while the third one is a spin-stabilized concept. Each concept was chosen for self-righting capabilities as well as the fuel settling capabilities, however the purpose of this paper is to prove which of the three concepts is the most efficient passively cooled system. The specific areas to be discussed are the heating time from the fusion temperature to the vaporization temperature and the amount of boiloff for a specific number of orbits. Each of the previous points is compared using various sun exposed surface areas of the tanks.

  7. Standardization: using comparative maintenance costs in an economic analysis

    OpenAIRE

    Clark, Roger Nelson

    1987-01-01

    Approved for public release; distribution is unlimited This thesis investigates the use of comparative maintenance costs of functionally interchangeable equipments in similar U.S. Navy shipboard applications in an economic analysis of standardization. The economics of standardization, life-cycle costing, and the Navy 3-M System are discussed in general. An analysis of 3-M System maintenance costs for a selected equipment, diesel engines, is conducted. The potential use of comparative ma...

  8. Multiple-Depot Integrated Vehicle and Crew Scheduling

    NARCIS (Netherlands)

    D. Huisman (Dennis); R. Freling (Richard); A.P.M. Wagelmans (Albert)

    2003-01-01

    textabstractThis paper presents two different models and algorithms for integrated vehicle and crew scheduling in the multiple-depot case. The algorithms are both based on a combination of column generation and Lagrangian relaxation. Furthermore, we compare those integrated approaches with each

  9. Locating Depots for Capacitated Vehicle Routing

    DEFF Research Database (Denmark)

    Gørtz, Inge Li; Nagarajan, Viswanath

    2016-01-01

    depots, one for each vehicle, and compute routes for the vehicles so that all demands are satisfied and the total cost is minimized. Our main result is a constant-factor approximation algorithm for k-LocVRP. In obtaining this result, we introduce a common generalization of the k-median and minimum...... spanning tree problems (called k median forest), which might be of independent interest. We give a local-search based (3+ε)-approximation algorithm for k median forest, which leads to a (12+ε)-approximation algorithm for k-LocVRP, for any constant ε>0.......We study a location-routing problem in the context of capacitated vehicle routing. The input to the k-location capacitated vehicle routing problem (k-LocVRP) consists of a set of demand locations in a metric space and a fleet of k identical vehicles, each of capacity Q. The objective is to locate k...

  10. A Fuzzy Goal Programming for a Multi-Depot Distribution Problem

    Science.gov (United States)

    Nunkaew, Wuttinan; Phruksaphanrat, Busaba

    2010-10-01

    A fuzzy goal programming model for solving a Multi-Depot Distribution Problem (MDDP) is proposed in this research. This effective proposed model is applied for solving in the first step of Assignment First-Routing Second (AFRS) approach. Practically, a basic transportation model is firstly chosen to solve this kind of problem in the assignment step. After that the Vehicle Routing Problem (VRP) model is used to compute the delivery cost in the routing step. However, in the basic transportation model, only depot to customer relationship is concerned. In addition, the consideration of customer to customer relationship should also be considered since this relationship exists in the routing step. Both considerations of relationships are solved using Preemptive Fuzzy Goal Programming (P-FGP). The first fuzzy goal is set by a total transportation cost and the second fuzzy goal is set by a satisfactory level of the overall independence value. A case study is used for describing the effectiveness of the proposed model. Results from the proposed model are compared with the basic transportation model that has previously been used in this company. The proposed model can reduce the actual delivery cost in the routing step owing to the better result in the assignment step. Defining fuzzy goals by membership functions are more realistic than crisps. Furthermore, flexibility to adjust goals and an acceptable satisfactory level for decision maker can also be increased and the optimal solution can be obtained.

  11. Comparative Cost-Effectiveness Analysis Of Streptomycin And ...

    African Journals Online (AJOL)

    Healthcare organizations, governments and individuals have been forced by prevailing circumstances of economic crisis to be increasingly oriented towards cost containment due to escalating nature of health expenditure. Objective: The objective of this study is to determine the comparative cost effectiveness of various ...

  12. Space Transportation Infrastructure Supported By Propellant Depots

    Science.gov (United States)

    Smitherman, David; Woodcock, Gordon

    2011-01-01

    A space transportation infrastructure is described that utilizes propellant depots to support all foreseeable missions in the Earth-Moon vicinity and deep space out to Mars. The infrastructure utilizes current expendable launch vehicles such as the Delta IV Heavy, Atlas V, and Falcon 9, for all crew, cargo, and propellant launches to orbit. Propellant launches are made to a Low-Earth-Orbit (LEO) Depot and an Earth-Moon Lagrange Point 1 (L1) Depot to support new reusable in-space transportation vehicles. The LEO Depot supports missions to Geosynchronous Earth Orbit (GEO) for satellite servicing, and to L1 for L1 Depot missions. The L1 Depot supports Lunar, Earth-Sun L2 (ESL2), Asteroid, and Mars missions. A Mars Orbital Depot is also described to support ongoing Mars missions. New concepts for vehicle designs are presented that can be launched on current 5-meter diameter expendable launch vehicles. These new reusable vehicle concepts include a LEO Depot, L1 Depot, and Mars Orbital Depot based on International Space Station (ISS) heritage hardware. The high-energy depots at L1 and Mars orbit are compatible with, but do not require, electric propulsion tug use for propellant and/or cargo delivery. New reusable in-space crew transportation vehicles include a Crew Transfer Vehicle (CTV) for crew transportation between the LEO Depot and the L1 Depot, a new reusable Lunar Lander for crew transportation between the L1 Depot and the lunar surface, and a Deep Space Habitat (DSH) to support crew missions from the L1 Depot to ESL2, Asteroid, and Mars destinations. A 6 meter diameter Mars lander concept is presented that can be launched without a fairing based on the Delta IV heavy Payload Planners Guide, which indicates feasibility of a 6.5 meter fairing. This lander would evolve to re-usable operations when propellant production is established on Mars. Figure 1 provides a summary of the possible missions this infrastructure can support. Summary mission profiles are presented

  13. Comparing Methods for Estimating Direct Costs of Adverse Drug Events.

    Science.gov (United States)

    Gyllensten, Hanna; Jönsson, Anna K; Hakkarainen, Katja M; Svensson, Staffan; Hägg, Staffan; Rehnberg, Clas

    2017-12-01

    To estimate how direct health care costs resulting from adverse drug events (ADEs) and cost distribution are affected by methodological decisions regarding identification of ADEs, assigning relevant resource use to ADEs, and estimating costs for the assigned resources. ADEs were identified from medical records and diagnostic codes for a random sample of 4970 Swedish adults during a 3-month study period in 2008 and were assessed for causality. Results were compared for five cost evaluation methods, including different methods for identifying ADEs, assigning resource use to ADEs, and for estimating costs for the assigned resources (resource use method, proportion of registered cost method, unit cost method, diagnostic code method, and main diagnosis method). Different levels of causality for ADEs and ADEs' contribution to health care resource use were considered. Using the five methods, the maximum estimated overall direct health care costs resulting from ADEs ranged from Sk10,000 (Sk = Swedish krona; ~€1,500 in 2016 values) using the diagnostic code method to more than Sk3,000,000 (~€414,000) using the unit cost method in our study population. The most conservative definitions for ADEs' contribution to health care resource use and the causality of ADEs resulted in average costs per patient ranging from Sk0 using the diagnostic code method to Sk4066 (~€500) using the unit cost method. The estimated costs resulting from ADEs varied considerably depending on the methodological choices. The results indicate that costs for ADEs need to be identified through medical record review and by using detailed unit cost data. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. The Global Economic Cost of Osteoarthritis: How the UK Compares

    Directory of Open Access Journals (Sweden)

    A. Chen

    2012-01-01

    Full Text Available Aims. To examine all relevant literature on the economic costs of osteoarthritis in the UK, and to compare such costs globally. Methods. A search of MEDLINE was performed. The search was expanded beyond peer-reviewed journals into publications by the department of health, national orthopaedic associations, national authorities and registries, and arthritis charities. Results. No UK studies were identified in the literature search. 3 European, 6 North American, and 2 Asian studies were reviewed. Significant variation in direct and indirect costs were seen in these studies. Costs for topical and oral NSAIDs were estimated to be £19.2 million and £25.65 million, respectively. Cost of hip and knee replacements was estimated to exceed £850 million, arthroscopic surgery for osteoarthritis was estimated to be £1.34 million. Indirect costs from OA caused a loss of economic production over £3.2 billion, £43 million was spent on community services and £215 million on social services for osteoarthritis. Conclusions. While estimates of economic costs can be made using information from non-published data, there remains a lack of original research looking at the direct or indirect costs of osteoarthritis in the UK. Differing methodology in calculating costs from overseas studies makes direct comparison with the UK difficult.

  15. Storage depot for radioactive material

    International Nuclear Information System (INIS)

    Szulinski, M.J.

    1983-01-01

    Vertical drilling of cylindrical holes in the soil, and the lining of such holes, provides storage vaults called caissons. A guarded depot is provided with a plurality of such caissons covered by shielded closures preventing radiation from penetrating through any linear gap to the atmosphere. The heat generated by the radioactive material is dissipated through the vertical liner of the well into the adjacent soil and thus to the ground surface so that most of the heat from the radioactive material is dissipated into the atmosphere in a manner involving no significant amount of biologically harmful radiation. The passive cooling of the radioactive material without reliance upon pumps, personnel, or other factor which might fail, constitutes one of the most advantageous features of this system. Moreover this system is resistant to damage from tornadoes or earthquakes. Hermetically sealed containers of radioactive material may be positioned in the caissons. Loading vehicles can travel throughout the depot to permit great flexibility of loading and unloading radioactive materials. Radioactive material can be shifted to a more closely spaced caisson after ageing sufficiently to generate much less heat. The quantity of material stored in a caisson is restricted by the average capacity for heat dissipation of the soil adjacent such caisson

  16. Comparing the Cost of Treatment with Octreotide Long-Acting Release versus Lanreotide in Patients with Metastatic Gastrointestinal Neuroendocrine Tumors.

    Science.gov (United States)

    Ayyagari, Rajeev; Neary, Maureen; Li, Shang; Rokito, Ariel; Yang, Hongbo; Xie, Jipan; Benson, Al B

    2017-11-01

    The 2 somatostatin analogs currently recommended by the National Comprehensive Cancer Network for the treatment of gastrointestinal (GI) neuroendocrine tumors (NETs) include octreotide long-acting release (Sandostatin LAR) for injectable suspension and lanreotide (Somatuline Depot) injection for subcutaneous use. To estimate the costs to payers associated with 30-mg octreotide LAR and 120-mg lanreotide treatment among patients with metastatic GI-NETs. The costs to payers associated with the 2 drugs were estimated by including the costs of each drug, drug administration, and adverse events. The unit drug costs for octreotide LAR and for lanreotide were obtained from ReadyPrice Wholesale Acquisition Cost; the doses were obtained from published studies. The adverse event rates were obtained from 2 phase 3 clinical trials, PROMID and CLARINET. Deterministic one-way sensitivity analyses were used to assess the impact of modifying assumptions and inputs on the results, including the 2017 Average Sales Price (ASP). All costs were estimated in 2016 US dollars, with a constant discount of 3%. The costs to payers associated with the treatment of GI-NETs during 1-, 3-, and 5-year horizons were $74,566, $180,082, and $262,344, respectively, for octreotide LAR and $84,856, $205,562, and $299,667, respectively, for lanreotide. Thus, octreotide LAR was associated with lower costs by $10,290 (1 year), $25,480 (3 years), and $37,323 (5 years) compared with lanreotide. Over a 5-year horizon, the costs of adverse events and administration accounted for 0.72% of the total cost for octreotide LAR and 0.51% of the total cost for lanreotide. Sensitivity analyses confirmed that the main factor affecting the cost difference was the price of the drugs; analyses using the ASP yielded similar results. For the management of metastatic GI-NETs, the cost to payers of treatment with 30-mg octreotide LAR is considerably lower than with 120-mg lanreotide over 1-, 3-, and 5-year horizons. In the

  17. DEPOT database: Reference manual and user's guide

    International Nuclear Information System (INIS)

    Clancey, P.; Logg, C.

    1991-03-01

    DEPOT has been developed to provide tracking for the Stanford Linear Collider (SLC) control system equipment. For each piece of equipment entered into the database, complete location, service, maintenance, modification, certification, and radiation exposure histories can be maintained. To facilitate data entry accuracy, efficiency, and consistency, barcoding technology has been used extensively. DEPOT has been an important tool in improving the reliability of the microsystems controlling SLC. This document describes the components of the DEPOT database, the elements in the database records, and the use of the supporting programs for entering data, searching the database, and producing reports from the information

  18. Comparative Life-Cycle Cost Analysis Of Solar Photovoltaic Power ...

    African Journals Online (AJOL)

    Many homes in Nigeria are in remote locations where grid electricity supply could not be extended. This paper attempts to present a concise life-cycle-cost comparison of diesel generator power supply system and photovoltaic power system for a remote rural application. In this comparative analysis, conceptual designs ...

  19. Comparative costs between myocardial revascularization with or without extracorporeal circulation.

    Science.gov (United States)

    Girardi, Priscyla B M A; Hueb, Whady; Nogueira, Célia R S R; Takiuti, Myrthes E; Nakano, Teryo; Garzillo, Cibele Larrosa; Paulitsch, Felipe da S; Góis, Aécio F T; Lopes, Neuza H M; Stolf, Noedir A

    2008-12-01

    Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p WECC when compared to the SECC group (606.00 +/- 525.00 vs. 945.90 +/- 440.00), as well as ICU costs: 432.20 +/- 391.70 vs. 717.70 +/- 257.70, respectively. The duration of the operating room stay were 4.9 +/- 1.1 h vs. 3.9 +/- 1.0 h, p < 0.001; at the ICU it was 48.2 +/- 17.2 h vs. 29.2 +/- 26.1h) (p < 0.001), with intubation time of 9.2 +/- 4.5 h vs. 6.4 +/- 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.

  20. Differential screening identifies transcripts with depot-dependent expression in white adipose tissues

    Directory of Open Access Journals (Sweden)

    Zhou Shengli

    2008-08-01

    Full Text Available Abstract Background The co-morbidities of obesity are tied to location of excess fat in the intra-abdominal as compared to subcutaneous white adipose tissue (WAT depot. Genes distinctly expressed in WAT depots may impart depot-dependent physiological functions. To identify such genes, we prepared subtractive cDNA libraries from murine subcutaneous (SC or intra-abdominal epididymal (EP white adipocytes. Results Differential screening and qPCR validation identified 7 transcripts with 2.5-fold or greater enrichment in EP vs. SC adipocytes. Boc, a component of the hedgehog signaling pathway demonstrated highest enrichment (~12-fold in EP adipocytes. We also identified a dramatic enrichment in SC adipocytes vs. EP adipocytes and in SC WAT vs. EP WAT for transcript(s for the major urinary proteins (Mups, small secreted proteins with pheromone functions that are members of the lipocalin family. Expression of Boc and Mup transcript was further assessed in murine tissues, adipogenesis models, and obesity. qPCR analysis reveals that EP WAT is a major site of expression of Boc transcript. Furthermore, Boc transcript expression decreased in obese EP WAT with a concomitant upregulation of Boc transcript in the obese SC WAT depot. Assessment of the Boc binding partner Cdon in adipose tissue and cell fractions thereof, revealed transcript expression similar to Boc; suggestive of a role for the Boc-Cdon axis in WAT depot function. Mup transcripts were predominantly expressed in liver and in the SC and RP WAT depots and increased several thousand-fold during differentiation of primary murine preadipocytes to adipocytes. Mup transcripts were also markedly reduced in SC WAT and liver of ob/ob genetically obese mice compared to wild type. Conclusion Further assessment of WAT depot-enriched transcripts may uncover distinctions in WAT depot gene expression that illuminate the physiological impact of regional adiposity.

  1. [Treatment of Adult Schizophrenic Patients With Depot Antipsychotics].

    Science.gov (United States)

    Jaramillo González, Luis Eduardo; Gómez Restrepo, Carlos; García Valencia, Jenny; de la Hoz Bradford, Ana María; Ávila-Guerra, Mauricio; Bohórquez Peñaranda, Adriana

    2014-01-01

    To determine the indications of long-acting antipsychotic injection and what its effectiveness and safety in adult patients with schizophrenia during the treatment maintenance phase. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. The literature review shows that the evidence has moderate to low quality. 8 articles were used. The risk of relapse was lower with depot risperidone and paliperidone palmitate when compared with placebo. For the risk of hospitalizations comparing depot antipsychotics (APD) versus oral AP, the result is inconclusive. Globally the second-generation APD had a lower risk of discontinuation when compared with placebo. The second generation AP had higher risk of extrapyramidal syndromes than placebo, as in the use of antiparkinsonian. The comparison of second-generation AP injections versus placebo showed an increased risk of early weight gain. The use of depot antipsychotics in the maintenance phase of adult patients diagnosed with schizophrenia is recommended if there is no adherence to oral antipsychotics as the patient's preference. It is not recommended depot antipsychotics in the acute phase of schizophrenia in adults. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  2. Male bovine GH transgenic mice have decreased adiposity with an adipose depot-specific increase in immune cell populations.

    Science.gov (United States)

    Benencia, Fabian; Harshman, Stephanie; Duran-Ortiz, Silvana; Lubbers, Ellen R; List, Edward O; Householder, Lara; Al-Naeeli, Mawadda; Liang, Xiaoyu; Welch, Lonnie; Kopchick, John J; Berryman, Darlene E

    2015-05-01

    White adipose tissue (WAT) is composed of mature adipocytes and a stromal vascular fraction (SVF), which contains a variety of cells, including immune cells that vary among the different WAT depots. Growth hormone (GH) impacts immune function and adiposity in an adipose depot-specific manner. However, its effects on WAT immune cell populations remain unstudied. Bovine GH transgenic (bGH) mice are commonly used to study the in vivo effects of GH. These giant mice have an excess of GH action, impaired glucose metabolism, decreased adiposity, increased lean mass, and a shortened lifespan. Therefore, the purpose of this study was to characterize the WAT depot-specific differences in immune cell populations in the presence of excess GH in vivo. Three WAT depots were assessed: inguinal (sc), epididymal (EPI), and mesenteric (MES). Subcutaneous and MES bGH WAT depots showed a significantly higher number of total SVF cells, yet only MES bGH WAT had higher leukocyte counts compared with control samples. By means of flow cytometry analysis of the SVF, we detected greater macrophage and regulatory T-cell infiltration in sc and MES bGH WAT depots compared with controls. However, no differences were observed in the EPI WAT depot. RNA-sequencing confirmed significant alterations in pathways related to T-cell infiltration and activation in the sc depot with fewer significant changes in the EPI bGH WAT depot. These findings collectively point to a previously unrecognized role for GH in influencing the distribution of WAT immune cell populations in a depot-specific manner.

  3. Implementation of Geographical Information System for Bacteriological Contamination Analysis on Refill Drinking Water Depot (Study in Tembalang District)

    Science.gov (United States)

    Rahmitha, Amelia; Utami, Endang Sri; Sitohang, Marya Yenita

    2018-02-01

    People used refilled-drinking-water for household and food stall because its efficient and low cost. Based on Indonesian Health Ministry regulation, it should not have any coliform bacteria. This study aimed to describe the bacteriological contamination of refilled drinking water using geographical information system (GIS). In this research, it was used an analytic observational method. The samples were from all available (37) depots in Tembalang district, one form each depot took used a sterile bottle. Contamination of bacteria was identified by Most Probable Number (MPN) method lactose broth media, Mac Conkey media, and IMVIC media. The depot samples were then plotted on (GIS). This study showed 95% samples were not feasible to consume since they contamined coliform. All sub-district had one that contaminated by coliform, 75% sub-districts had depots that contaminated Escherichia coli, while 55% sub-districts had depots that contaminated with other bacteria. The internal risk factors of the contamination were the absence of hygiene-sanitation worthy certificate (95%), depots location near to pollution sources (5%), and the misused of UV light. The external risk factor was lack of quality control that was not as the sterilization from office health Semarang city. Policy reinforcement should be done to all of the depots.

  4. Comparative evaluation of activity-based costing and variable costing: a case study at IPEN

    International Nuclear Information System (INIS)

    Esteves, Josefina Maria da Silva SILVA

    2010-01-01

    This research aims to compare the results with the application of Activity Based Costing and Variable Costing methods in an administrative unit of the Brazilian Federal Government: the Radiopharmacy Facility of IPEN (Institute for Energy and Nuclear Research), which produces radiopharmaceuticals products and develops R and D activities. Faced with the need to adopt a more economical and managerial public administration, this research has provided information to assess which of the two costing methods proves more suitable for cost management in that unit. The research is exploratory and a single-case study. We traced about 80% of material costs by observation 'in loco' of the entire manufacturing process of technetium generator, which represents the main product in terms of production volume and revenues. The results show that the Contribution Margin Variable Costing of 29.12% is very close to the operating income of 28.86%, ahead of support activities, obtained by ABC. It is also noted that the operational result of the product does not change by using either one or another costing method. In the two costing methods the end result is 24.20%. This occurs because the production is on demand. There is no inventory of finished product because it is radioactive. The research has revealed that both methods provide useful information for the management and optimization of costs and results of processes/activities, and that the two methods, in this case, may be used in an integrated and complementary approach, enabling to use the best information content of both. (author)

  5. Study on Multi-Depot Collaborative Transportation Problem of Milk-Run Pattern

    Directory of Open Access Journals (Sweden)

    Lou Zhenkai

    2016-01-01

    Full Text Available Analyze the relevance between Milk Run mode and collaborative transportation problem, put forward collaborative transportation problem of multiple-depot on Milk Run mode under the supply and demand separate nodes, consider the value of transport and transport costs, introduce the concept of node - arc flow, by comparing the size of traffic flow determine nodes collection, and then constructed multi-transport model of the problem. Considering one-way pickup and delivery closed, construct two-stage algorithm model, use dynamic programming recursive solution to determine the best route to pick up, and then solving delivery routing problem with different start and return point based on geometric method of Cosine. Finally use a numerical example illustrates the effectiveness of the algorithm and reasonable model.

  6. Comparing the costs of three prostate cancer follow-up strategies: a cost minimisation analysis.

    Science.gov (United States)

    Pearce, Alison M; Ryan, Fay; Drummond, Frances J; Thomas, Audrey Alforque; Timmons, Aileen; Sharp, Linda

    2016-02-01

    Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors mean that this model of care may not be economically sustainable, and a number of alternative approaches have been suggested. The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland-the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice. A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for men with prostate cancer treated with curative intent. The model took a health care payer's perspective over a 10-year time horizon. Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74 % of current practice costs) and the EAU guidelines intermediate (92 % of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish health care system could have saved €760,000 over a 10-year period if the NICE guidelines were adopted. This is the first study investigating costs of prostate cancer follow-up in the Irish setting. While economic models are designed as a simplification of complex real-world situations, these results suggest potential for significant savings within the Irish health care system associated with implementation of alternative models of prostate cancer follow-up care.

  7. THE COMPARATIVE COST-EFFICACY ANALYSIS OF VARIOUS ANTIHYPERTENSIVE THERAPIES

    Directory of Open Access Journals (Sweden)

    S. V. Malchikova

    2016-01-01

    Full Text Available Aim. To perform the comparative cost-efficacy analysis of various antihypertensive therapies in hypertensives patients.Material and methods. 140 hypertensive patients with history of ineffective antihypertensive therapy were randomized in to 4 groups, 35 patients in each one. Patients of Group A received indapamide retard plus perindopril; group B - indapamide retard plus amlodipine; group C - amlodipine plus lisinopril; group D - amlodipine plus bisoprolol. The Russian version of general questionnaire MOS-SF-36 was applied for quality of a life estimated. Endothelium function was evaluated with B-mode ultrasonography (Acuson 128 ХР/10. Albuminuria level was detected by immunoturbometric method (Integra-700, Roche.Results. The drug combination B had the least cost. The drug combination C was the most effective. The drug combination C was the most economically rational. The drug combination A was the least economically rational for BP reduction. However the drug combination A was comparable with drug combination C in effects on quality of life and on endothelium function, and it was the most economically rational for albuminuria reduction.Conclusion. Indapamide retard plus perindopril combination is the most economically rational in patients with target-organ lesions (nephropathy. Lisinopril plus amlodipine combination is economically rational in patients without target-organ lesions. 

  8. THE COMPARATIVE COST-EFFICACY ANALYSIS OF VARIOUS ANTIHYPERTENSIVE THERAPIES

    Directory of Open Access Journals (Sweden)

    S. V. Malchikova

    2009-01-01

    Full Text Available Aim. To perform the comparative cost-efficacy analysis of various antihypertensive therapies in hypertensives patients.Material and methods. 140 hypertensive patients with history of ineffective antihypertensive therapy were randomized in to 4 groups, 35 patients in each one. Patients of Group A received indapamide retard plus perindopril; group B - indapamide retard plus amlodipine; group C - amlodipine plus lisinopril; group D - amlodipine plus bisoprolol. The Russian version of general questionnaire MOS-SF-36 was applied for quality of a life estimated. Endothelium function was evaluated with B-mode ultrasonography (Acuson 128 ХР/10. Albuminuria level was detected by immunoturbometric method (Integra-700, Roche.Results. The drug combination B had the least cost. The drug combination C was the most effective. The drug combination C was the most economically rational. The drug combination A was the least economically rational for BP reduction. However the drug combination A was comparable with drug combination C in effects on quality of life and on endothelium function, and it was the most economically rational for albuminuria reduction.Conclusion. Indapamide retard plus perindopril combination is the most economically rational in patients with target-organ lesions (nephropathy. Lisinopril plus amlodipine combination is economically rational in patients without target-organ lesions. 

  9. Time-driven activity based costing: a comparative study with the activity based costing

    Directory of Open Access Journals (Sweden)

    Marina Battistella Luna

    2017-06-01

    Full Text Available The activity-based costing (ABC emerged in the 1980s to meet the new necessities of cost information facing companies, the result of continuous changes in the business environment. In the 2000s, a new costing method, known as time-driven activity-based costing (TDABC was introduced in order to simplify the ABC. This paper compares these methods in order to provide information to assist managers to decide which of these methods better suits the reality of their companies. Therefore, they were analyzed based on information obtained through a systematic search in the Scopus and Web of Knowledge databases, as well as papers from the annals of the Congresso Brasileiro de Custos, Congresso de Controladoria e Contabilidade da USP and Encontro Nacional de Engenharia de Produção (considering scientific papers published between 2004 and 2016. From this analysis, in most cases it was concluded that TDABC is a simpler and more practical option than ABC. However, it was also apparent that managers, before choosing a particular method, must verify whether the conditions that enable its applicability exist.

  10. Calculation of comparative utilisation and cost: a South African ...

    African Journals Online (AJOL)

    ... probably be used conservatively as it increases the anaesthetic cost and contributes to pollution and ozone depletion. Propofol TCI can be considered instead of sevoflurane inhalational anaesthesia for longer procedures. Keywords: cost of anaesthesia; inhalational anaesthesia, intravenous anaesthesia, nitrous oxide

  11. Locating Depots for Capacitated Vehicle Routing

    DEFF Research Database (Denmark)

    Gørtz, Inge Li; Nagarajan, Viswanath

    2011-01-01

    We study a location-routing problem in the context of capacitated vehicle routing. The input to k-LocVRP is a set of demand locations in a metric space and a fleet of k vehicles each of capacity Q. The objective is to locate k depots, one for each vehicle, and compute routes for the vehicles so t...

  12. Depot medroxyprogesterone injectable contraception at the ...

    African Journals Online (AJOL)

    the introduction of post-abortal and puerperal administrations of depot medroxyprogesterone acetate and its new formulation; depo sub-Q provera in all our .... disease, uterine fibroids, ectopic pregnancy, iron- deficiency anemia and ovarian .... contraception. Clinical Gynaecologic Endocrinology and. Infertility. 15th ed.

  13. Comparative study of cost models for tokamak DEMO fusion reactors

    International Nuclear Information System (INIS)

    Oishi, Tetsutarou; Yamazaki, Kozo; Arimoto, Hideki; Ban, Kanae; Kondo, Takuya; Tobita, Kenji; Goto, Takuya

    2012-01-01

    Cost evaluation analysis of the tokamak-type demonstration reactor DEMO using the PEC (physics-engineering-cost) system code is underway to establish a cost evaluation model for the DEMO reactor design. As a reference case, a DEMO reactor with reference to the SSTR (steady state tokamak reactor) was designed using PEC code. The calculated total capital cost was in the same order of that proposed previously in cost evaluation studies for the SSTR. Design parameter scanning analysis and multi regression analysis illustrated the effect of parameters on the total capital cost. The capital cost was predicted to be inside the range of several thousands of M$s in this study. (author)

  14. Artificial immune algorithm for multi-depot vehicle scheduling problems

    Science.gov (United States)

    Wu, Zhongyi; Wang, Donggen; Xia, Linyuan; Chen, Xiaoling

    2008-10-01

    In the fast-developing logistics and supply chain management fields, one of the key problems in the decision support system is that how to arrange, for a lot of customers and suppliers, the supplier-to-customer assignment and produce a detailed supply schedule under a set of constraints. Solutions to the multi-depot vehicle scheduling problems (MDVRP) help in solving this problem in case of transportation applications. The objective of the MDVSP is to minimize the total distance covered by all vehicles, which can be considered as delivery costs or time consumption. The MDVSP is one of nondeterministic polynomial-time hard (NP-hard) problem which cannot be solved to optimality within polynomial bounded computational time. Many different approaches have been developed to tackle MDVSP, such as exact algorithm (EA), one-stage approach (OSA), two-phase heuristic method (TPHM), tabu search algorithm (TSA), genetic algorithm (GA) and hierarchical multiplex structure (HIMS). Most of the methods mentioned above are time consuming and have high risk to result in local optimum. In this paper, a new search algorithm is proposed to solve MDVSP based on Artificial Immune Systems (AIS), which are inspirited by vertebrate immune systems. The proposed AIS algorithm is tested with 30 customers and 6 vehicles located in 3 depots. Experimental results show that the artificial immune system algorithm is an effective and efficient method for solving MDVSP problems.

  15. COMPARATIVE ANALYSIS FOR THE PRACTICAL PRACTICE OF COST CALCULATION

    Directory of Open Access Journals (Sweden)

    Veronika Fenyves

    2015-07-01

    Full Text Available Basic topic of our treatise is to introduce the system of cost calculation. Our reason for choice of this topic is that, in the economic environment of today, it is very important for a production company to have the most possible accurate knowledge about costs of the activity. This informational demand emerges in case of more and more managing entities since the cost cutback is often the only tool for retaining the competitiveness – of course, within certain frameworks. There is a frequent question among the corporate owners and management: “How could our costs be cut – even if only to a small extent?” One of the devices is the moderation of the activity costs, in order to do this it is essential to know how much the production of the unit of product costs for the company, that is to say, how many its first cost is. Our goal is to aim the attention at values and importance of the management information system as well as information obtained during determination of the cost, the differences in results of the individual cost calculation methods and the reasons of differences. In addition, our intention was to know and acquaint a complex cost calculation procedure in depth during which we endeavoured to form a system theory of a kind.

  16. Comparing Cost Of New Supply Chain Designs Under Uncertainty

    DEFF Research Database (Denmark)

    Wæhrens, Brian Vejrum; Kristensen, Jesper; Asmussen, Jesper Normann

    2016-01-01

    Accounting, Operational Modelling and SCM inform decision making for new SCDs. Through four embedded cases, a gap is found between the practice of a global OEM and literature. Results shows complications when assessing SCDs due to limited understanding of the internal activity costs, supply chain dynamics......Companies pursuing improvements to their global supply chain (SC) are challenged with unravelling the true cost of operating with their supply chain design (SCD). This challenge is further intensified as SCs are faced with increasing uncertainty. To rectify this it is investigated how Cost...... and how uncertainties affects the SC cost performance....

  17. Comparing extinction risk and economic cost in wildlife conservation planning

    Science.gov (United States)

    Robert G. Haight

    1995-01-01

    Planning regulations pursuant to the National Forest Management Act of 1976 require the USDA Forest Service to produce cost-effective, multiple-use forest plans that ensure the viability of native wildlife populations within the planning area. In accordance with these regulations, this paper presents a method for determining cost-effective conservation plans for...

  18. A Comparative Cost Analysis of Picture Archiving and ...

    African Journals Online (AJOL)

    Method: An incremental cost analysis for chest radiographs,, computed tomography and magnetic resonance imaging brain scans with and without contrast were performed. The overall incremental cost for PACS in comparison with a conventional radiology site was determined. The net present value was also determined to ...

  19. Which cost of alcohol? What should we compare it against?

    Science.gov (United States)

    Bhattacharya, Aveek

    2017-04-01

    This paper explores and develops issues raised by recent debates about the cost of alcohol to England and Wales. It advances two arguments. First, that the commonly used estimates for alcohol harm in England and Wales are outdated, not fully reliable and in need of revisiting. These estimates rely on data that are between 4 and 12 years out of date and sensitive to questionable assumptions and methodological judgements. Secondly, it argues that policymakers, academics and non-governmental organizations should be more careful in their use of these numbers. In particular, it is imperative that the numbers quoted fit the argument advanced. To help guide such appropriate usage, the different types of cost of alcohol are surveyed, alongside some thoughts on the questions they help us to answer and what they imply for policy. For example, comprehensive estimates of the total social cost of alcohol provide an indication of the scale of the problem, but have limited policy relevance. External cost estimates represent a 'lowest common denominator' approach acceptable to most, but require additional assumptions to guide action. Narrower perspectives, such as fiscal, economic or health costs, may be relevant in specific contexts. However, optimal policy should take a holistic view of all the relevant costs and benefits. Similarly, focusing solely on tangible costs may be less controversial, but will result in an under-estimate of the relevant costs of alcohol. © 2016 Society for the Study of Addiction.

  20. Calculation of comparative utilisation and cost: a South African ...

    African Journals Online (AJOL)

    2012-07-19

    Jul 19, 2012 ... Setting and subjects: No patients were involved in this theoretical cost analysis. Outcome measures: The calculated costs ... Elimination of nitrogen from the functional residual capacity. • Establishment of a ..... anaesthesia was noted in others.6,7,30,31 A meta-analysis that was carried out by Sneyd et al in ...

  1. ATTITUDES OF SHOP FLOOR EMPLOYEES TOWARD WOMEN MANAGERS IN FUEL DEPOTS: A CASE OF THE FUEL DEPOTS IN LUBUMBASHI, DEMOCRATIC REPUBLIC OF THE CONGO

    Directory of Open Access Journals (Sweden)

    Stephen N. M. Nzuve

    2014-12-01

    Full Text Available The International Labour Organization and all organizations of human rights advocate against any form of negative attitude in employment based on gender, its terms, promotion and relations. Shop floor employees play a very important role in the daily advancement and profitability of an organisation. The purpose of this study was to establish the attitude of shop floor employees toward women managers in fuel depots in Lubumbashi, Democratic Republic of the Congo. The study adopted a descriptive survey design with the population consisting of one hundred and ninety three (193 shop floor employees. A semi structured questionnaire was used to collect primary data. In total one hundred and twenty one (121 shop floor employees responded yielding a response rate of sixty three percent (63%. The findings of this study indicate that a negative attitude toward woman managers is prevalent in the Fuel Depots of Lubumbashi, Democratic Republic of the Congo. At the fuel depots, the number of women working was less than a third of the males. In spite of this, women managers are rated higher in management qualities and are considered to be more honest, diligent, compassionate, creative and intelligent when compared to their male counterparts. The study recommends a culture change among employees in fuel depots in Lubumbashi in order to enable them perceive women as equal partners at the work place.

  2. Distinct developmental signatures of human abdominal and gluteal subcutaneous adipose tissue depots.

    Science.gov (United States)

    Karastergiou, Kalypso; Fried, Susan K; Xie, Hui; Lee, Mi-Jeong; Divoux, Adeline; Rosencrantz, Marcus A; Chang, R Jeffrey; Smith, Steven R

    2013-01-01

    Fat distribution differs in men and women, but in both sexes, a predominantly gluteal-femoral compared with abdominal (central) fat distribution is associated with lower metabolic risk. Differences in cellular characteristics and metabolic functions of these depots have been described, but the molecular mechanisms involved are not understood. Our objective was to identify depot- and sex-dependent differences in gene expression in human abdominal and gluteal sc adipose tissues. Abdominal and gluteal adipose tissue aspirates were obtained from 14 premenopausal women [age 27.5 ± 7.0 yr, body mass index (BMI) 27.3 ± 6.2 kg/m(2), and waist-to-hip ratio 0.82 ± 0.04] and 21 men (age 29.7±7.4 yr, BMI 27.2 ± 4.5 kg/m(2), and waist-to-hip ratio 0.91 ± 0.07) and transcriptomes were analyzed using Illumina microarrays. Expression of selected genes was determined in isolated adipocytes and stromal vascular fractions from each depot, and in in vitro cultures before and after adipogenic differentiation. A total of 284 genes were differentially expressed between the abdominal and gluteal depot, either specifically in males (n = 66) or females (n = 159) or in both sexes (n = 59). Most notably, gene ontology and pathway analysis identified homeobox genes (HOXA2, HOXA3, HOXA4, HOXA5, HOXA9, HOXB7, HOXB8, HOXC8, and IRX2) that were down-regulated in the gluteal depot in both sexes (P = 2 × 10(-10)). Conversely, HOXA10 was up-regulated in gluteal tissue and HOXC13 was detected exclusively in this depot. These differences were independent of BMI, were present in both adipocytes and stromal vascular fractions of adipose tissue, and were retained throughout in vitro differentiation. We conclude that developmentally programmed differences may contribute to the distinct phenotypic characteristics of peripheral fat.

  3. Comparative analysis of production costs and revenues of small ...

    African Journals Online (AJOL)

    The capital investment and the operational costs for the non-motorized canoe fishery ranged between N7,250.00 for hand line and N42,750.00 for stow net fishery. Only 6.0% of the canoes were motorized and the cost of the outboard engine accounted for 38% of the capital assets for encircling net 43% for beach seine net ...

  4. The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

    2018-02-21

    In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

  5. D:epot Medroxyprogesterone Acetate (Depo-Provlera) as a Contrac ...

    African Journals Online (AJOL)

    1971-07-17

    Jul 17, 1971 ... Experience with depot medroxyprogesterone acetate as a contraceptive preparation in 7335 patients for a total of. 38 714 months over a 3-year period is described. The discontinuation rate was 18'3% and the failure rate 0'35 per 100 women-years of use. This compares very well with all other methods of ...

  6. Cost utility analysis of sildenafil compared with papaverine-phentolamine injections

    NARCIS (Netherlands)

    E.A. Stolk (Elly); M. Caffa; E.J. Meuleman; F.F.H. Rutten (Frans); J.J. van Busschbach (Jan)

    2000-01-01

    textabstractOBJECTIVE: To compare the cost effectiveness of sildenafil and papaverine-phentolamine injections for treating erectile dysfunction. DESIGN: Cost utility analysis comparing treatment with sildenafil (allowing a switch to injection therapy) and treatment

  7. A Cost Evaluation of a Donation after Cardiac Death Program: How Cost per Organ Compares to Other Donor Types.

    Science.gov (United States)

    Lindemann, Jessica; Dageforde, Leigh Anne; Vachharajani, Neeta; Stahlschmidt, Emily; Brockmeier, Diane; Wellen, Jason R; Khan, Adeel; Chapman, William C; Doyle, Majella

    2018-03-02

    Donation after cardiac death (DCD) is one method of organ donation. Nationally, more than half of evaluated DCD donors do not yield transplantable organs. There is no algorithm for predicting which DCD donors will be appropriate for organ procurement. DCD program costs from an organ procurement organization (OPO) accounting for all evaluated donors have not been reported. Hospital, transportation, and supply costs of potential DCD donors evaluated at a single OPO from January 2009 to June 2016 were collected. Average costs per donor and per organ were calculated. Cost of DCD donors that did not yield a transplantable organ were included in cost analyses resulting in total cost of the DCD program. DCD donor costs were compared to costs of in hospital donation after brain death (DBD) donors. There were 289 organs transplanted from 264 DCD donors evaluated. Average cost per DCD donor yielding transplantable organs was $9,306. However, 127 donors yielded no organs at an average cost of $8,794 per donor. The total cost of the DCD program was $32,020 per donor and $15,179 per organ. The average cost for an in hospital DBD donor was $33,546 and $9,478 per organ transplanted. Average organ yield for DBD donors was 3.54 versus 2.21 for DCD donors (porgan 63% of the cost of a DCD organ. The average cost per DCD donor is comparable to DBD donors however, individual cost of DCD organs increases by almost forty percent when all costs of an entire DCD program are included. Copyright © 2018. Published by Elsevier Inc.

  8. Can we reduce costs and prevent more unintended pregnancies? A cost of illness and cost-effectiveness study comparing two methods of EHC.

    Science.gov (United States)

    Thomas, Christine M; Cameron, Sharon

    2013-12-18

    To calculate the cost of an unintended pregnancy in 2011 and use this cost in a cost-effectiveness model comparing ulipristal acetate (UPA) with levonorgestrel (LNG) for emergency hormonal contraception (EHC). Retrospective analysis of published data sources and published cost-effectiveness model. Women presenting in primary care in England for EHC within 24 or 72 h of unprotected sexual intercourse (UPSI). EHC of either LNG (1.5 mg) or UPA (30 mg). The primary outcome measure is the number and direct and indirect costs of an unintended pregnancy. The secondary outcome measure is the consequence of unintended pregnancy: miscarriage, abortion, ectopic pregnancy, stillbirth or live birth. From the comparative clinical studies of EHC we observe that if 125 women receive either LNG or UPA within 72 h of UPSI, there will be one less pregnancy due to method failure in the UPA group than in the LNG group. We calculate the cost of an unintended pregnancy to be £1663 in direct healthcare costs rising to £2922 with the inclusion of social costs. Using these costs in the comparative cost-effectiveness model shows that it costs £194 less in direct health costs alone to prevent one more pregnancy with UPA than with LNG. The inclusion of social costs of pregnancy increases this cost-saving potential to £1453 for each extra pregnancy avoided with UPA compared with LNG. Clinical trials have demonstrated the superior efficacy of UPA compared with LNG as a method of EHC. Given that it costs less overall in health and social costs of pregnancy while preventing more pregnancies, UPA is said to be the dominant treatment, and primary care services should shift to offering UPA as the preferred oral option to women presenting within 24 and 72 h of UPSI.

  9. Cost minimization of generation, storage, and new loads, comparing costs with and without externalities

    DEFF Research Database (Denmark)

    Noel, Lance Douglas; Brodie, Joseph; Kempton, Willett

    2017-01-01

    The goal of this research is to understand the economics of anticipated large-scale changes in the electric system. 86 million different combinations of renewable generation (wind and solar), natural gas, and three storage types (hydrogen storage, electric vehicles equipped with vehicle-to-grid (V2...... cost energy systems. Using today’s costs of conventional and renewable electricity and without adding any externalities, the cost-minimum system includes no renewable generation, but does include EVs. When externalities are included, however, the most cost-effective to system covers 50% of the electric...... load with renewable energy and runs reliably without need for either new conventional generation or purpose-built storage. The three novel energy policy implications of this research are: (1) using today’s cost of renewable electricity and estimates of externalities, it is cost effective to implement...

  10. Comparative utilization and cost benefit of feeding three novel ...

    African Journals Online (AJOL)

    This study was conducted to determine the effect of feeding three differently processed discarded vegetable-bovine blood-rumen content mixture on nutrient digestibility and cost benefits of broiler chickens. A total of 1,080 day-old Marshal broiler chickens were fed diet containing discarded vegetablefresh bovine ...

  11. comparative cost and strength analysis of cement and aggregate

    African Journals Online (AJOL)

    2012-07-02

    Jul 2, 2012 ... 30% when palm kernel shell and quarry dust are used as partial replacement for aggregate. This study suggests that; the cost of construction and concrete production can be reduced if cement and aggregate replacement materials are used. Keywords: cement replacement material, aggregate replacement ...

  12. 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…

  13. Comparative analysis of sticky SGA costs and cost of goods sold: Evidence from Tehran Stock Exchange

    Directory of Open Access Journals (Sweden)

    Majid Zanjirdar

    2014-03-01

    Full Text Available One of the primary assumptions in accounting industries is to expect an increase (decrease in cost of production is proportion to increase (decrease in sales revenue. However, there are some evidences that the cost of production does not decrease with the same trend as revenue decreases. This phenomenon is called sticky behavior since the cost of production in not reduced as the sales decreases especially in operating as well as administration department. In this paper, we present an empirical investigation to study sticky behavior on 70 selected firms from Tehran Stock Exchange over the period 2002-2011. The results indicate that sales and general administration cost (SGA as well as the costs of sold goods strongly have sticky behaviors.

  14. Comparative Evaluation of Productivity and Cost Effectiveness of ...

    African Journals Online (AJOL)

    However, bigger sized (2.2 ± 0.23g) fingerlings were obtained from the earthen pond relative to those cultured in the recirculation system (0.9 ± 0.07g). The cost of raising frys in a recirculation system (N34,000) was twice that needed for earthen pond (N17,000), but this was more than made up for in the profit from sales, ...

  15. A constructive heuristic for time-dependent multi-depot vehicle routing problem with time-windows and heterogeneous fleet

    Directory of Open Access Journals (Sweden)

    Behrouz Afshar-Nadjafi

    2017-01-01

    Full Text Available In this paper, we consider the time-dependent multi-depot vehicle routing problem. The objective is to minimize the total heterogeneous fleet cost assuming that the travel time between locations depends on the departure time. Also, hard time window constraints for the customers and limitation on maximum number of the vehicles in depots must be satisfied. The problem is formulated as a mixed integer programming model. A constructive heuristic procedure is proposed for the problem. Also, the efficiency of the proposed algorithm is evaluated on 180 test problems. The obtained computational results indicate that the procedure is capable to obtain a satisfying solution.

  16. Architecture Study for a Fuel Depot Supplied from Lunar Resources

    Science.gov (United States)

    Perrin, Thomas M.

    2016-01-01

    Heretofore, discussions of space fuel depots assumed the depots would be supplied from Earth. However, the confirmation of deposits of water ice at the lunar poles in 2009 suggests the possibility of supplying a space depot with liquid hydrogen/liquid oxygen produced from lunar ice. This architecture study sought to determine the optimum architecture for a fuel depot supplied from lunar resources. Four factors - the location of propellant processing (on the Moon or on the depot), the location of the depot (on the Moon, or at L1, GEO, or LEO), the location of propellant transfer (L1, GEO, or LEO), and the method of propellant transfer (bulk fuel or canister exchange) were combined to identify 18 potential architectures. Two design reference missions (DRMs) - a satellite servicing mission and a cargo mission to Mars - were used to create demand for propellants, while a third DRM - a propellant delivery mission - was used to examine supply issues. The architectures were depicted graphically in a network diagram with individual segments representing the movement of propellant from the Moon to the depot, and from the depot to the customer.

  17. Stock Funding of Depot Level Reparables: Win, Lose, or Draw?

    Science.gov (United States)

    1993-06-04

    trends Identified, Based on this analysis, it appears that the stook funiding of depot level reparables in adversely affauting •qulpmnnt availability...Deborah A. Elliot, "The Effect of Defense Management Revlow Decision 904. Stook Funding of Depot Level Reparables, on Cash Flow within the Reparable

  18. Peak Expiratory Flow Rate in Petroleum Depot Workers and Petrol ...

    African Journals Online (AJOL)

    Peak Expiratory Flow Rate (PEFR) values in litres per minute were determined in petrol depot loaders, petrol station attendants and in control subjects. The PEFR values were 315 ± 94, 386 + 91 and 529 + 94 litres/min. in depot workers, petrol attendants and control subjects respectively. The value in the control subjects ...

  19. Ligand Depot: a data warehouse for ligands bound to macromolecules.

    Science.gov (United States)

    Feng, Zukang; Chen, Li; Maddula, Himabindu; Akcan, Ozgur; Oughtred, Rose; Berman, Helen M; Westbrook, John

    2004-09-01

    Ligand Depot is an integrated data resource for finding information about small molecules bound to proteins and nucleic acids. The initial release (version 1.0, November, 2003) focuses on providing chemical and structural information for small molecules found as part of the structures deposited in the Protein Data Bank. Ligand Depot accepts keyword-based queries and also provides a graphical interface for performing chemical substructure searches. A wide variety of web resources that contain information on small molecules may also be accessed through Ligand Depot. Ligand Depot is available at http://ligand-depot.rutgers.edu/. Version 1.0 supports multiple operating systems including Windows, Unix, Linux and the Macintosh operating system. The current drawing tool works in Internet Explorer, Netscape and Mozilla on Windows, Unix and Linux.

  20. Effect of water treatment on the comparative costs of evaporative and dry cooled power plants

    International Nuclear Information System (INIS)

    Gold, H.; Goldstein, D.J.; Yung, D.

    1976-07-01

    The report presents the results of a study on the relative cost of energy from a nominal 1000 Mwe nuclear steam electric generating plant using either dry or evaporative cooling at four sites in the United States: Rochester, New York; Sheridan, Wyoming; Gallup, New Mexico and Dallas, Texas. Previous studies have shown that because of lower efficiencies the total annual evaluated costs for dry cooling systems exceeds the total annual evaluated costs of evaporative cooling systems, not including the cost of water. The cost of water comprises the cost of supplying the makeup water, the cost of treatment of the makeup and/or the circulating water in the tower, and the cost of treatment and disposal of the blowdown in an environmentally acceptable manner. The purpose of the study is to show the effect of water costs on the comparative costs of dry and evaporative cooled towers

  1. Celtic steel - an evaluation of depot finds

    Energy Technology Data Exchange (ETDEWEB)

    Presslinger, H.; Mayr, M. [Vereinigte Oesterreichische Eisen- und Stahlwerke AG (VOeST)-Alpine Industrieanlagenbau GmbH, Linz (Austria)

    2001-08-01

    In the course of archaeological excavations on the Gruendberg in Linz/Austria, several depots containing a total of 45 steel objects were discovered. These depots had been set up around 100 before Christ (BC). 25 objects were used to take samples for metallographic and microanalytical investigations. In the exercise of his trade, the Celtic smith could resort to different steel grades: non-alloyed, carbon alloyed, phosphorus alloyed. The technique applied was that of fire-forging single pieces of steel - which had previously been widened by hammering - to give flat bars showing a multi-layer structure. For workpieces with special requirements with regard both to hardness and to toughness, a number of carefully selected flat bars with differing contents of alloying metals were bonded by forge welding, which produced a compound material. Hardening by cold working as well as by torquing was already known to these Celtic craftsmen. To obtain tools with a hard edge and a tough core, cementation was used. (orig.)

  2. Apples and oranges: Comparing nuclear construction costs across nations, time periods, and technologies

    International Nuclear Information System (INIS)

    Lovering, Jessica R.; Nordhaus, Ted; Yip, Arthur

    2017-01-01

    The literature on energy technology costs, diffusion, and learning has been characterized by data limitations, partial or arbitrary data sets, apples to oranges comparisons, and imprecision in the use of key concepts and terminology. Two responses to our paper, Lovering et al. (2016), by Koomey et al. and Gilbert et al. reflect many of these problems, conflating learning curves with experience curves, trends in actual costs with the relationship between cost estimates and final construction costs, and component costs with total installed costs. The respondents use inconsistent definitions of demonstration, first-of-a-kind, and commercial deployment across different energy technologies. They also propose to compare final installed costs for nuclear power plants, encompassing construction and finance costs, across different national economies and time periods encompassing a wide range of macro-economic circumstances and finance arrangements that overwhelm any signal from trends associated with the actual construction costs of the plants in question. In this response, we address the specific issues raised in these papers and suggest better practices for comparing energy technology costs, trends, and technological learning. - Highlights: • Responds to arguments in and • Discusses shortcomings in broader energy cost literature. • Defends metric of Overnight Construction Cost (OCC). • Suggests better practices for comparing energy technology costs and trends.

  3. 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…

  4. Social welfare and the Affordable Care Act: is it ever optimal to set aside comparative cost?

    Science.gov (United States)

    Mortimer, Duncan; Peacock, Stuart

    2012-10-01

    The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Fat Depots, Free Fatty Acids, and Dyslipidemia

    Directory of Open Access Journals (Sweden)

    Jon O. Ebbert

    2013-02-01

    Full Text Available Body fat deposition and excess free fatty acid (FFA metabolism contribute to dyslipidemia and the adverse health consequences of obesity. Individuals with upper body obesity have impaired functioning of adipocytes, the primary fatty acid storage site. Excess visceral fat is strongly associated with impaired suppression of FFA release in response to insulin, as well as with hypertriglyceridemia and low concentrations of high density lipoprotein (HDL cholesterol. High FFA concentrations can induce insulin resistance in muscle and liver. Furthermore, failure of hyperinsulinemia to normally suppress FFA is associated with impaired carbohydrate oxidation and muscle glucose storage, reduced hepatic insulin clearance and elevated triglycerides. Understanding the impact of body fat distribution on FFA metabolism and dyslipidemia is critical for determining the link between overweight and obesity and cardiovascular disease risk. In the current review, we will explore the relationship between adipose tissue, body fat depots, and FFA metabolism.

  6. Comparative Examination of Fair Value Accounting and Historical Cost Accountingin Perspective of Advantages and Disadvantages

    OpenAIRE

    Arı, Mustafa; Yılmaz, Rıfat

    2015-01-01

    In this study, it has examined that advantages and disadvantages of fair value accounting and historical cost accounting in comparatively. We discuss advantages and disadvantages of produced financial information according to fair value accounting and historical cost accounting in perspective of reliability, relavance, transparency, intelligibility, comparability, timeliness and financial stability. Literature review results of this study indicate that there are advantages and disadvantages b...

  7. Examination of adipose depot-specific PPAR moieties

    International Nuclear Information System (INIS)

    Dodson, M.V.; Vierck, J.L.; Hausman, G.J.; Guan, L.L.; Fernyhough, M.E.; Poulos, S.P.; Mir, P.S.; Jiang, Z.

    2010-01-01

    Molecular mechanisms of peroxisome proliferator activated receptors (PPARs) are being defined rapidly, as illustrated by the volume of papers published. Much of the research is directed towards a clinical end-point/application; however, the non-homogeneous nature of adipose depots in laboratory animals is spurring similar research in domestic meat animals (such as beef cattle). Moreover, the size of adipose depots in meat animals remains an attractive feature for using them to obtain cells for PPAR research. Examination of meat-animal depot-specific PPAR moieties may provide novel information about adipocyte regulation that might be extrapolated to all animals.

  8. DEPOT database: Reference manual and user's guide

    Energy Technology Data Exchange (ETDEWEB)

    Clancey, P.; Logg, C.

    1991-03-01

    DEPOT has been developed to provide tracking for the Stanford Linear Collider (SLC) control system equipment. For each piece of equipment entered into the database, complete location, service, maintenance, modification, certification, and radiation exposure histories can be maintained. To facilitate data entry accuracy, efficiency, and consistency, barcoding technology has been used extensively. DEPOT has been an important tool in improving the reliability of the microsystems controlling SLC. This document describes the components of the DEPOT database, the elements in the database records, and the use of the supporting programs for entering data, searching the database, and producing reports from the information.

  9. Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare.

    Science.gov (United States)

    Olsson, Tina M

    2011-10-01

    This study compares two approaches to the estimation of social welfare intervention costs: one "top-down" and the other "bottom-up" for a group of social welfare clients with severe problem behavior participating in a randomized trial. Intervention costs ranging over a two-year period were compared by intervention category (foster care placement, institutional placement, mentorship services, individual support services and structured support services), estimation method (price, micro costing, average cost) and treatment group (intervention, control). Analyses are based upon 2007 costs for 156 individuals receiving 404 interventions. Overall, both approaches were found to produce reliable estimates of intervention costs at the group level but not at the individual level. As choice of approach can greatly impact the estimate of mean difference, adjustment based on estimation approach should be incorporated into sensitivity analyses. Analysts must take care in assessing the purpose and perspective of the analysis when choosing a costing approach for use within economic evaluation.

  10. Cost Analysis of Noninvasive Helmet Ventilation Compared with Use of Noninvasive Face Mask in ARDS

    Directory of Open Access Journals (Sweden)

    Kwadwo Kyeremanteng

    2018-01-01

    Full Text Available Intensive care unit (ICU costs have doubled since 2000, totalling 108 billion dollars per year. Acute respiratory distress syndrome (ARDS has a prevalence of 10.4% and a 28-day mortality of 34.8%. Noninvasive ventilation (NIV is used in up to 30% of cases. A recent randomized controlled trial by Patel et al. (2016 showed lower intubation rates and 90-day mortality when comparing helmet to face mask NIV in ARDS. The population in the Patel et al. trial was used for cost analysis in this study. Projections of cost savings showed a decrease in ICU costs by $2527 and hospital costs by $3103 per patient, along with a 43.3% absolute reduction in intubation rates. Sensitivity analysis showed consistent cost reductions. Projected annual cost savings, assuming the current prevalence of ARDS, were $237538 in ICU costs and $291682 in hospital costs. At a national level, using yearly incidence of ARDS cases in American ICUs, this represents $449 million in savings. Helmet NIV, compared to face mask NIV, in nonintubated patients with ARDS, reduces ICU and hospital direct-variable costs along with intubation rates, LOS, and mortality. A large-scale cost-effectiveness analysis is needed to validate the findings.

  11. Green open location-routing problem considering economic and environmental costs

    Directory of Open Access Journals (Sweden)

    Eliana M. Toro

    2016-12-01

    Full Text Available This paper introduces a new bi-objective vehicle routing problem that integrates the Open Location Routing Problem (OLRP, recently presented in the literature, coupled with the growing need for fuel consumption minimization, named Green OLRP (G-OLRP. Open routing problems (ORP are known to be NP-hard problems, in which vehicles start from the set of existing depots and are not required to return to the starting depot after completing their service. The OLRP is a strategic-level problem involving the selection of one or many depots from a set of candidate locations and the planning of delivery radial routes from the selected depots to a set of customers. The concept of radial paths allows us to use a set of constraints focused on maintaining the radiality condition of the paths, which significantly simplifies the set of constraints associated with the connectivity and capacity requirements and provides a suitable alternative when compared with the elimination problem of sub-tours traditionally addressed in the literature. The emphasis in the paper will be placed on modeling rather than solution methods. The model proposed is formulated as a bi-objective problem, considering the minimization of operational costs and the minimization of environmental effects, and it is solved by using the epsilon constraint technique. The results illustrate that the proposed model is able to generate a set of trade-off solutions leading to interesting conclusions about the relationship between operational costs and environmental impact.

  12. Inventory Accuracy at the Defense Depot, Columbus, Ohio

    National Research Council Canada - National Science Library

    Lane, F

    1997-01-01

    We identified issues on the accuracy of inventory reporting for materiel stored at the Defense Depot, Columbus, Ohio during our overall audit of the inventory accounts in the FY 1996 Defense Business...

  13. Air Force Depot Maintenance: Analysis of Its Financial Operations

    National Research Council Canada - National Science Library

    1999-01-01

    The Air Force depot maintenance activity group is part of the Air Force Working Capital Fund, a revolving fund that relies on sales revenue rather than direct congressional appropriations to finance its operations...

  14. Expandable Cryogenic Tankage for On Orbit Depot Storage, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed expandable depot storage tanks would make it possible to have an on-orbit tank larger in volume than any existing or planned launch vehicles. The size...

  15. Radiological Final Status Survey of the Hammond Depot, Hammond, Indiana

    Energy Technology Data Exchange (ETDEWEB)

    T.J. Vitkus

    2008-04-07

    ORISE conducted extensive scoping, characterization, and final status surveys of land areas and structures at the DNSC’s Hammond Depot located in Hammond, Indiana in multiple phases during 2005, 2006 and 2007.

  16. Trip Reports. Hazardous Waste Minimization and Control at Army Depots

    Science.gov (United States)

    1989-08-01

    regulations because it processes aircraft. Most depot personel expressed the belief that control technology is too expensive and may not be practicable because...perldot, gloss beads, and plastic. A few depots W use some sood as a blasting media, but It is being phased out as a remlt of helth conrns. A da base... technology . Letterkenny is interested in recycling chromium rinse water. These efforts are potential projects under the current Task Order. Tobyhanna’s

  17. Comparison of human adipose-derived stem cells isolated from subcutaneous, omental, and intrathoracic adipose tissue depots for regenerative applications.

    Science.gov (United States)

    Russo, Valerio; Yu, Claire; Belliveau, Paul; Hamilton, Andrew; Flynn, Lauren E

    2014-02-01

    Adipose tissue is an abundant source of multipotent progenitor cells that have shown promise in regenerative medicine. In humans, fat is primarily distributed in the subcutaneous and visceral depots, which have varying biochemical and functional properties. In most studies to date, subcutaneous adipose tissue has been investigated as the adipose-derived stem cell (ASC) source. In this study, we sought to develop a broader understanding of the influence of specific adipose tissue depots on the isolated ASC populations through a systematic comparison of donor-matched abdominal subcutaneous fat and omentum, and donor-matched pericardial adipose tissue and thymic remnant samples. We found depot-dependent and donor-dependent variability in the yield, viability, immunophenotype, clonogenic potential, doubling time, and adipogenic and osteogenic differentiation capacities of the ASC populations. More specifically, ASCs isolated from both intrathoracic depots had a longer average doubling time and a significantly higher proportion of CD34(+) cells at passage 2, as compared with cells isolated from subcutaneous fat or the omentum. Furthermore, ASCs from subcutaneous and pericardial adipose tissue demonstrated enhanced adipogenic differentiation capacity, whereas ASCs isolated from the omentum displayed the highest levels of osteogenic markers in culture. Through cell culture analysis under hypoxic (5% O(2)) conditions, oxygen tension was shown to be a key mediator of colony-forming unit-fibroblast number and osteogenesis for all depots. Overall, our results suggest that depot selection is an important factor to consider when applying ASCs in tissue-specific cell-based regenerative therapies, and also highlight pericardial adipose tissue as a potential new ASC source.

  18. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    NARCIS (Netherlands)

    Thanh, le L.; Ierland, van E.C.; Zhu, X.; Wesseler, J.H.H.; Ngo, G.

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a

  19. SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery?

    Science.gov (United States)

    Islam, Saidul; Adams, Stephen D; Mahomed, Anies A

    2012-01-01

    The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008-2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-Whitney U-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus £467; £942 versus £1127; £394 versus £495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus £400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations.

  20. Uranium solution mining cost estimating technique: means for rapid comparative analysis of deposits

    International Nuclear Information System (INIS)

    Anon.

    1978-01-01

    Twelve graphs provide a technique for determining relative cost ranges for uranium solution mining projects. The use of the technique can provide a consistent framework for rapid comparative analysis of various properties of mining situations. The technique is also useful to determine the sensitivities of cost figures to incremental changes in mining factors or deposit characteristics

  1. Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only

    NARCIS (Netherlands)

    Vijgen, Sylvia M. C.; Westerhuis, Michelle E. M. H.; Opmeer, Brent C.; Visser, Gerard H. A.; Moons, Karl G. M.; Porath, Martina M.; Oei, Guid S.; van Geijn, Herman P.; Bolte, Antoinette C.; Willekes, Christine; Nijhuis, Jan G.; van Beek, Erik; Graziosi, Giuseppe C. M.; Schuitemaker, Nico W. E.; van Lith, Jan M. M.; van den Akker, Eline S. A.; Drogtrop, Addy P.; van Dessel, Hendrikus J. H. M.; Rijnders, Robbert J. P.; Oosterbaan, Herman P.; Mol, Ben Willem J.; Kwee, Anneke

    2011-01-01

    To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only. Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG. Obstetric

  2. Comparative costs of coal and nuclear-generated electricity in the united states

    International Nuclear Information System (INIS)

    Brandfon, W.W.

    1987-01-01

    This paper compares the future first-year operating costs and lifetime levelized costs of producing baseload coal- and nuclear-generated electricity under schedules shorter than those recently experienced at U.S. plants. Nuclear appears to have a clear economic advantage. Coal is favorable only when it is assumed that the units will operate at very low capacity factors and/or when the capital cost differential between nuclear and coal is increased far above the recent historical level. Nuclear is therefore a cost-competitive electric energy option for utilities and should be considered as an alternative to coal when large baseload capacity is required. (author)

  3. Comparing cost of indwelling pleural catheter vs talc pleurodesis for malignant pleural effusion.

    Science.gov (United States)

    Penz, Erika D; Mishra, Eleanor K; Davies, Helen E; Manns, Braden J; Miller, Robert F; Rahman, Najib M

    2014-10-01

    Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events. Using data from the clinical trial, we compared costs associated with use of IPCs and with talc pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow-up. Costs for outpatient and inpatient visits, diagnostic imaging, nursing, and doctor time were obtained from the UK National Health Service reference costs and University of Kent's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index. Procedure supply costs were obtained from the manufacturer. Difference in mean costs was compared using nonparametric bootstrapping. All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index. Overall mean cost (SD) for managing patients with IPCs and talc pleurodesis was $4,993 ($5,529) and $4,581 ($4,359), respectively. The incremental mean cost difference was $401, with 95% CI of -$1,387 to $2,261. The mean cost related to ongoing drainage in the IPC group was $1,011 ($732) vs $57 ($213) in the talc pleurodesis group (P = .001). This included the cost of drainage bottles, dressing changes in the first month, and catheter removal. There was no significant difference in cost of the initial intervention or adverse events between the groups. For patients with survival < 14 weeks, IPC is significantly less costly than talc pleurodesis, with mean cost difference of -$1,719 (95% CI, -$3,376 to -$85). There is no significant difference in the mean cost of managing patients with IPCs compared with talc pleurodesis. For patients with limited survival, IPC appears less costly. isrctn.org; No.: ISRCTN

  4. Comparing costs of power and heat production by prospective and present sources

    International Nuclear Information System (INIS)

    Novak, S.

    1979-01-01

    Capital and running costs are compared of power and heat production from different sources. The lowest capital costs were found for coal-fired power plants followed by light water reactor power plants. The capital costs of other types of power plants, such as wind, geothermal, solar, thermonuclear power plants are significantly higher. The estimated specific cost for electric power production in 1985 for a nuclear power plant is lower than for a fossil-fuel power plant. It is estimated that in 1985 coal will be the cheapest heat source. (Ha)

  5. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs.

    Science.gov (United States)

    Ielpo, Benedetto; Duran, H; Diaz, E; Fabra, I; Caruso, R; Malavé, L; Ferri, V; Nuñez, J; Ruiz-Ocaña, A; Jorge, E; Lazzaro, S; Kalivaci, D; Quijano, Y; Vicente, E

    2017-10-01

    The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis. This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded. A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection. Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.

  6. Welfare costs in patients with rheumatoid arthritis and their partners compared with matched controls

    DEFF Research Database (Denmark)

    Løppenthin, Katrine; Esbensen, Bente Appel; Østergaard, Mikkel

    2017-01-01

    costs were calculated for patients and their partners and compared to matched controls. These included inpatient and outpatient treatment, medication, income from employment and social transfer payments. Patients with RA had statistically significantly more inpatient and outpatient costs than control...... subjects, i.e., treatment (€346 vs. €211), hospitalization (€1261 vs. €778), and medication use (€654 vs. €393). The costs associated with the patients were present 11 years before diagnosis of RA (€1592) compared with control subjects (€1172). Furthermore, income from employment was lower for patients...

  7. Using Genetic Algorithm For Winter Maintenance Operations: Multi Depot K-Chinese Postman Problem

    Directory of Open Access Journals (Sweden)

    İbrahim Zeki Akyurt

    2015-02-01

    Full Text Available In this study, the assignment and routing problem of one of Istanbul’s winter maintenance activities, salt pouring, was scrutinized. The starting point of the study considers the high cost of winter maintenance work, a shrinking assigned budget, high numbers of vehicles and streets to service that the increase in difficulty to solve the problem due to their high numbers. In this respect, the problem was modeled as multi depot k-Chinese postman problem, a type of arc routing problem. This mathematical model was solved by genetic algorithm. For comparison, the current solution, Clarke and Wright Algorithm and Sweep Algorithm were used.

  8. Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

    Science.gov (United States)

    Johnson, R K; Wright, C K; Gandhi, A; Charny, M C; Barr, L

    2013-03-01

    We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. AUTOMATED DETECTION OF OIL DEPOTS FROM HIGH RESOLUTION IMAGES: A NEW PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    A. O. Ok

    2015-03-01

    Full Text Available This paper presents an original approach to identify oil depots from single high resolution aerial/satellite images in an automated manner. The new approach considers the symmetric nature of circular oil depots, and it computes the radial symmetry in a unique way. An automated thresholding method to focus on circular regions and a new measure to verify circles are proposed. Experiments are performed on six GeoEye-1 test images. Besides, we perform tests on 16 Google Earth images of an industrial test site acquired in a time series manner (between the years 1995 and 2012. The results reveal that our approach is capable of detecting circle objects in very different/difficult images. We computed an overall performance of 95.8% for the GeoEye-1 dataset. The time series investigation reveals that our approach is robust enough to locate oil depots in industrial environments under varying illumination and environmental conditions. The overall performance is computed as 89.4% for the Google Earth dataset, and this result secures the success of our approach compared to a state-of-the-art approach.

  10. The cost of post-abortion care in developing countries: a comparative analysis of four studies

    Science.gov (United States)

    Vlassoff, Michael; Singh, Susheela; Onda, Tsuyoshi

    2016-01-01

    Over the last five years, comprehensive national surveys of the cost of post-abortion care (PAC) to national health systems have been undertaken in Ethiopia, Uganda, Rwanda and Colombia using a specially developed costing methodology—the Post-abortion Care Costing Methodology (PACCM). The objective of this study is to expand the research findings of these four studies, making use of their extensive datasets. These studies offer the most complete and consistent estimates of the cost of PAC to date, and comparing their findings not only provides generalizable implications for health policies and programs, but also allows an assessment of the PACCM methodology. We find that the labor cost component varies widely: in Ethiopia and Colombia doctors spend about 30–60% more time with PAC patients than do nurses; in Uganda and Rwanda an opposite pattern is found. Labor costs range from I$42.80 in Uganda to I$301.30 in Colombia. The cost of drugs and supplies does not vary greatly, ranging from I$79 in Colombia to I$115 in Rwanda. Capital and overhead costs are substantial amounting to 52–68% of total PAC costs. Total costs per PAC case vary from I$334 in Rwanda to I$972 in Colombia. The financial burden of PAC is considerable: the expense of treating each PAC case is equivalent to around 35% of annual per capita income in Uganda, 29% in Rwanda and 11% in Colombia. Providing modern methods of contraception to women with an unmet need would cost just a fraction of the average expenditure on PAC: one year of modern contraceptive services and supplies cost only 3–12% of the average cost of treating a PAC patient. PMID:27045001

  11. Oil fuel delivery optimization for multi product and multi depot: the case of petrol station replenishment problem (PSRP)

    Science.gov (United States)

    Surjandari, Isti; Rachman, Amar; Dianawati, Fauzia; Wibowo, R. Pramono

    2011-10-01

    With the Oil and Gas Law No. 22 of 2001, national and foreign private enterprises can invest in all sectors of Oil and Gas in Indonesia. In anticipation of this free competition, Pertamina, as a state-owned enterprises, which previously had monopolized the oil and gas business activities in Indonesia, should be able to improve services as well as the efficiency in order to compete in the free market, especially in terms of cost efficiency of fuel distribution to gas station (SPBU). To optimize the distribution activity, it is necessary to design a scheduling system and its fuel delivery routes daily to every SPBU. The determination of routes and scheduling delivery of fuel to the SPBU can be modeled as a Petrol Station Replenishment Problem (PSRP) with the multi-depot, multi-product, time windows and split deliveries, which in this study will be completed by the Tabu Search algorithm (TS). This study was conducted in the area of Bandung, the capital of West Java province, which is a big city and the neighboring city of Jakarta, the capital city of Indonesia. By using the fuel delivery data for one day, the results showed a decrease of 16.38% of the distance of the route compared to the current conditions, which impacted on the reduction of distribution costs and decrease the number of total trips by 5.22% and 3.83%.

  12. Architecture Study for a Fuel Depot Supplied from Lunar Assets

    Science.gov (United States)

    Perrin, Thomas M.; Casler, James G.

    2016-01-01

    This architecture study sought to determine the optimum architecture for a fuel depot supplied from lunar assets. Four factors - the location of propellant processing (on the Moon or on the depot), the depot location (on the Moon, L1, GEO, or LEO), the propellant transfer location (L1, GEO, or LEO), and the propellant transfer method (bulk fuel or canister exchange) were combined to identify 18 candidate architectures. Two design reference missions (DRMs) - a commercial satellite servicing mission and a Government cargo mission to Mars - created demand for propellants, while a propellant delivery DRM examined supply issues. The study concluded Earth-Moon L1 is the best location for an orbiting depot. For all architectures, propellant boiloff was less than anticipated, and was far overshadowed by delta-v requirements and resulting fuel consumption. Bulk transfer is the most flexible for both the supplier and customer. However, since canister exchange bypasses the transfer of bulk cryogens and necessary chilldown losses, canister exchange shows promise and merits further investigation. Overall, this work indicates propellant consumption and loss is an essential factor in assessing fuel depot architectures.

  13. Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment.

    Science.gov (United States)

    Rollins, Angela L; Kukla, Marina; Salyers, Michelle P; McGrew, John H; Flanagan, Mindy E; Leslie, Doug L; Hunt, Marcia G; McGuire, Alan B

    2017-09-01

    Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.

  14. Comparing biologic persistence and healthcare costs in rheumatoid arthritis patients initiating subcutaneous biologics.

    Science.gov (United States)

    Nadkarni, Anagha; McMorrow, Donna; Fowler, Robert; Smith, David

    2017-11-01

    Comparing biologic persistence and healthcare costs between rheumatoid arthritis (RA) patients initiating first- or second-line subcutaneous abatacept, adalimumab, or etanercept. Retrospective, observational cohort study, which included adults with RA who initiated either of the three treatments between 29 July 2011 and 1 July 2015. Total healthcare costs were measured during baseline and follow-up. Biologic persistence was compared using multivariable Cox proportional hazards regression. Subcutaneous abatacept-treated patients had numerically lowest adjusted hazards of nonpersistence and increase from baseline in total healthcare costs. Sensitivity analyses measuring outcomes over an alternative follow-up definition produced consistent results. Abatacept-treated RA patients appeared to have the poorest health status yet often had the lowest increase from baseline in healthcare costs and longest duration of biologic persistence.

  15. Cost of wind energy: comparing distant wind resources to local resources in the midwestern United States.

    Science.gov (United States)

    Hoppock, David C; Patiño-Echeverri, Dalia

    2010-11-15

    The best wind sites in the United States are often located far from electricity demand centers and lack transmission access. Local sites that have lower quality wind resources but do not require as much power transmission capacity are an alternative to distant wind resources. In this paper, we explore the trade-offs between developing new wind generation at local sites and installing wind farms at remote sites. We first examine the general relationship between the high capital costs required for local wind development and the relatively lower capital costs required to install a wind farm capable of generating the same electrical output at a remote site,with the results representing the maximum amount an investor should be willing to pay for transmission access. We suggest that this analysis can be used as a first step in comparing potential wind resources to meet a state renewable portfolio standard (RPS). To illustrate, we compare the cost of local wind (∼50 km from the load) to the cost of distant wind requiring new transmission (∼550-750 km from the load) to meet the Illinois RPS. We find that local, lower capacity factor wind sites are the lowest cost option for meeting the Illinois RPS if new long distance transmission is required to access distant, higher capacity factor wind resources. If higher capacity wind sites can be connected to the existing grid at minimal cost, in many cases they will have lower costs.

  16. Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion.

    Science.gov (United States)

    Gariepy, Aileen M; Duffy, Jennifer Y; Xu, Xiao

    2015-07-01

    To evaluate the cost-effectiveness of immediate compared with delayed (6 weeks) postpartum etonogestrel implant insertion in preventing future unintended pregnancy. We constructed a decision-analytic model to examine a hypothetical population of women who request a contraceptive implant after giving birth. The timeframe for analysis was from the time of childbirth to 1 year postpartum. Model inputs were derived from a comprehensive literature review. We compared immediate (before discharge from the childbirth hospital stay) compared with delayed (at first postpartum office visit) postpartum placement of the contraceptive implant from a health care system's perspective. Implant insertion and removal, loss to follow-up at the postpartum visit, use of alternative contraceptive methods, and contraceptive failure were incorporated into the model. We calculated the incremental cost of immediate insertion for each pregnancy prevented during the first postpartum year and cost savings associated with pregnancies prevented. One-way sensitivity analyses were also performed. Cost estimates are reported in 2014 U.S. dollars. Immediate postpartum implant insertion is associated with higher expected cost than delayed insertion ($1,091/patient compared with $650/patient) but is more effective in preventing pregnancies (expected pregnancy rate: 2.4% and 21.6%, respectively). This results in an incremental cost-effectiveness ratio of $2,304 per pregnancy prevented. When taking into consideration medical costs of the resulting unintended pregnancies that could be avoided, immediate implant insertion is expected to save $1,263 per patient. Immediate postpartum provision of the contraceptive implant is cost-effective in preventing unintended pregnancies and should be provided to women requesting this form of contraception.

  17. Cost-of-illness in psoriasis: comparing inpatient and outpatient therapy.

    Directory of Open Access Journals (Sweden)

    Sabine I B Steinke

    Full Text Available Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €. Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives.

  18. Cost-effectiveness Analysis Comparing Conventional, Hypofractionated, and Intraoperative Radiotherapy for Early-Stage Breast Cancer.

    Science.gov (United States)

    Deshmukh, Ashish A; Shirvani, Shervin M; Lal, Lincy; Swint, J Michael; Cantor, Scott B; Smith, Benjamin D; Likhacheva, Anna

    2017-11-01

    Early-stage breast cancer is among the most prevalent and costly malignancies treated in the American health care system. Adjuvant radiotherapy after lumpectomy represents a substantial portion of breast cancer expenditures. The relative value of novel radiotherapeutic approaches such as intraoperative radiotherapy (IORT) and hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) is unknown. Therefore, we used prospectively collected outcomes from randomized clinical trials (RCTs) to compare the cost-effectiveness of these approaches. We constructed a decision-analytic model that followed women who were treated with lumpectomy for early-stage breast cancer. Recurrence, mortality, complication rates, and utilities (five-year radiation-associated quality of life scores), were extracted from RCTs. Costs were based on Medicare reimbursement rates. Cost-effectiveness from societal and health care sector perspectives was estimated considering two scenarios-the first assumes that radiation-associated disutility persists five years after treatment, and the second assumes that disutility discontinues. Lifetime outcomes were summarized using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses evaluated the robustness of the results. HF-WBI dominated CF-WBI (ie, resulted in higher quality-adjusted life-years [QALYs] and lower cost) in all scenarios. HF-WBI also had a greater likelihood of cost-effectiveness compared with IORT; under a societal perspective that assumes that radiation-associated disutility persists, HF-WBI results in an ICER of $17 024 per QALY compared with IORT with a probability of cost-effectiveness of 80% at the $100 000 per QALY willingness-to-pay threshold. If radiation-associated disutility is assumed to discontinue, the ICER is lower ($11 461/QALY), resulting in an even higher (83%) probability of relative cost

  19. Comparing the Cost of Protecting Selected Lightweight Block Ciphers against Differential Power Analysis in Low-Cost FPGAs

    Directory of Open Access Journals (Sweden)

    William Diehl

    2018-04-01

    Full Text Available Lightweight block ciphers are an important topic in the Internet of Things (IoT since they provide moderate security while requiring fewer resources than the Advanced Encryption Standard (AES. Ongoing cryptographic contests and standardization efforts evaluate lightweight block ciphers on their resistance to power analysis side channel attack (SCA, and the ability to apply countermeasures. While some ciphers have been individually evaluated, a large-scale comparison of resistance to side channel attack and the formulation of absolute and relative costs of implementing countermeasures is difficult, since researchers typically use varied architectures, optimization strategies, technologies, and evaluation techniques. In this research, we leverage the Test Vector Leakage Assessment (TVLA methodology and the FOBOS SCA framework to compare FPGA implementations of AES, SIMON, SPECK, PRESENT, LED, and TWINE, using a choice of architecture targeted to optimize throughput-to-area (TP/A ratio and suitable for introducing countermeasures to Differential Power Analysis (DPA. We then apply an equivalent level of protection to the above ciphers using 3-share threshold implementations (TI and verify the improved resistance to DPA. We find that SIMON has the highest absolute TP/A ratio of protected versions, as well as the lowest relative cost of protection in terms of TP/A ratio. Additionally, PRESENT uses the least energy per bit (E/bit of all protected implementations, while AES has the lowest relative cost of protection in terms of increased E/bit.

  20. A simulation comparing the cost-effectiveness of adult incontinence products.

    Science.gov (United States)

    Yamasato, Kelly; Kaneshiro, Bliss; Oyama, Ian A

    2014-01-01

    To compare leak point volumes and cost-effectiveness of a variety of adult incontinence products. Adult incontinence products were purchased from local retail stores and categorized into moderate absorbency pads, moderate absorbency briefs, maximum absorbency pads, and maximum absorbent briefs. The leak point for each product was determined by applying fluid to the pad until the first drop of leakage from the pad or brief occurred. Cost-effectiveness was calculated by dividing the cost per product by the amount of fluid absorbed prior to the leak point. The leak points and cost-effectiveness of incontinence products were compared within and between categories. Significant differences in leak point volumes were present within all product categories except moderate absorbency pads. When comparing product categories, moderate absorbency pads were the least cost-effective, followed by maximum absorbency pads and absorbent briefs (P points and cost-effectiveness. These findings may influence physician assessment of urinary incontinence as well as patient selection of incontinence products.

  1. Comparative costs and activity from a sample of UK clinical trials units.

    Science.gov (United States)

    Hind, Daniel; Reeves, Barnaby C; Bathers, Sarah; Bray, Christopher; Corkhill, Andrea; Hayward, Christopher; Harper, Lynda; Napp, Vicky; Norrie, John; Speed, Chris; Tremain, Liz; Keat, Nicola; Bradburn, Mike

    2017-05-02

    The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ

  2. Comparative efficiency research (COMER): meta-analysis of cost-effectiveness studies.

    Science.gov (United States)

    Crespo, Carlos; Monleon, Antonio; Díaz, Walter; Ríos, Martín

    2014-12-22

    The aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER). We built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15-500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively. The Frank copula with positive dependence (-0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and COMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.

  3. Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC.

    Directory of Open Access Journals (Sweden)

    Amanda D Castel

    Full Text Available Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.We sought to evaluate the cost effectiveness of the District of Columbia (DC Department of Health's routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations; collected testing and labor costs; and calculated effectiveness measures including cost per new diagnosis and cost per averted transmission.Compared to routine testing, targeted testing resulted in higher positivity rates (1.33% vs. 0.44%. Routine testing averted 34.30 transmissions per year compared to targeted testing at 17.78. The cost per new diagnosis was lower for targeted testing ($2,467 vs. $7,753 per new diagnosis as was the cost per transmission averted ($33,160 vs. $104,205. When stratified by testing site, both testing approaches were most cost effective in averting new transmissions when conducted by community based organizations ($25,037 routine; $33,123 targeted compared to hospitals or clinics.While routine testing identified more newly diagnosed infections and averted more infections than targeted testing, targeted testing is more cost effective per diagnosis and per transmission averted overall. Given the high HIV prevalence in DC, the DC Department of Health's implementation strategy should continue to encourage routine testing implementation with emphasis on a combined testing strategy among community-based organizations.

  4. Pengembangan Merek dan Pengkajian Strategi Pemasaran di Depot Rasa Suka Kediri

    OpenAIRE

    Raharjo, Rini; Surjani, Rosita Meitha; Rinawiyanti, Esti Dwi

    2013-01-01

    Depot Rasa Suka is a culinary business that provides a variety of Indonesian dishes. However people still do not know and yet loyal to Depot Rasa Suka due to the unavailability of parking space, quite a long serving time, hot room, less attractive promotion and room design. Therefore Depot Rasa Suka need to devise strategies to develop brands through brand equity analysis and improvement of brand elements as well as designing a marketing strategies. The goal of this research is to make Depot ...

  5. Societal costs of non-cardiac chest pain compared with ischemic heart disease - a longitudinal study

    Science.gov (United States)

    2013-01-01

    Background Non-cardiac chest pain (NCCP) is a common complaint. Our aim was to present a detailed description of the costs of patients with NCCP compared to patients with acute myocardial infarction (AMI) and Angina Pectoris (AP) from a societal perspective. Methods Data on healthcare utilization and annual societal costs, including direct healthcare costs and indirect costs due to productivity loss, were collected from different databases. The participants consisted of 199 patients from a general hospital in Sweden (99 with NCCP, 51 with AMI, 49 with AP), mean age of 67 years, 59% men. Results NCCP, AMI, and AP patients had on average 54, 50 and 65 primary care contacts and 3, 4, and 4 hospital admissions during a period of 2 years. Length of hospital stay was 6, 11 and 11 days. On average, 14%, 18%, and 25% of NCCP, AMI and AP patients were on sick-leave annually, and about 12% in each group received a disability pension. The mean annual societal costs of NCCP, AMI and AP patients were €10,068, €15,989 and €14,737. Conclusions Although the annual societal cost of NCCP patients was lower than in AMI and AP patients, the cost was still considerable (€10,068). Taken into account the high prevalence of NCCP, the cumulative annual national cost of these patients could be more than the double of AMI and AP if all patients incurred the same costs as in this study. Targeted interventions are important in order to support patients with NCCP and minimize healthcare utilization and costs. PMID:24107009

  6. Comparative Cost Analysis for Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysms in South Korea.

    Science.gov (United States)

    Kim, Myungsoo; Park, Jaechan; Lee, Joomi

    2015-06-01

    A cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms (UIAs), and the identification of the principal cost determinants of these treatments. This study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of UIAs between January 2011 and May 2014. The medical records, radiological data, and hospital cost data were all examined. When comparing the total hospital costs for surgical clipping of a single UIA (n=188) and endovascular coiling of a single UIA (n=188), surgical treatment [mean±standard deviation (SD) : ₩8,280,000±1,490,000] resulted in significantly lower total hospital costs than endovascular treatment (mean±SD : ₩11,700,000±3,050,000, p<0.001). In a multi regression analysis, the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter (p<0.001) and patient age (p=0.014). For the endovascular group, a Pearson correlation analysis revealed a strong positive correlation (r=0.77) between the aneurysm diameter and the total hospital costs, while a simple linear regression provided the equation, y (₩)=6,658,630+855,250x (mm), where y represents the total hospital costs and x is the aneurysm diameter. In South Korea, the total hospital costs for the surgical clipping of UIAs were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications. Plus, a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling.

  7. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease.

    Science.gov (United States)

    Rosselli, Diego; Rueda, Juan-David; Diaz, Carlos Eduardo

    2015-01-01

    To estimate the costs and effectiveness measured in quality-adjusted life years (QALY) of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35%) for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay) was three times gross domestic product (GDP) = USD 20,000 per QALY. The costs were adopted in US dollars (USD) using the 2012 average exchange rate (1 USD = COP$ 1798). The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.

  8. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Diego Rosselli

    2015-01-01

    Full Text Available To estimate the costs and effectiveness measured in quality-adjusted life years (QALY of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35% for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay was three times gross domestic product (GDP = USD 20,000 per QALY. The costs were adopted in US dollars (USD using the 2012 average exchange rate (1 USD = COP$ 1798. The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.

  9. Comparative effectiveness and cost-effectiveness analyses frequently agree on value.

    Science.gov (United States)

    Glick, Henry A; McElligott, Sean; Pauly, Mark V; Willke, Richard J; Bergquist, Henry; Doshi, Jalpa; Fleisher, Lee A; Kinosian, Bruce; Perfetto, Eleanor; Polsky, Daniel E; Schwartz, J Sanford

    2015-05-01

    The Patient-Centered Outcomes Research Institute, known as PCORI, was established by Congress as part of the Affordable Care Act (ACA) to promote evidence-based treatment. Provisions of the ACA prohibit the use of a cost-effectiveness analysis threshold and quality-adjusted life-years (QALYs) in PCORI comparative effectiveness studies, which has been understood as a prohibition on support for PCORI's conducting conventional cost-effectiveness analyses. This constraint complicates evidence-based choices where incremental improvements in outcomes are achieved at increased costs of care. How frequently this limitation inhibits efficient cost containment, also a goal of the ACA, depends on how often more effective treatment is not cost-effective relative to less effective treatment. We examined the largest database of studies of comparisons of effectiveness and cost-effectiveness to see how often there is disagreement between the more effective treatment and the cost-effective treatment, for various thresholds that may define good value. We found that under the benchmark assumption, disagreement between the two types of analyses occurs in 19 percent of cases. Disagreement is more likely to occur if a treatment intervention is musculoskeletal and less likely to occur if it is surgical or involves secondary prevention, or if the study was funded by a pharmaceutical company. Project HOPE—The People-to-People Health Foundation, Inc.

  10. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    International Nuclear Information System (INIS)

    Le, Loan T.; Ierland, Ekko C. van; Zhu, Xueqin; Wesseler, Justus; Ngo, Giang

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a functional unit defined as 1 km of vehicle transportation. We base our empirical results on a case study in Vietnam and compare two biofuels and their alternative fossil fuels: ethanol and gasoline, and biodiesel and diesel with a focus on the blends of E5 and E10 for ethanol, and B5 and B10 for biodiesel. At the discount rate of 4%, ethanol substitution for gasoline in form of E5 or E10 saves 33% of the social cost of gasoline if the fuel consumption of E5 and E10 is the same as gasoline. The ethanol substitution will be cost-effective if the fuel consumption of E5 and E10, in terms of L km −1 , is not exceeding the consumption of gasoline by more than 1.7% and 3.5% for E5 and E10 respectively. The biodiesel substitution would be cost-effective if the fuel consumption of B5 and B10, in terms of L km −1 compared to diesel, would decrease by more than 1.4% and 2.8% for B5 and B10 respectively at the discount rate of 4%. -- Highlights: •We examine cost-effectiveness of biofuels under efficiency levels of blends. •Cassava-based ethanol used as E5 saves 33% of social cost compared to gasoline. •Ethanol is cost-effective if E5 consumption per km is less than 1.017 times gasoline consumption. •Jatropha-based biodiesel used as B5 or B10 is currently not cost-effective in comparison to diesel. •Biodiesel would be cost-effective if B5 consumption per km would be less than 0.986 times diesel consumption

  11. Cost-effective cloud computing: a case study using the comparative genomics tool, roundup.

    Science.gov (United States)

    Kudtarkar, Parul; Deluca, Todd F; Fusaro, Vincent A; Tonellato, Peter J; Wall, Dennis P

    2010-12-22

    Comparative genomics resources, such as ortholog detection tools and repositories are rapidly increasing in scale and complexity. Cloud computing is an emerging technological paradigm that enables researchers to dynamically build a dedicated virtual cluster and may represent a valuable alternative for large computational tools in bioinformatics. In the present manuscript, we optimize the computation of a large-scale comparative genomics resource-Roundup-using cloud computing, describe the proper operating principles required to achieve computational efficiency on the cloud, and detail important procedures for improving cost-effectiveness to ensure maximal computation at minimal costs. Utilizing the comparative genomics tool, Roundup, as a case study, we computed orthologs among 902 fully sequenced genomes on Amazon's Elastic Compute Cloud. For managing the ortholog processes, we designed a strategy to deploy the web service, Elastic MapReduce, and maximize the use of the cloud while simultaneously minimizing costs. Specifically, we created a model to estimate cloud runtime based on the size and complexity of the genomes being compared that determines in advance the optimal order of the jobs to be submitted. We computed orthologous relationships for 245,323 genome-to-genome comparisons on Amazon's computing cloud, a computation that required just over 200 hours and cost $8,000 USD, at least 40% less than expected under a strategy in which genome comparisons were submitted to the cloud randomly with respect to runtime. Our cost savings projections were based on a model that not only demonstrates the optimal strategy for deploying RSD to the cloud, but also finds the optimal cluster size to minimize waste and maximize usage. Our cost-reduction model is readily adaptable for other comparative genomics tools and potentially of significant benefit to labs seeking to take advantage of the cloud as an alternative to local computing infrastructure.

  12. Depression in working adults: comparing the costs and health outcomes of working when ill.

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

    Full Text Available OBJECTIVE: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism" amongst employed Australians reporting lifetime major depression. METHODS: Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs, captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar. RESULTS: Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism. However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover, and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. CONCLUSIONS: Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work

  13. Comparing the cost of alcohol-related traffic crashes in rural and urban environments.

    Science.gov (United States)

    Czech, Suzanne; Shakeshaft, Anthony P; Byrnes, Joshua M; Doran, Christopher M

    2010-07-01

    Existing studies have identified that, although to a lesser extent than individual factors such as males and young people, rural (compared to urban) communities represent a disproportionately high-risk of alcohol-related traffic crashes (ARTCs). To date, however, few studies have attempted to apply different costs to alcohol crashes of different severity, to provide more precise, and practically useful, data on which to base public health policy and intervention decisions. The aim of this study is to quantify the per capita prevalence and differential costs of alcohol crashes of different levels of severity to determine the extent to which urban and rural geographical areas may differ in the costs attributable to ARTCs. A cross-sectional analysis of alcohol-related traffic crash and costs data from 2001 to 2007. Data from New South Wales, Australia. Modified routinely collected traffic accident data to which costs relevant to alcohol crashes of different severity are applied. Although the rate per 10,000 population of alcohol-related crashes is 1.5 times higher in rural, relative to urban, communities, the attributable cost is four times higher, which largely reflects that rural alcohol-fatalities are seven to eight times more prevalent and costly. Given that per capita alcohol-related fatal crashes in rural areas account for a disproportionately large proportion of the harms and costs associated with alcohol-related traffic crashes, the cost-effectiveness of public health interventions and public policy initiatives should consider the relative extent of ARTC-harm in rural versus urban communities. Copyright 2010 Elsevier Ltd. All rights reserved.

  14. [Comparative analysis of insulin glargine vs. insulin detemir: A cost-minimization study applicable to Colombia].

    Science.gov (United States)

    Fragozo, Argemiro; Puerta, María Fernanda; Misas, Juan Diego

    2015-01-01

    More than 90% of subjects diagnosed with diabetes mellitus present with type 2, which is recognized for peripheral insulin resistance. To determine the costs of achieving glycemic target with the use of basal insulin analogs, insulin glargine (IG) once a day vs. insulin detemir (ID) once or twice a day, with a cost minimization model built from a third-party payer perspective in Colombia. A systematic review of comparative clinical trials between IG and ID in patients with insulin-resistant type 2 diabetes was performed to determine data of use, effectiveness and frequency of and adverse events. The goal of glycemic control (effectiveness measure) was defined as HbA1c=7%. The costs of insulin were extracted from the Integrated System of Medication Prices 2012 (Ministerio de Salud y Protección Social de Colombia) and the IMS Consulting Group mobile average cost for the past year as of December, 2012. Sensitivity analyses were performed via Montecarlo simulations for dose and medication costs (insulin). Five publications met inclusion criteria. The range of the difference between insulin doses was 3.2 IU to 33 IU. The percentage of patients requiring two ID doses was 12.6-100%. There were no significant differences in hypoglycemic events. For both retail and institutional channels, there was a higher differential cost between IG vs. ID favoring IG in 4 and 5 studies, respectively. For the retail channel only one study showed the opposite results. As only medication costs are considered, differences in insulin units between IG and ID result in a differential cost in favor of IG that makes it a cost/effective alternative.

  15. 24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

    Science.gov (United States)

    2010-04-01

    ... Public Housing With the Cost of Tenant-Based Assistance I. Public Housing-Net Present Value The costs... year after the initial year. The sum of the discounted values for each year (net present value) for public housing will then be compared to the net present value of the stream of costs associated with...

  16. The cost of dental implants as compared to that of conventional strategies

    NARCIS (Netherlands)

    van der Wijk, P; Bouma, J; van Waas, MAJ; van Oort, RP; Rutten, FFH

    1998-01-01

    The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are

  17. Comparative costs of mobile and fixed-clinic primary health care ...

    African Journals Online (AJOL)

    mobile and fixed-clinic primary health care services. J. J. Dyer. With restructuring and rationalisation of health services in. South Africa imminent, the development of methods for comparing and evaluating health services is of great importance at both national and local level, including comparisons of cost-efficiency and ...

  18. Comparative costs of mobile and fixed-clinic primary health care ...

    African Journals Online (AJOL)

    The costs of different methods of delivering primary health care in a local authority through mobile and fixed-clinic services have been analysed and aspects of their costefficiency compared. The information gained from such an analysis can be used for management purposes to optimise both the use of resources and the ...

  19. A comparative assessment of the financial costs and carbon benefits of REDD+ strategies in Southeast Asia

    Science.gov (United States)

    Graham, Victoria; Laurance, Susan G.; Grech, Alana; McGregor, Andrew; Venter, Oscar

    2016-11-01

    REDD+ holds potential for mitigating emissions from tropical forest loss by providing financial incentives for carbon stored in forests, but its economic viability is under scrutiny. The primary narrative raised in the literature is that REDD+ will be of limited utility for reducing forest carbon loss in Southeast Asia, while the level of finance committed falls short of profits from alternative land-use activities in the region, including large-scale timber and oil palm operations. Here we assess the financial costs and carbon benefits of various REDD+ strategies deployed in the region. We find the cost of reducing emissions ranges from 9 to 75 per tonne of avoided carbon emissions. The strategies focused on reducing forest degradation and promoting forest regrowth are the most cost-effective ways of reducing emissions and used in over 60% of REDD+ projects. By comparing the financial costs and carbon benefits of a broader range of strategies than previously assessed, we highlight the variation between different strategies and draw attention to opportunities where REDD+ can achieve maximum carbon benefits cost-effectively. These findings have broad policy implications for Southeast Asia. Until carbon finance escalates, emissions reductions can be maximized from reforestation, reduced-impact logging and investing in improved management of protected areas. Targeting cost-efficient opportunities for REDD+ is important to improve the efficiency of national REDD+ policy, which in-turn fosters greater financial and political support for the scheme.

  20. Computer-aided acquisition and logistics support (CALS): Concept of Operations for Depot Maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Bourgeois, N.C.; Greer, D.K.

    1993-04-01

    This CALS Concept of Operations for Depot Maintenance provides the foundation strategy and the near term tactical plan for CALS implementation in the depot maintenance environment. The user requirements enumerated and the overarching architecture outlined serve as the primary framework for implementation planning. The seamless integration of depot maintenance business processes and supporting information systems with the emerging global CALS environment will be critical to the efficient realization of depot user's information requirements, and as, such will be a fundamental theme in depot implementations.

  1. Technology requirements for an orbiting fuel depot - A necessary element of a space infrastructure

    Science.gov (United States)

    Stubbs, R. M.; Corban, R. R.; Willoughby, A. J.

    1988-01-01

    Advanced planning within NASA has identified several bold space exploration initiatives. The successful implementation of these missions will require a supporting space infrastructure which would include a fuel depot, an orbiting facility to store, transfer and process large quantities of cryogenic fluids. In order to adequately plan the technology development programs required to enable the construction and operation of a fuel depot, a multidisciplinary workshop was convened to assess critical technologies and their state of maturity. Since technology requirements depend strongly on the depot design assumptions, several depot concepts are presented with their effect of criticality ratings. Over 70 depot-related technology areas are addressed.

  2. Technology requirements for an orbiting fuel depot: A necessary element of a space infrastructure

    Science.gov (United States)

    Stubbs, R. M.; Corban, R. R.; Willoughby, A. J.

    1988-01-01

    Advanced planning within NASA has identified several bold space exploration initiatives. The successful implementation of these missions will require a supporting space infrastructure which would include a fuel depot, an orbiting facility to store, transfer and process large quantities of cryogenic fluids. In order to adequately plan the technology development programs required to enable the construction and operation of a fuel depot, a multidisciplinary workshop was convened to assess critical technologies and their state of maturity. Since technology requirements depend strongly on the depot design assumptions, several depot concepts are presented with their effect on criticality ratings. Over 70 depot-related technology areas are addressed.

  3. Locoregional cancer therapy using polymer-based drug depots

    NARCIS (Netherlands)

    Ramazani, F.; van Nostrum, C.F.; Storm, Gerrit; Kiessling, F.; Lammers, Twan Gerardus Gertudis Maria; Hennink, W.E.; Kok, R.J.

    2016-01-01

    Locoregional delivery of anticancer drugs is an attractive approach to minimize adverse effects associated with intravenous chemotherapy. Polymer-based drug depots injected or implanted intratumorally or adjacent to the tumor can provide long-term local drug exposure. This review highlights studies

  4. Contraception with depot medroxy progesterone acetate (DMPA) in ...

    African Journals Online (AJOL)

    Clinical experience with depot medroxy progesterone acetate (DMPA) at the family planning clinic of the University of Port Harcourt Teaching Hospital st st between 1 of January 2004 and 31 of December 2013 is presented. This was a descriptive retrospective study aimed at establishing the acceptance, safety and ...

  5. Simultaneously Recovering Rolling Stock Schedules and Depot Plans Under Disruption

    DEFF Research Database (Denmark)

    Haahr, Jørgen Thorlund; Lusby, Richard Martin; Larsen, Jesper

    2015-01-01

    In this paper we consider two important railway optimization problems. In particular, we focus on the Rolling Stock Rescheduling problem and the Depot Replanning problem, respectively. We present an integrated framework for solving these two problems simultaneously, and show that it is fast enoug...

  6. Whole tree transportation system for timber processing depots

    Science.gov (United States)

    John Lancaster; Tom Gallagher; Tim  McDonald; Dana Mitchell

    2016-01-01

    The growing demand for alternative energy has led those who are interested in producing sustainable energy from renewable timber to devise new concepts to satisfy those demands. The concept of timber processing depots, where whole stem trees will be delivered for future processing into wood products and high quality energy fuel, has led to the re-evaluation of our...

  7. Training Needs Analysis for Bus Depot Managers at GSRTC

    Science.gov (United States)

    Shah, Hardik; Gopal, Raj

    2012-01-01

    Purpose: With rapid industrialization and population growth in the urban and rural areas in India, the demand for public transport has risen sharply. In the fast changing scenario in the public transit sector, the role of a bus depot manager (DM) has also undergone substantial transformation. This paper aims to identify and gauge the…

  8. The cost effectiveness of lung transplantation compared with that of heart and liver transplantation in the Netherlands

    NARCIS (Netherlands)

    Ouwens, Jan Paul; van Enckevort, Petra J.; TenVergert, Els M.; Bonsel, Gauke J.; van der Bij, Wim; Haagsma, Els B.; Rutten, Frans F. H.; Slooff, Maarten J. H.; Koëter, Gerard H.

    2003-01-01

    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

  9. 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

  10. Eradicating hepatitis C virus ameliorates insulin resistance without change in adipose depots.

    Science.gov (United States)

    Milner, K-L; Jenkins, A B; Trenell, M; Tid-Ang, J; Samocha-Bonet, D; Weltman, M; Xu, A; George, J; Chisholm, D J

    2014-05-01

    Chronic hepatitis C (CHC) is associated with lipid-related changes and insulin resistance; the latter predicts response to antiviral therapy, liver disease progression and the risk of diabetes. We sought to determine whether insulin sensitivity improves following CHC viral eradication after antiviral therapy and whether this is accompanied by changes in fat depots or adipokine levels. We compared 8 normoglycaemic men with CHC (genotype 1 or 3) before and at least 6 months post viral eradication and 15 hepatitis C antibody negative controls using an intravenous glucose tolerance test and two-step hyperinsulinaemic-euglycaemic clamp with [6,6-(2) H2 ] glucose to assess peripheral and hepatic insulin sensitivity. Magnetic resonance imaging and spectroscopy quantified abdominal fat compartments, liver and intramyocellular lipid. Peripheral insulin sensitivity improved (glucose infusion rate during high-dose insulin increased from 10.1 ± 1.6 to 12 ± 2.1 mg/kg/min/, P = 0.025), with no change in hepatic insulin response following successful viral eradication, without any accompanying change in muscle, liver or abdominal fat depots. There was corresponding improvement in incremental glycaemic response to intravenous glucose (pretreatment: 62.1 ± 8.3 vs post-treatment: 56.1 ± 8.5 mm, P = 0.008). Insulin sensitivity after viral clearance was comparable to matched controls without CHC. Post therapy, liver enzyme levels decreased but, interestingly, levels of glucagon, fatty acid-binding protein and lipocalin-2 remained elevated. Eradication of the hepatitis C virus improves insulin sensitivity without alteration in fat depots, adipokine or glucagon levels, consistent with a direct link of the virus with insulin resistance. © 2013 John Wiley & Sons Ltd.

  11. Exploring the Use of Cost-Benefit Analysis to Compare Pharmaceutical Treatments for Menorrhagia.

    Science.gov (United States)

    Sanghera, Sabina; Frew, Emma; Gupta, Janesh Kumar; Kai, Joe; Roberts, Tracy Elizabeth

    2015-09-01

    The extra-welfarist theoretical framework tends to focus on health-related quality of life, whilst the welfarist framework captures a wider notion of well-being. EQ-5D and SF-6D are commonly used to value outcomes in chronic conditions with episodic symptoms, such as heavy menstrual bleeding (clinically termed menorrhagia). Because of their narrow-health focus and the condition's periodic nature these measures may be unsuitable. A viable alternative measure is willingness to pay (WTP) from the welfarist framework. We explore the use of WTP in a preliminary cost-benefit analysis comparing pharmaceutical treatments for menorrhagia. A cost-benefit analysis was carried out based on an outcome of WTP. The analysis is based in the UK primary care setting over a 24-month time period, with a partial societal perspective. Ninety-nine women completed a WTP exercise from the ex-ante (pre-treatment/condition) perspective. Maximum average WTP values were elicited for two pharmaceutical treatments, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral treatment. Cost data were offset against WTP and the net present value derived for treatment. Qualitative information explaining the WTP values was also collected. Oral treatment was indicated to be the most cost-beneficial intervention costing £107 less than LNG-IUS and generating £7 more benefits. The mean incremental net present value for oral treatment compared with LNG-IUS was £113. The use of the WTP approach was acceptable as very few protests and non-responses were observed. The preliminary cost-benefit analysis results recommend oral treatment as the first-line treatment for menorrhagia. The WTP approach is a feasible alternative to the conventional EQ-5D/SF-6D approaches and offers advantages by capturing benefits beyond health, which is particularly relevant in menorrhagia.

  12. Sympathetic denervation of one white fat depot changes norepinephrine content and turnover in intact white and brown fat depots

    Science.gov (United States)

    Harris, Ruth B.S.

    2013-01-01

    It is well established that the sympathetic nervous system regulates adipocyte metabolism and recently it has been reported that sensory afferents from white fat overlap anatomically with sympathetic efferents to white fat. The studies described here characterize the response of intact fat pads to selective sympathectomy (local 6-hydroxydopamine injections) of inguinal (ING) or epididymal (EPI) fat in male NIH Swiss mice and provide in vivo evidence for communication between individual white and brown fat depots. The contralateral ING pad, both EPI pads, perirenal and mesenteric pads were significantly enlarged four weeks after denervating one ING pad, but only intrascapular brown fat (IBAT) increased when both ING pads were denervated. Denervation of one or both EPI pad had no effect on fat depot weights. In an additional experiment, NE turnover was inhibited in ING, retroperitoneal, mesenteric and IBAT two days after denervation of both EPI or of both ING pads. NE content was reduced to 10-30% of control values in all fat depots. There was no relation between early changes in NE turnover and fat pad weight 4 weeks after denervation, even though the reduction in NE content of intact fat pads was maintained. These data demonstrate that there is communication among individual fat pads, presumably through central integration of activity of sensory afferent and sympathetic efferent fibers,that changes sympathetic drive to white adipose tissue in a unified manner. In specific situations, removal of sympathetic efferents to one pad induces a compensatory enlargement of other intact depots. PMID:22513494

  13. Analytic model comparing the cost utility of TVT versus duloxetine in women with urinary stress incontinence.

    Science.gov (United States)

    Jacklin, Paul; Duckett, Jonathan; Renganathan, Arasee

    2010-08-01

    The purpose of this study was to assess cost utility of duloxetine versus tension-free vaginal tape (TVT) as a second-line treatment for urinary stress incontinence. A Markov model was used to compare the cost utility based on a 2-year follow-up period. Quality-adjusted life year (QALY) estimation was performed by assuming a disutility rate of 0.05. Under base-case assumptions, although duloxetine was a cheaper option, TVT gave a considerably higher QALY gain. When a longer follow-up period was considered, TVT had an incremental cost-effectiveness ratio (ICER) of pound 7,710 ($12,651) at 10 years. If the QALY gain from cure was 0.09, then the ICER for duloxetine and TVT would both fall within the indicative National Institute for Health and Clinical Excellence willingness to pay threshold at 2 years, but TVT would be the cost-effective option having extended dominance over duloxetine. This model suggests that TVT is a cost-effective treatment for stress incontinence.

  14. Early-Stage Capital Cost Estimation of Biorefinery Processes: A Comparative Study of Heuristic Techniques.

    Science.gov (United States)

    Tsagkari, Mirela; Couturier, Jean-Luc; Kokossis, Antonis; Dubois, Jean-Luc

    2016-09-08

    Biorefineries offer a promising alternative to fossil-based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital-intensive projects that involve state-of-the-art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well-documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early-stage capital cost estimation tool suitable for biorefinery processes. © 2015 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA.

  15. Cost of outpatient hypertension pharmacotherapy - comparative study between Bulgaria and Serbia.

    Directory of Open Access Journals (Sweden)

    Ivanova A

    2009-06-01

    Full Text Available Objective: To compare the prescribing practice and pharmacotherapy outpatient cost of hypertension and its common complications between two neighboring countries, Bulgaria and Serbia. The study questions focus on consistency of the prescribing practice with the treatment guidelines; comparability of the treatment patterns among both countries, and burden of hypertension cost to the population and third party payer in the countries under consideration.Methods: Retrospective study, one year time horizon is for outpatient therapy.Results: Patients with arterial hypertension in Bulgaria are most often on monotherapy (61% vs 6% in Serbia, as well as those with complications (66% vs 0% Serbia. In both countries the first choice of therapy are the ACE inhibitors (37.01% in Serbia and 41% in Bulgaria and then follows the calcium antagonists, beta-blockers, and diuretics. The weighed monthly cost of hypertension and complicated hypertension is almost doubled in Serbia (12.56 vs 8.23 EUR for hypertension, and 13.39 vs 8.23 EUR and prevailing part is reimbursed (88% vs 44% in Bulgaria.Conclusion: Our study confirms that hypertension and its complications therapy consumes a huge amount of financial resources. In both countries under consideration the therapy is corresponding with the European treatment guidelines. The international cost comparisons are possible but they depend on many external factors as the regulatory measures, prescribing habits and reimbursement policy and should be analysed within this framework.

  16. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  17. Cost Utility of Omalizumab Compared with Standard of Care for the Treatment of Chronic Spontaneous Urticaria.

    Science.gov (United States)

    Graham, Jonathan; McBride, Doreen; Stull, Donald; Halliday, Anna; Alexopoulos, Stamatia Theodora; Balp, Maria-Magdalena; Griffiths, Matthew; Agirrezabal, Ion; Zuberbier, Torsten; Brennan, Alan

    2016-08-01

    Chronic spontaneous urticaria (CSU) negatively impacts patient quality of life and productivity and is associated with considerable indirect costs to society. The aim of this study was to assess the cost utility of add-on omalizumab treatment compared with standard of care (SOC) in moderate or severe CSU patients with inadequate response to SOC, from the UK societal perspective. A Markov model was developed, consisting of health states based on Urticaria Activity Score over 7 days (UAS7) and additional states for relapse, spontaneous remission and death. Model cycle length was 4 weeks, and total model time horizon was 20 years in the base case. The model considered early discontinuation of non-responders (response: UAS7 ≤6) and retreatment upon relapse (relapse: UAS7 ≥16) for responders. Clinical and cost inputs were derived from omalizumab trials and published sources, and cost utility was expressed as incremental cost-effectiveness ratios (ICERs). Scenario analyses included no early discontinuation of non-responders and an altered definition of response (UAS7 omalizumab was associated with increased costs and benefits relative to SOC. Probabilistic sensitivity analysis supported this result. Productivity inputs were key model drivers, and individual scenarios without early discontinuation of non-responders and adjusted response definitions had little impact on results. ICERs were generally robust to changes in key model parameters and inputs. In this, the first economic evaluation of omalizumab in CSU from a UK societal perspective, omalizumab consistently represented a treatment option with societal benefit for CSU in the UK across a range of scenarios.

  18. DIDEM - An integrated model for comparative health damage costs calculation of air pollution

    Science.gov (United States)

    Ravina, Marco; Panepinto, Deborah; Zanetti, Maria Chiara

    2018-01-01

    Air pollution represents a continuous hazard to human health. Administration, companies and population need efficient indicators of the possible effects given by a change in decision, strategy or habit. The monetary quantification of health effects of air pollution through the definition of external costs is increasingly recognized as a useful indicator to support decision and information at all levels. The development of modelling tools for the calculation of external costs can provide support to analysts in the development of consistent and comparable assessments. In this paper, the DIATI Dispersion and Externalities Model (DIDEM) is presented. The DIDEM model calculates the delta-external costs of air pollution comparing two alternative emission scenarios. This tool integrates CALPUFF's advanced dispersion modelling with the latest WHO recommendations on concentration-response functions. The model is based on the impact pathway method. It was designed to work with a fine spatial resolution and a local or national geographic scope. The modular structure allows users to input their own data sets. The DIDEM model was tested on a real case study, represented by a comparative analysis of the district heating system in Turin, Italy. Additional advantages and drawbacks of the tool are discussed in the paper. A comparison with other existing models worldwide is reported.

  19. Cost-effectiveness of vedolizumab compared with conventional therapy for ulcerative colitis patients in the UK

    Directory of Open Access Journals (Sweden)

    Wilson MR

    2017-10-01

    Full Text Available Michele R Wilson,1 Ismail Azzabi Zouraq,2 Helene Chevrou-Severac,2 Ross Selby,3 Matthew C Kerrigan4 1RTI Health Solutions, Research Triangle Park, NC, USA; 2Takeda Pharmaceuticals International AG, Zurich, Switzerland; 3Takeda UK Ltd., Bucks, UK; 4PHMR Limited, London, UK Objective: To examine the clinical and economic impact of vedolizumab compared with conventional therapy in the treatment of moderately-to-severely active ulcerative colitis (UC in the UK based on results of the GEMINI I trial. Methods: A decision-analytic model in Microsoft Excel was used to compare vedolizumab with conventional therapy (aminosalicylates, corticosteroids, immunomodulators for the treatment of patients with UC in the UK. We considered the following three populations: the overall intent-to-treat population from the GEMINI I trial, patients naïve to anti-TNF therapy, and those who had failed anti-TNF-therapy. Population characteristics and efficacy data were obtained from the GEMINI I trial. Other inputs (eg, unit costs, probability of surgery, mortality were obtained from published literature. Time horizon was a lifetime horizon, with costs and outcomes discounted by 3.5% per year. One-way and probabilistic sensitivity analyses were conducted to measure the impact of parameter uncertainty. Results: Vedolizumab had incremental cost-effectiveness ratios of £4,095/quality-adjusted life-year (QALY, £4,423/QALY, and £5,972/QALY compared with conventional therapy in the intent-to-treat, anti-TNF-naïve, and anti-TNF-failure populations, respectively. Patients on vedolizumab accrued more QALYs while incurring more costs than patients on conventional therapy. The sensitivity analyses showed that the results were most sensitive to induction response and transition probabilities for each treatment. Conclusion: The results suggest that vedolizumab results in more QALYs and may be a cost-effective treatment option compared with conventional therapy for both anti

  20. Relationships between rodent white adipose fat pads and human white adipose fat depots

    Directory of Open Access Journals (Sweden)

    Daniella E. Chusyd

    2016-04-01

    Full Text Available The objective of this review was to compare and contrast the physiological and metabolic profiles of rodent white adipose fat pads with white adipose fat depots in humans. Human fat distribution and its metabolic consequences have received extensive attention, but much of what has been tested in translational research has relied heavily on rodents. Unfortunately, the validity of using rodent fat pads as a model of human adiposity has received less attention. There is a surprisingly lack of studies demonstrating an analogous relationship between rodent and human adiposity on obesity-related comorbidities. Therefore, we aimed to compare known similarities and disparities in terms of white adipose tissue development and distribution, sexual dimorphism, weight loss, adipokine secretion, and aging. While the literature supports the notion that many similarities exist between rodents and humans, notable differences emerge related to fat deposition and function of white adipose tissue. Thus, further research is warranted to more carefully define the strengths and limitations of rodent white adipose tissue as a model for humans, with a particular emphasis on comparable fat depots, such as mesenteric fat.

  1. LCA and external costs in comparative assessment of electricity chains. Decision support for sustainable electricity provision?

    International Nuclear Information System (INIS)

    Voss, A.

    2002-01-01

    The provision of energy and electricity plays an important role in a country's economic and environmental performance and the sustainability of its development. Sustainable development of the energy and electricity sector depends on finding ways of meeting energy service demands of the present generation that are economically viable, environmentally sound, and socially acceptable and do not jeopardize the ability of future generations to meet their own energy needs. Life Cycle Assessment (LCA) and external cost valuation are considered to offer opportunities to assist energy policy in a comprehensive comparative evaluation of electricity supply options with regard to the different dimensions of sustainable energy provision as well as in the implementation of appropriate internalization strategies. The paper addresses life cycle assessment and external cost analysis carried out for selected electricity systems of interest under German conditions. Results from a comprehensive comparative assessment of various electricity supply options with regard to their environmental impacts, health risks, raw materials requirements as well as their resulting external cost will be summarised. The use of LCA based indicators for assessing the relative sustainability of electricity systems and the use of total (internal plus external) cost assessment as measure of economic and environmental efficiency of energy systems will be discussed. Open problems related to life cycle analysis of energy chains and the assessment of environmental damage costs are critically reviewed, to illustrate how in spite of existing uncertainties the state of the art results may provide helpful energy policy decision support. The paper starts with some remarks on what the concept of sustainability in terms of energy systems means. (author)

  2. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis.

    Science.gov (United States)

    Cotton, Cary C; Erim, Daniel; Eluri, Swathi; Palmer, Sarah H; Green, Daniel J; Wolf, W Asher; Runge, Thomas M; Wheeler, Stephanie; Shaheen, Nicholas J; Dellon, Evan S

    2017-06-01

    Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  3. Comparative analysis of cost and efficacy for mono and dual therapy of antiepileptics among children

    Directory of Open Access Journals (Sweden)

    Easwaran Vigneshwaran

    2017-01-01

    Full Text Available Introduction: Developing countries contribute to major number of patients living with epilepsy, around five million people are living with epilepsy in India alone. Most of the epileptic children may require multiple antiepileptic therapy due to the failure of monotherapy. Basic research evidence suggest that sodium valproate and carbamazepine (CBZ may have synergistic anticonvulsant effects when they are used together. In addition to that, chronic disorders make the patients economically weak and produce more burden. Aim and Objective: Therefore, this study was designed to compare the efficacy of valproate monotherapy with valproate and CBZ dual therapy. Methodology: It is a prospective, comparative study conducted at a secondary care referral hospital and private clinic. A nonprobabilistic convenient sampling was done to recruit the study subjects. A total of fifty subjects were recruited into the present study, and they were divided into two groups, i.e., monotherapy group (CBZ and dual therapy group (CBZ and valproate. After providing appropriate counseling, subjects were interviewed to estimate the quality of life (QOL using child version of TNO-AZL Children's Quality of Life questionnaire. Hospital patient records, prescription data from the pharmacy were also used to obtain the direct and indirect cost of treatment. Results: Our study results showed that monotherapy has a potential to produce a higher level of QOL than dual therapy. It also involved with decreased seizure frequency. Although there was no statistically significant difference in terms of cost for both the treatment groups, still dual therapy is associated with higher cost burden. The average costs per QOL and changes in the frequency of seizure are also identified to produce higher economic burden to the patients.Conclusion: Thus, the present study has concluded that monotherapy may be considered as better cost-effective treatment in partial seizures than dual therapy

  4. On the transition to sustainability: an analysis of the costs of school feeding compared with the costs of primary education.

    Science.gov (United States)

    Bundy, Donald; Burbano, Carmen; Gelli, Aulo; Risley, Claire; Neeser, Kristie

    2011-09-01

    The current food, fuel, and financial crises have highlighted the importance of school feeding programs both as a social safety net for children living in poverty and food insecurity, and as part of national educational policies and plans. To examine the costs of school feeding, in terms of both the absolute cost per child and the cost per child relative to overall education expenditure and gross domestic product (GDP) in low-, middle-, and high-income countries. Data on the costs of school feeding in different countries were collected from multiple sources, including World Food Programme project data, reports from government ministries, and, where such searches failed, newspaper articles and other literature obtained from internet searches. Regression models were then used to analyze the relationships between school feeding costs, the per capita costs of primary education and GDP per capita. School feeding programs in low-income countries exhibit large variations in cost, with concomitant opportunities for cost containment. As countries get richer, however, school feeding costs become a much smaller proportion of the investment in education. The per capita costs of feeding relative to education decline nonlinearly with increasing GDP. These analyses suggest that the main reason for this decline in the relative cost of school feeding versus primary education is a greatly increased investment per child in primary education as GDP rises, but a fairly flat investment in food. The analyses also show that there appears to be a transitional discontinuity at the interface between the lower- and middle-income countries, which tends to coincide with changes in the capacity of governments to take over the management and funding of programs. Further analysis is required to define these relationships, but an initial conclusion is that supporting countries to maintain an investment in school feeding through this transition may emerge as a key role for development partners.

  5. Gram-stain-based antimicrobial selection reduces cost and overuse compared with Japanese guidelines.

    Science.gov (United States)

    Taniguchi, Tomohiro; Tsuha, Sanefumi; Shiiki, Soichi; Narita, Masashi

    2015-10-26

    The Gram stain has been used as an essential tool for antimicrobial stewardship in our hospital since the 1970s. The objective of this study was to clarify the difference in the targeted therapies selected based on the Gram stain and simulated empirical therapies based on the antimicrobial guidelines used in Japan. A referral-hospital-based prospective descriptive study was undertaken between May 2013 and April 2014 in Okinawa, Japan. All enrolled patients were adults who had been admitted to the Division of Infectious Diseases through the emergency room with suspected bacterial infection at one of three sites: respiratory system, urinary tract, or skin and soft tissues. The study outcomes were the types and effectiveness of the antibiotics initially selected, and their total costs. Two hundred eight patients were enrolled in the study. The median age was 80 years. A significantly narrower spectrum of antibiotics was selected based on the Gram stain than was selected based on the Japanese guidelines. The treatments based on the Gram stain and on the guidelines were estimated to be equally highly effective. The total cost of antimicrobials after Gram-stain testing was less than half the cost after the guidelines were followed. Compared with the Japanese guidelines, the Gram stain dramatically reduced the overuse of broad-spectrum antimicrobials without affecting the effectiveness of the treatment. Drug costs were reduced by half when the Gram stain was used. The Gram stain should be included in all antimicrobial stewardship programs.

  6. Influence of the discount rate when comparing costs of different nuclear fuel cycles

    International Nuclear Information System (INIS)

    Le Dars, A.; Loaec, Ch.

    2007-01-01

    The article describes the methodology and technical economic results obtained by Cea in the DERECO project. This project was aimed at evaluating ground-breaking and intricate scenarios of the nuclear fuel cycle, and developed on the long term (150 years), in the context of France. All 5 scenarios studied assume that the reliance on nuclear energy will continue in order to satisfy the electricity demand. Despite uncertainties, the trends are breaking free from the analysis. It appears that the scenarios in which fourth generation fast reactors take part are globally more economical than the keeping to the present strategy of plutonium mono-recycling in PWR. The scenario in which fuel reprocessing is stopped has a total cost concerning the fuel cycle similar to that of the present strategy but the disposal cost is twice as high because of the necessity of disposing spent fuels directly in geological formations. The comparative costs of the different scenarios are set out and the influence of the discount rate is highlighted. One must keep in mind that the actualization theory entails a diminishing value for long term costs due to an unavoidable mechanical effect of the discount rate

  7. Adesão ao tratamento e hospitalizações entre pacientes que realizam aplicações de Flufenazina Depot Adhesión al tratamiento y hospitalización entre pacientes que realizan aplicaciones de Flufenazina Depot Compliance with treatment and hospitalization among patients using Flufenazine Depot

    Directory of Open Access Journals (Sweden)

    José Menna Oliveira

    2003-08-01

    patients, 66 continued to receive deposit applications until the end of the period studied. Of these, 40 (61% presented good compliance with the treatment, while in 26 (39% patients compliance was poor. Twenty-five patients in all underwent hospitalizations, most of whom were not in treatment by the end of the study or presented poor compliance. Among patients from the neighborhood in which the hospital is located 10 (67% presented good compliance with treatment as compared to 30 patients (59% from different neighborhoods. DISCUSSION: The number of hospitalizations clearly varied according to remaining or not in treatment and compliance with the latter. Patients coming from distant neighborhoods tended to be less compliant with treatment. CONCLUSIONS: It is possible that patients on a depot medication regime who live close to the application site benefit more from the treatment that those who live far away. Further studies are required comparing depot administration with PO in terms of adhesion and investigating predictive factors of good compliance with treatment.

  8. Rotational Thromboelastometry or Conventional Coagulation Tests in Liver Transplantation: Comparing Blood Loss, Transfusions, and Cost.

    Science.gov (United States)

    Smart, Laura; Mumtaz, Khalid; Scharpf, Danielle; Gray, Nicole O'Bleness; Traetow, Daniel; Black, Sylvester; Michaels, Anthony J; Elkhammas, Elmahdi; Kirkpatrick, Robert; Hanje, A James

    Orthotopic liver transplantation (OLT) can be associated with significant bleeding requiring multiple blood product transfusions. Rotational thromboelastometry (ROTEM) is a point-of-care device that has been used to monitor coagulation during OLT. Whether it reduces blood loss/transfusions during OLT remains controversial. We aim to compare ROTEM with conventional coagulation tests (aPTT, PT, INR, platelet count, fibrinogen) to guide transfusion of platelets, cryoprecipitate, and fresh frozen plasma (FFP) during OLT over 3 years. Thirty-four patients who had transfusions guided by ROTEM were compared to 34 controls who received transfusions guided by conventional coagulation tests (CCT). Intraoperative blood loss, type/ amount of blood products transfused, and direct costs were compared between the two groups. The ROTEM group had significantly less intra-operative blood loss (2.0 vs. 3.0 L, p = 0.04) and fresh frozen plasma (FFP) transfusion (4 units vs. 6.5 units, p = 0.015) compared to the CCT group (2.0L vs. 3.0L, p = 0.04). However, total number of patients transfused cryoprecipitate was increased in ROTEM (n = 25;73%) as compared to CCT (n = 19; 56%), p = 0.033. The direct cost of blood products plus testing was reduced in the ROTEM group ($113,142.89 vs. $127,814.77). In conclusion implementation of a ROTEM-guided transfusion algorithm resulted in a reduction in intra-operative blood loss, FFP transfusion and a decrease in direct cost during OLT. ROTEM is a useful and safe point of care device in OLT setting.

  9. Inflammatory characteristics of distinct abdominal adipose tissue depots relate differently to metabolic risk factors for cardiovascular disease Distinct fat depots and vascular risk factors

    NARCIS (Netherlands)

    Kranendonk, Mariette E. G.; van Herwaarden, Joost A.; Stupkova, Tereza; de Jager, Wilco; Vink, Aryan; Moll, Frans L.; Kalkhoven, Eric; Visseren, Frank L. J.

    Objective: Abdominal obesity is associated with insulin resistance and metabolic syndrome. However, specific contributions of distinct adipose tissue (AT) depots to metabolic complications of obesity are still unclear. In this study, the inflammatory profile of four distinct abdominal AT-depots and

  10. An Analysis of the Cost Effectiveness of Various Electronic Alternatives for Delivering Distance Education Compared to the Travel Costs for Live Instruction.

    Science.gov (United States)

    Caffarella, Edward; And Others

    The feasibility and relative costs of four telecommunication systems for delivering university courses to distant locations in Colorado were compared. The four systems were compressed video, vertical blanking interval video, satellite video, and audiographic systems. Actual costs to install and operate each for a 5-year period were determined,…

  11. Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

    Science.gov (United States)

    Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

    2017-01-01

    Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p financial loss for the operating department. PMID:28107366

  12. A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion.

    Science.gov (United States)

    Singh, Kern; Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Fineberg, Steven J; Oglesby, Mathew; Pelton, Miguel A; Andersson, Gunnar B; Isayeva, Darya; Jegier, Briana J; Phillips, Frank M

    2014-08-01

    Emerging literature suggests superior clinical short- and long-term outcomes of MIS (minimally invasive surgery) TLIFs (transforaminal lumbar interbody fusion) versus open fusions. Few studies to date have analyzed the cost differences between the two techniques and their relationship to acute clinical outcomes. The purpose of the study was to determine the differences in hospitalization costs and payments for patients treated with primary single-level MIS versus open TLIF. The impact of clinical outcomes and their contribution to financial differences was explored as well. This study was a nonrandomized, nonblinded prospective review. Sixty-six consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open, 33 MIS). Patients in either cohort (MIS/open) were matched based on race, sex, age, smoking status, medical comorbidities (Charlson Comorbidity index), payer, and diagnosis. Every patient in the study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (minutes), length of stay (LOS, days), estimated blood loss (EBL, mL), anesthesia time (minutes), Visual Analog Scale (VAS) scores, and hospital cost/payment amount were assessed. The MIS and open TLIF groups were compared based on clinical outcomes measures and hospital cost/payment data using SPSS version 20.0 for statistical analysis. The two groups were compared using bivariate chi-squared analysis. Mann-Whitney tests were used for non-normal distributed data. Effect size estimate was calculated with the Cohen d statistic and the r statistic with a 95% confidence interval. Average surgical time was shorter for the MIS than the open TLIF group (115.8 minutes vs. 186.0 minutes respectively; p=.001). Length of stay was also reduced for the MIS versus the open group (2.3 days vs. 2.9 days, respectively; p=.018). Average anesthesia time and EBL were also lower in the MIS group (pFinancial analysis demonstrated lower total hospital direct

  13. Master Environmental Plan: Fort Wingate Depot Activity, Gallup, New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Biang, C.A.; Yuen, C.R.; Biang, R.P.; Antonopoulos, A.A.; Ditmars, J.D.

    1990-12-01

    The master environmental plan is based on an environmental assessment of the areas requiring environmental evaluation (AREEs) at Fort Wingate Depot Activity near Gallup, New Mexico. The Fort Wingate Depot Activity is slated for closure under the Base Closure and Realignment Act, Public Law 100--526. The MEP assesses the current status, describes additional data requirements, recommends actions for the sites, and establishes a priority order for actions. The plan was developed so that actions comply with hazardous waste and water quality regulations of the State of New Mexico and applicable federal regulations. It contains a brief history of the site, relevant geological and hydrological information, and a description of the current status for each AREE along with a discussion of the available site-specific data that pertain to existing or potential contamination and the impact on the environment. 35 refs., 27 figs., 23 tabs.

  14. Radiological Final Status Survey of the Hammond Depot, Hammond, Indiana

    International Nuclear Information System (INIS)

    Vitkus, T.J.

    2008-01-01

    ORISE conducted extensive scoping, characterization, and final status surveys of land areas and structures at the DNSC's Hammond Depot located in Hammond, Indiana in multiple phases during 2005, 2006 and 2007. This report provides a detailed discussion of the radiological survey planning, survey implementation, remediation, and the results for these activities supporting the conclusion that radioactive contamination previously identified at the Hammond Depot (HD) has been reduced to levels such that the site may be released without radiological restrictions. The objective of the radiological final status survey (FSS) was to obtain the data necessary to demonstrate compliance with the U.S. Nuclear Regulatory Commission (NRC)-approved site-specific derived concentration guideline levels (DCGLs) for both structural surfaces and outdoor areas (ORISE 2006a and NRC 2007). The DCGLs were modeled such that any residual licensed material would not exceed the NRC's basic dose limit for license termination of 25 millirem per year (mrem/y)

  15. Automated Diabetic Retinopathy Image Assessment Software: Diagnostic Accuracy and Cost-Effectiveness Compared with Human Graders.

    Science.gov (United States)

    Tufail, Adnan; Rudisill, Caroline; Egan, Catherine; Kapetanakis, Venediktos V; Salas-Vega, Sebastian; Owen, Christopher G; Lee, Aaron; Louw, Vern; Anderson, John; Liew, Gerald; Bolter, Louis; Srinivas, Sowmya; Nittala, Muneeswar; Sadda, SriniVas; Taylor, Paul; Rudnicka, Alicja R

    2017-03-01

    With the increasing prevalence of diabetes, annual screening for diabetic retinopathy (DR) by expert human grading of retinal images is challenging. Automated DR image assessment systems (ARIAS) may provide clinically effective and cost-effective detection of retinopathy. We aimed to determine whether ARIAS can be safely introduced into DR screening pathways to replace human graders. Observational measurement comparison study of human graders following a national screening program for DR versus ARIAS. Retinal images from 20 258 consecutive patients attending routine annual diabetic eye screening between June 1, 2012, and November 4, 2013. Retinal images were manually graded following a standard national protocol for DR screening and were processed by 3 ARIAS: iGradingM, Retmarker, and EyeArt. Discrepancies between manual grades and ARIAS results were sent to a reading center for arbitration. Screening performance (sensitivity, false-positive rate) and diagnostic accuracy (95% confidence intervals of screening-performance measures) were determined. Economic analysis estimated the cost per appropriate screening outcome. Sensitivity point estimates (95% confidence intervals) of the ARIAS were as follows: EyeArt 94.7% (94.2%-95.2%) for any retinopathy, 93.8% (92.9%-94.6%) for referable retinopathy (human graded as either ungradable, maculopathy, preproliferative, or proliferative), 99.6% (97.0%-99.9%) for proliferative retinopathy; Retmarker 73.0% (72.0 %-74.0%) for any retinopathy, 85.0% (83.6%-86.2%) for referable retinopathy, 97.9% (94.9%-99.1%) for proliferative retinopathy. iGradingM classified all images as either having disease or being ungradable. EyeArt and Retmarker saved costs compared with manual grading both as a replacement for initial human grading and as a filter prior to primary human grading, although the latter approach was less cost-effective. Retmarker and EyeArt systems achieved acceptable sensitivity for referable retinopathy when compared

  16. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    .001 in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 € was less than open surgery (17,260 €, (p=0.001. Conclusion: Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs. Keywords: laparoscopy, aortobifemoral bypass, cost-utility, quality-adjusted life years, QALYs, EQ-5D, health-related quality of life, HRQoL, cost-effectiveness

  17. Comparative analysis of costs for the generation of electrical energy in Brazil using the screening curve

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Thaisa C. de; Castrillo, Lazara S.; Xavier, Aline G.; Goncalves, Gabriela de L.; Melo, Julio Angelo, E-mail: barros.camara@gmail.com, E-mail: lazaracastrillo@hotmail.com, E-mail: alinegxavier@gmail.com, E-mail: gabilimag_@hotmail.com, E-mail: angelo_mecanic@hotmail.com [Escola Politecnica de Pernambuco (UPE), Recife, PE (Brazil). Departamento de Engenharia Mecanica Industrial

    2017-11-01

    To meet the demand for electric consumption, it is fundamental to prepare an efficient energy planning that guarantees the safe supply of energy, so that the price of kilowatt-hours for the consumer respects the tariff modality and the socio-environmental impact is the smallest possible. In recent years, alternative sources of energy have been gaining considerable space in the Brazilian generating park. Among the many options for energy supply, choosing the most feasible involves the use of techniques that compare all the costs involved in generating electricity from the sources available in the Brazilian energy matrix. The objective of the work is to show a quick, practical and objective tool that performs this comparison and assists in decision making. The method based on the comparison is the Cost of Energy and the tool for the application of the same are the Screening curves, widely used by the International Atomic Energy Agency (IAEA). In this analysis, the following parameters are considered: operating capacity, toxic gas emission rate, fuel consumption and values, fixed and variable costs of operation and maintenance, investment values for each source, construction time and useful life. It is worth noting that the method does not consider in calculations aspects such as inflation, forced interruptions of the plant and other more specific factors. With the work, it was possible to perform an examination of the costs of the generation technologies available in Brazil and, through the obtained data, the economic viability of the generating parks was discussed through simulations in different scenarios, comparing the sources among themselves. (author)

  18. Comparative analysis of costs for the generation of electrical energy in Brazil using the screening curve

    International Nuclear Information System (INIS)

    Barros, Thaisa C. de; Castrillo, Lazara S.; Xavier, Aline G.; Goncalves, Gabriela de L.; Melo, Julio Angelo

    2017-01-01

    To meet the demand for electric consumption, it is fundamental to prepare an efficient energy planning that guarantees the safe supply of energy, so that the price of kilowatt-hours for the consumer respects the tariff modality and the socio-environmental impact is the smallest possible. In recent years, alternative sources of energy have been gaining considerable space in the Brazilian generating park. Among the many options for energy supply, choosing the most feasible involves the use of techniques that compare all the costs involved in generating electricity from the sources available in the Brazilian energy matrix. The objective of the work is to show a quick, practical and objective tool that performs this comparison and assists in decision making. The method based on the comparison is the Cost of Energy and the tool for the application of the same are the Screening curves, widely used by the International Atomic Energy Agency (IAEA). In this analysis, the following parameters are considered: operating capacity, toxic gas emission rate, fuel consumption and values, fixed and variable costs of operation and maintenance, investment values for each source, construction time and useful life. It is worth noting that the method does not consider in calculations aspects such as inflation, forced interruptions of the plant and other more specific factors. With the work, it was possible to perform an examination of the costs of the generation technologies available in Brazil and, through the obtained data, the economic viability of the generating parks was discussed through simulations in different scenarios, comparing the sources among themselves. (author)

  19. The Home Depot Upgrades its Corporate Building Prototype

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-03-01

    The Home Depot partnered with the Department of Energy (DOE) to develop and implement solutions to build new, low-energy buildings that are at least 50% below Standard 90.1-2007 of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), the American National Standards Institute (ANSI), and the Illuminating Engineering Society of North America (IESNA) as part of DOE’s Commercial Building Partnerships (CBP) Program.

  20. Randomised controlled single-blind study of conventional versus depot mydriatic drug delivery prior to cataract surgery

    Directory of Open Access Journals (Sweden)

    Madge Simon

    2006-11-01

    Full Text Available Abstract Background A prerequisite for safe cataract surgery is an adequately dilated pupil. The authors conducted a trial to assess the efficacy (in terms of pupil diameter of a depot method of pre-operative pupil dilatation, as compared with repeated instillations of drops (which is time-consuming for the nursing staff and uncomfortable for the patient. Methods A prospective randomised masked trial was conducted comprising 130 patients with no significant ocular history undergoing elective clear corneal phacoemulsification. 65 patients had mydriatic drops (Tropicamide 1%, Phenylephrine 2.5%, Diclofenac sodium 0.1% instilled prior to surgery, 65 had a wick soaked in the same drop mixture placed in the inferior fornix. Horizontal pupil diameters were recorded on a millimetre scale immediately prior to surgery. Results There was no significant difference in pupil size between the two groups (p = 0.255, Student's t-test. Conclusion There was no significant difference between the mydriasis obtained with the depot system compared with conventional drop application. Use of a depot mydriatic delivery system appears to be a safe and efficient method of drug delivery. Trial Registration International Standard Randomised Controlled Trial Number Register ISRCTN78047760

  1. Comparative evaluation of low cost materials as constructed wetland filling media

    Science.gov (United States)

    Pinho, Henrique J. O.; Vaz, Mafalda M.; Mateus, Dina M. R.

    2017-11-01

    Three waste materials from civil construction activities were assessed as low cost alternative filling materials used in Constructed Wetlands (CW). CW are green processes for wastewater treatment, whose design includes an appropriate selection of vegetation and filling material. The sustainability of such processes may be incremented using recovered wastes as filling materials. The abilities of the materials to support plant growth and to contribute to pollutants removal from wastewater were assessed and compared to expanded clay, a filling usually used in CW design. Statistical analysis, using one-way ANOVA and Welch's ANOVA, demonstrate that limestone fragments are a better choice of filling material than brick fragments and basalt gravel.

  2. Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

    International Nuclear Information System (INIS)

    Busch, Jonah; Strassburg, Bernardo; Cattaneo, Andrea; Lubowski, Ruben; Bruner, Aaron; Rice, Richard; Boltz, Frederick; Creed, Anna; Ashton, Ralph

    2009-01-01

    The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

  3. Reconnaissance of Overseas Depot-Level Maintenance.

    Science.gov (United States)

    1984-04-01

    CONTRACTOR COUNTRY EQUIPMENT COST SUPPORTED (THOUSANDS) Oficinas Gerais de Portugal C-2A, C-130 $ 750 Materia Aeronautica (OGMA) Industria Aeronautica Italy...Aircraft Industries Industria Aeronautica Italy C-130 1.4 Meridionale Lockheed Support Services Germany F-15 TCTO2 2.0 Israeli Aircraft Industries Belgium...Aerospace UK F-I11 100.0 Construcciones Aeronauticas Spain F-4 60.2 Hellenic Aerospace Greece J-79 Engines 20.9 MBB Germany F-4 4.2 Aviation Traders UK F-4

  4. The multi-depot electric vehicle location routing problem with time windows

    Directory of Open Access Journals (Sweden)

    Juan Camilo Paz

    2018-01-01

    Full Text Available In this paper, the Multi-Depot Electric Vehicle Location Routing Problem with Time Windows (MDVLRP is addressed. This problem is an extension of the MDVLRP, where electric vehicles are used instead of internal combustion engine vehicles. The recent development of this model is explained by the advantages of this technology, such as the diminution of carbon dioxide emissions, and the support that they can provide to the design of the logistic and energy-support structure of electric vehicle fleets. There are many models that extend the classical VRP model to take electric vehicles into consideration, but the multi-depot case for location-routing models has not been worked out yet. Moreover, we consider the availability of two energy supply technologies: the “Plug-in” Conventional Charge technology, and Battery Swapping Stations; options in which the recharging time is a function of the amount of energy to charge and a fixed time, respectively. Three models are proposed: one for each of the technologies mentioned above, and another in which both options are taken in consideration. The models were solved for small scale instances using C++ and Cplex 12.5. The results show that the models can be used to design logistic and energy-support structures, and compare the performance of the different options of energy supply, as well as measure the impact of these decisions on the overall distance traveled or other optimization objectives that could be worked on in the future.

  5. Cost-effectiveness of Low-dose Submicron Diclofenac Compared With Generic Diclofenac.

    Science.gov (United States)

    Mladsi, Deirdre; Ronquest, Naoko; Odom, Dawn; Miles, LaStella; Saag, Kenneth

    2016-11-01

    NSAIDs are commonly prescribed for the treatment of pain and inflammation. Despite the effectiveness of NSAIDs, concerns exist regarding their tolerability. Worldwide health authorities, including the European Medicines Agency, Health Canada, and the US Food and Drug Administration, have advised that NSAIDs be prescribed at the lowest effective dosage and for the shortest duration. Effective lowering of NSAID dosage without compromising pain relief has been demonstrated in randomized, controlled trials of the recently approved NSAID lower-dose submicron diclofenac. Building on previously published work from an independently published systematic review and meta-analysis, a linear dose-toxicity relationship between diclofenac dose and serious gastrointestinal (GI) events was recently demonstrated, indicating that reductions in adverse events (AEs) may be seen even with modest dose reductions in many patients. The objective of the present study was to estimate the potential reduction in risk for NSAID dose-related AEs, corresponding savings in health care costs, and the incremental cost-effectiveness of submicron diclofenac compared with generic diclofenac in the United States. Our decision-analytic cost-effectiveness model considered a subset of potential AEs that may be avoided by lowering NSAID dosage. To estimate the expected reductions in upper GI bleeding/perforation and major cardiovascular events with submicron diclofenac, our model used prediction equations estimated by meta-regressions using data from systematic literature reviews. Utilities, lifetime costs, and health outcomes associated with AEs were estimated using data from the literature. The face validity of the model structure and inputs was confirmed by clinical experts in the United States. Results were evaluated in 1-way and probabilistic sensitivity analyses. The model predicted that submicron diclofenac versus generic diclofenac could reduce the occurrence of modeled GI events (by 18

  6. Study of the comparative costs of five wet/dry cooling tower concepts

    Energy Technology Data Exchange (ETDEWEB)

    Zaloudek, F.R.; Allemann, R.T.; Faletti, D.W.; Johnson, B.M.; Parry, H.L.; Smith, G.C.; Tokarz, R.D.; Walter, R.A.

    1976-09-01

    The projected cost of five alternative dry/wet power plant heat rejection concepts was studied under conditions imposed by hypothetical use in association with the San Juan Plant Unit 3, a 550-MWe facility currently under construction near the ''Four Corners'' area of New Mexico. The five alternative concepts were: integrated dry/wet tower; separate dry and wet towers; metal fin-tube induced draft tower with deluge water augmentation; plastic heat exchanger tower with deluge water augmentation, and metal fin-tube/deluge augmentation tower with an intermediate ammonia evaporation-condensation condenser and the cooling tower. The integrated dry/wet tower concept, already chosen for service at San Juan Unit 3, was included for reference purposes. All concepts were conceptually designed and estimated using the same bases and employing uniform practices. Each concept was assumed to use all water allocated for consumptive use in Unit 3. The cost estimates obtained showed the following descending order of ''comparable capital cost'': separate dry/wet; metal fin-tube/deluge; integrated dry/wet; plastic tube/deluge; and metal fin-tube/deluge/ammonia. The results indicate that two of the advanced concepts considered, i.e., the plastic tube/deluge concept and the metal fin tube/deluge/ammonia concept, can possibly reduce the overall costs of dry/wet cooling under conditions imposed by the site considered. It was recommended that these two concepts receive additional attention by the ERDA Dry Cooling Tower Program and industry to further quantify their potential benefits and demonstrate their performance and reliability.

  7. Fat depot-specific gene signature and ECM remodeling of Sca1(high) adipose-derived stem cells.

    Science.gov (United States)

    Tokunaga, Masakuni; Inoue, Mayumi; Jiang, Yibin; Barnes, Richard H; Buchner, David A; Chun, Tae-Hwa

    2014-06-01

    Stem cell antigen-1 (Sca1 or Ly6A/E) is a cell surface marker that is widely expressed in mesenchymal stem cells, including adipose-derived stem cells (ASCs). We hypothesized that the fat depot-specific gene signature of Sca1(high) ASCs may play the major role in defining adipose tissue function and extracellular matrix (ECM) remodeling in a depot-specific manner. Herein we aimed to characterize the unique gene signature and ECM remodeling of Sca1(high) ASCs isolated from subcutaneous (inguinal) and visceral (epididymal) adipose tissues. Sca1(high) ASCs are found in the adventitia and perivascular areas of adipose tissues. Sca1(high) ASCs purified with magnetic-activated cell sorting (MACS) demonstrate dendrite or round shape with the higher expression of cytokines and chemokines (e.g., Il6, Cxcl1) and the lower expression of a glucose transporter (Glut1). Subcutaneous and visceral fat-derived Sca1(high) ASCs particularly differ in the gene expressions of adhesion and ECM molecules. While the expression of the major membrane-type collagenase (MMP14) is comparable between the groups, the expressions of secreted collagenases (MMP8 and MMP13) are higher in visceral Sca1(high) ASCs than in subcutaneous ASCs. Consistently, slow but focal MMP-dependent collagenolysis was observed with subcutaneous adipose tissue-derived vascular stromal cells, whereas rapid and bulk collagenolysis was observed with visceral adipose tissue-derived cells in MMP-dependent and -independent manners. These results suggest that the fat depot-specific gene signatures of ASCs may contribute to the distinct patterns of ECM remodeling and adipose function in different fat depots. Copyright © 2014 International Society of Matrix Biology. Published by Elsevier B.V. All rights reserved.

  8. Feasibility Study of Economics and Performance of Wind Turbine Generators at the Newport Indiana Chemical Depot Site

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, Joseph Owen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Mosey, Gail [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-11-01

    The U.S. Environmental Protection Agency (EPA), in accordance with the RE-Powering America's Land initiative, selected the Newport Indiana Chemical Depot site in Newport, Indiana, for a feasibility study of renewable energy production. The National Renewable Energy Laboratory (NREL) was contacted to provide technical assistance for this project. The purpose of this report is to assess the sitefor possible wind turbine electrical generator installation and estimate the cost, performance, and site impacts of different wind energy options. In addition, the report recommends financing options that could assist in the implementation of a wind system at the site.

  9. 24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

    Science.gov (United States)

    2010-04-01

    ... remain a walkup structure containing five hundred two-bedroom occupied and five hundred three-bedroom... occupancy rate, tenant composition, physical configuration and management structure of the revitalized....T.) and $100,000 monthly in utility costs paid by the authority and $50,000 monthly in utility...

  10. Report on Geothermal Power Plant Cost and Comparative Cost of Geothermal and Coal Fired Steam Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    None

    1977-07-01

    This report is to be used by Utah Power and Light Company (UP and L) in making studies of geothermal power plants. The dollars per kilowatt comparison between a geothermal plant and a UP and L coal-fired plant is to be developed. Geothermal gathering system costs and return to owner are to be developed for information.

  11. Cost effectiveness of varenicline in Belgium, compared with bupropion, nicotine replacement therapy, brief counselling and unaided smoking cessation: a BENESCO Markov cost-effectiveness analysis.

    Science.gov (United States)

    Annemans, Lieven; Nackaerts, Kristiaan; Bartsch, Pierre; Prignot, Jacques; Marbaix, Sophie

    2009-01-01

    Varenicline is a nicotinic acetylcholine receptor partial agonist that is approved for use as an aid to smoking cessation. Randomized clinical trials show that its efficacy is superior to that of other current smoking cessation therapies. This study set out to determine the cost effectiveness of varenicline relative to other smoking cessation interventions (bupropion and nicotine replacement therapy [NRT]) as well as brief counselling alone and unaided cessation in a cohort of Belgian adult smokers making a one-time quit attempt, from the perspective of the healthcare payer (public and private). A Markov model, the Benefits of Smoking Cessation on Outcomes (BENESCO) model, was applied to calculate the long-term health and economic benefits of smoking cessation. Cost effectiveness was expressed as cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained. Clinical and economic model inputs were obtained from the literature and public healthcare databases. Costs were discounted at 3% and health outcomes at 1.5%. A probabilistic sensitivity analysis and a one-way sensitivity analysis were performed to test the robustness of the results. Varenicline is associated with a reduction of smoking-related morbidity and mortality as well as with a decrease in healthcare costs compared with the pharmacological agents bupropion and NRT. Varenicline also leads to additional LYs and QALYs compared with brief counselling alone and unaided cessation over a lifetime period. Varenicline is a dominant strategy compared with bupropion and NRT. Compared with brief counselling alone and unaided cessation, varenicline presents a cost/QALY of euro240 and euro1656, respectively. Varenicline is a cost-effective alternative to brief counselling and unaided cessation, and is a cost-saving treatment in comparison with bupropion and NRT, in a Belgian population of smokers willing to quit.

  12. Comparative life cycle cost assessment of painted and hot-dip galvanized bridges.

    Science.gov (United States)

    Rossi, B; Marquart, S; Rossi, G

    2017-07-15

    The study addresses the life cycle cost assessment (LCCA) of steel bridges, focusing on the maintenance activities and the maintenance scenario. Firstly, the unit costs of maintenance activities and their durability (i.e. the time between two activities) are evaluated. Pragmatic data are provided for the environment category C4 and for three activities: Patch Up, Overcoating and Remove & Replace. A comparative LCCA for a typical hypothetic steel girder bridge is carried out, either painted or hot-dip galvanized (HDG), in the environmental class C4. The LCC versus the cumulated life is provided for both options. The initial cost of the steel unpainted option is only 50.3% of the HDG option. It is shown that after 'Overcoating' occurring at 18.5 years, the total Net Present Value (NPV) of the painted option surpasses that of the HDG option. A sensitivity analysis of the NPV to the cost and service life parameters, the escalation and discount rates is then performed. The discount and escalation rates, considerably influences the total LCC, following a non-linear trend. The total LCC decreases with the discount rate increasing and, conversely, increases with the escalation rate increasing. Secondly, the influence of the maintenance scenario on the total LCC is assessed based on a probabilistic approach. A permutation of the three independent maintenance activities assumed to occur six times over the life of the bridge is considered and a probability of occurrence is associated to each unique scenario. The most probable scenarios are then classified according to their NPV or achieved service life. This approach leads to the definition of a cost-effective maintenance scenario i.e. the scenario, within all the considered permutations, that has the minimum LCC in a range of lifespan. Besides, the probabilistic analysis also shows that, whatever the scenario, the return on investment period ranges between 18.5 years and 24.2 years. After that period, the HDG option becomes

  13. Investigation into life-cycle costing as a comparative analysis approach of energy systems

    CSIR Research Space (South Africa)

    Mokheseng, B

    2010-08-31

    Full Text Available selection based on a simple payback period. Due to life-cycle stages, often the real costs of the project or equipment, either to the decision maker or the cost bearer, are not reflected by the upfront capital costs. In this paper, the life-cycle costing...

  14. Incorporating Maritime Stakeholder Perspectives for Implementing an ‘Inland-Depots-for-Empty-Containers’ System Using an Analytic Hierarchy Process

    OpenAIRE

    Neha Mittal; Maria Boilé; Alok Baveja; Sotiris Theofanis

    2013-01-01

    Container movement involves several stakeholders where each group is focused on achieving its own objectives. By actively considering the perspective of different maritime stakeholders, this paper identifies a set of implementation strategies and prioritizes them to successfully implement an ‘Inland-Depots-for-Empty-Containers’ (IDEC) system in a region. It builds on the authors’ earlier work that developed and evaluated an IDEC system to minimize the overall system costs associated wit...

  15. Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia in the United States

    Directory of Open Access Journals (Sweden)

    Smolen Lee J

    2009-04-01

    Full Text Available Abstract Background Schizophrenia is often a persistent and costly illness that requires continued treatment with antipsychotics. Differences among antipsychotics on efficacy, safety, tolerability, adherence, and cost have cost-effectiveness implications for treating schizophrenia. This study compares the cost-effectiveness of oral olanzapine, oral risperidone (at generic cost, primary comparator, quetiapine, ziprasidone, and aripiprazole in the treatment of patients with schizophrenia from the perspective of third-party payers in the U.S. health care system. Methods A 1-year microsimulation economic decision model, with quarterly cycles, was developed to simulate the dynamic nature of usual care of schizophrenia patients who switch, continue, discontinue, and restart their medications. The model captures clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs, treatment discontinuation by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct medical care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outcomes included mean annual total direct cost per treatment, cost per stable patient, and incremental cost-effectiveness values per QALY gained. Results The results of the microsimulation model indicated that olanzapine had the lowest mean annual direct health care cost ($8,544 followed by generic risperidone ($9,080. In addition, olanzapine resulted in more QALYs than risperidone (0.733 vs. 0.719. The base case and multiple sensitivity analyses found olanzapine to be the dominant choice in terms of incremental cost-effectiveness per QALY gained. Conclusion The utilization of olanzapine is predicted in this model to result in better clinical outcomes and lower total direct health care costs compared to generic risperidone, quetiapine, ziprasidone, and

  16. The cost and cost-effectiveness of expedited partner therapy compared with standard partner referral for the treatment of chlamydia or gonorrhea.

    Science.gov (United States)

    Gift, Thomas L; Kissinger, Patricia; Mohammed, Hamish; Leichliter, Jami S; Hogben, Matthew; Golden, Matthew R

    2011-11-01

    Partner treatment is an important component of sexually transmitted disease control. Several randomized controlled trials have compared expedited partner treatment (EPT) to unassisted standard partner referral (SR). All of these trials found that EPT significantly increased partner treatment over SR, whereas some found that EPT significantly lowered reinfection rates in index patients. We collected cost data to assess the payer-specific, health care system, and societal-level cost of EPT and SR. We used data on partner treatment and index patient reinfection rates from 2 randomized controlled trials examining EPT and SR for patients diagnosed with chlamydia or gonorrhea. Additional elements were estimated or drawn from the literature. We used a Monte Carlo simulation to assess the impact on cost and effectiveness of varying several variables simultaneously, and calculated threshold values for selected variables at which EPT and SR costs per patient were equal. From a health care system or societal perspective, EPT was less costly and it treated more partners than SR. From the perspective of an individual payer, EPT was less costly than SR if ≥32% to 37% of male index patients' female partners or ≥29% of female index patients' male partners received care from the same payer. EPT has a lower cost from a societal or health care system perspective than SR and treats more partners. Individual payers may find EPT to be more costly than SR, depending on how many of their patients' partners receive care from the same payer.

  17. Fatty acid composition of subcutaneous and visceral fat depots in New Zealand White rabbits

    Directory of Open Access Journals (Sweden)

    P. Y. Yonkova

    2017-09-01

    Full Text Available The aim of this study was to identify the differences in the fatty acid composition of subcutaneous and visceral fat depots in healthy New Zealand White rabbits. Twelve clinically healthy rabbits with an average weight of 3.00±0.03 kg were used. The fatty acid composition of interscapular, inguinal, pericardial, perirenal and omental fat depots was determined by gas chromatography. The palmitic (C16:0 and linoleic (C18:2 acids, followed by oleic acid (C18:1 prevailed in all fat depots. The highest percentage of palmitic acid (C16:0 was detected in subcutaneous depots: inguinal (41.05±1.80% and interscapular (38.30±0.73%, whereas the highest percentage of linoleic acid (C18:2 was found in the visceral depots: perirenal (44.26±0.96% and pericardial (42.77±1.19%. Among the saturated fatty acids, myristic (C14:0 and stearic acid (C18:0 were established in higher content in subcutaneous depots than in visceral ones. Palmitoleic acid (C16:1 content in the pericardial fat depot was 10.63±2.60%, while in the interscapular, perirenal, omental and inguinal FD it was almost twice lower (Р<0.001. In the omental depot, α-linolenic acid (C18:3 content was significantly higher only vs the interscapular depot (P<0.05. The high content of saturated fatty acids in the subcutaneous depots determined their higher atherogenic and saturation index, unlike visceral ones, where a significantly higher content of unsaturated fatty acids was reported. Differences in fatty acid composition of subcutaneous and visceral fat depots proved the specific metabolism in each of them. On the other hand, this led to differences in the nutritional value of various parts of rabbit carcass.

  18. Comparing electricity distribution network revenues and costs in New South Wales, Great Britain and Victoria

    International Nuclear Information System (INIS)

    Mountain, Bruce; Littlechild, Stephen

    2010-01-01

    A decade ago, electricity distribution network revenues per customer in New South Wales (NSW) were twice those in Great Britain (GB). Recent price controls imply that by 2014 they will be nearly four times as high. This paper examines possible reasons for this. The main reason does not seem to be geography, operating environment or industry structure. GB and Victoria have managed to accommodate increasing demand at broadly constant or even declining costs and revenues while delivering higher quality of service, while NSW has not. The regulatory framework and the practice of the regulatory body within that framework seem relevant. Australian regulators have not used benchmarking techniques as the GB regulator has. Perhaps the most important explanatory factor is private ownership in GB and Victoria compared to state ownership in NSW. This could also impact on the nature and effectiveness of regulation. (author)

  19. Cellular Responses and Tissue Depots for Nanoformulated Antiretroviral Therapy.

    Directory of Open Access Journals (Sweden)

    Andrea L Martinez-Skinner

    Full Text Available Long-acting nanoformulated antiretroviral therapy (nanoART induces a range of innate immune migratory, phagocytic and secretory cell functions that perpetuate drug depots. While recycling endosomes serve as the macrophage subcellular depots, little is known of the dynamics of nanoART-cell interactions. To this end, we assessed temporal leukocyte responses, drug uptake and distribution following both intraperitoneal and intramuscular injection of nanoformulated atazanavir (nanoATV. Local inflammatory responses heralded drug distribution to peritoneal cell populations, regional lymph nodes, spleen and liver. This proceeded for three days in male Balb/c mice. NanoATV-induced changes in myeloid populations were assessed by fluorescence-activated cell sorting (FACS with CD45, CD3, CD11b, F4/80, and GR-1 antibodies. The localization of nanoATV within leukocyte cell subsets was determined by confocal microscopy. Combined FACS and ultra-performance liquid chromatography tandem mass-spectrometry assays determined nanoATV carriages by cell-based vehicles. A robust granulocyte, but not peritoneal macrophage nanoATV response paralleled zymosan A treatment. ATV levels were highest at sites of injection in peritoneal or muscle macrophages, dependent on the injection site. The spleen and liver served as nanoATV tissue depots while drug levels in lymph nodes were higher than those recorded in plasma. Dual polymer and cell labeling demonstrated a nearly exclusive drug reservoir in macrophages within the liver and spleen. Overall, nanoART induces innate immune responses coincident with rapid tissue macrophage distribution. Taken together, these works provide avenues for therapeutic development designed towards chemical eradication of human immunodeficiency viral infection.

  20. Analysis of Tobyhanna Army Depot's Radio Frequency Identification (RFID) Pilot Program: RFID as an Asset Management Tool

    National Research Council Canada - National Science Library

    Miertschin, Keith W; Forrest, Brian D

    2005-01-01

    ...) used for inventory and asset management at the Tobyhanna Army Maintenance Depot. Tobyhanna Army Depot recently partnered with WhereNet Corporation for a pilot program to incorporate a real-time locating system that uses RFID...

  1. Mechanisms and Metabolic Implications of Regional Differences among Fat Depots

    Science.gov (United States)

    Zhu, Yi; Karagiannides, Iordanes; Pothoulakis, Charalabos; Jensen, Michael D.; Kirkland, James L.

    2014-01-01

    Fat distribution is closely linked to metabolic disease risk. Distribution varies with sex, genetic background, disease state, certain drugs and hormones, development, and aging. Preadipocyte replication and differentiation, developmental gene expression, susceptibility to apoptosis and cellular senescence, vascularity, inflammatory cell infiltration, and adipokine secretion vary among depots, as do fatty-acid handling and mechanisms of enlargement with positive-energy and loss with negative-energy balance. How interdepot differences in these molecular, cellular, and pathophysiological properties are related is incompletely understood. Whether fat redistribution causes metabolic disease or whether it is a marker of underlying processes that are primarily responsible is an open question. PMID:23583168

  2. Comparative Energy and Cost Analysis Between Conventional HVAC Systems and Geothermal Heat Pump Systems

    National Research Council Canada - National Science Library

    Vanderburg, David

    2002-01-01

    ...., though initial installation cost are a deterrent. This thesis uses Monte Carlo simulation to predict energy consumption, life cycle cost and payback period for the vertical closed-loop ground source heat pump (GSHP...

  3. A Comparative Cost Analysis of Commodity Foods from the U. S. Department of Agriculture in the National School Lunch Program

    Science.gov (United States)

    Peterson, Cora

    2009-01-01

    Schools that participate in the National School Lunch Program receive a portion of their federal funding as commodity foods rather than cash payments. This research compared the product costs and estimated total procurement costs of commodity and commercial foods from the school district perspective using data from 579 Minnesota ordering sites in…

  4. Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials

    NARCIS (Netherlands)

    Dijkgraaf, Marcel G. W.; van der Zanden, Bart P.; de Borgie, Corianne A. J. M.; Blanken, Peter; van Ree, Jan M.; van den Brink, Wim

    2005-01-01

    Objective To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. Design Cost utility analysis of two pooled open label randomised controlled trials. Setting Methadone maintenance programmes in

  5. Comparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial.

    NARCIS (Netherlands)

    Verstappen, W.H.; Merode, F. van; Grimshaw, J.; Dubois, W.; Grol, R.P.T.M.; Weijden, T. van der

    2004-01-01

    OBJECTIVE: To determine the costs and cost reductions of an innovative strategy aimed at improving test ordering routines of primary care physicians, compared with a traditional strategy. DESIGN: Multicenter randomized controlled trial with randomization at the local primary care physicians group

  6. A method for quantifying and comparing the costs and benefits of alternative riparian zone buffer widths

    Science.gov (United States)

    Chris B. LeDoux; Ethel Wilkerson

    2008-01-01

    We developed a method that can be used to quantify the opportunity costs and ecological benefits of implementing alternative streamside management zones/buffer zone widths. The opportunity costs are computed based on the net value of the timber left behind in the buffer zone, the stump-to-mill logging costs for the logging technology that would have been used to...

  7. An integrative transcriptomic approach to identify depot differences in genes and microRNAs in adipose tissues from high fat fed mice

    Science.gov (United States)

    Wijayatunga, Nadeeja N.; Pahlavani, Mandana; Kalupahana, Nishan S.; Kottapalli, Kameswara Rao; Gunaratne, Preethi H.; Coarfa, Cristian; Ramalingam, Latha; Moustaid-Moussa, Naima

    2018-01-01

    Obesity contributes to metabolic disorders such as diabetes and cardiovascular disease. Characterization of differences between the main adipose tissue depots, white (WAT) [including subcutaneous (SAT) and visceral adipose tissue (VAT)] and brown adipose tissue (BAT) helps to identify their roles in obesity. Thus, we studied depot-specific differences in whole transcriptome and miRNA profiles of SAT, VAT and BAT from high fat diet (HFD/45% of calories from fat) fed mice using RNA sequencing and small RNA-Seq. Using quantitative real-time polymerase chain reaction, we validated depot-specific differences in endoplasmic reticulum (ER) stress related genes and miRNAs using mice fed a HFD vs. low fat diet (LFD/10% of calories from fat). According to the transcriptomic analysis, lipogenesis, adipogenesis, inflammation, endoplasmic reticulum (ER) stress and unfolded protein response (UPR) were higher in VAT compared to BAT, whereas energy expenditure, fatty acid oxidation and oxidative phosphorylation were higher in BAT than in VAT of the HFD fed mice. In contrast to BAT, ER stress marker genes were significantly upregulated in VAT of HFD fed mice than the LFD fed mice. For the first time, we report depot specific differences in ER stress related miRNAs including; downregulation of miR-125b-5p, upregulation miR-143-3p, and miR-222-3p in VAT following HFD and upregulation of miR-30c-2-3p only in BAT following a HFD in mice than the LFD mice. In conclusion, HFD differentially regulates miRNAs and genes in different adipose depots with significant induction of genes related to lipogenesis, adipogenesis, inflammation, ER stress, and UPR in WAT compared to BAT. PMID:29507687

  8. Adipose tissue in muscle : a novel depot similar in size to visceral adipose tissue

    NARCIS (Netherlands)

    Gallagher, Dympna; Kuznia, Patrick; Heshka, Stanley; Albu, Jeanine; Heymsfield, Steven B; Goodpaster, Bret H; Visser, Marjolein; Harris, Tamara B

    BACKGROUND: The manner in which fat depot volumes and distributions, particularly the adipose tissue (AT) between the muscles, vary by race is unknown. OBJECTIVE: The objective was to quantify a previously unstudied and novel intermuscular AT (IMAT) depot and subcutaneous AT, visceral AT (VAT), and

  9. Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes

    DEFF Research Database (Denmark)

    Aasbjerg, Kristian; Torp-Pedersen, Christian; Vaag, Allan

    2013-01-01

    In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay fever patients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful...

  10. A hybrid metaheuristic algorithm for the multi-depot covering tour vehicle routing problem

    NARCIS (Netherlands)

    Allahyari, S.; Salari, M.; Vigo, D.

    2015-01-01

    We propose a generalization of themulti-depot capacitated vehicle routing problem where the assumption of visiting each customer does not hold. In this problem, called the Multi-Depot Covering Tour Vehicle Routing Problem (MDCTVRP), the demand of each customer could be satisfied in two different

  11. Measuring Customer Satisfaction of Depot Maintenance: An Analysis of Customer Satisfaction of F/A-18 Maintenance at Naval Aviation Depot North Island, CA

    National Research Council Canada - National Science Library

    Forsyth, Brian

    1997-01-01

    .... A key focus of commercial practices is delivering customer satisfaction. To this extent, it is imperative that DoD depots understand and properly measure their customer's concerns if they wish to improve their performance...

  12. Cost-effectiveness Analysis of Treatment Sequence Initiating With Etanercept Compared With Leflunomide in Rheumatoid Arthritis: Impact of Reduced Etanercept Cost With Patent Expiration in South Korea.

    Science.gov (United States)

    Park, Sun-Kyeong; Park, Seung-Hoo; Lee, Min-Young; Park, Ji-Hyun; Jeong, Jae-Hong; Lee, Eui-Kyung

    2016-11-01

    In south Korea, the price of biologics has been decreasing owing to patent expiration and the availability of biosimilars. This study evaluated the cost-effectiveness of a treatment strategy initiated with etanercept (ETN) compared with leflunomide (LFN) after a 30% reduction in the medication cost of ETN in patients with active rheumatoid arthritis (RA) with an inadequate response to methotrexate (MTX-IR). A cohort-based Markov model was designed to evaluate the lifetime cost-effectiveness of treatment sequence initiated with ETN (A) compared with 2 sequences initiated with LFN: LFN-ETN sequence (B) and LFN sequence (C). Patients transited through the treatment sequences, which consisted of sequential biologics and palliative therapy, based on American College of Rheumatology (ACR) responses and the probability of discontinuation. A systematic literature review and a network meta-analysis were conducted to estimate ACR responses to ETN and LFN. Utility was estimated by mapping an equation for converting the Health Assessment Questionnaire-Disability Index score to utility weight. The costs comprised medications, outpatient visits, administration, dispensing, monitoring, palliative therapy, and treatment for adverse events. A subanalysis was conducted to identify the influence of the ETN price reduction compared with the unreduced price, and sensitivity analyses explored the uncertainty of model parameters and assumptions. The ETN sequence (A) was associated with higher costs and a gain in quality-adjusted life years (QALYs) compared with both sequences initiated with LFN (B, C) throughout the lifetime of patients with RA and MTX-IR. The incremental cost-effectiveness ratio (ICER) for strategy A versus B was ₩13,965,825 (US$1726) per QALY and that for strategy A versus C was ₩9,587,983 (US$8050) per QALY. The results indicated that strategy A was cost-effective based on the commonly cited ICER threshold of ₩20,000,000 (US$16,793) per QALY in South Korea. The

  13. Comparative Studies on the Composition and Purchase Costs of some Edible Land Snails in Nigeria

    Directory of Open Access Journals (Sweden)

    Omo Erigbe, P.

    2009-01-01

    Full Text Available Four species of edible land snails of the moist forest belt of Nigeria, Archachatina marginata (Swainson, Archachatina papyracae (Pfeiffer, Limicolaria flammea (Muller and Limicolaria aurora (Jay were used in the study of their body composition and purchase cost analysis. Data on Limicolaria flammea and Limicolaria aurora were pooled together to simulate their occurrence in nature and presentation in the markets. They were designated as Limicolaria flammea / aurora throughout this study. The results showed that there was no significant (P> 0.05 difference between the dressing out percentages of the three study group of snails. However, all body component parts studied were significantly (P< 0.01 greater for A. marginata than for A. papyracae or L. flammea/aurora. When the mean weights of shell, visceral mass, edible flesh and the sum of the mean weights of drainable fluid, mucus and other wettings were in each case expressed as percentages of the liveweight, the results were consistently similar (P> 0.05, indicating some regular pattern of weight distribution for these mollusk species studied. When the cost implications were carefully analyzed, the results showed possible savings of $ 1.95 and $ 2.06 US dollars in favour of consumption of fresh edible snail meat from one kilogram liveweight each of A. papyracae and L. flammea/aurora respectively, as compared to the consumption of fresh edible snail meat from one kilogram liveweight of A. marginata. On dried snail meat basis, A. papyracae was cheapest ($ 0.28 US dollars / 100 g, followed closely by L. flammea/aurora ($0.40 US dollars / 100 g, while A. marginata was the costliest ($ 2.30 US dollars / 100 g.

  14. Comparative Analysis Of Conventional Method With Activity Based Costing In PT Mulia Sejati Gallery

    Directory of Open Access Journals (Sweden)

    Irma Nadia Erena

    2016-09-01

    Full Text Available The goal of this research was to provide readers the information about the calculation methods, both traditional and activity-based costing in the application of the cost of production. The method used in this research was the qualitative method. The analysis was done by calculating the amount of the production cost using the traditional system and the magnitude of the production cost when using the activity-based costing system. The amount of each acquisition was then performed into data analysis. The results achieved are massive distortion between the calculations using traditional systems and activity based costing system. The conclusions of the whole thesis are activity-based costing system is considered more relevant than traditional systems that are currently used by the company.

  15. Cost Description and Comparative Cost Efficiency of Post-Exposure Prophylaxis and Canine Mass Vaccination against Rabies in N’Djamena, Chad

    Science.gov (United States)

    Mindekem, Rolande; Lechenne, Monique Sarah; Naissengar, Kemdongarti Service; Oussiguéré, Assandi; Kebkiba, Bidjeh; Moto, Daugla Doumagoum; Alfaroukh, Idriss Oumar; Ouedraogo, Laurent Tinoanga; Salifou, Sahidou; Zinsstag, Jakob

    2017-01-01

    Rabies claims approximately 59,000 human lives annually and is a potential risk to 3.3 billion people in over 100 countries worldwide. Despite being fatal in almost 100% of cases, human rabies can be prevented by vaccinating dogs, the most common vector, and the timely administration of post-exposure prophylaxis (PEP) to exposed victims. For the control and prevention of human rabies in N’Djamena, the capital city of Chad, a free mass vaccination campaign for dogs was organized in 2012 and 2013. The campaigns were monitored by parallel studies on the incidence of canine rabies based on diagnostic testing of suspect animals and the incidence of human bite exposure recorded at selected health facilities. Based on the cost description of the campaign and the need for PEP registered in health centers, three cost scenarios were compared: cumulative cost-efficiency of (1) PEP alone, (2) dog mass vaccination and PEP, (3) dog mass vaccination, PEP, and maximal communication between human health and veterinary workers (One Health communication). Assuming ideal One Health communication, the cumulative prospective cost of dog vaccination and PEP break even with the cumulative prospective cost of PEP alone in the 10th year from the start of the calculation (2012). The cost efficiency expressed in cost per human exposure averted is much higher with canine vaccination and One Health communication than with PEP alone. As shown in other studies, our cost-effectiveness analysis highlights that canine vaccination is financially the best option for animal rabies control and rabies prevention in humans. This study also provides evidence of the beneficial effect of One Health communication. Only with close communication between the human and animal health sectors will the decrease in animal rabies incidence be translated into a decline for PEP. An efficiently applied One Health concept would largely reduce the cost of PEP in resource poor countries and should be implemented for

  16. Cost Description and Comparative Cost Efficiency of Post-Exposure Prophylaxis and Canine Mass Vaccination against Rabies in N'Djamena, Chad.

    Science.gov (United States)

    Mindekem, Rolande; Lechenne, Monique Sarah; Naissengar, Kemdongarti Service; Oussiguéré, Assandi; Kebkiba, Bidjeh; Moto, Daugla Doumagoum; Alfaroukh, Idriss Oumar; Ouedraogo, Laurent Tinoanga; Salifou, Sahidou; Zinsstag, Jakob

    2017-01-01

    Rabies claims approximately 59,000 human lives annually and is a potential risk to 3.3 billion people in over 100 countries worldwide. Despite being fatal in almost 100% of cases, human rabies can be prevented by vaccinating dogs, the most common vector, and the timely administration of post-exposure prophylaxis (PEP) to exposed victims. For the control and prevention of human rabies in N'Djamena, the capital city of Chad, a free mass vaccination campaign for dogs was organized in 2012 and 2013. The campaigns were monitored by parallel studies on the incidence of canine rabies based on diagnostic testing of suspect animals and the incidence of human bite exposure recorded at selected health facilities. Based on the cost description of the campaign and the need for PEP registered in health centers, three cost scenarios were compared: cumulative cost-efficiency of (1) PEP alone, (2) dog mass vaccination and PEP, (3) dog mass vaccination, PEP, and maximal communication between human health and veterinary workers (One Health communication). Assuming ideal One Health communication, the cumulative prospective cost of dog vaccination and PEP break even with the cumulative prospective cost of PEP alone in the 10th year from the start of the calculation (2012). The cost efficiency expressed in cost per human exposure averted is much higher with canine vaccination and One Health communication than with PEP alone. As shown in other studies, our cost-effectiveness analysis highlights that canine vaccination is financially the best option for animal rabies control and rabies prevention in humans. This study also provides evidence of the beneficial effect of One Health communication. Only with close communication between the human and animal health sectors will the decrease in animal rabies incidence be translated into a decline for PEP. An efficiently applied One Health concept would largely reduce the cost of PEP in resource poor countries and should be implemented for

  17. A comparative analysis of monthly out-of-pocket costs for patients with breast cancer as compared with other common cancers in Ontario, Canada

    Science.gov (United States)

    Longo, C.J.; Bereza, B.G.

    2011-01-01

    Background Monthly out-of-pocket costs (oopc) for Ontario patients with cancer have previously been reported, but little detail has been provided on differences based on tumour type. Methods A questionnaire administered in cancer clinics in the province of Ontario, with a mix of urban and rural patients, was analyzed using descriptive statistics and a regression analysis of cross-sectional data. The dependent variable was oopc (Canadian dollars), analyzed separately for total oopc (excluding imputed travel costs), and for each of the individual cost categories. Results Compared with colorectal, lung, and prostate cancer patients combined, breast cancer patients had statistically significantly higher total oopc ($393 vs. $149, p = 0.02), device costs ($142 vs. $12, p = 0.018), and family care costs ($38 vs. $3, p = 0.01). By contrast, they trended toward lower costs for travel ($225 vs. $426, p = 0.055) and had lower costs for parking ($32 vs. $53, p = 0.0198). Compared with non-breast cancer patients, patients with breast cancer reported a greater perceived financial burden (31% vs. 17% p = 0.0133). Interpretation These findings highlight that financial burden for cancer patients can vary by tumour type, and that patients with breast cancer may require a different mix of supportive services than do patients with other common tumour types. Supportive care programs related to financial burden should consider the likelihood and nature of financial burden when counselling breast cancer patients. PMID:21331267

  18. [Cost of medical treatment with methotrexate for ectopic pregnancy. Study comparing medical treatment versus laparoscopy. Experience of Aziza Othmana Hospital].

    Science.gov (United States)

    Fadhlaoui, Anis; Oueslati, Hanene; Khedhiri, Zied; Khrouf, Mohamed; Chaker, Anis; Zhioua, Fethi

    2013-02-01

    The ectopic pregnancy can be treated surgically (conservative or radical) or medically. Currently, the choice between medical and surgical treatment is a critical issue. One of the parameters of this choice is the total cost of management. To compare the cost of the management of ectopic pregnancy by medical treatment (methotrexate, MTX) and coeliochirurgicaux. This is a prospective, comparative, nonrandomized,unicentric study, on 39 patients who have ectopic pregnancies treated with MTX versus 16 patients treated by laparoscopic surgery with conservative treatment. This study was collected at the service of Obstetrics and Gynecology Reproductive Medicine Aziza Othmana Hospital (Tunis) for a period of two years. The average cost of hospital stay per patient was 549.38 dt for the MTX group against 268.39 dt for laparoscopic surgery group (p treatment with MTX costs more cost than the conservative laparoscopic treatment and this is mainly due to the long period of hospitalization.

  19. An Efficient and Benign Antimicrobial Depot Based on Silver-Infused MoS2.

    Science.gov (United States)

    Cao, Fangfang; Ju, Enguo; Zhang, Yan; Wang, Zhenzhen; Liu, Chaoqun; Li, Wei; Huang, Yanyan; Dong, Kai; Ren, Jinsong; Qu, Xiaogang

    2017-05-23

    Silver nanoparticles (AgNPs) have been used as a broad-spectrum antimicrobial agent, whose toxicity originates from the localized release of Ag + ions. However, the residual AgNPs core could generate potential risk to humans and waste of noble metals. Herein, we infused the cysteine-modified molybdenum disulfide with minimum Ag + ions and coated with a layer of cationic polyelectrolyte to construct an efficient and benign antimicrobial depot. The system exhibited much enhanced broad-spectrum antibacterial activity compared with an equivalent amount of silver nitrate, owing to its increasing accessibility of released Ag + to the cell walls of microorganisms. More importantly, the antibacterial system could be successfully applied to treat wound infection, while retaining high antibacterial activities, exhibiting negligible biotoxicity and avoiding the waste of Ag.

  20. LEUPRORELIN ACETATE DEPOT (ELIGARD IN THE TREATMENT OF PROSTATE CANCER: WHAT DO PATIENTS WIN?

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2014-08-01

    Full Text Available Eligard (leupropelin acetate, Atrigel delivery system is a synthetic analogue of luteinizing-hormone-realizing hormone (LHRH, which causes a rapid reduction in the level of testosterone to the concentration comparable with that after surgical castration. Eligard demonstrated a considerable advantage over other LHRH analogues in the depth of androgenic suppression and in the frequency of transient increases in testosterone levels at the beginning and during therapy. Eligard is available as 1-, 3-, and 6-month depot formulations, which allows a flexible approach to be applied to individually making up a therapy regimen. Eligard is as effective as castration therapy techniques. Treatment with this drug shows the low frequency of side effects and is well tolerated by patients.

  1. LEUPRORELIN ACETATE DEPOT (ELIGARD IN THE TREATMENT OF PROSTATE CANCER: WHAT DO PATIENTS WIN?

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2010-01-01

    Full Text Available Eligard (leupropelin acetate, Atrigel delivery system is a synthetic analogue of luteinizing-hormone-realizing hormone (LHRH, which causes a rapid reduction in the level of testosterone to the concentration comparable with that after surgical castration. Eligard demonstrated a considerable advantage over other LHRH analogues in the depth of androgenic suppression and in the frequency of transient increases in testosterone levels at the beginning and during therapy. Eligard is available as 1-, 3-, and 6-month depot formulations, which allows a flexible approach to be applied to individually making up a therapy regimen. Eligard is as effective as castration therapy techniques. Treatment with this drug shows the low frequency of side effects and is well tolerated by patients.

  2. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States.

    Science.gov (United States)

    Dagenais, Simon; Brady, O'Dane; Haldeman, Scott; Manga, Pran

    2015-10-19

    Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise. A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining: 1. private health plans, 2. workers' compensation (WC) plans, and 3. clinical outcomes. The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list. The search uncovered 1276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear. Although cost comparison studies suggest that health care costs were generally lower among patients whose spine pain was managed with chiropractic care, the studies reviewed had many methodological limitations. Better research is needed to determine if these differences in health care costs were attributable to the

  3. Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Compared With Radiofrequency Ablation for Inoperable Colorectal Liver Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hayeon, E-mail: kimh2@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Gill, Beant; Beriwal, Sushil; Huq, M. Saiful [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Roberts, Mark S. [Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (United States); Smith, Kenneth J. [Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

    2016-07-15

    Purpose: To conduct a cost-effectiveness analysis to determine whether stereotactic body radiation therapy (SBRT) is a cost-effective therapy compared with radiofrequency ablation (RFA) for patients with unresectable colorectal cancer (CRC) liver metastases. Methods and Materials: A cost-effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities, and costs associated with SBRT and RFA were captured in the model on the basis of a comprehensive literature review and Medicare reimbursements in 2014. Strategies were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Results: In base case analysis, treatment costs for 3 fractions of SBRT and 1 RFA procedure were $13,000 and $4397, respectively. Median survival was assumed the same for both strategies (25 months). The SBRT costs $8202 more than RFA while gaining 0.05 QALYs, resulting in an incremental cost-effectiveness ratio of $164,660 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. Stereotactic body radiation therapy was economically reasonable if better survival was presumed (>1 month gain) or if used for large tumors (>4 cm). Conclusions: If equal survival is assumed, SBRT is not cost-effective compared with RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost-effective. Ideally, these results should be confirmed with prospective comparative data.

  4. Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up.

    Science.gov (United States)

    Miller, Ted R; Hendrie, Delia

    2015-12-01

    The literature that addresses cost differences between randomized trials and full-scale replications is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first-time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs. $12,398, p = .01), and lower costs per visit ($354 vs. $400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal a wide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale.

  5. Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC in myelodysplastic syndrome (MDS

    Directory of Open Access Journals (Sweden)

    Myrna Candelaria-Hernández

    2017-06-01

    Full Text Available ABSTRACTIntroductionMyelodysplastic syndrome (MDS comprises a group of clonal hematological disorders, characterized by ineffective hematopoiesis and progressive bone marrow failure. It increases the risk of transformation to acute myeloid leukemia (AML. Therapeutic benefit should include overall survival increase (OS, hematological improvement, transfusion dependence and time to progression to AML decrease.ObjectiveAssess, from a Mexican health-care perspective, the cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC plus best supportive care (BSC for the treatment of adult patients with intermediate-2 and high-risk MDS, who are not eligible for hematopoietic stem-cell transplantation. We developed a cost-effectiveness survival analysis model of three stages: MDS, AML, and death. OS and costs are extrapolated beyond three-year time horizon. Discount rate of 5% was applied. To estimate the model cycle probability transition to mortality state, survival curves were constructed for each treatment arm using individual patient-level data from Study AZA-001. Unitary costs are from public price list, and profiles for the management of MDS and AML were collected separately using a structured questionnaire. Probabilistic sensitivity analyses (PSA were conducted by simultaneously sampling from estimated probability distributions of model parameters.ResultsOverall survival was projected to increase by 72.26 weeks with azacitidine. Incremental expected total costs for azacitidine compared to LDC was MXN$68,045. However, the cost of the drug therapy was lower with azacitidine. The incremental cost-effectiveness ratio (ICER for azacitidine compared to LDC was MXN$48,932 per life-year gained (LYG. PSA showed that azacitidine was a highly cost-effective option in 96.49% of the simulated cases in MXN$180,000/LYG willingness-to-pay.ConclusionsCompared with LDC, azacitidine represents a cost-effective treatment alternative in patients

  6. Comparative survival and cost of antifungal therapy: posaconazole versus standard antifungals in the treatment of refractory invasive aspergillosis.

    Science.gov (United States)

    Herbrecht, Raoul; Rajagopalan, Srinivasan; Danna, Robert; Papadopoulos, George

    2010-10-01

    Refractory invasive aspergillosis (IA) is a life-threatening condition. Cost of treatment, although secondary, is important if newer drugs are to be widely accepted. Posaconazole has been shown to have activity against aspergillosis. Analyses were conducted to compare the effectiveness and cost of posaconazole 800 mg/day with those of standard antifungal therapy, using Walsh et al. 2007 data. All-cause mortality and total drug costs were analyzed for three patient groups: All Refractory, Refractory Non-neutropenic, and Refractory Neutropenic IA Patients. Comparative survival analysis using Kaplan-Meier estimates after censoring data at 28, 42, 84, 182, and 365 days and Cox proportional hazard method was used to estimate hazard rates after controlling for difference in baseline neutropenia. For cost analysis, only antifungal drug acquisition cost was used. Significantly more of the 94 patients treated with posaconazole remained alive at every time point compared with the 68 external control patients within the All Refractory group (p = 0.0001). Similar results were obtained for the other two groups. For the posaconazole-treated patients mean total drug costs were $11846 (±$12406), $12642 (±$11811), and $8903 (±$14345), and for the external controls total drug costs were $35537 (±$73059), $48097 (±$88702), and $13556 (±$16324) for the All Refractory, Refractory Non-neutropenic, and Neutropenic IA groups, respectively. Key limitations of the study included noninclusion of hospitalization or other drug costs, low patient numbers beyond 84 days, and the fact that the Walsh et al. 2007 study was completed before other newer antifungal agents (such as voriconazole and caspofungin) were available. Posaconazole appears to confer a survival benefit and reduced total drug cost compared with standard antifungal therapy, such as amphotericin B (lipid and nonlipid formulations), itraconazole, or both, to treat patients with probable or proven refractory IA.

  7. Costs and financial benefits of video communication compared to usual care at home: a systematic review.

    NARCIS (Netherlands)

    Peeters, J.M.; Mistiaen, P.; Francke, A.L.

    2011-01-01

    We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home

  8. [Comparative cost analysis of molecular biology methods in the diagnosis of sarcomas].

    Science.gov (United States)

    Baffert, Sandrine; Italiano, Antoine; Pierron, Gaëlle; Traoré, Marie-Angèle; Rapp, Jocelyn; Escande, Fabienne; Ghnassia, Jean-Pierre; Terrier, Philippe; Voegeli, Anne-Claire; Ranchere-Vince, Dominique; Coindre, Jean-Michel; Pedeutour, Florence

    2013-10-01

    Sarcomas represent a complex and heterogeneous group of rare malignant tumors and their correct diagnosis is often difficult. Recent molecular biological techniques have been of great diagnostic use and there is a need to assess the cost of these procedures in routine clinical practice. Using prospective and observational data from eight molecular biology laboratories in France, we used "microcosting" method to assess the cost of molecular biological techniques in the diagnosis of five types of sarcoma. The mean cost of fluorescence in situ hybridization (FISH) was 318 € (273-393) per sample; mean reverse transcription polymerase chain reaction (RT-PCR) cost ranged from 300 € (229-481) per formalin-fixed, paraffin-embedded specimen to 258 € (213-339) per frozen specimen; mean quantitative polymerase chain reaction (Q-PCR) cost was 184 € (112-229) and mean CGH-array cost was 332 € (329-335). The cost of these recently implemented techniques varied according to the type of sarcoma; the method of tissue collection and local organizational factors including the level of local expertise and investment. The cost of molecular diagnostic techniques needs to be balanced against their respective performance.

  9. Cost-Effectiveness of Emissions Reduction through Vehicle Repair Compared to CNG Conversion.

    Science.gov (United States)

    Guenther, Paul L; Lesko, Jon M; Stedman, Donald H

    1996-10-01

    In return for a temporary waiver from converting five vehicles to operate on compressed natural gas (CNG) for the Denver Clean Fuels program, the University of Denver identified, tested, repaired, and retested nine employee commuter vehicles. The results of the study validated the concept that employer-based identification and repair programs can be carried out in a cost-effective way. On average, each repaired vehicle removed fifty times more carbon monoxide (CO) emissions from Denver air than each CNG conversion. The average cost of each repair was eight times less than the average cost of each conversion. The average fuel economy benefit from the repairs was enough to pay for the average cost of repairs in less than three years of normal driving. When the expected lifetimes of repairs and conversions are included, the targeted repair program appears to be over sixty times more cost-effective as a CO emissions reduction strategy than CNG conversion.

  10. Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms.

    Science.gov (United States)

    Hoenigl, Martin; Graff-Zivin, Joshua; Little, Susan J

    2016-02-15

    In nonhealthcare settings, widespread screening for acute human immunodeficiency virus (HIV) infection (AHI) is limited by cost and decision algorithms to better prioritize use of resources. Comparative cost analyses for available strategies are lacking. To determine cost-effectiveness of community-based testing strategies, we evaluated annual costs of 3 algorithms that detect AHI based on HIV nucleic acid amplification testing (EarlyTest algorithm) or on HIV p24 antigen (Ag) detection via Architect (Architect algorithm) or Determine (Determine algorithm) as well as 1 algorithm that relies on HIV antibody testing alone (Antibody algorithm). The cost model used data on men who have sex with men (MSM) undergoing community-based AHI screening in San Diego, California. Incremental cost-effectiveness ratios (ICERs) per diagnosis of AHI were calculated for programs with HIV prevalence rates between 0.1% and 2.9%. Among MSM in San Diego, EarlyTest was cost-savings (ie, ICERs per AHI diagnosis less than $13.000) when compared with the 3 other algorithms. Cost analyses relative to regional HIV prevalence showed that EarlyTest was cost-effective (ie, ICERs less than $69.547) for similar populations of MSM with an HIV prevalence rate >0.4%; Architect was the second best alternative for HIV prevalence rates >0.6%. Identification of AHI by the dual EarlyTest screening algorithm is likely to be cost-effective not only among at-risk MSM in San Diego but also among similar populations of MSM with HIV prevalence rates >0.4%. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  11. Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

    Science.gov (United States)

    Hoenigl, Martin; Graff-Zivin, Joshua; Little, Susan J.

    2016-01-01

    Background. In nonhealthcare settings, widespread screening for acute human immunodeficiency virus (HIV) infection (AHI) is limited by cost and decision algorithms to better prioritize use of resources. Comparative cost analyses for available strategies are lacking. Methods. To determine cost-effectiveness of community-based testing strategies, we evaluated annual costs of 3 algorithms that detect AHI based on HIV nucleic acid amplification testing (EarlyTest algorithm) or on HIV p24 antigen (Ag) detection via Architect (Architect algorithm) or Determine (Determine algorithm) as well as 1 algorithm that relies on HIV antibody testing alone (Antibody algorithm). The cost model used data on men who have sex with men (MSM) undergoing community-based AHI screening in San Diego, California. Incremental cost-effectiveness ratios (ICERs) per diagnosis of AHI were calculated for programs with HIV prevalence rates between 0.1% and 2.9%. Results. Among MSM in San Diego, EarlyTest was cost-savings (ie, ICERs per AHI diagnosis less than $13.000) when compared with the 3 other algorithms. Cost analyses relative to regional HIV prevalence showed that EarlyTest was cost-effective (ie, ICERs less than $69.547) for similar populations of MSM with an HIV prevalence rate >0.4%; Architect was the second best alternative for HIV prevalence rates >0.6%. Conclusions. Identification of AHI by the dual EarlyTest screening algorithm is likely to be cost-effective not only among at-risk MSM in San Diego but also among similar populations of MSM with HIV prevalence rates >0.4%. PMID:26508512

  12. Comparative costs of hydrogen produced from photovoltaic electrolysis and from photoelectrochemical processes

    International Nuclear Information System (INIS)

    Block, D.L.

    1998-01-01

    The need for hydrogen produced from renewable energy sources is the key element to the world's large-scale usage of hydrogen and to the hydrogen economy envisioned by the World Hydrogen Energy Association. Renewables-produced hydrogen is also the most technically difficult problem to be solved. Hydrogen will never achieve large-scale usage until it can be competitively produced from renewable energy. One of the important questions that has to be addressed is: What are the economics of present and expected future technologies that will be used to produce hydrogen from renewables? The objective of this study is to give an answer to this question by determining the cost of hydrogen (in U.S.$/MBtu) from competing renewable production technologies. It should be noted that the costs and efficiencies assumed in this paper are assumptions of the author, and that the values are expected to be achieved after additional research on photoelectrochemical process technologies. The cost analysis performed is for three types of hydrogen (H 2 ) produced from five different types of renewable processes: photovoltaic (PV) electrolysis, three photoelectrochemical (PEC) processes and higher temperature electrolysis (HTE). The costs and efficiencies for PV, PEC and HTE processes are established for present day, and for expected costs and efficiencies 10 years into the future. A second objective of this analysis is to set base case costs of PV electrolysis. For any other renewable process, the costs for PV electrolysis, which is existing technology, sets the numbers which the other processes must better. (author)

  13. Comparative analysis of Flue-cured tobacco production costs in Santander and Huila (Colombia

    Directory of Open Access Journals (Sweden)

    Juan Carlos Barrientos F

    2012-08-01

    Full Text Available Santander and Huila are the largest producers of Flue-cured tobacco in Colombia. They differ in their production systems and, consequently, in their production costs. Costs provide valuable information on the efficiency of resource use, a variable that determines the profitability of the crop. The purpose of this study was to determine and analyze the structure of production costs by department, as well as, their differences and possibilities for reduction. Data for the analysis was obtained from the records of Protabaco and surveys of 50 producers (farms in the municipalities of Campoalegre and Garzon in Huila, and Capitanejo and Enciso in Santander. The results say the costs of the most important factors of production in both departments are: labor, inputs and services. Huila has higher total costs per hectare than Santander, but similar unit costs. Huila has a higher technological level of production, more capital and greater surface area per crop unit than Santander. Production costs can be reduced by increasing the availability of investment capital, and irrigation water, as well as, more efficient management of fertilization, cultural practices and mechanization of land preparation

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

    International Nuclear Information System (INIS)

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

    1995-03-01

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

  15. Denosumab: A Unique Perspective on Adherence and Cost-effectiveness Compared With Oral Bisphosphonates in Osteoporosis Patients.

    Science.gov (United States)

    Morizio, Paige; Burkhart, Jena I; Ozawa, Sachiko

    2018-04-01

    To assess the cost-effectiveness as well as adherence and patient preference for denosumab compared with oral bisphosphonates for the treatment of osteoporosis. Two comprehensive PubMed literature searches (from data inception to December 2017) were performed. The first search included the terms osteoporosis, denosumab, bisphosphonate, and adherence or persistence or compliance or preference. The search terms osteoporosis, denosumab, cost, and effectiveness were used in the second literature search. Additional references were included from reviewing literature citations. All English-language clinical trials on adherence (as compliance and persistence) or patient preference for denosumab compared with oral bisphosphonates were evaluated. In addition, articles analyzing the cost-effectiveness of denosumab compared with generic alendronate were evaluated. Four studies that assessed patient preference showed positive outcomes for preference and satisfaction for subcutaneous use of denosumab every 6 months versus oral alendronate weekly, oral ibandronate monthly, or oral risedronate monthly. Three studies evaluated persistence and compliance and/or adherence and showed improved persistence and compliance rates with denosumab compared with bisphosphonate therapy. Twelve articles and 3 abstracts assessed cost-effectiveness of denosumab compared with generic alendronate. The majority of articles showed that denosumab was cost-effective, and even cost-saving in patients older than 75 years of age and those who have a history of previous fractures, lower bone mineral density T-scores, and more risk factors. Denosumab compared with oral bisphosphonates may improve patient preference and adherence as well as provide a cost-effective treatment strategy, especially among higher-risk and older adults with osteoporosis.

  16. Costs and effects of paliperidone extended release compared with alternative oral antipsychotic agents in patients with schizophrenia in Greece: a cost effectiveness study.

    Science.gov (United States)

    Geitona, Maria; Kousoulakou, Hara; Ollandezos, Markos; Athanasakis, Kostas; Papanicolaou, Sotiria; Kyriopoulos, Ioannis

    2008-08-28

    To compare the costs and effects of paliperidone extended release (ER), a new pharmaceutical treatment for the management of schizophrenia, with the most frequently prescribed oral treatments in Greece (namely risperidone, olanzapine, quetiapine, aripiprazole and ziprasidone) over a 1-year time period. A decision tree was developed and tailored to the specific circumstances of the Greek healthcare system. Therapeutic effectiveness was defined as the annual number of stable days and the clinical data was collected from international clinical trials and published sources. The study population was patients who suffer from schizophrenia with acute exacerbation. During a consensus panel of 10 psychiatrists and 6 health economists, data were collected on the clinical practice and medical resource utilisation. Unit costs were derived from public sources and official reimbursement tariffs. For the comparators official retail prices were used. Since a price had not yet been granted for paliperidone ER at the time of the study, the conservative assumption of including the average of the highest targeted European prices was used, overestimating the price of paliperidone ER in Greece. The study was conducted from the perspective of the National Healthcare System. The data indicate that paliperidone ER might offer an increased number of stable days (272.5 compared to 272.2 for olanzapine, 265.5 f risperidone, 260.7 for quetiapine, 260.5 for ziprasidone and 258.6 for aripiprazole) with a lower cost compared to the other therapies examined (euro 7,030 compared to euro 7,034 for olanzapine, euro 7,082 for risperidone, euro 8,321 for quetiapine, euro 7,713 for ziprasidone and euro 7,807 for aripiprazole). During the sensitivity analysis, a +/- 10% change in the duration and frequency of relapses and the economic parameters did not lead to significant changes in the results. Treatment with paliperidone ER can lead to lower total cost and higher number of stable days in most of the

  17. Comparative Cost-Effectiveness Analysis of Three Different Automated Medication Systems Implemented in a Danish Hospital Setting.

    Science.gov (United States)

    Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

    2018-02-01

    Automated medication systems have been found to reduce errors in the medication process, but little is known about the cost-effectiveness of such systems. The objective of this study was to perform a model-based indirect cost-effectiveness comparison of three different, real-world automated medication systems compared with current standard practice. The considered automated medication systems were a patient-specific automated medication system (psAMS), a non-patient-specific automated medication system (npsAMS), and a complex automated medication system (cAMS). The economic evaluation used original effect and cost data from prospective, controlled, before-and-after studies of medication systems implemented at a Danish hematological ward and an acute medical unit. Effectiveness was described as the proportion of clinical and procedural error opportunities that were associated with one or more errors. An error was defined as a deviation from the electronic prescription, from standard hospital policy, or from written procedures. The cost assessment was based on 6-month standardization of observed cost data. The model-based comparative cost-effectiveness analyses were conducted with system-specific assumptions of the effect size and costs in scenarios with consumptions of 15,000, 30,000, and 45,000 doses per 6-month period. With 30,000 doses the cost-effectiveness model showed that the cost-effectiveness ratio expressed as the cost per avoided clinical error was €24 for the psAMS, €26 for the npsAMS, and €386 for the cAMS. Comparison of the cost-effectiveness of the three systems in relation to different valuations of an avoided error showed that the psAMS was the most cost-effective system regardless of error type or valuation. The model-based indirect comparison against the conventional practice showed that psAMS and npsAMS were more cost-effective than the cAMS alternative, and that psAMS was more cost-effective than npsAMS.

  18. Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

    Science.gov (United States)

    Kuo, Ming-Jeng; Chen, Hsiu-Hsi; Chen, Chi-Ling; Fann, Jean Ching-Yuan; Chen, Sam Li-Sheng; Chiu, Sherry Yueh-Hsia; Lin, Yu-Min; Liao, Chao-Sheng; Chang, Hung-Chuen; Lin, Yueh-Shih; Yen, Amy Ming-Fang

    2016-01-01

    AIM: To assess the cost-effectiveness of two population-based hepatocellular carcinoma (HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography (AUS). METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per life-year gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental cost-effectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening. CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval. PMID:27022228

  19. Comparing data quality and cost from three modes of on-board transit passenger surveys.

    Science.gov (United States)

    2015-06-01

    This report presents the findings from a research project investigating the relative data quality and administration costs for three : different modes of surveying bus passengers that produce results generalizable to the full passenger population. Th...

  20. Couches Minces de Titanate de Baryum Par Depot Organometallique

    Science.gov (United States)

    Ousi Benomar, Wahib

    1993-01-01

    Nous avons demontre la possibilite de realiser des couches minces de titanate de baryum par depot organometallique. Les films sont obtenus apres dissolution d'organometalliques choisis dans un solvant et une cuisson a une temperature determinee par thermogravimetrie. Apres un second traitement thermique a des temperatures plus elevees, les echantillons presentent une structure polycristalline tetragonale; les cristallites sont observes par microscopie electronique a balayage. La mesure de la constante dielectrique a permis de mettre en evidence une transition de phase de la structure tetragonale a la structure cubique a une temperature d'environ 125^circC. Les mesures d'indice ont ete effectuees. On note une augmentation de l'indice de refraction des films avec la temperature indiquant une meilleure densification des films. Nous avons aussi montre qu'il etait possible d'utiliser ce materiau en tant que guide d'onde optique pour pouvoir exploiter ses proprietes electrooptiques dans l'avenir.

  1. MODELING OF HIGH STORAGE SHEET DEPOT WITH PLANT SIMULATION

    Directory of Open Access Journals (Sweden)

    Andrzej Jardzioch

    2013-03-01

    Full Text Available Manufacturing processes are becoming increasingly automated. Introduction of innovative solutions often necessitate processing very large number of signals from various devices. Correctness tests of the components configuration becomes a compiled operation requiring vast expenditure of time and knowledge. The models may be a mathematical reflection of the actual object. Many actions can be computer-assisted to varying degree. One example is construction of simulation models. These can also be simulation models developed in advanced software. The stages of creating a model may be purely random. This paper aims at a closer analysis of the simulation model based on the high storage sheet depot modeling using Plant Simulation software. The results of analysis can be used for optimization, but this stage is a separate issue.

  2. Comparing service use and costs among adolescents with autism spectrum disorders, special needs and typical development.

    Science.gov (United States)

    Barrett, Barbara; Mosweu, Iris; Jones, Catherine Rg; Charman, Tony; Baird, Gillian; Simonoff, Emily; Pickles, Andrew; Happé, Francesca; Byford, Sarah

    2015-07-01

    Autism spectrum disorder is a complex condition that requires specialised care. Knowledge of the costs of autism spectrum disorder, especially in comparison with other conditions, may be useful to galvanise policymakers and leverage investment in education and intervention to mitigate aspects of autism spectrum disorder that negatively impact individuals with the disorder and their families. This article describes the services and associated costs for four groups of individuals: adolescents with autistic disorder, adolescents with other autism spectrum disorders, adolescents with other special educational needs and typically developing adolescents using data from a large, well-characterised cohort assessed as part of the UK Special Needs and Autism Project at the age of 12 years. Average total costs per participant over 6 months were highest in the autistic disorder group (£11,029), followed by the special educational needs group (£9268), the broader autism spectrum disorder group (£8968) and the typically developing group (£2954). Specialised day or residential schooling accounted for the vast majority of costs. In regression analysis, lower age and lower adaptive functioning were associated with higher costs in the groups with an autism spectrum disorder. Sex, ethnicity, number of International Classification of Diseases (10th revision) symptoms, autism spectrum disorder symptom scores and levels of mental health difficulties were not associated with cost. © The Author(s) 2014.

  3. Fatty acid composition of subcutaneous and visceral fat depots in New Zealand White rabbits

    OpenAIRE

    P. Y. Yonkova; G. S. Mihaylova; S. S. Ribarski; V. Doichev; R. Dimitrov; M. G. Stefanov

    2017-01-01

    The aim of this study was to identify the differences in the fatty acid composition of subcutaneous and visceral fat depots in healthy New Zealand White rabbits. Twelve clinically healthy rabbits with an average weight of 3.00±0.03 kg were used. The fatty acid composition of interscapular, inguinal, pericardial, perirenal and omental fat depots was determined by gas chromatography. The palmitic (C16:0) and linoleic (C18:2) acids, followed by oleic acid (C18:1) prevailed in all fat depots. The...

  4. The Linehaul-Feeder Vehicle Routing Problem with Virtual Depots and Time Windows

    Directory of Open Access Journals (Sweden)

    Huey-Kuo Chen

    2011-01-01

    Full Text Available This paper addresses the linehaul-feeder vehicle routing problem with virtual depots and time windows (LFVRPTW. Small and large vehicles deliver services to customers within time constraints; small vehicles en route may reload commodities from either the physical depot or from the larger vehicle at a virtual depot before continuing onward. A two-stage solution heuristic involving Tabu search is proposed to solve this problem. The test results show that the LFVRPTW performs better than the vehicle routing problem with time windows in terms of both objective value and the number of small vehicles dispatched.

  5. The Genetics of Brown Adipocyte Induction in White Fat Depots

    Directory of Open Access Journals (Sweden)

    Leslie P. Kozak

    2011-10-01

    Full Text Available Evidence that adult humans have functional brown adipose tissue has stirred interest in the possibility that the impressive effectiveness of induction of brown adipocytes to reduce obesity in mice may be translated to the human condition. A major focus recently on the identification of signaling and transcription factor that stimulate the induction of brown adipocytes has come from transgenic and gene KO models. However, these models have created a very complex picture of the regulatory mechanisms for brown fat induction. In this review insights into the critical regulatory pathways involved in brown adipocyte induction in the retroperitoneal fat depot of mice are described from quantitative trait locus analysis of allelic variability determining Ucp1 levels and brown adipocyte induction in A/J vs B6 mice. The key observation is that recombinant genotypes, found in recombinant inbred stains and backcross and intercross progeny , show transgressive variation for Ucp1 mRNA levels. These genetic crosses also show that the levels of Ucp1 mRNA are determined by interactions that control the levels of PPARα, PGC-1α and type 2 deiodinase and that each factor is controlled by a subset of QTLs that also control Ucp1expression. These results indicate that induction of Ucp1 in the retroperitoneal fat depot involves synergy between signaling and transcription factors that vary depending upon the environmental conditions. Inherent in this model is the idea that there is a high level of redundancy that can involve any factor with the potential to influence expression of the core factors, PPARα, PGC-1a and DIO2.

  6. Comparing treatment persistence, healthcare resource utilization, and costs in adult patients with major depressive disorder treated with escitalopram or citalopram.

    Science.gov (United States)

    Wu, Eric Q; Greenberg, Paul E; Ben-Hamadi, Rym; Yu, Andrew P; Yang, Elaine H; Erder, M Haim

    2011-03-01

    Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (-$1174) and major depressive disorder-related costs (-$109; P escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare

  7. Cost-effectiveness of sacral neuromodulation compared to botulinum neurotoxin a or continued medical management in refractory overactive bladder.

    Science.gov (United States)

    Arlandis, Salvador; Castro, David; Errando, Carlos; Fernández, Eldiberto; Jiménez, Miguel; González, Paloma; Crespo, Carlos; Staeuble, Funke; Rodríguez, José Manuel; Brosa, Max

    2011-01-01

    This study assessed the cost-effectiveness and health-care budget impact of sacral neuromodulation (SNM) in refractory idiopathic OAB-wet patients in Spain. A 10-year Markov analytic model was developed to estimate quality-adjusted life-years (QALYs) gained and incontinence episode avoided associated with SNM therapy compared with botulinum neurotoxin A (BoNT-A) or continued optimized medical treatment (OMT). At 10 years, the cumulative costs of SNM, BoNT-A, and OMT were €29,166, €29,458, and €29,370, respectively, whereas the QALYs for SNM, BoNT-A, and OMT are 6.89, 6.38, and 5.12, respectively. Consequently, incremental cost-effectiveness ratios (ICERs) for SNM demonstrate that although the initial costs for SNM are higher than those for the other treatments, decreasing follow-up costs coupled with consistently greater effectiveness in the long term make SNM the economically dominant option at 10 years. Sensitivity analyses suggest that 99.7% and 99.9% (for SNM vs. BoNT-A and OMT, respectively) of the 1000 Monte Carlo iterations fall within the €30,000 cost-effectiveness threshold, considered to be acceptable in Spain. The 10-year incremental cost per incontinence episode avoided for SNM also makes this therapy the dominant option compared to BoNT-A or OMT. Additionally, the estimated budget impact of the gradually increased referral for SNM for the management of OAB patients in Spain is small. As a treatment option for refractory idiopathic OAB, at 10 years, SNM provides a considerable possibility of symptom and quality-of-life improvement and is cost-effective compared to BoNT-A or continued OMT. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. Comparing the Cost-Effectiveness of Campaigns Delivered via Various Combinations of Television and Online Media.

    Science.gov (United States)

    Allom, Vanessa; Jongenelis, Michelle; Slevin, Terry; Keightley, Stacey; Phillips, Fiona; Beasley, Sarah; Pettigrew, Simone

    2018-01-01

    Reflecting the increasing prevalence of online media, many mass media health campaigns are now delivered using both television (TV) and online media formats. The aim of this study was to evaluate a smoking cessation mass media campaign according to the cost-effectiveness of the various combinations of TV and online media formats to inform future media buying decisions. A quasi-experimental interrupted time series approach was employed. The campaign was delivered in seven 1-week bursts using TV, online video (OV), or online display (OD) (e.g., banner ads) formats in isolation and in various combinations over a 13-week period. Campaign bursts were separated by "off-weeks" in which no campaign materials were delivered. Assessed outcomes were the number of campaign response "events" recorded (campaign web page views, calls to a smoking cessation telephone service, and registrations for smoking cessation services). The cost-effectiveness of each individual and combined media format condition in terms of these outcome variables was calculated using attributed production and broadcasting costs. Overall, OD alone was found to be the most cost-effective means of achieving the nominated campaign outcomes, followed by a combination of OV and OD and a combination of TV and OV. The use of TV in isolation was the least cost-effective. The results of this evaluation indicate that online media constitute a promising means of enhancing the cost-effectiveness of smoking cessation campaigns. Future research assessing a broader range of outcomes, especially smoking cessation, is needed to provide a more comprehensive account of the cost-effectiveness of various campaign media.

  9. Societal costs of non-cardiac chest pain compared with ischemic heart disease--a longitudinal study.

    Science.gov (United States)

    Mourad, Ghassan; Alwin, Jenny; Strömberg, Anna; Jaarsma, Tiny

    2013-10-09

    Non-cardiac chest pain (NCCP) is a common complaint. Our aim was to present a detailed description of the costs of patients with NCCP compared to patients with acute myocardial infarction (AMI) and Angina Pectoris (AP) from a societal perspective. Data on healthcare utilization and annual societal costs, including direct healthcare costs and indirect costs due to productivity loss, were collected from different databases. The participants consisted of 199 patients from a general hospital in Sweden (99 with NCCP, 51 with AMI, 49 with AP), mean age of 67 years, 59% men. NCCP, AMI, and AP patients had on average 54, 50 and 65 primary care contacts and 3, 4, and 4 hospital admissions during a period of 2 years. Length of hospital stay was 6, 11 and 11 days. On average, 14%, 18%, and 25% of NCCP, AMI and AP patients were on sick-leave annually, and about 12% in each group received a disability pension. The mean annual societal costs of NCCP, AMI and AP patients were €10,068, €15,989 and €14,737. Although the annual societal cost of NCCP patients was lower than in AMI and AP patients, the cost was still considerable (€10,068). Taken into account the high prevalence of NCCP, the cumulative annual national cost of these patients could be more than the double of AMI and AP if all patients incurred the same costs as in this study. Targeted interventions are important in order to support patients with NCCP and minimize healthcare utilization and costs.

  10. Paying for convenience: comparing the cost of takeaway meals with their healthier home-cooked counterparts in New Zealand.

    Science.gov (United States)

    Mackay, Sally; Vandevijvere, Stefanie; Xie, Pei; Lee, Amanda; Swinburn, Boyd

    2017-09-01

    Convenience and cost impact on people's meal decisions. Takeaway and pre-prepared foods save preparation time but may contribute to poorer-quality diets. Analysing the impact of time on relative cost differences between meals of varying convenience contributes to understanding the barrier of time to selecting healthy meals. Six popular New Zealand takeaway meals were identified from two large national surveys and compared with similar, but healthier, home-made and home-assembled meals that met nutrition targets consistent with New Zealand Eating and Activity Guidelines. The cost of each complete meal, cost per kilogram, and confidence intervals of the cost of each meal type were calculated. The time-inclusive cost was calculated by adding waiting or preparation time cost at the minimum wage. A large urban area in New Zealand. For five of six popular meals, the mean cost of the home-made and home-assembled meals was cheaper than the takeaway meals. When the cost of time was added, all home-assembled meal options were the cheapest and half of the home-made meals were at least as expensive as the takeaway meals. The home-prepared meals were designed to provide less saturated fat and Na and more vegetables than their takeaway counterparts; however, the home-assembled meals provided more Na than the home-made meals. Healthier home-made and home-assembled meals were, except one, cheaper options than takeaways. When the cost of time was added, either the home-made or the takeaway meal was the most expensive. This research questions whether takeaways are better value than home-prepared meals.

  11. The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe.

    Science.gov (United States)

    Jit, Mark; Bilcke, Joke; Mangen, Marie-Josée J; Salo, Heini; Melliez, Hugues; Edmunds, W John; Yazdan, Yazdanpanah; Beutels, Philippe

    2009-10-19

    Cost-effectiveness analyses are usually not directly comparable between countries because of differences in analytical and modelling assumptions. We investigated the cost-effectiveness of rotavirus vaccination in five European Union countries (Belgium, England and Wales, Finland, France and the Netherlands) using a single model, burden of disease estimates supplied by national public health agencies and a subset of common assumptions. Under base case assumptions (vaccination with Rotarix, 3% discount rate, health care provider perspective, no herd immunity and quality of life of one caregiver affected by a rotavirus episode) and a cost-effectiveness threshold of euro30,000, vaccination is likely to be cost effective in Finland only. However, single changes to assumptions may make it cost effective in Belgium and the Netherlands. The estimated threshold price per dose for Rotarix (excluding administration costs) to be cost effective was euro41 in Belgium, euro28 in England and Wales, euro51 in Finland, euro36 in France and euro46 in the Netherlands.

  12. Comparing Usage and Cost- Effectiveness Analysis of English Printed and Electronic Books for University of Tehran

    Directory of Open Access Journals (Sweden)

    Davoud Haseli

    2014-09-01

    The result showed that the use of English printed books has different in four subject areas of Engineering, Sciences, Social and Behavioral Sciences, and Humanities, unlike English ebooks. The average of use of the printed books in Social and behavioral sciences Was 1.09, and it shows the most among all, and for Sciences, was only 0.14, this is the minimum among. 20 percent of English printed books have been used and the mean for total printed books was 0.77. 52 percent of ebooks have been used, and the average of use of ebooks was 5.16, respectively. So the use and cost- effectiveness analysis of English ebooks are more than English print books. The uses statistics and cost analysis showed that cost per use for English printed books is 787168 Rial and for ebooks is 80,388.

  13. Cost-effectiveness of radiotherapy during surgery compared with external radiation therapy in the treatment of women with breast cancer

    Directory of Open Access Journals (Sweden)

    Hedie Mosalanezhad

    2016-04-01

    Full Text Available Introduction: Intraoperative radiation therapy device (IORT is one of the several options for partial breast irradiation. IORT is sent to the tumor bed during surgery and can be replaced with conventional standard therapy (EBRT. The aim of this study was to evaluate the safety and effectiveness of IORT machine compared with EBRT and to determine the dominant option in terms of the cost-effectiveness. Method: This study was conducted in two phases; the first phase was a comprehensive review of the electronic databases search that was extracted after extraction and selection of the articles used in this article on effectiveness outcomes. Data collection form was completed by professionals and experts to estimate the cost of treatment, intraoperative radiotherapy and radiotherapy cost when using external radiation therapy process; direct costs were considered from the perspective of service provider and they were calculated in the second phase to determine the option of cost-effective ICER. Excel software was used for data analysis and sensitivity analysis was performed to determine the strength of the results of cost-effectiveness. Results:18 studies were selected but only 8 of them were shown to have acceptable quality. The consequences like “rate of cancer recurrence”, “seroma”, “necrosis”, “toxic”, “skin disorders and delayed wound healing” and “spread the pain” were among the consequences used in the selected articles. The total costs for each patient during a course of treatment for EBRT and IORT were estimated 1398 and $5337.5, respectively. During the analysis, cost-effectiveness of the consequences of cancer recurrence, seroma, necrosis and skin disorders and delayed wound healing ICER was calculated. And IORT was found to be the dominant supplier in all cases. Also, in terms of implications of toxicity and prevalence of pain, IORT had a lower cost and better effectiveness and consequently the result was more cost

  14. Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies.

    Science.gov (United States)

    Prada, Sergio I

    2017-12-01

    The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of

  15. Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

    Science.gov (United States)

    Ellis, Charles; Hardy, Rose Y; Lindrooth, Richard C

    2017-05-15

    To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Comparing Hospitalist-Resident to Hospitalist-Midlevel Practitioner Team Performance on Length of Stay and Direct Patient Care Cost.

    Science.gov (United States)

    Iannuzzi, Michael C; Iannuzzi, James C; Holtsbery, Andrew; Wright, Stuart M; Knohl, Stephen J

    2015-03-01

    A perception exists that residents are more costly than midlevel providers (MLPs). Since graduate medical education (GME) funding is a key issue for teaching programs, hospitals should conduct cost-benefit analyses when considering staffing models. Our aim was to compare direct patient care costs and length of stay (LOS) between resident and MLP inpatient teams. We queried the University HealthSystems Consortium clinical database (UHC CDB) for 13 553 "inpatient" discharges at our institution from July 2010 to June 2013. Patient assignment was based on bed availability rather than "educational value." Using the UHC CDB data, discharges for resident and MLP inpatient teams were compared for observed and expected LOS, direct cost derived from hospital charges, relative expected mortality (REM), and readmissions. We also compared patient satisfaction for physician domain questions using Press Ganey data. Bivariate analysis was performed for factors associated with differences between the 2 services using χ(2) analysis and Student t test for categorical and continuous variables, respectively. During the 3-year period, while REM was higher on the hospitalist-resident services (P higher for resident teams. There were no differences in patient demographics, daily discharge rates, readmissions, or deaths. Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. The findings offer guidance when considering GME costs and inpatient staffing models.

  17. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

    Science.gov (United States)

    Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

    2015-09-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

  18. Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy.

    Science.gov (United States)

    Atluri, Pavan; Stetson, Robert L; Hung, George; Gaffey, Ann C; Szeto, Wilson Y; Acker, Michael A; Hargrove, W Clark

    2016-02-01

    Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy. All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records. Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups. Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  19. The Numerical Investigation of Temperature and Velocity Distribution in the High-Bay Depot

    Directory of Open Access Journals (Sweden)

    Xuehong Wu

    2014-07-01

    Full Text Available High-bay depot plays an important role in the storage industry. Due to large and high space of high-bay depot, it is difficult to make temperature distribution uniform, which will influence the storage time of raw materials. In this paper, the aim is to find the reasonable air supply and energy-saving method; a supply-air method of high-bay depot is investigated as an example. The results show the radius and spacing of the supply-air inlet have great influence on temperature distribution. The temperature nonuniformity coefficient of summer is smaller than that of winter. The investigated results can provide a theoretical reference for the high-bay depot design and economic operation.

  20. Software Cost Estimating Models: A Comparative Study of What the Models Estimate

    Science.gov (United States)

    1993-09-01

    generate good cost estimates. One model developer best summed up this sentiment by stating: Estimation is not a mechanical process. Art, skill, and...Allocation Perc.uinta~es for SASEY Development Phases Sysieni Conce~pt 7.5% yseS/W Requ~irements Anlysis _________%__ S/W Raq;iirements Analysis 9.0

  1. Comparing Service Use and Costs among Adolescents with Autism Spectrum Disorders, Special Needs and Typical Development

    Science.gov (United States)

    Barrett, Barbara; Mosweu, Iris; Jones, Catherine R. G.; Charman, Tony; Baird, Gillian; Simonoff, Emily; Pickles, Andrew; Happé, Francesca; Byford, Sarah

    2015-01-01

    Autism spectrum disorder is a complex condition that requires specialised care. Knowledge of the costs of autism spectrum disorder, especially in comparison with other conditions, may be useful to galvanise policymakers and leverage investment in education and intervention to mitigate aspects of autism spectrum disorder that negatively impact…

  2. A comparative study of transaction costs of payments for forest ecosystem services in Vietnam

    NARCIS (Netherlands)

    Phan, Thu Ha Dang; Brouwer, Roy; Davidson, Marc David; Hoang, Long Phi

    2017-01-01

    Two payments for forest ecosystem services (PFES) schemes under one common legal-institutional coordination mechanism but different historical-institutional background and organizational design are analyzed to measure and explain their transaction costs (TC). Data on TC related to payment

  3. A comparative study on indoor air quality in a low cost and a green ...

    African Journals Online (AJOL)

    A study on Indoor Air Quality (IAQ) is important because people spend most of their time inside houses. IAQ was monitored in two different types of rural houses namely a low cost house and a “green” house built with pyramidal shape of roof in the rural area. Carbon monoxide (CO) and Carbon Dioxide (CO2) concentrations ...

  4. Cost-effectiveness of conjugate pneumococcal vaccination in Singapore: comparing estimates for 7-valent, 10-valent, and 13-valent vaccines.

    Science.gov (United States)

    Tyo, Karen Richards; Rosen, Melissa M; Zeng, Wu; Yap, Mabel; Pwee, Keng Ho; Ang, Li Wei; Shepard, Donald S

    2011-09-02

    Although multiple studies of cost-effectiveness of pneumococcal conjugate vaccines have been conducted, no such study has examined Singapore's situation nor compared the licensed conjugate vaccines in an Asian population. This paper estimates the costs and public health impacts of pneumococcal conjugate vaccine programs, varying estimates of serotype replacement and herd immunity effects as key parameters in the analysis. Based in part on a 2008 analysis also presented here, Singapore has approved the PCV-7, PHiD-10, and PCV-13 pneumococcal conjugate vaccines as part of its National Childhood Immunisation Programme. An economic evaluation was performed using a Markov simulation model populated with Singapore-specific population parameters, vaccine costs, treatment costs, and disease incidence data. The vaccinated infant and child cohort of 226,000 was 6% of the Singapore resident population of 3.8 million. Vaccine efficacy estimates were constructed for PCV-7, PHiD-10, and PCV-13 vaccines based on their serotype coverage in Singapore and compared to 'no vaccination'. The model estimated impacts over a five-year time horizon with 3% per year discounting of costs and health effects. Costs were presented in 2010 U.S. dollars (USD) and Singapore dollars (SGD). Sensitivity analyses included varying herd immunity, serotype replacement rates, vaccine cost, and efficacy against acute otitis media. Under base case assumptions for the revised analysis (i.e., herd effects in the unvaccinated population equivalent to 20% of direct effects) PCV-13 prevented 834 cases and 7 deaths due to pneumonia, meningitis, and bacteremia in the vaccinated population, and 952 cases and 191 deaths in the unvaccinated population over the 5-year time horizon. Including herd effects, the cost-effectiveness ratio for PCV-13 was USD $37,644 (SGD $51,854) per QALY. Without herd effects, however, the ratio was USD $204,535 (SGD $281,743) per QALY. The PCV-7 cost per QALY including herd effects was

  5. Comparing Life-Cycle Costs of ESPCs and Appropriations-Funded Energy Projects: An Update to the 2002 Report

    International Nuclear Information System (INIS)

    Shonder, John A.; Hughes, Patrick; Atkin, Erica

    2006-01-01

    A study was sponsored by FEMP in 2001 - 2002 to develop methods to compare life-cycle costs of federal energy conservation projects carried out through energy savings performance contracts (ESPCs) and projects that are directly funded by appropriations. The study described in this report follows up on the original work, taking advantage of new pricing data on equipment and on $500 million worth of Super ESPC projects awarded since the end of FY 2001. The methods developed to compare life-cycle costs of ESPCs and directly funded energy projects are based on the following tasks: (1) Verify the parity of equipment prices in ESPC vs. directly funded projects; (2) Develop a representative energy conservation project; (3) Determine representative cycle times for both ESPCs and appropriations-funded projects; (4) Model the representative energy project implemented through an ESPC and through appropriations funding; and (5) Calculate the life-cycle costs for each project.

  6. Cooperative vehicle routing problem: an opportunity for cost saving

    Science.gov (United States)

    Zibaei, Sedighe; Hafezalkotob, Ashkan; Ghashami, Seyed Sajad

    2016-09-01

    In this paper, a novel methodology is proposed to solve a cooperative multi-depot vehicle routing problem. We establish a mathematical model for multi-owner VRP in which each owner (i.e. player) manages single or multiple depots. The basic idea consists of offering an option that owners cooperatively manage the VRP to save their costs. We present cooperative game theory techniques for cost saving allocations which are obtained from various coalitions of owners. The methodology is illustrated with a numerical example in which different coalitions of the players are evaluated along with the results of cooperation and cost saving allocation methods.

  7. Prospective randomized controlled trial comparing the outcomes and costs of two eyecare adherence interventions in diabetes patients.

    Science.gov (United States)

    Pizzi, Laura T; Zangalli, Camila S; Murchison, Ann P; Hale, Nicole; Hark, Lisa; Dai, Yang; Leiby, Benjamin E; Haller, Julia A

    2015-04-01

    Diabetic retinopathy is one of the leading causes of vision impairment among adults in the USA. While it is suggested that diabetics receive annual dilated fundus examinations (DFE), many patients do not adhere to these recommendations. This paper investigates the outcomes and costs of an educational and telephone intervention on DFE follow-up adherence in patients with diabetes. In a prospective trial, 356 diabetic patients due for a DFE at an urban eye clinic were randomly assigned to usual care (UC; reference case), mailed intervention (MI), or telephone intervention (TI). UC patients (n = 119) received a standard form letter. MI patients (n = 117) received a personalized letter encouraging scheduling of an eye examination with an educational brochure about diabetic eye disease. TI patients (n = 120) received personal calls (up to three attempts) to schedule a follow-up with standard form letter. The primary outcome was obtaining a DFE within 90 days of suggested return. Costs (US$ 2013) included time costs for staff, phone charges, supplies, and postage. Since TI involved greater cost components compared to MI, univariate sensitivity analysis examined the impact of reducing phone costs. Patients were mostly female (66 %) and African American (70 %) with a mean age of 61 years. TI patients were more likely to schedule DFE [65 vs. 42 %; relative risk (RR) 1.54; CI 1.20-1.96; P < 0.001] versus UC patients. Obtaining a DFE within 90 days of suggested return was also significantly higher among TI patients compared to UC patients (51 vs. 36 %, RR 1.41; CI 1.05-1.89; P = 0.024). MI patients were slightly less likely to schedule DFE versus UC patients (38 vs. 42 %, RR 0.90; CI 0.66-1.22; P = NSS) and obtain a DFE (32 vs. 36 %; RR 0.90; CI 0.63-1.28; P = NSS). The total cost of TI was US$798.28 or US$6.65/patient and the cost/follow-up DFE was US$26.05. Sensitivity analyses revealed that the cost/follow-up can be greatly reduced but remains

  8. An Archeological Overview and Management Plan for the Pueblo Depot Activity, Pueblo County, Colorado.

    Science.gov (United States)

    1984-10-01

    Denver, CO. Rippeteau, Bruce. 1977. 5LA1115: Hackberry Springs, a Colorado Millenial Source. Office of the State Archaeologist Publication Series No 9...AD-Ai59 239 AN ARCHEOLOGICAL OVERVIEW AND MANAGEMENT PLAN FOR THE 1/2 PUEBLO DEPOT ACTIVI.(U) WOODWARD-CLYDE CONSULTANTS WALNUT CREEK CR R KNUDSON 81...7 --- Final /Report No. 19 October 1, 1984 CJ 0 An Archeological Overview and Management Plan for the Pueblo Depot Activity, Pueblo County, Colorado

  9. Overview and comparative study of GPR international standards and guidelines - COST Action TU1208

    Science.gov (United States)

    Pajewski, Lara; Marciniak, Marian; Benedetto, Andrea; Tosti, Fabio

    2016-04-01

    and Technology) Action TU1208 "Civil engineering applications of Ground Penetrating Radar." The Authors thank COST (www.cost.eu) for funding the Action TU1208 (www.GPRadar.eu). Part of this work was carried out during the Short-Term Scientific Mission STSM-TU1208-24656 "Comparative study of GPR international standards and guidelines" (Dr Lara Pajewski, Italy, visiting Prof Marian Marciniak, Poland).

  10. Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy

    NARCIS (Netherlands)

    Peters, Max; Piena, Marjanne A; Steuten, Lotte M G; van der Voort van Zyp, Jochem R N; Moerland, Rien; van Vulpen, Marco

    2016-01-01

    PURPOSE: Focal salvage (FS) iodine 125 ((125)I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study

  11. Costs and effects of paliperidone extended release compared with alternative oral antipsychotic agents in patients with schizophrenia in Greece: A cost effectiveness study

    Directory of Open Access Journals (Sweden)

    Papanicolaou Sotiria

    2008-08-01

    Full Text Available Abstract Background To compare the costs and effects of paliperidone extended release (ER, a new pharmaceutical treatment for the management of schizophrenia, with the most frequently prescribed oral treatments in Greece (namely risperidone, olanzapine, quetiapine, aripiprazole and ziprasidone over a 1-year time period. Methods A decision tree was developed and tailored to the specific circumstances of the Greek healthcare system. Therapeutic effectiveness was defined as the annual number of stable days and the clinical data was collected from international clinical trials and published sources. The study population was patients who suffer from schizophrenia with acute exacerbation. During a consensus panel of 10 psychiatrists and 6 health economists, data were collected on the clinical practice and medical resource utilisation. Unit costs were derived from public sources and official reimbursement tariffs. For the comparators official retail prices were used. Since a price had not yet been granted for paliperidone ER at the time of the study, the conservative assumption of including the average of the highest targeted European prices was used, overestimating the price of paliperidone ER in Greece. The study was conducted from the perspective of the National Healthcare System. Results The data indicate that paliperidone ER might offer an increased number of stable days (272.5 compared to 272.2 for olanzapine, 265.5 f risperidone, 260.7 for quetiapine, 260.5 for ziprasidone and 258.6 for aripiprazole with a lower cost compared to the other therapies examined (€7,030 compared to €7,034 for olanzapine, €7,082 for risperidone, €8,321 for quetiapine, €7,713 for ziprasidone and €7,807 for aripiprazole. During the sensitivity analysis, a ± 10% change in the duration and frequency of relapses and the economic parameters did not lead to significant changes in the results. Conclusion Treatment with paliperidone ER can lead to lower total cost

  12. Paliperidone palmitate three-month depot formulation: a helpful innovation with practical pitfalls.

    Science.gov (United States)

    Hope, Judith D; Keks, Nicholas A

    2018-04-01

    Paliperidone palmitate is now available as a three-month depot injection. This paper will review the pharmacokinetics, pharmacodynamics, efficacy and tolerability, as well as practical issues and pitfalls for clinicians with this innovative treatment for schizophrenia. The three-month depot formulation of paliperidone for the treatment of schizophrenia is not a new compound. The nanocrystalline structure of the three-month formulation is larger and takes longer to disperse than the one-month formulation, hence its extended depot action. As expected, it is non-inferior to one-month depot paliperidone, and superior to placebo, for the treatment of schizophrenia. The side effect profile of three-month paliperidone is identical to the one-month formulation. The relapse rate on treatment is low, and the median time to relapse after ceasing the drug is 395 days. An understanding of half-life and kinetics is crucial for clinicians using this compound, and the loading strategy is important to ensure effectiveness. There are significant challenges: ensuring timely administration and switching a three-month depot treatment to another antipsychotic may be problematic. Paliperidone palmitate three-month depot injection represents an advance for both convenience and effectiveness in the long term psychopharmacological treatment of schizophrenia.

  13. Cost-effectiveness of endodontic molar retreatment compared with fixed partial dentures and single-tooth implant alternatives.

    Science.gov (United States)

    Kim, Sahng G; Solomon, Charles

    2011-03-01

    One of the most challenging situations in dentistry is a failed root canal treatment case. Should a failed root canal-treated tooth be retreated nonsurgically or surgically, or should the tooth be extracted and replaced with an implant-supported restoration or fixed partial denture? These four treatment alternatives were compared from the perspective of cost-effectiveness on the basis of the current best available evidence. The costs of the four major treatment modalities were calculated using the national fee averages from the 2009 American Dental Association survey of dental fees. The outcome data of all treatment modalities were retrieved from meta-analyses after electronic and manual searches were undertaken in the database from MEDLINE, Cochrane, ISI Web of Knowledge, and Scopus up to April 2010. The treatment strategy model was built and run with TreeAge decision analysis software (TreeAge Software, Inc, Williamstown, MA). Endodontic microsurgery was the most cost-effective approach followed by nonsurgical retreatment and crown, then extraction and fixed partial denture, and finally extraction and single implant-supported restoration. The cost-effectiveness analysis showed that endodontic microsurgery was the most cost-effective among all the treatment modalities for a failed endodontically treated first molar. A single implant-supported restoration, despite its high survival rate, was shown to be the least cost-effective treatment option based on current fees. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Comparative life cycle assessment and life cycle costing of lodging in the Himalaya

    DEFF Research Database (Denmark)

    Bhochhibhoya, Silu; Pizzol, Massimo; Achten, Wouter M J

    2017-01-01

    Purpose The main aim of the study is to assess the environmental and economic impacts of the lodging sector located in the Himalayan region of Nepal, from a life cycle perspective. The assessment should support decision making in technology and material selection for minimal environmental...... and economic burden in future construction projects. Methods The study consists of the life cycle assessment and life cycle costing of lodging in three building types: traditional, semi-modern and modern. The life cycle stages under analysis include raw material acquisition, manufacturing, construction, use....... Both primary and secondary data were used in the life cycle inventory. Results and discussion The modern building has the highest global warming potential (kg CO2-eq) as well as higher costs over 50 years of building lifespan. The results show that the use stage is responsible for the largest share...

  15. Comparative cost-effectiveness of the components of a behavior change communication campaign on HIV/AIDS in North India.

    Science.gov (United States)

    Sood, Suruchi; Nambiar, Devaki

    2006-01-01

    Numerous studies show that exposure to entertainment-education-based mass media campaigns is associated with reduction in risk behaviors. Concurrently, there is a growing interest in comparing the cost-effectiveness of HIV prevention interventions taking into account infrastructural and programmatic costs. In such analyses, though few in number, mass media campaigns have fared well. Using data from a mass media communication campaign in the low HIV prevalence states of Uttar Pradesh, Rajasthan, and Delhi in Northern India, in this article we examine the following: (1) factors that mediate behavior change in different components of the campaign, comprising a TV drama, reality show for youth audiences, and TV spots; (2) the relative impact of campaign components on the behavioral outcome: condom use; and (3) the cost-effectiveness calculations arising from this analysis. Results suggest that recall of the TV spots and the TV drama influences behavior change and is strongly associated with interpersonal communication and positive gender attitudes. The TV drama, in spite of being the costliest, emerges as the most cost-effective component when considering the behavioral outcome of interest. The analysis of the comparative cost-effectiveness of individual campaign components provides insights into the planning of resources for communication interventions globally.

  16. Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

    Science.gov (United States)

    Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre

    2018-01-01

    Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.

  17. Cost-Effectiveness Analysis Comparing Two Approaches for Empirical Antifungal Therapy in Hematological Patients with Persistent Febrile Neutropenia

    Science.gov (United States)

    Gil-Navarro, M. Victoria; Aguilar-Guisado, Manuela; Espigado, Ildefonso; de Pipaón, Maite Ruiz Pérez; Falantes, José; Pachón, Jerónimo

    2013-01-01

    New approaches of empirical antifungal therapy (EAT) in selected hematological patients with persistent febrile neutropenia (PFN) have been proposed in recent years, but their cost-effectiveness has not been studied. The aim of this study was to compare the cost-effectiveness of two different approaches of EAT in hematological patients with PFN: the diagnosis-driven antifungal therapy (DDAT) approach versus the standard approach of EAT. A decision tree to assess the cost-effectiveness of both approaches was developed. Outcome probabilities and treatment pathways were extrapolated from two studies: a prospective cohort study following the DDAT approach and a randomized clinical trial following the standard approach. Uncertainty was undertaken through sensitivity analyses and Monte Carlo simulation. The average effectiveness and economic advantages in the DDAT approach compared to the standard approach were 2.6% and €5,879 (33%) per PFN episode, respectively. The DDAT was the dominant approach in the 99.5% of the simulations performed with average cost-effectiveness per PFN episode of €32,671 versus €52,479 in the EAT approach. The results were robust over a wide range of variables. The DDAT approach is more cost-effective than the EAT approach in the management of PFN in hematological patients. PMID:23856767

  18. A comparative analysis of performance and cost metrics associated with a diesel to biodiesel fleet transition

    International Nuclear Information System (INIS)

    Shrake, Scott O.; Landis, Amy E.; Bilec, Melissa M.; Collinge, William O.; Xue Xiaobo

    2010-01-01

    With energy security, economic stabilization, and environmental sustainability being at the forefront of US policy making, the development of biodiesel production and use within the United States has been growing at an astonishing rate. According to the latest DOE energy report, biodiesel production and consumption in the US has decreased since its peak in 2008, but still remains an important factor in the US energy mix. However, despite recent studies showing that B5 has similar performance qualities to that of the currently used ultra-low-sulfur petroleum diesel (ULSD) fleet managers and corporations still remain hesitant regarding a switch to B5. This research examined the major areas of concern that arise with transitioning fleets from ULSD to B5 with the goal of alleviating those concerns with quantitative results from an actual fleet implementation and transition. In conjunction with the Pennsylvania Department of Transportation (PennDOT) a comparison of cost, cold weather fuel properties, engine performance, fuel economy, and maintenance and repairs was conducted using data obtained over 3 years from a pilot study. The results found that B5 performed as well or better than ULSD in all performance metrics. - Research Highlights: →Conducted multi-year study of a DOT fleet transition from ULSD to biodiesel (B5)→No significant difference in cold weather performance, engine power output, or torque→No significant difference in fuel economy→No resulting increase in maintenance and repair costs or frequency→Life-cycle costing revealed no hidden costs as a result of B5 implementation

  19. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

    Science.gov (United States)

    Westaby, Daniel T; Wu, Olivia; Duncan, W Colin; Critchley, Hilary O D; Tong, Stephen; Horne, Andrew W

    2012-09-17

    There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP), especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate. We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1) investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2) to compare the cost of medical management for women with hCG concentrations 1500-3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1) those who had initial medical management with methotrexate, (2) those who were eligible for initial medical management but chose surgery ('elected' surgery) and (3) those who initially 'required' surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS) in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method. Methotrexate was £1179 (CI 819-1550) per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures. Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.

  20. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

    Directory of Open Access Journals (Sweden)

    Westaby Daniel T

    2012-09-01

    Full Text Available Abstract Background There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP, especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate. Methods We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1 investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2 to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1 those who had initial medical management with methotrexate, (2 those who were eligible for initial medical management but chose surgery (‘elected’ surgery and (3 those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method. Results Methotrexate was £1179 (CI 819–1550 per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures. Conclusions Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.

  1. A comparative analysis of methods to represent uncertainty in estimating the cost of constructing wastewater treatment plants.

    Science.gov (United States)

    Chen, Ho-Wen; Chang, Ni-Bin

    2002-08-01

    Prediction of construction cost of wastewater treatment facilities could be influential for the economic feasibility of various levels of water pollution control programs. However, construction cost estimation is difficult to precisely evaluate in an uncertain environment and measured quantities are always burdened with different types of cost structures. Therefore, an understanding of the previous development of wastewater treatment plants and of the related construction cost structures of those facilities becomes essential for dealing with an effective regional water pollution control program. But deviations between the observed values and the estimated values are supposed to be due to measurement errors only in the conventional regression models. The inherent uncertainties of the underlying cost structure, where the human estimation is influential, are rarely explored. This paper is designed to recast a well-known problem of construction cost estimation for both domestic and industrial wastewater treatment plants via a comparative framework. Comparisons were made for three technologies of regression analyses, including the conventional least squares regression method, the fuzzy linear regression method, and the newly derived fuzzy goal regression method. The case study, incorporating a complete database with 48 domestic wastewater treatment plants and 29 industrial wastewater treatment plants being collected in Taiwan, implements such a cost estimation procedure in an uncertain environment. Given that the fuzzy structure in regression estimation may account for the inherent human complexity in cost estimation, the fuzzy goal regression method does exhibit more robust results in terms of some criteria. Moderate economy of scale exists in constructing both the domestic and industrial wastewater treatment plants. Findings indicate that the optimal size of a domestic wastewater treatment plant is approximately equivalent to 15,000 m3/day (CMD) and higher in Taiwan

  2. Total cost of ownership of electric vehicles compared to conventional vehicles: A probabilistic analysis and projection across market segments

    International Nuclear Information System (INIS)

    Wu, Geng; Inderbitzin, Alessandro; Bening, Catharina

    2015-01-01

    While electric vehicles (EV) can perform better than conventional vehicles from an environmental standpoint, consumers perceive them to be more expensive due to their higher capital cost. Recent studies calculated the total cost of ownership (TCO) to evaluate the complete cost for the consumer, focusing on individual vehicle classes, powertrain technologies, or use cases. To provide a comprehensive overview, we built a probabilistic simulation model broad enough to capture most of a national market. Our findings indicate that the comparative cost efficiency of EV increases with the consumer's driving distance and is higher for small than for large vehicles. However, our sensitivity analysis shows that the exact TCO is subject to the development of vehicle and operating costs and thus uncertain. Although the TCO of electric vehicles may become close to or even lower than that of conventional vehicles by 2025, our findings add evidence to past studies showing that the TCO does not reflect how consumers make their purchase decision today. Based on these findings, we discuss policy measures that educate consumers about the TCO of different vehicle types based on their individual preferences. In addition, measures improving the charging infrastructure and further decreasing battery cost are discussed. - Highlights: • Calculates the total cost of ownership across competing vehicle technologies. • Uses Monte Carlo simulation to analyse distributions and probabilities of outcomes. • Contains a comprehensive assessment across the main vehicle classes and use cases. • Indicates that cost efficiency of technology depends on vehicle class and use case. • Derives specific policy measures to facilitate electric vehicle diffusion

  3. Comparability of Weighed Dietary Records and a Self-Administered Diet History Questionnaire for Estimating Monetary Cost of Dietary Energy

    Directory of Open Access Journals (Sweden)

    Kentaro Murakami

    2008-01-01

    Full Text Available An increasing number of studies have estimated monetary diet cost using various dietary assessment methods, based on databases on retail food prices, for investigating its association with dietary intake and health outcomes. However, information regarding the comparability of monetary diet cost across dietary assessment methods is absolutely lacking. This study compared monetary cost of dietary energy estimated from weighed dietary records (DRs with that estimated from a self-administered diet history questionnaire (DHQ. The subjects were 92 Japanese women aged 31–69 years and 92 Japanese men aged 32–76 years. The DHQ (assessing diet during the preceding month and 4-day DRs (one weekend day and three weekdays were completed in each season over a 1-year period (DHQs1-4 and DRs1-4, respectively. An additional DHQ was completed at one year after completing DHQ1 (DHQ5. Monetary cost of dietary energy (Japanese yen/4184 kJ was calculated using food intake information derived from each dietary assessment method, based on retail food prices. Pearson correlation between the mean of DRs1-4 and mean of DHQs1-4 was 0.64 for women and 0.69 for men. Pearson correlation between the mean of DRs1-4 and DHQ1 was 0.60 for women and 0.52 for men, while intraclass correlation between DHQ1 and DHQ5 was 0.64 for women and 0.51 for men. These data indicate reasonable comparability of monetary cost of dietary energy across DR and a DHQ as well as usefulness of a single administration of the DHQ for estimating monetary cost of dietary energy.

  4. Comparability of Weighed Dietary Records and a Self-Administered Diet History Questionnaire for Estimating Monetary Cost of Dietary Energy

    Directory of Open Access Journals (Sweden)

    Kentaro Murakami

    2008-01-01

    Full Text Available An increasing number of studies have estimated monetary diet cost using various dietary assessment methods, based on databases on retail food prices, for investigating its association with dietary intake and health outcomes. However, information regarding the comparability of monetary diet cost across dietary assessment methods is absolutely lacking. This study compared monetary cost of dietary energy estimated from weighed dietary records (DRs with that estimated from a self-administered diet history questionnaire (DHQ. The subjects were 92 Japanese women aged 31-69 years and 92 Japanese men aged 32-76 years. The DHQ (assessing diet during the preceding month and 4-day DRs (one weekend day and three weekdays were completed in each season over a 1-year period (DHQs1-4 and DRs1-4, respectively. An additional DHQ was completed at one year after completing DHQ1 (DHQ5. Monetary cost of dietary energy (Japanese yen/4184 kJ was calculated using food intake information derived from each dietary assessment method, based on retail food prices. Pearson correlation between the mean of DRs1-4 and mean of DHQs1-4 was 0.64 for women and 0.69 for men. Pearson correlation between the mean of DRs1-4 and DHQ1 was 0.60 for women and 0.52 for men, while intraclass correlation between DHQ1 and DHQ5 was 0.64 for women and 0.51 for men. These data indicate reasonable comparability of monetary cost of dietary energy across DR and a DHQ as well as usefulness of a single administration of the DHQ for estimating monetary cost of dietary energy.

  5. At what price? A cost-effectiveness analysis comparing trial of labour after previous Caesarean versus elective repeat Caesarean delivery.

    LENUS (Irish Health Repository)

    Fawsitt, Christopher G

    2013-01-01

    Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.

  6. [Cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of rheumatoid arthritis].

    Science.gov (United States)

    Salinas-Escudero, Guillermo; Vargas-Valencia, Juan; García-García, Erika Gabriela; Munciño-Ortega, Emilio; Galindo-Suárez, Rosa María

    2013-01-01

    to conduct cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of moderate or severe rheumatoid arthritis in patients with previous unresponse to immune selective anti-inflammatory derivatives failure. a pharmacoeconomic model based on decision analysis to assess the clinical outcome after giving etanercept, infliximab, adalimumab or tocilizumab to treat moderate or severe rheumatoid arthritis was employed. Effectiveness of medications was assessed with improvement rates of 20 % or 70 % of the parameters established by the American College of Rheumatology (ACR 20 and ACR 70). the model showed that etanercept had the most effective therapeutic response rate: 79.7 % for ACR 20 and 31.4 % for ACR 70, compared with the response to other treatments. Also, etanercept had the lowest cost ($149,629.10 per patient) and had the most cost-effective average ($187,740.40 for clinical success for ACR 20 and $476,525.80 for clinical success for ACR 70) than the other biologic therapies. we demonstrated that treatment with etanercept is more effective and less expensive compared to the other drugs, thus making it more efficient therapeutic option both in terms of means and incremental cost-effectiveness ratios for the treatment of rheumatoid arthritis.

  7. Comparative cost-effectiveness of antiviral therapies in patients with chronic hepatitis B: a systematic review of economic evidence.

    Science.gov (United States)

    Sun, Xin; Qin, Wen-Xia; Li, You-Ping; Jiang, Xu-Hua

    2007-09-01

    Economic efficiency of the alternative antiviral therapies for chronic hepatitis B has not been systematically investigated and their quality remains unknown. The aim of the present study was to systematically overview economic evidence of antiviral therapies for chronic hepatitis B. We searched six databases and eight major journals supplemented with screening references of eligible studies. Full economic evaluations comparing alternative antiviral therapies in patients with chronic hepatitis B virus infection were included. Two investigators assessed the study quality and transferability, independently. Data were analyzed qualitatively with adjustment when appropriate. Fourteen studies (six modeling vs eight trials and database analyses) were included. Quality was high in five studies, moderate in one US and five Chinese studies, and low in three Chinese studies. The major problems of quality are costing methods and analysis and the presentation of results. In Australia and Poland, lamivudine-preferred strategies dominated interferon (IFN)-alpha and its related strategy from the health-care sector perspective. In the US, adefovir salvage produced US$8446 per additional quality-adjusted life years (QALY) compared with IFN-alpha. In Spain, the cost of adefovir was US$34,840 for additional virological response. In Taiwan, the use of pegylated IFN-alpha (pegIFN-alpha) produced US$11,711.4 per additional QALY, compared with lamivudine. In China, the incremental cost-effectiveness ratios of combination therapy lamivudine ranged from US$2860 to US$22,160 per additional loss of hepatitis B e antigen (HBeAg), and IFN-alpha versus lamivudine ranged from US$2490 to US$8890 per additional loss of HBeAg. The cost-effectiveness frontiers of treatment alternatives vary and are influenced by the comparators and socioeconomic conditions of countries. Lamivudine-containing therapy is cost-effective when newer antiviral agents (e.g. adefovir/pegIFN-alpha) were not available

  8. Comparative risk-benefit-cost effectiveness in nuclear and alternate power sources: methodology, perspective, limitations

    International Nuclear Information System (INIS)

    Vinck, W.; Van Reijen, G.; Maurer, H.; Volta, G.

    1980-01-01

    A critical survey is given of the use of quantitative risk assessment in defining acceptable limits of safety and of its use together with cost-benefit analyses for decision making. The paper indicates uncertainties and even unknowns in risk assessment in particular if the whole fuel cycle for energy production is considered. It is made clear that for decisions on acceptance of risk also the risk perception factor must be considered. A difficult issue here is the potential for low-probability/large consequence accidents. Examples are given, suggestions for improvement are made and perspectives are outlined

  9. Cost-effectiveness analysis of Mammostrat® compared with Oncotype DX® to inform the treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Mislick K

    2014-01-01

    Full Text Available Kimberly Mislick,1 Warren Schonfeld,2 Carolyn Bodnar,3 Kuo Bianchini Tong2 1Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, USA; 2Quorum Consulting, Inc, San Francisco, CA, USA; 3GE Healthcare, Chalfont St Giles, Buckinghamshire, UK Purpose: To compare the cost-effectiveness of the tumor subtyping assays Mammostrat® and Oncotype DX® for assessing risk of recurrence in early-stage breast cancer and the potential benefit of adjuvant chemotherapy. Methods: Cost-effectiveness analysis from a US third-party payer perspective. A 10 year Markov model was developed to estimate costs and effects of using each method of risk assessment. The percentages of patients assessed as high, moderate, or low risk were obtained from multicenter, prospective, randomized controlled trials. The analysis simulated the experience of women progressing through various model states representing clinical treatments and subsequent disease. Published recurrence data for Mammostrat® were adjusted appropriately to account for differences between definitions and samples of Oncotype DX® and Mammostrat® in the original clinical trials. Cost and utility data were obtained from previously published studies. Sensitivity analyses examined how base-case results might differ when input values and assumptions varied. Results: Base-case costs for women assessed using Mammostrat® were $15,782, compared with $18,051 for women assessed with Oncotype DX®. Thus, cost savings of $2,268 resulted from using Mammostrat®. Both Mammostrat® and Oncotype DX® resulted in similar life years (9.880 and 9.882 and quality-adjusted life years (7.935 and 7.940, respectively. Sensitivity analyses demonstrated that the assumptions made about recurrence are the key drivers of model results. Discussion: Cost savings associated with the use of Mammostrat® instead of Oncotype DX® are largely due to the difference in cost between the two tests. Since survival and quality-adjusted life years

  10. A comparative analysis of different pulse width modulation methods for low cost induction motor drives

    International Nuclear Information System (INIS)

    Kojabadi, Hossein Madadi

    2011-01-01

    Many pulse width modulation (PWM) methods for low cost induction motor (IM) drives have been proposed to design high performance industrial motor drives. However most of them have unbalance three phase output currents due to the dynamic unbalance between the two capacitors. Three different PWM methods, namely; hysteresis current control, sinusoidal pulse width modulation (SPWM) and a novel four switch low cost IM drives are discussed in this paper. The second one, namely SPWM, is based on the generalization of existing methods, and the third one is the proposed method, which is an improvement over the two other methods. Although all three schemes can provide three output currents with 120 o phase shift for IM drive, the proposed technique is superior to others in achieving more precise current control with minimum distortion and harmonic noise, and at the same time, negligible unbalance in output currents. Simulation and experimental results of hysteresis current control, SPWM method and new proposed method is presented in order to confirm the effectiveness of proposed method in providing balanced three phase output currents and voltages.

  11. Cost-Effectiveness Analysis in Comparing Alginate Silver Dressing with Silver Zinc Sulfadiazine Cream in the Treatment of Pressure Ulcers

    Directory of Open Access Journals (Sweden)

    Apirag Chuangsuwanich

    2013-09-01

    Full Text Available BackgroundThe treatment of pressure ulcers is complicated, given the various wound dressing products available. The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated. We compare two wound dressing protocols-alginate silver dressing (AlSD and silver zinc sulfadiazine cream (AgZnSD with regard to wound healing and cost-effectiveness.MethodsPatients with grade III or IV sacral or trochanteric pressure ulcers were eligible for this prospective, randomized controlled trial. The patients were randomized to receive one of the two dressings for an eight-week period. The criteria of efficacy were based on the Pressure Ulcer Scale for Healing (PUSH scoring tool. The cost of treatment was also assessed.ResultsTwenty patients (12 women and 8 men were randomly assigned to receive either AlSD (n=10 or AgZnSD cream (n=10. The demographic data and wound characteristics were comparable in the two groups. The two groups showed no significant difference in the reduction of PUSH score, wound size, or volume of exudate. The tissue type score was significantly lower in the AlSD group (3.15±0.68-1.85±0.68 vs. 2.73±0.79-2.2±0.41; P=0.015. The cost of treatment was significantly lower in the AlSD group (377.17 vs. 467.74 USD, respectively; P<0.0001.ConclusionsAlginate silver dressing could be effectively used in the treatment of grade III and IV pressure ulcers. It can improve wound tissue characteristics and is cost-effective.

  12. Differential sympathetic outflow to adipose depots is required for visceral fat loss in response to calorie restriction

    OpenAIRE

    Sipe, L M; Yang, C; Ephrem, J; Garren, E; Hirsh, J; Deppmann, C D

    2017-01-01

    The sympathetic nervous system (SNS) regulates energy homeostasis in part by governing fatty acid liberation from adipose tissue. We first examined whether SNS activity toward discrete adipose depots changes in response to a weight loss diet in mice. We found that SNS activity toward each adipose depot is unique in timing, pattern of activation, and habituation with the most dramatic contrast between visceral and subcutaneous adipose depots. Sympathetic drive toward visceral epididymal adipos...

  13. Performance Gains of Propellant Management Devices for Liquid Hydrogen Depots

    Science.gov (United States)

    Hartwig, Jason W.; McQuillen, John B.; Chato, David J.

    2013-01-01

    This paper presents background, experimental design, and preliminary experimental results for the liquid hydrogen bubble point tests conducted at the Cryogenic Components Cell 7 facility at the NASA Glenn Research Center in Cleveland, Ohio. The purpose of the test series was to investigate the parameters that affect liquid acquisition device (LAD) performance in a liquid hydrogen (LH2) propellant tank, to mitigate risk in the final design of the LAD for the Cryogenic Propellant Storage and Transfer Technology Demonstration Mission, and to provide insight into optimal LAD operation for future LH2 depots. Preliminary test results show an increase in performance and screen retention over the low reference LH2 bubble point value for a 325 2300 screen in three separate ways, thus improving fundamental LH2 LAD performance. By using a finer mesh screen, operating at a colder liquid temperature, and pressurizing with a noncondensible pressurant gas, a significant increase in margin is achieved in bubble point pressure for LH2 screen channel LADs.

  14. Limited risk assessment and some cost/benefit considerations for greater confinement disposal compared to shallow land burial

    International Nuclear Information System (INIS)

    Hunter, P.H.; Lester, D.H.; Robertson, L.D.; Spaeth, M.E.; Stoddard, J.A.; Dickman, P.T.

    1984-09-01

    A limited risk assessment and some cost/benefit considerations of greater confinement disposal (GCD) compared to shallow land burial (SLB) are presented. This study is limited to an analysis of the postclosure phase of hypothetical GCD and SLB facilities. Selected release scenarios are used which bound the range of risks to a maximally exposed individual and a hypothetical population. Based on the scenario assessments, GCD had a significant risk advantage over SLB for normal exposure pathways at both humid and arid sites, particularly for the human intrusion scenario. Since GCD costs are somewhat higher than SLB, it is necessary to weigh the higher costs of GCD against the higher risks of SLB. In this regard, GCD should be pursued as an alternative to SLB for certain types of low-level waste, and as an alternative to processing for wastes requiring improved stabilization or higher integrity packaging to be compatible with SLB. There are two reasons for this conclusion. First, GCD might diminish public apprehension regarding the disposal of wastes perceived to be too hazardous for SLB. Second, GCD may be a relatively cost-effective alternative to various stabilization and packaging schemes required to meet 10 CFR 61 near-surface requirements as well as being a cost-effective alternative to deep geologic disposal. Radionuclide transport through the biosphere and resultant dose consequences were determined using the RADTRAN radionuclide transport code. 19 references, 4 figures, 5 tables

  15. Advanced Imaging Reduces Cost Compared to Standard of Care in Emergency Department of Triage of Acute Chest Pain.

    Science.gov (United States)

    Noack, Pamela S; Moore, Jhanna A; Poon, Michael

    2017-11-13

    To evaluate medical costs of novel therapies in complex medical settings using registry data. Primary data, from 2008 to 2010. We used patient registry data to evaluate cost and quality performance of coronary computed tomography angiography (CCTA) in triaging chest pain patients in our tertiary care emergency department and to model financial performance under Medicare's two midnight rule. Using generalized linear modeling, we retrospectively compared estimated expenditures for evaluation of low-to-intermediate-risk chest pain for demographic and medically risk matched samples of 894 patients each, triaged with CCTA or local standard of care (SOC) using Medicare reimbursement as a proxy. Predefined data elements were downloaded from the hospital mainframe into the CCTA registry, where they were validated and maintained electronically. We found that predicted standard of care costs were 2.5 times higher on the initial visit and 1.98 times higher over 30 days (p < .001) than those using CCTA. Predicted cost was 1.6 times higher when we applied our two midnight rule model (p < .001). Rapid assessment of treatment using registry data is a promising means of analyzing cost performance in complex health care environments. © Health Research and Educational Trust.

  16. Cost-effectiveness of amlodipine compared with valsartan in preventing stroke and myocardial infarction among hypertensive patients in Taiwan

    Directory of Open Access Journals (Sweden)

    Chan L

    2016-05-01

    Full Text Available Lung Chan,1 Chen-Huan Chen,2 Juey-Jen Hwang,3 San-Jou Yeh,4 Kou-Gi Shyu,5 Ruey-Tay Lin,6 Yi-Heng Li,7 Larry Z Liu,8 Jim Z Li,9 Wen-Yi Shau,10 Te-Chang Weng,10 1Department of Neurology, Shuang-Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University, New Taipei, 2Department of Internal Medicine, Faculty of Medicine, National Yang-Ming University, 3Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 4Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, 5Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 6Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, 7Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 8Pfizer Inc, New York, NY, USA; 9Pfizer Inc, San Diego, CA ,USA; 10Pfizer Ltd., New Taipei City, Taiwan Abstract: Hypertension is a major risk factor for strokes and myocardial infarction (MI. Given its effectiveness and safety profile, the calcium channel blocker amlodipine is among the most frequently prescribed antihypertensive drugs. This analysis was conducted to determine the costs and quality-adjusted life years (QALYs associated with the use of amlodipine and valsartan, an angiotensin II receptor blocker, in preventing stroke and MI in Taiwanese hypertensive patients. A state transition (Markov model was developed to compare the 5-year costs and QALYs for amlodipine and valsartan. Effectiveness data were based on the NAGOYA HEART Study, local studies, and a published meta-analysis. Utility data and costs of MI and stroke were retrieved from the published literature. Medical costs were based on the literature and inflated to 2011 prices; drug costs were based on National Health Insurance prices in 2014. A 3% discount rate was used for costs and QALYs and a third-party payer perspective

  17. Comparing Value of Urban Green Space Using Contingent Valuation and Travel Cost Methods

    Directory of Open Access Journals (Sweden)

    Chintantya Dea

    2018-01-01

    Full Text Available Green urban open space are an important element of the city. They gives multiple benefits for social life, human health, biodiversity, air quality, carbon sequestration, and water management. Travel Cost Method (TCM and Contingent Valuation Method (CVM are the most frequently used method in various studies that assess environmental good and services in monetary term for valuing urban green space. Both of those method are determined the value of urban green space through willingness to pay (WTP for ecosystem benefit and collected data through direct interview and questionnaire. Findings of this study showed the weaknesses and strengths of both methods for valuing urban green space and provided factors influencing the probability of user’s willingness to pay in each method.

  18. Comparing Value of Urban Green Space Using Contingent Valuation and Travel Cost Methods

    Science.gov (United States)

    Chintantya, Dea; Maryono

    2018-02-01

    Green urban open space are an important element of the city. They gives multiple benefits for social life, human health, biodiversity, air quality, carbon sequestration, and water management. Travel Cost Method (TCM) and Contingent Valuation Method (CVM) are the most frequently used method in various studies that assess environmental good and services in monetary term for valuing urban green space. Both of those method are determined the value of urban green space through willingness to pay (WTP) for ecosystem benefit and collected data through direct interview and questionnaire. Findings of this study showed the weaknesses and strengths of both methods for valuing urban green space and provided factors influencing the probability of user's willingness to pay in each method.

  19. Arsenic removal from water using low-cost adsorbents: A comparative study

    Directory of Open Access Journals (Sweden)

    Rajaković Ljubinka V.

    2011-01-01

    Full Text Available Inorganic arsenic removal from water using low-cost adsorbents is presented in this paper. Selective removal of As(III and As(V from water was performed with natural materials (zeolite, bentonite, sepiolite, pyrolusite and limonite and industrial by-products (waste filter sand as a water treatment residual and blast furnace slag from steel production; all inexpensive and locally available. Kinetic and equilibrium studies were realized using batch system techniques under conditions that are likely to occur in real water treatment systems. The natural zeolite and the industrial by-products were found to be good and inexpensive sorbents for arsenic while bentonite and sepiolite clays showed little affinity towards arsenic. The highest maximum sorption capacities were obtained for natural zeolite, 4.07 mg As(V g-1, and waste iron slag, 4.04 mg As(V g-1.

  20. Comparative analysis of cost benefit division methodologies in a hydrothermal generation system

    International Nuclear Information System (INIS)

    Pereira, M.V.F.; Gorenstin, B.G.; Campodonico, N.M.; Costa, J.P. da; Kelman, J.

    1989-01-01

    The development and operation planning of the Brazilian generation system has been realized in a coordinate way by several years, due to some organizations, where the main generating companies from the country take part. The benefit share of the system to each participant of the planning and integrated operation has aroused interest. This paper describes the alternate forms of cost benefit allocation, between the participant companies of a coordinate operation, in order to reach an adequateness of remuneration and incentives. It was analysed two proposal of benefit allocation for energy export/import contracts: share by generation value and share by marginal benefit, concluding that the second one represents the best way of contribution for the several factors that comprising a hydroelectric power plant (storage capacity, effective storage and turbine capacity). (C.G.C.). 1 tab

  1. A Computational Tool for Comparative Energy Cost Analysis of Multiple-Crop Production Systems

    Directory of Open Access Journals (Sweden)

    Efthymios Rodias

    2017-06-01

    Full Text Available Various crops can be considered as potential bioenergy and biofuel production feedstocks. The selection of the crops to be cultivated for that purpose is based on several factors. For an objective comparison between different crops, a common framework is required to assess their economic or energetic performance. In this paper, a computational tool for the energy cost evaluation of multiple-crop production systems is presented. All the in-field and transport operations are considered, providing a detailed analysis of the energy requirements of the components that contribute to the overall energy consumption. A demonstration scenario is also described. The scenario is based on three selected energy crops, namely Miscanthus, Arundo donax and Switchgrass. The tool can be used as a decision support system for the evaluation of different agronomical practices (such as fertilization and agrochemicals application, machinery systems, and management practices that can be applied in each one of the individual crops within the production system.

  2. Compilation and review of methodologies for estimating the comparative electric power system costs for renewable energy systems. Working material

    International Nuclear Information System (INIS)

    1993-01-01

    This Working Material provides a review of methodologies for estimating the costs of renewable energy systems and the state of art knowledge on stochastic features and economic evaluation methodologies of renewable energy systems for electricity generation in a grid integrated system. It is expected that this material facilitates the wider access by interested persons to sources for relevant comparative assessment activities which are progressing in the IAEA. Refs, figs, tabs

  3. Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

    Science.gov (United States)

    Shah, Nirali M; Wang, Wenjuan; Bishai, David M

    2011-07-01

    Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

  4. Cognitive skills and bacterial load: comparative evidence of costs of cognitive proficiency in birds

    Science.gov (United States)

    Soler, Juan José; Peralta-Sánchez, Juan Manuel; Martín-Vivaldi, Manuel; Martín-Platero, Antonio Manuel; Flensted-Jensen, Einar; Møller, Anders Pape

    2012-02-01

    Parasite-mediated selection may affect the evolution of cognitive abilities because parasites may influence development of the brain, but also learning capacity. Here, we tested some predictions of this hypothesis by analyzing the relationship between complex behaviours (feeding innovations (as a measure of behavioural flexibility) and ability to detect foreign eggs in their nests (i.e. a measure of discriminatory ability)) and abundance of microorganisms in different species of birds. A positive relationship would be predicted if these cognitive abilities implied a larger number of visited environments, while if these skills favoured detection and avoidance of risky environments, a negative relationship would be the prediction. Bacterial loads of eggshells, estimated for mesophilic and potentially pathogenic bacteria (i.e. Enterococcus, Staphylococcus and Enterobacteriaceae), were used as a surrogate of probability of contact with pathogenic bacteria. We found that bird species with higher feeding innovation rates and rejection rates of experimental brood parasitic eggs had higher density of bacteria on their eggshells than the average species. Since the analysed groups of microorganisms include pathogenic bacteria, these results suggest that both feeding innovation and ability to recognize foreign eggs are costly and highlight the importance of parasite-mediated selection in explaining the evolution of cognitive abilities in animals.

  5. Capturing Fine Details Involving Low-Cost Sensors -a Comparative Study

    Science.gov (United States)

    Rehany, N.; Barsi, A.; Lovas, T.

    2017-11-01

    Capturing the fine details on the surface of small objects is a real challenge to many conventional surveying methods. Our paper discusses the investigation of several data acquisition technologies, such as arm scanner, structured light scanner, terrestrial laser scanner, object line-scanner, DSLR camera, and mobile phone camera. A palm-sized embossed sculpture reproduction was used as a test object; it has been surveyed by all the instruments. The result point clouds and meshes were then analyzed, using the arm scanner's dataset as reference. In addition to general statistics, the results have been evaluated based both on 3D deviation maps and 2D deviation graphs; the latter allows even more accurate analysis of the characteristics of the different data acquisition approaches. Additionally, own-developed local minimum maps were created that nicely visualize the potential level of detail provided by the applied technologies. Besides the usual geometric assessment, the paper discusses the different resource needs (cost, time, expertise) of the discussed techniques. Our results proved that even amateur sensors operated by amateur users can provide high quality datasets that enable engineering analysis. Based on the results, the paper contains an outlook to potential future investigations in this field.

  6. Labor Market Policy: A Comparative View on the Costs and Benefits of Labor Market Flexibility

    Science.gov (United States)

    Kahn, Lawrence M.

    2012-01-01

    I review theories and evidence on wage-setting institutions and labor market policies in an international comparative context. These include collective bargaining, minimum wages, employment protection laws, unemployment insurance (UI), mandated parental leave, and active labor market policies (ALMPs). Since it is unlikely that an unregulated…

  7. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes.

    Science.gov (United States)

    Sherman, Jodi D; Raibley, Lewis A; Eckelman, Matthew J

    2018-01-09

    Traditional medical device procurement criteria include efficacy and safety, ease of use and handling, and procurement costs. However, little information is available about life cycle environmental impacts of the production, use, and disposal of medical devices, or about costs incurred after purchase. Reusable and disposable laryngoscopes are of current interest to anesthesiologists. Facing mounting pressure to quickly meet or exceed conflicting infection prevention guidelines and oversight body recommendations, many institutions may be electively switching to single-use disposable (SUD) rigid laryngoscopes or overcleaning reusables, potentially increasing both costs and waste generation. This study provides quantitative comparisons of environmental impacts and total cost of ownership among laryngoscope options, which can aid procurement decision making to benefit facilities and public health. We describe cradle-to-grave life cycle assessment (LCA) and life cycle costing (LCC) methods and apply these to reusable and SUD metal and plastic laryngoscope handles and tongue blade alternatives at Yale-New Haven Hospital (YNHH). The US Environmental Protection Agency's Tool for the Reduction and Assessment of Chemical and other environmental Impacts (TRACI) life cycle impact assessment method was used to model environmental impacts of greenhouse gases and other pollutant emissions. The SUD plastic handle generates an estimated 16-18 times more life cycle carbon dioxide equivalents (CO2-eq) than traditional low-level disinfection of the reusable steel handle. The SUD plastic tongue blade generates an estimated 5-6 times more CO2-eq than the reusable steel blade treated with high-level disinfection. SUD metal components generated much higher emissions than all alternatives. Both the SUD handle and SUD blade increased life cycle costs compared to the various reusable cleaning scenarios at YNHH. When extrapolated over 1 year (60,000 intubations), estimated costs increased

  8. Distinct Adipose Depots from Mice Differentially Respond to a High-Fat, High-Salt Diet.

    Science.gov (United States)

    DeClercq, Vanessa C; Goldsby, Jennifer S; McMurray, David N; Chapkin, Robert S

    2016-06-01

    Dietary factors such as high-sodium or high-fat (HF) diets have been shown to induce a proinflammatory phenotype. However, there is limited information with respect to how microenvironments of distinct intra-abdominal adipose depots respond to the combination of a high-salt, HF diet. We tested the hypothesis that HF feeding would cause changes in distinct adipose depots, which would be further amplified by the addition of high salt to the diet. Twenty-seven male C57BL6 mice were fed an HF diet (60% of kcal from fat), an HF + high-salt diet (4% wt:wt), a control diet [low-fat (LF);10% of kcal from fat], or an LF + high-salt diet for 12 wk. The main sources of fat in the diets were corn oil and lard. Adipokines in serum and released from adipose tissue organ cultures were measured by immunoassays. QIAGEN's Ingenuity Pathway Analysis was used to perform functional analysis of the RNA-sequencing data from distinct adipose depots. Diet-induced obesity resulted in a classical inflammatory phenotype characterized by increased concentrations of circulating inflammatory mediators (38-56%) and reduced adiponectin concentrations (27%). However, high-salt feeding did not exacerbate the HF diet-induced changes in adipokines and cytokines. Leptin and interleukin-6 were differentially released from adipose depots and HF feeding impaired adiponectin and resistin secretion across all 3 depots (34-48% and 45-83%, respectively). The addition of high salt to the HF diet did not further modulate secretion in cultured adipose tissue experiments. Although gene expression data from RNA sequencing indicated a >4.3-fold upregulation of integrin αX (Itgax) with HF feeding in all 3 depots, markers of cellular function were differentially expressed in response to diet across depots. Collectively, these findings highlight the role of distinct adipose depots in mice in the development of obesity and emphasize the importance of selecting specific depots to study the effects of therapeutic

  9. Financing end-use solar technologies in a restructured electricity industry: Comparing the cost of public policies

    International Nuclear Information System (INIS)

    Jones, E.; Eto, J.

    1997-09-01

    Renewable energy technologies are capital intensive. Successful public policies for promoting renewable energy must address the significant resources needed to finance them. Public policies to support financing for renewable energy technologies must pay special attention to interactions with federal, state, and local taxes. These interactions are important because they can dramatically increase or decrease the effectiveness of a policy, and they determine the total cost of a policy to society as a whole. This report describes a comparative analysis of the cost of public policies to support financing for two end-use solar technologies: residential solar domestic hot water heating (SDHW) and residential rooftop photovoltaic (PV) systems. The analysis focuses on the cost of the technologies under five different ownership and financing scenarios. Four scenarios involve leasing the technologies to homeowners in return for a payment that is determined by the financing requirements of each form of ownership. For each scenario, the authors examine nine public policies that might be used to lower the cost of these technologies: investment tax credits (federal and state), production tax credits (federal and state), production incentives, low-interest loans, grants (taxable and two types of nontaxable), direct customer payments, property and sales tax reductions, and accelerated depreciation

  10. Cost-effectiveness of HPV vaccination regime: comparing twice versus thrice vaccinations dose regime among adolescent girls in Malaysia.

    Science.gov (United States)

    Aljunid, Syed; Maimaiti, Namaitijiang; Nur, Amrizal M; Noor, Mohd Rushdan Md; Wan Puteh, Sharifa Ezat

    2016-01-23

    The HPV vaccine was introduced to Malaysian national immunization programme in 2010. The current implementation age of HPV vaccination in Malaysian is at the age of 13 years school girls, given according to a 3 doses protocol which may complicate implementation and compliance. Aim of the study is to determine the cost-effectiveness of HPV vaccination regime comparing twice versus thrice HPV vaccinations dose regime among adolescent girls in Malaysia. A Markov cohort model reflecting the natural history of HPV infection accounting for oncogenic and low-risk HPV was adapted for 13 year old Malaysian girls cohort (n = 274,050). Transition probabilities, utilities values, epidemiological and cost data were sourced from published literature and local data. Vaccine effectiveness was based on overall efficacy reported from 3-doses clinical trials, with the assumption that the 2-doses is non-inferior to the 3-doses allowing overall efficacy to be inferred from the 3-doses immunogenicity data. Price parity and life-long protection were assumed. The payer perspective was adopted, with appropriate discounting for costs (3 %) and outcomes (3 %). One way sensitivity analysis was conducted. The sensitivity analysis on cost of vaccine, vaccine coverage and discount rate with a 2-doses protocol was performed. The 3-doses and 2-doses regimes showed same number of Cervical Cancers averted (361 cases); QALYs saved at 7,732,266. However, the lifetime protection under the 2-doses regime, showed a significant cost-savings of RM 36, 722,700 compared to the 3-doses scheme. The MOH Malaysia could vaccinate 137,025 more girls in this country using saving 2-doses regime vaccination programme. The model predicted that 2-doses HPV vaccination schemes can avoid additional 180 Cervical Cancers and 63 deaths compare to 3-doses. A 2-doses HPV vaccination scheme may enable Malaysian women to be protected at a lower cost than that achievable under a 3-doses scheme, while avoiding the same number of

  11. Comparing Equation of Exchange and Wage-Cost Mark-up Identity for Turkish Economy

    Directory of Open Access Journals (Sweden)

    Rahmi Yamak

    2015-12-01

    Full Text Available In economic literature, Monetarists have argued that money growth over transactions growth would exactly cause the same growth in the price level. In contrast, Weintraub, one of the leading economists of the Post Keynesian School has believed that the effect of the money supply on the price level is not direct. The aim of this study is to empirically investigate and to compare the arguments of Monetarists and Post Keynesians on the inflation for the case of Turkey. The data used in the study are annual and cover the period of 1990-2013. In this study, the equations implied by both Schools were compared to each other in terms of their predictive powers, their statistical robustness and the validity of the hypotheses provided by them. In a result, strong support was found for WCMI especially in terms of its predictive power.

  12. Electric or pneumatic? Comparing electric and pneumatic linear drives with regard to energy efficiency and costs

    OpenAIRE

    Hirzel, Simon; Hettesheimer, Tim; Schröter, Marcus

    2014-01-01

    Linear drives are broadly used in industrial automation, e.g. for material handling systems, assembly lines or machine tools. In many applications, both compressed-air powered pneumatic drives as well as linear electric drives can be used. The use of compressed air is generally associated with comparatively low energy efficiency. This has triggered a debate about the energy-related performance of alternative drive systems. In this paper, we contribute to this debate by providing insights into...

  13. Depo-Provera (depot medroxyprogesterone acetate) use after bariatric surgery.

    Science.gov (United States)

    Lam, Clarissa; Murthy, Amitasrigowri S

    2016-01-01

    In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m 2 and 29.9 kg/m 2 ) or obese (body mass index >30 kg/m 2 ). In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA) and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE). The obesity-associated increase in VTE should be mitigated by surgically induced weight loss. The concurrent use of DMPA in the post bariatric surgical period should not further increase the risk of VTE.

  14. Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance.

    Science.gov (United States)

    Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P; Colla, Carrie H

    2018-01-31

    To examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) is associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). Three waves of the National Survey of ACOs and corresponding publicly available Centers for Medicare & Medicaid Services performance data for NSACO respondents participating in the MSSP (N = 204); SK&A Office Based Physicians Database from QuintilesIMS. We compare the performance of three ACO types (physician-led, integrated, and hybrid) for three domains: quality, spending, and likelihood of achieving savings. Sources of performance variation within and between ACO types are compared for each performance measure. There is greater heterogeneity within ACO types than between ACO types. There were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year. There was evidence for higher spending on physician services for physician-led ACOs. ACOs of diverse structures perform comparably on core MSSP quality and spending measures. CMS should maintain its flexibility and continue to support participation of diverse ACOs. Future research to identify modifiable organizational factors that account for performance variation within ACO types may provide insight as to how best to improve ACO performance based on organizational structure and ownership. © Health Research and Educational Trust.

  15. Enhanced intelligent water drops algorithm for multi-depot vehicle routing problem.

    Science.gov (United States)

    Ezugwu, Absalom E; Akutsah, Francis; Olusanya, Micheal O; Adewumi, Aderemi O

    2018-01-01

    The intelligent water drop algorithm is a swarm-based metaheuristic algorithm, inspired by the characteristics of water drops in the river and the environmental changes resulting from the action of the flowing river. Since its appearance as an alternative stochastic optimization method, the algorithm has found applications in solving a wide range of combinatorial and functional optimization problems. This paper presents an improved intelligent water drop algorithm for solving multi-depot vehicle routing problems. A simulated annealing algorithm was introduced into the proposed algorithm as a local search metaheuristic to prevent the intelligent water drop algorithm from getting trapped into local minima and also improve its solution quality. In addition, some of the potential problematic issues associated with using simulated annealing that include high computational runtime and exponential calculation of the probability of acceptance criteria, are investigated. The exponential calculation of the probability of acceptance criteria for the simulated annealing based techniques is computationally expensive. Therefore, in order to maximize the performance of the intelligent water drop algorithm using simulated annealing, a better way of calculating the probability of acceptance criteria is considered. The performance of the proposed hybrid algorithm is evaluated by using 33 standard test problems, with the results obtained compared with the solutions offered by four well-known techniques from the subject literature. Experimental results and statistical tests show that the new method possesses outstanding performance in terms of solution quality and runtime consumed. In addition, the proposed algorithm is suitable for solving large-scale problems.

  16. A blended design in acute care training: similar learning results, less training costs compared with a traditional format.

    Science.gov (United States)

    Dankbaar, Mary E W; Storm, Diana J; Teeuwen, Irene C; Schuit, Stephanie C E

    2014-09-01

    Introduction There is a demand for more attractive and efficient training programmes in postgraduate health care training. This retrospective study aims to show the effectiveness of a blended versus traditional face-to-face training design. For nurses in postgraduate Acute and Intensive Care training, the effectiveness of a blended course design was compared with a traditional design. Methods In a first pilot study 57 students took a traditional course (2-h lecture and 2-h workshop) and 46 students took a blended course (2-h lecture and 2-h online self-study material). Test results were compared for both groups. After positive results in the pilot study, the design was replicated for the complete programme in Acute and Intensive Care. Now 16 students followed the traditional programme (11 days face-to-face education) and 31 students did the blended programme (7 days face-to-face and 40 h online self-study). An evaluation was done after the pilot and course costs were calculated. Results Results show that the traditional and blended groups were similar regarding the main characteristics and did not differ in learning results for both the pilot and the complete programme. Student evaluations of both designs were positive; however, the blended group were more confident that they had achieved the learning objectives. Training costs were reduced substantially. Conclusion The blended training design offers an effective and attractive training solution, leading to a significant reduction in costs.

  17. Time-Driven Activity-Based Costing: A Comparative Cost Analysis of Whole-Breast Radiotherapy Versus Balloon-Based Brachytherapy in the Management of Early-Stage Breast Cancer.

    Science.gov (United States)

    Schutzer, Matthew E; Arthur, Douglas W; Anscher, Mitchell S

    2016-05-01

    Value in health care is defined as outcomes achieved per dollar spent, and understanding cost is critical to delivering high-value care. Traditional costing methods reflect charges rather than fundamental costs to provide a service. The more rigorous method of time-driven activity-based costing was used to compare cost between whole-breast radiotherapy (WBRT) and accelerated partial-breast irradiation (APBI) using balloon-based brachytherapy. For WBRT (25 fractions with five-fraction boost) and APBI (10 fractions twice daily), process maps were created outlining each activity from consultation to post-treatment follow up. Through staff interviews, time estimates were obtained for each activity. The capacity cost rates (CCR), defined as cost per minute, were calculated for personnel, equipment, and physical space. Total cost was calculated by multiplying the time required of each resource by its CCR. This was then summed and combined with cost of consumable materials. The total cost for WBRT was $5,333 and comprised 56% personnel costs and 44% space/equipment costs. For APBI, the total cost was $6,941 (30% higher than WBRT) and comprised 51% personnel costs, 6% space/equipment costs, and 43% consumable materials costs. The attending physician had the highest CCR of all personnel ($4.28/min), and APBI required 24% more attending time than WBRT. The most expensive activity for APBI was balloon placement and for WBRT was computed tomography simulation. APBI cost more than WBRT when using the dose/fractionation schemes analyzed. Future research should use time-driven activity-based costing to better understand cost with the aim of reducing expenditure and defining bundled payments. Copyright © 2016 by American Society of Clinical Oncology.

  18. A cost of illness study of children with high-functioning autism spectrum disorders and comorbid anxiety disorders as compared to clinically anxious and typically developing children

    NARCIS (Netherlands)

    van Steensel, F.J.A.; Dirksen, C.D.; Bögels, S.M.

    2013-01-01

    The study’s aim was to estimate the societal costs of children with high-functioning ASD and comorbid anxiety disorder(s) (ASD + AD-group; n = 73), and to compare these costs to children with anxiety disorders (AD-group; n = 34), and typically developing children (controls; n = 87). Mean total costs

  19. At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery.

    Directory of Open Access Journals (Sweden)

    Christopher G Fawsitt

    Full Text Available BACKGROUND: Elective repeat caesarean delivery (ERCD rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland. METHODS: Using a decision analytic model, a cost-effectiveness analysis (CEA was performed where the measure of health gain was quality-adjusted life years (QALYs over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations. RESULTS: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€ 1,835.06 versus € 4,039.87 per women, respectively, and QALYs were modestly higher (0.84 versus 0.70. Our findings were supported by probabilistic sensitivity analysis. CONCLUSIONS: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single

  20. Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK.

    Science.gov (United States)

    Lloyd, A; Townsend, C; Munro, V; Twena, N; Nielsen, S; Holman, A

    2009-03-01

    In women with type 1 diabetes, poor glycaemic control during pregnancy is associated with high risk of pre-term delivery, perinatal mortality and morbidity. This economic analysis utilises clinical effectiveness data from the Insulin Aspart Pregnancy Study Group Trial to assess costs and outcomes associated with insulin aspart (IAsp) and human insulin (HI) as part of a basal-bolus insulin regimen in pregnant women with type 1 diabetes in the UK. Women with type 1 diabetes were enrolled if IAsp or HI in a basal-bolus regimen with NPH insulin, with doses titrated according to American Diabetes Association guidelines. An effectiveness endpoint, retrospectively defined for this analysis, was the percentage of women with a live birth at term (>or=37 weeks' gestation). We considered costs of insulin, adverse events, delivery, and neonatal care for pre-term infants. Expected need for neonatal care was estimated from gestational age, using data from the literature and a large UK hospital. Costs were calculated from the perspective of the UK National Health Service. A total of 322 pregnant women were enrolled in the study and the outcome of pregnancy was known for 302, 151 in each arm. More women experienced a live birth at term with IAsp (72.8%) than with HI (60.9%), difference 11.9% (95% CI 2.0%, 22.5%, p = 0.028). Mean cost per woman was 3222 pounds for IAsp and 3539 pounds for HI, difference--318 pounds (95% CI--1353 pounds, 576 pounds; p = 0.49). Compared with HI, the use of IAsp in pregnant women with type 1 diabetes resulted in more live births at term, without increasing total costs of treatment. A prospectively defined study is required to confirm these conclusions.

  1. Cost-Effectiveness Analysis in Comparing Alginate Silver Dressing with Silver Zinc Sulfadiazine Cream in the Treatment of Pressure Ulcers

    Directory of Open Access Journals (Sweden)

    Apirag Chuangsuwanich

    2013-09-01

    Full Text Available Background The treatment of pressure ulcers is complicated, given the various wound dressingproducts available. The cost of different treatments varies and the cost-effectiveness of eachproduct has not been thoroughly evaluated. We compare two wound dressing protocolsalginatesilver dressing (AlSD and silver zinc sulfadiazine cream (AgZnSD with regard towound healing and cost-effectivenessMethods Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible forthis prospective, randomized controlled trial. The patients were randomized to receive oneof the two dressings for an eight-week period. The criteria of efficacy were based on thePressure Ulcer Scale for Healing (PUSH scoring tool. The cost of treatment was also assessed.Results Twenty patients (12 women and 8 men were randomly assigned to receive eitherAlSD (n=10 or AgZnSD cream (n=10. The demographic data and wound characteristics werecomparable in the two groups. The two groups showed no significant difference in the reductionof PUSH score, wound size, or volume of exudate. The tissue type score was significantlylower in the AlSD group (3.15±0.68-1.85±0.68 vs. 2.73±0.79-2.2±0.41; P=0.015. The costof treatment was significantly lower in the AlSD group (377.17 vs. 467.74 USD, respectively;P<0.0001.Conclusions Alginate silver dressing could be effectively used in the treatment of grade IIIand IV pressure ulcers. It can improve wound tissue characteristics and is cost-effective.

  2. Comparative assessment of TRU waste forms and processes. Volume II. Waste form data, process descriptions, and costs

    International Nuclear Information System (INIS)

    Ross, W.A.; Lokken, R.O.; May, R.P.; Roberts, F.P.; Thornhill, R.E.; Timmerman, C.L.; Treat, R.L.; Westsik, J.H. Jr.

    1982-09-01

    This volume contains supporting information for the comparative assessment of the transuranic waste forms and processes summarized in Volume I. Detailed data on the characterization of the waste forms selected for the assessment, process descriptions, and cost information are provided. The purpose of this volume is to provide additional information that may be useful when using the data in Volume I and to provide greater detail on particular waste forms and processes. Volume II is divided into two sections and two appendixes. The first section provides information on the preparation of the waste form specimens used in this study and additional characterization data in support of that in Volume I. The second section includes detailed process descriptions for the eight processes evaluated. Appendix A lists the results of MCC-1 leach test and Appendix B lists additional cost data. 56 figures, 12 tables

  3. Therapeutic Efficacy and Cost Effectiveness of High Cut-Off Dialyzers Compared to Conventional Dialysis in Patients with Cast Nephropathy.

    Directory of Open Access Journals (Sweden)

    Adriano Curti

    Full Text Available High Cut-Off (HCO dialysis membranes efficiently reduce serum free light chain (FLC concentrations and may improve renal recovery and survival from multiple myeloma (MM associated renal failure with cast nephropathy. However, clinical trials comparing dialysis with HCO versus conventional filters are lacking. The aim of this study was to assess clinical outcomes and economic impact of HCO dialyzers compared to conventional hemodialysis membranes in cast nephropathy.Multicenter retrospective analysis of 19 patients treated for renal failure from FLC associated cast nephropathy with standard induction chemotherapy (bortezomib/dexamethasone. We compared hemodialysis treatment with High Cut-Off (n = 12 versus conventional dialyzers (n = 7. Primary endpoint was survival; secondary endpoints were renal recovery, renal function and treatment costs.At 12 months, patient survival was 25% in the HCO group versus 0% in controls (p = NS. A tendency towards faster renal recovery (p = 0.066 and better renal function at 3, 6 and 12 months (p = 0.109 after diagnosis of MM was noted in the HCO group. Complete renal response rate was achieved in 10.5 and 0% of HCO and control patients, respectively, partial renal response in 15.8 and 5.3%, and minor renal response in 26.3 and 15.8%, respectively. Both patient survival and renal recovery were significantly correlated with the extent of free light chain (FLC reduction in serum. Median treatment costs were CHF 230'000 and 223'000 (p = NS in the HCO and control group, respectively.Hemodialysis treatment with HCO membranes for cast nephropathy tended towards better survival as well as faster and better recovery of renal function versus conventional dialyzers. Moreover, total medical costs were comparable between groups. In the absence of results from randomized prospective trials on this topic, the use of HCO dialyzers in patients with renal failure from cast nephropathy may be recommended. Prospective randomized

  4. Comparative costs of the Mouse Inoculation Test (MIT) and Virus Isolation in Cell Culture (VICC) for use in rabies diagnosis in Brazil.

    Science.gov (United States)

    Bones, Vanessa C; Gameiro, Augusto H; Castilho, Juliana G; Molento, Carla F M

    2015-05-01

    The decision to use laboratory animals rather than in vitro methods is frequently based on the financial costs involved, so the objective of our study was to compare the costs of performing the Mouse Inoculation Test (MIT) and Virus Isolation in Cell Culture (VICC) for use in rabies diagnosis in Brazil. Based on observations of laboratory routines at the Pasteur Institute, São Paulo, we listed the fixed cost (FC) and variable cost (VC) items necessary to perform both tests. Considering that 200 MITs are equivalent to 350 VICC assays, in terms of facilities and staff-hours needed per month, we calculated, for both tests, the average total cost per sample, the costs of the implementation of the laboratory structure, and the costs of routine use. With regard to absolute values, the total cost was mainly influenced by FC items, as they represented 60% of the cost for the MIT and 86% of the cost for VICC. A sample analysed by the MIT costs around 205% more than one analysed by using VICC. The MIT costs 74% and 406% more than VICC, when implementation costs and routine use per month, respectively, are taken into account. Our results can assist in the resolution of costing disputes that could hinder the replacement of animals for rabies diagnosis in Brazil. The method demonstrated here might also be useful for cost comparisons in other situations where animal use still continues when validated alternatives exist. 2015 FRAME.

  5. Artificial intelligence technology assessment for the US Army Depot System Command

    Energy Technology Data Exchange (ETDEWEB)

    Pennock, K A

    1991-07-01

    This assessment of artificial intelligence (AI) has been prepared for the US Army's Depot System Command (DESCOM) by Pacific Northwest Laboratory. The report describes several of the more promising AI technologies, focusing primarily on knowledge-based systems because they have been more successful in commercial applications than any other AI technique. The report also identifies potential Depot applications in the areas of procedural support, scheduling and planning, automated inspection, training, diagnostics, and robotic systems. One of the principal objectives of the report is to help decisionmakers within DESCOM to evaluate AI as a possible tool for solving individual depot problems. The report identifies a number of factors that should be considered in such evaluations. 22 refs.

  6. The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health.

    Science.gov (United States)

    Guilbert, Edith R; Brown, Jacques P; Kaunitz, Andrew M; Wagner, Marie-Soleil; Bérubé, Jocelyn; Charbonneau, Louise; Francoeur, Diane; Gilbert, Andrée; Gilbert, François; Roy, Geneviève; Senikas, Vyta; Jacob, Robert; Morin, Réal

    2009-03-01

    In the fall of 2007, the controversy about the contraceptive use of depot-medroxyprogesterone acetate (DMPA) and its potential impact on skeletal health reached the media in the province of Quebec, Canada, thereby becoming a matter of concern for the lay public and physicians. In order to discuss this subject openly, the National Institute of Public Health of Quebec (INSPQ) organized a scientific meeting on February 15, 2008, with targeted physicians delegated by their medical associations in the fields of general practice, obstetrics and gynaecology, rheumatology, orthopaedic surgery, physiatry and endocrinology. Participants reviewed the scientific literature using the study classification method according to the level of evidence, reviewed published guidelines of medical societies and organizations on the subject and reached a consensus position. This manuscript presents a review of the literature and describes the consensus position of the targeted medical associations. The consensus position adopted by all the targeted medical associations determined that DMPA was a cost-effective contraceptive option that must be considered in the light of the clinical situation and preference of each woman. Candidates for injectable contraception should be informed that the use of DMPA is associated with a slight decrease in bone mineral density (BMD), which is largely, if not completely, reversible. There should not be an absolute limit to the length of time that the DMPA contraceptive is used, regardless of the woman's age. Monitoring BMD is not recommended among users of DMPA for contraceptive purposes. Finally, the consensus statement declared that, although supplements of calcium and vitamin D are beneficial for skeletal health for women in general, such supplementation should not be recommended solely based on a woman's use of DMPA. Given the scientific evidences, DMPA use remains a valid contraceptive option for women. Its potential impact on BMD must be balanced

  7. Why Sleep Matters-The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis.

    Science.gov (United States)

    Hafner, Marco; Stepanek, Martin; Taylor, Jirka; Troxel, Wendy M; van Stolk, Christian

    2017-01-01

    The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

  8. The comparative cost of food and beverages at remote Indigenous communities, Northern Territory, Australia.

    Science.gov (United States)

    Ferguson, Megan; O'Dea, Kerin; Chatfield, Mark; Moodie, Marjory; Altman, Jon; Brimblecombe, Julie

    2016-04-01

    To determine the average price difference between foods and beverages in remote Indigenous community stores and capital city supermarkets and explore differences across products. A cross-sectional survey compared prices derived from point-of-sale data in 20 remote Northern Territory stores with supermarkets in capital cities of the Northern Territory and South Australia for groceries commonly purchased in remote stores. Average price differences for products, supply categories and food groups were examined. The 443 products examined represented 63% of food and beverage expenditure in remote stores. Remote products were, on average, 60% and 68% more expensive than advertised prices for Darwin and Adelaide supermarkets, respectively. The average price difference for fresh products was half that of packaged groceries for Darwin supermarkets and more than 50% for food groups that contributed most to purchasing. Strategies employed by manufacturers and supermarkets, such as promotional pricing, and supermarkets' generic products lead to lower prices. These opportunities are not equally available to remote customers and are a major driver of price disparity. Food affordability for already disadvantaged residents of remote communities could be improved by policies targeted at manufacturers, wholesalers and/or major supermarket chains. © 2015 The Authors.

  9. Approach to cost-benefit analysis between supported employment and special employment centers through comparative simulation with 24 workers

    Directory of Open Access Journals (Sweden)

    Francisco de Borja Jordán de Urríes Vega

    2014-06-01

    Full Text Available This work presents a cost-benefit analysis comparing supported employment (SE with special employment center (EEC, from an individual, corporate and society perspective. A simulation was carried out with a sample of 24 workers in regular employment by SE and hypothetical data were obtained for the same workers as if they were in a similar job in EEC. The results show that SE workers, working the same amount of hours, have higher hourly earnings than in EEC (9.22 € compared to 4.59 €. The SE also generates less social burden from the company (22.21 % than EEC (85.54 %. The Supported Employment’s payoff for society is much higher (315.03% than that of the EEC (83.14%. Therefore, the conclusions of the study are directed towards the consideration that supported employment is more beneficial in terms of cost benefit for the individual, business and society when compared to the special employment centers.

  10. Open-source electronic data capture system offered increased accuracy and cost-effectiveness compared with paper methods in Africa.

    Science.gov (United States)

    Dillon, David G; Pirie, Fraser; Rice, Stephen; Pomilla, Cristina; Sandhu, Manjinder S; Motala, Ayesha A; Young, Elizabeth H

    2014-12-01

    Existing electronic data capture options are often financially unfeasible in resource-poor settings or difficult to support technically in the field. To help facilitate large-scale multicenter studies in sub-Saharan Africa, the African Partnership for Chronic Disease Research (APCDR) has developed an open-source electronic questionnaire (EQ). To assess its relative validity, we compared the EQ against traditional pen-and-paper methods using 200 randomized interviews conducted in an ongoing type 2 diabetes case-control study in South Africa. During its 3-month validation, the EQ had a lower frequency of errors (EQ, 0.17 errors per 100 questions; paper, 0.73 errors per 100 questions; P-value ≤0.001), and a lower monetary cost per correctly entered question, compared with the pen-and-paper method. We found no marked difference in the average duration of the interview between methods (EQ, 5.4 minutes; paper, 5.6 minutes). This validation study suggests that the EQ may offer increased accuracy, similar interview duration, and increased cost-effectiveness compared with paper-based data collection methods. The APCDR EQ software is freely available (https://github.com/apcdr/questionnaire). Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  11. A fluorescence-based assay for octreotide in kinetic release from depot formulations

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Guerreiro

    2012-01-01

    Full Text Available Here we report the validation of a derivatization method that makes use of fluorescamine as a selective reactant for the quantitative analysis of peptide and protein drugs in the dissolution profile from depot formulations. Typical current methods require separation of the nano/microparticles and time-consuming chromatographic runs. In this study we report a method which can be conducted without the need for complete physical separation of the particles or removal of the unreacted probe. This method was used here for the analysis of the release profile of octreotide in a depot formulation, with results in excellent agreement with reported chromatographic assays.

  12. Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis

    Science.gov (United States)

    Maldonado, Yvonne; Ioannidis, John P. A.; Contopoulos-Ioannidis, Despina

    2017-01-01

    Background Inclusion of vaccine herd-protection effects in cost-effectiveness analyses (CEAs) can impact the CEAs-conclusions. However, empirical epidemiologic data on the size of herd-protection effects from original studies are limited. Methods We performed a quantitative comparative analysis of the impact of herd-protection effects in CEAs for four childhood vaccinations (pneumococcal, meningococcal, rotavirus and influenza). We considered CEAs reporting incremental-cost-effectiveness-ratios (ICERs) (per quality-adjusted-life-years [QALY] gained; per life-years [LY] gained or per disability-adjusted-life-years [DALY] avoided), both with and without herd protection, while keeping all other model parameters stable. We calculated the size of the ICER-differences without vs with-herd-protection and estimated how often inclusion of herd-protection led to crossing of the cost-effectiveness threshold (of an assumed societal-willingness-to-pay) of $50,000 for more-developed countries or X3GDP/capita (WHO-threshold) for less-developed countries. Results We identified 35 CEA studies (20 pneumococcal, 4 meningococcal, 8 rotavirus and 3 influenza vaccines) with 99 ICER-analyses (55 per-QALY, 27 per-LY and 17 per-DALY). The median ICER-absolute differences per QALY, LY and DALY (without minus with herd-protection) were $15,620 (IQR: $877 to $48,376); $54,871 (IQR: $787 to $115,026) and $49 (IQR: $15 to $1,636) respectively. When the target-vaccination strategy was not cost-saving without herd-protection, inclusion of herd-protection always resulted in more favorable results. In CEAs that had ICERs above the cost-effectiveness threshold without herd-protection, inclusion of herd-protection led to crossing of that threshold in 45% of the cases. This impacted only CEAs for more developed countries, as all but one CEAs for less developed countries had ICERs below the WHO-cost-effectiveness threshold even without herd-protection. In several analyses, recommendation for the

  13. Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis.

    Science.gov (United States)

    Holubar, Marisa; Stavroulakis, Maria Christina; Maldonado, Yvonne; Ioannidis, John P A; Contopoulos-Ioannidis, Despina

    2017-01-01

    Inclusion of vaccine herd-protection effects in cost-effectiveness analyses (CEAs) can impact the CEAs-conclusions. However, empirical epidemiologic data on the size of herd-protection effects from original studies are limited. We performed a quantitative comparative analysis of the impact of herd-protection effects in CEAs for four childhood vaccinations (pneumococcal, meningococcal, rotavirus and influenza). We considered CEAs reporting incremental-cost-effectiveness-ratios (ICERs) (per quality-adjusted-life-years [QALY] gained; per life-years [LY] gained or per disability-adjusted-life-years [DALY] avoided), both with and without herd protection, while keeping all other model parameters stable. We calculated the size of the ICER-differences without vs with-herd-protection and estimated how often inclusion of herd-protection led to crossing of the cost-effectiveness threshold (of an assumed societal-willingness-to-pay) of $50,000 for more-developed countries or X3GDP/capita (WHO-threshold) for less-developed countries. We identified 35 CEA studies (20 pneumococcal, 4 meningococcal, 8 rotavirus and 3 influenza vaccines) with 99 ICER-analyses (55 per-QALY, 27 per-LY and 17 per-DALY). The median ICER-absolute differences per QALY, LY and DALY (without minus with herd-protection) were $15,620 (IQR: $877 to $48,376); $54,871 (IQR: $787 to $115,026) and $49 (IQR: $15 to $1,636) respectively. When the target-vaccination strategy was not cost-saving without herd-protection, inclusion of herd-protection always resulted in more favorable results. In CEAs that had ICERs above the cost-effectiveness threshold without herd-protection, inclusion of herd-protection led to crossing of that threshold in 45% of the cases. This impacted only CEAs for more developed countries, as all but one CEAs for less developed countries had ICERs below the WHO-cost-effectiveness threshold even without herd-protection. In several analyses, recommendation for the adoption of the target

  14. Depo-Provera (depot medroxyprogesterone acetate use after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lam C

    2016-09-01

    Full Text Available Clarissa Lam,1 Amitasrigowri S Murthy2,3 1New York University School of Medicine, 2Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York University School of Medicine, 3New York University Langone Medical Center, New York, NY, USA Abstract: In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2 or obese (body mass index >30 kg/m2. In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE. The

  15. Comparative effectiveness research as choice architecture: the behavioral law and economics solution to the health care cost crisis.

    Science.gov (United States)

    Korobkin, Russell

    2014-02-01

    With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  17. Depot-specific differences in fat mass expansion in WT and ob/ob mice.

    Science.gov (United States)

    Wang, Xinxia; Yu, Caihua; Feng, Jie; Chen, Jin; Jiang, Qin; Kuang, Shihuan; Wang, Yizhen

    2017-07-11

    The study was designed to investigate the cellular mechanisms underlying the differential fat expansion in different fat depots in wild type (WT) and ob/ob (OB) mice. At 6 weeks old, no differences in fat mass were found between SAT and VAT in WT mice, while O-SAT showed significantly higher weight than that of O-VAT. The average adipocyte size of SAT (~ 4133.47 μm2) was smaller than that of VAT (~ 7438.91 μm2) in OB mice. O-SAT preadipocytes gained higher triglyceride contents and higher levels of PPARγ and C/EBPα than did O-VAT preadipocytes upon in vitro differentiation. W-SAT and W-VAT displayed no significant differences in fatty acid uptake, while 1.36 fold significantly higher fatty acid uptake was found in O-SAT compared to O-VAT. Approximately 52% of the radioactivity recovered in cellular lipids was found in TAG in O-SAT, which was significantly higher than the other three adipocyte types. Significantly more radiolabelled oleic acid was β-oxidized to CO2 in adipocytes from O-VAT than that from O-SAT. ATP production was significantly lower in W-SAT compared with W-VAT, whereas no significantly ATP level was observed between O-SAT and O-VAT. Expression of UCP-1 in SAT from either WT or OB mice was significantly higher than the counterpart of VAT, which demonstrated higher uncoupled respiration and lower oxidative phosphorylation in SAT. Together, a combined increase in adipogenesis and FA uptake, and decreases in β-oxidation and ATP production, contributed to greater expansion of SAT compared to VAT in obese mice.

  18. Multicenter clinical trial of leuprolide acetate depot (Luphere depot 3.75 mg for efficacy and safety in girls with central precocious puberty

    Directory of Open Access Journals (Sweden)

    You Jin Kim

    2013-12-01

    Full Text Available PurposeWe evaluated the efficacy, safety and psychological aspect of monthly administrations of the gonadotropin-releasing hormone agonists (GnRHa, leuprolide acetate depot (Luphere depot 3.75 mg, in patients with precocious puberty.MethodsA total of 54 girls with central precocious puberty were administered with leuprolide acetate (Luphere depot 3.75 mg every four weeks over 24 weeks. We evaluated the percentage of children exhibiting a suppressed luteinizing hormone (LH response to GnRH (LH peak≤3 IU/L, peak LH/follicle stimulating hormone (FSH ratio of GnRH stimulation test less than 1, change in bone age/chronologic age ratio, change in the Tanner stage and change in eating habit and psychological aspect.Results(1 The percentage of children exhibiting a suppressed LH response to GnRH, defined as an LH peak≤3 IU/L at 24 weeks was 96.3 % (52/54. (2 The percentage of children exhibiting peak LH/FSH ratio<1 at 24 weeks of the study was 94.4 % (51/54. (3 The ratio of bone age and chronological age significantly declined from 1.27±0.07 to 1.24±0.01 after the 6 months of the study. (4 The mean Tanner stage manifested a significant change 2.3±0.48 at baseline, down to 1.70±0.61 at 24 weeks. (5 Based on the questionnaires, the score for eating habits showed a significant change from the baseline 34.0±6.8 to 31.3±6.8. (6 The psychological assessment did not exhibit a significant difference except with scores for sociability, problem behavior total score and other problems.ConclusionThe leuprolide 3.75 mg (Luphere depot is useful and safety for treating children with central precocious puberty.

  19. Comparative analysis of clinical efficacy and cost between University of Wisconsin solution and histidine-tryptophan-ketoglutarate.

    Science.gov (United States)

    Bellamy, Chris A; Nicely, Bruce; Mattice, Burton J; Teaster, Rob

    2008-09-01

    To compare University of Wisconsin solution (Viaspan), the universal standard for organ preservation, with histidine-tryptophan-ketoglutarate solution. An analysis of each solution, in reference to clinical trials with specific organs, is presented and assessed to find the efficacy of each in a clinical environment. Also to view each solution from an economical standpoint, and in the end develop an overall understanding of the key similarities and differences between each solution in order to assess appropriate use of each in a clinical setting. A literature search was conducted by using PubMed, MEDLINE, BIOSIS, Embase, and other online data bases to find the most recent studies of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions. Search terms included University of Wisconsin solution, histidine-tryptophan-ketoglutarate, preservation solution, cost analysis, biliary complication, and other related subjects. Previous research was selected from the literature search to provide basic information on the 2 solutions and also to provide clinical examples of each solution and the efficacy of each with specific organs. Information and published articles on the 2 solutions were gathered for descriptive and comparative purposes. The 2 solutions appear equally effective in organ preservation. Each solution has its own organ-specific qualities, and each has different complications. The studies reviewed here indicate that the differences are minor and thus suggest that the 2 solutions are equally acceptable for clinical use. Of the 2 solutions, histidine-tryptophan-ketoglutarate costs less than University of Wisconsin solution.

  20. A Comparative Study of Activity-Based Costing vs. Current Pricing System for Pathology Examinations at Okmeydani Training and Research Hospital, Turkey.

    Science.gov (United States)

    Yarikkaya, Enver; Özekinci, Selver; Sargan, Aytül; Durmuş, Şenay Erdoğan; Yildiz, Fetin Rüştü

    2017-01-01

    To provide real cost data for pathology examinations by using activity-based costing method, in order to provide means to departments, health administrators and the social security institution to achieve improvements in financial planning, quality and cost control. The cost of the histopathological examinations, which were accepted by the Department of Pathology at Okmeydanı Training and Research Hospital during August 2014, was calculated using the activity-based costing method. The costs were compared with the amounts specified in the Healthcare Implementation Notification Tariff and the conventional volume-based costing. Most pathology examinations listed within a given band in the Healthcare Implementation Notification Tariff show variations in unit costs. The study found that the costs of 77.4% of the examinations were higher than the prices listed in the Healthcare Implementation Notification Tariff. The pathology examination tariffs specified in the Healthcare Implementation Notification do not reflect the real costs of the examinations. The costs that are calculated using the activity-based costing system may vary according to the service types and levels of health care institutions. However, the main parameters of the method used in the study reflect the necessity of a more accurate banding of pathology examinations. The banding specified by the Healthcare Implementation Notification Tariff needs to be revised to reflect the real costs in Turkey.

  1. A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia.

    Science.gov (United States)

    Obure, Carol Dayo; Gaitan-Duarte, Hernando; Losada Saenz, Ricardo; Gonzalez, Lina; Angel-Muller, Edith; Laverty, Maura; Perez, Freddy

    2017-11-01

    HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited. A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated. A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US$10.26 and US$607.99, respectively in the single RDT arm. For the dual RDTs, the cost per pregnant woman tested for HIV and syphilis and cost per woman treated for syphilis were US$15.89 and US$1859.26, respectively. Overall costs per woman tested for HIV and syphilis and cost per woman treated for syphilis were lower in Cali compared with Bogota across both intervention arms. Staff costs accounted for the largest proportion of costs while treatment costs comprised <1% of the preventive programme. Findings show lower average costs for single RDTs compared with dual RDTs with costs sensitive to personnel costs and the scale of output at the health facilities. NCT02454816; results. 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/.

  2. Strategic Inventory Positioning of Navy Depot Level Repairable

    National Research Council Canada - National Science Library

    Burton, Larry

    2005-01-01

    ... the benefits in modifying their current inventory positioning policy for repairable items. NAVICP wishes to incorporate a strategic inventory positioning policy that reduces transportation costs...

  3. Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations.

    Science.gov (United States)

    Müller, Kai Ivar; Alstadhaug, Karl Bjørnar; Bekkelund, Svein Ivar

    2016-05-30

    The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings. Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches. From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Tromsø University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee's average salary: 3.5 hours spent on travel and consultation=one day's salary. Distance and time spent on travel were estimated by using Google Maps. Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and the investigation, advice, and prescription practices were not statistically

  4. Base Closure and Realignment Act (BRAC) Cleanup Plan, Sacramento Army Depot, Sacramento, California

    Science.gov (United States)

    1995-10-01

    deal.BeetStaffWirtier one point, Sacrampnto developer The Sacramento Army Depot is "I came and said This is thlMarvin " Buzz " Oafea talked to a a...class of persistent, board-spectrum insecticides, that linger in the environment and accumulate in the food chain. Among them are DDT, aldrin , dieldrin

  5. Pharmacodynamic effects of depot-medroxyprogesterone acetate (DMPA) administered to lactating women on their male infants

    NARCIS (Netherlands)

    Virutamasen, P; Leepipatpaiboon, S; Kriengsinyot, R; Vichaidith, P; Muia, PN; SekaddeKigondu, CB; Mati, JKG; Forest, MG; Dikkeschei, LD; Wolthers, BG; dArcangues, C

    Normal postpartum women, who had a spontaneous vaginal delivery of one full-term male infant, free of congenital abnormalities and other diseases, were recruited for this study. Thirteen women received 150 mg depot-medroxyprogesterone acetate (DMPA), intramuscularly on days 42 + 1 and 126 + 1

  6. Intrinsic differences in adipocyte precursor cells from different white fat depots

    DEFF Research Database (Denmark)

    Macotela, Yazmín; Emanuelli, Brice; Mori, Marcelo A

    2012-01-01

    Obesity and body fat distribution are important risk factors for the development of type 2 diabetes and metabolic syndrome. Evidence has accumulated that this risk is related to intrinsic differences in behavior of adipocytes in different fat depots. In the current study, we demonstrate that adip......, differentiation properties, and responses to environmental/genetic factors. Regulation of these populations may provide a new target for the treatment and prevention of obesity and its metabolic complications.......Obesity and body fat distribution are important risk factors for the development of type 2 diabetes and metabolic syndrome. Evidence has accumulated that this risk is related to intrinsic differences in behavior of adipocytes in different fat depots. In the current study, we demonstrate...... is higher in obesity-prone C57BL/6 mice than obesity-resistant 129 mice, and the number in both depots is increased by up to 270% by exposure of mice to high-fat diet. Thus, APCs from visceral and subcutaneous depots are dynamic populations, which have intrinsic differences in gene expression...

  7. Population Pharmacokinetic Modeling of a Subcutaneous Depot for GnRH Antagonist Degarelix

    DEFF Research Database (Denmark)

    Tornøe, Christoffer Wenzel; Agersø, Henrik; Nielsen, Henrik Aalborg

    2004-01-01

    Purpose. The objective of this study is to develop a population pharmacokinetic (PK) model that describes the subcutaneous (SC) depot formation of gonadotropin-releasing hormone ( GnRH) antagonist degarelix, which is being developed for treatment of prostate cancer, exhibiting dose-volume and dose...

  8. Population pharmacokinetic modeling of a subcutaneous depot for GnRH antagonist degarelix

    DEFF Research Database (Denmark)

    Tornøe, Christoffer Wenzel; Agersø, Henrik; Nielsen, Henrik Aalborg

    Purpose. The objective of this study is to develop a population pharmacokinetic (PK) model that describes the subcutaneous (SC) depot formation of gonadotropin-releasing hormone (GnRH) antagonist degarelix, which is being developed for treatment of prostate cancer, exhibiting dose-volume and dose...

  9. Fatty acid profile of three adipose depots in seven Spanish breeds of suckling kids.

    Science.gov (United States)

    Horcada, A; Ripoll, G; Alcalde, M J; Sañudo, C; Teixeira, A; Panea, B

    2012-10-01

    Intramuscular, subcutaneous and kidney knob fat depot fatty acid profiles were studied in 104 male suckling kids from seven Spanish breeds: Blanca Andaluza, Blanca Celtibérica, Moncaína, Negra Serrana-Castiza, Pirenaica, Malagueña and Murciano-Granadina. Kids were raised in the traditional production system on mother's milk and slaughtered at around 7kg live weight. Differences were observed between dairy (Malagueña) and meat breeds (Blanca Andaluza, Blanca Celtibérica, Moncaína, Negra Serrana-Castiza, and Pirenaica). Malagueña showed higher monounsaturated and conjugated linoleic fatty acid levels than the other breeds. Highest percentages of saturated fatty acids were observed in meat breeds. For intramuscular fat depot, the range for desirable fatty acids was 66.16-72.27% was. The influence of breed on fatty acid profiles of intramuscular, subcutaneous and kidney knob fat depots studied was evident. Intramuscular fat depot is proposed as a differentiating factor between dairy and meat breed goat kids, but not between meat breed kids. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Clay Nanoparticles Elicit Long-Term Immune Responses by Forming Biodegradable Depots for Sustained Antigen Stimulation.

    Science.gov (United States)

    Chen, Weiyu; Zuo, Huali; Li, Bei; Duan, Chengcheng; Rolfe, Barbara; Zhang, Bing; Mahony, Timothy J; Xu, Zhi Ping

    2018-04-14

    Nanomaterials have been widely tested as new generation vaccine adjuvants, but few evoke efficient immunoreactions. Clay nanoparticles, for example, layered double hydroxide (LDH) and hectorite (HEC) nanoparticles, have shown their potent adjuvanticity in generating effective and durable immune responses. However, the mechanism by which clay nanoadjuvants stimulate the immune system is not well understood. Here, it is demonstrated that LDH and HEC-antigen complexes form loose agglomerates in culture medium/serum. They also form nodules with loose structures in tissue after subcutaneous injection, where they act as a depot for up to 35 d. More importantly, clay nanoparticles actively and continuously recruit immune cells into the depot for up to one month, and stimulate stronger immune responses than FDA-approved adjuvants, Alum and QuilA. Sustained antigen release is also observed in clay nanoparticle depots, with 50-60% antigen released after 35 d. In contrast, Alum-antigen complexes show minimal antigen release from the depot. Importantly, LDH and HEC are more effective than QuilA and Alum in promoting memory T-cell proliferation. These findings suggest that both clay nanoadjuvants can serve as active vaccine platforms for sustained and potent immune responses. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  11. Fatty acid composition of beef steers as affected by diet and fat depot

    African Journals Online (AJOL)

    Mapiye, C, Dr

    2015-10-09

    Oct 9, 2015 ... BHP composition of beef products should therefore include feeding designer diets and exploiting fat depot ..... performance and meat quality may therefore include feeding SS and 15% DDGS in forage-based diets and ... Eds: Hobson, P.N. & Stewart, C.S., Academic and Professional, London, UK. pp.

  12. 33 CFR 334.1244 - Puget Sound, Manchester Fuel Depot, Manchester, Washington; naval restricted area.

    Science.gov (United States)

    2010-07-01

    ... northern shoreline of the Manchester Fuel Depot at latitude 47°33′55″ North, longitude 122°31′55″, West... lights, which are mounted on poles at the end of the main fuel pier on the south side of Orchard Point at...

  13. Inoculation of weaned pigs with E. coli reduces depots of vitamin E

    DEFF Research Database (Denmark)

    Lauridsen, Charlotte; Vestergaard, Ellen-Margrethe; Højsgaard, Søren

    2011-01-01

    This study was designed to investigate the effect of vitamin E supplementation on vitamin E depots and immune responses in weaned pigs after an E. coli inoculation. The design was a 2 × 2 factorial with vitamin E supplementation (150 mg/kg RRR-α-tocopheryl acetate versus a control diet containing...

  14. Design of PLGA-based depot delivery systems for biopharmaceuticals prepared by spray drying

    DEFF Research Database (Denmark)

    Wan, Feng; Yang, Mingshi

    2016-01-01

    , a one-step, continuous microencapsulation process, for manufacturing of PLGA-based depot microparticle systems with a focus on the recent efforts on understanding of the role of nozzle design in the microencapsulation of proteins/peptides, and the effect of critical solvent properties and process...

  15. Inflammation and race and gender differences in computerized tomography-measured adipose depots

    NARCIS (Netherlands)

    Beasley, L.E.; Koster, A.; Newman, A.B.; Javaid, M.K.; Ferucci, L.; Kritchevsky, S.B.; Kuller, L.H.; Pahor, M.; Visser, M.; Rubin, S.M.; Goodpaster, B.H.; Everhart, J.E.; Harris, T.B.

    2009-01-01

    A growing body of evidence has consistently shown a correlation between obesity and chronic subclinical inflammation. It is unclear whether the size of specific adipose depots is more closely associated with concentrations of inflammatory markers than overall adiposity. This study investigated the

  16. A comparative signaling cost analysis of Macro Mobility scheme in NEMO (MM-NEMO) with mobility management protocol

    International Nuclear Information System (INIS)

    Islam, Shayla; Abdalla, Aisha H; Habaebi, Mohamed H; Latif, Suhaimi A; Hassan, Wan H; Hasan, Mohammad K; Ramli, H A M; Khalifa, Othman O

    2013-01-01

    NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it's Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, ''Signaling Storm'' occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6

  17. Nanosized sustained-release drug depots fabricated using modified tri-axial electrospinning.

    Science.gov (United States)

    Yang, Guang-Zhi; Li, Jiao-Jiao; Yu, Deng-Guang; He, Mei-Feng; Yang, Jun-He; Williams, Gareth R

    2017-04-15

    Nanoscale drug depots, comprising a drug reservoir surrounded by a carrier membrane, are much sought after in contemporary pharmaceutical research. Using cellulose acetate (CA) as a filament-forming polymeric matrix and ferulic acid (FA) as a model drug, nanoscale drug depots in the form of core-shell fibers were designed and fabricated using a modified tri-axial electrospinning process. This employed a solvent mixture as the outer working fluid, as a result of which a robust and continuous preparation process could be achieved. The fiber-based depots had a linear morphology, smooth surfaces, and an average diameter of 0.62±0.07μm. Electron microscopy data showed them to have clear core-shell structures, with the FA encapsulated inside a CA shell. X-ray diffraction and IR spectroscopy results verified that FA was present in the crystalline physical form. In vitro dissolution tests revealed that the fibers were able to provide close to zero-order release over 36h, with no initial burst release and minimal tailing-off. The release properties of the depot systems were much improved over monolithic CA/FA fibers, which exhibited a significant burst release and also considerable tailing-off at the end of the release experiment. Here we thus demonstrate the concept of using modified tri-axial electrospinning to design and develop new types of heterogeneous nanoscale biomaterials. Nanoscale drug depots with a drug reservoir surrounded by a carrier are highly attractive in biomedicine. A cellulose acetate based drug depot was investigated in detail, starting with the design of the nanostructure, and moving through its fabrication using a modified tri-axial electrospinning process and a series of characterizations. The core-shell fiber-based drug depots can provide a more sustained release profile with no initial burst effect and less tailing-off than equivalent monolithic drug-loaded fibers. The drug release mechanisms are also distinct in the two systems. This proof

  18. Paying the full cost of power : an indicative comparative analysis of residential electricity rates across Canadian provinces

    International Nuclear Information System (INIS)

    Goulding, A.J.; Sabatier, G.

    2005-01-01

    This study was commissioned to review electricity rates charged to residential consumers across Canada and to determine how the basics of ratemaking change from province to province. Rates in each province vary significantly due to differences in the industry structure and their resource base. It was noted that direct comparisons are difficult because some rates reflect the financing, fuel and opportunity costs of power. For that reason, a simple adjustment factor was developed for fair comparison between jurisdictions. This assessment compared the all-in cost to final consumers which includes power generation, transmission, distribution and all other charges, as calculated by Statistics Canada. It was revealed that Alberta is Canada's only province where prices to final consumers reflect the market value of the underlying commodity. Ratepayers have the advantage of not being responsible for bad investment choices in the power sector and there are no hidden subsidies due to provincial ownership of power resources. Another consumer advantage is that they receive appropriate price signals in terms of energy consumption and conservation. This report suggests that low electricity rates in other provinces can be expected to rise much more rapidly than those in Alberta in the coming decade as consumers may be charged the full value of the electricity they use. 18 refs., 9 figs

  19. Another Look at Transfer Prices for Depot-Level Reparables - Marginal Costs: A Revenue Perspective

    National Research Council Canada - National Science Library

    Wallace, John

    1999-01-01

    .... However, a far more compelling reason for such a change would be to lessen the effect on revenue recovery associated with problems in estimating DLR sales, in budgeting customers DLR funding, and in anticipating customers' reaction to new DLR prices.

  20. A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia.

    Science.gov (United States)

    Whitty, Jennifer A; Crosland, Paul; Hewson, Kaye; Narula, Rajan; Nathan, Timothy R; Campbell, Peter A; Keller, Andrew; Scuffham, Paul A

    2014-03-01

    To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider. A decision-analytic model was used to compare the costs of PVP and TURP. Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals. The probability of re-intervention was obtained from secondary literature sources. Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions. In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] -12 187 to 14 516) more costly per patient than TURP. The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention. Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ -684, 95% CrI -8319 to 5796 and AU$ -100, 95% CrI -13 026 to 13 678, respectively). However, CrIs were wide for all analyses. In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs. However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established. © 2013 The Authors. BJU International © 2013 BJU International.

  1. A Cost of Illness Study of Children with High-Functioning Autism Spectrum Disorders and Comorbid Anxiety Disorders as Compared to Clinically Anxious and Typically Developing Children

    Science.gov (United States)

    Steensel, Francisca J.; Dirksen, Carmen D.; Bögels, Susan M.

    2013-01-01

    The study's aim was to estimate the societal costs of children with high-functioning ASD and comorbid anxiety disorder(s) (ASD + AD-group; n = 73), and to compare these costs to children with anxiety disorders (AD-group; n = 34), and typically developing children (controls; n = 87). Mean total costs for the ASD + AD-group amounted €17,380 per…

  2. ACCELERATED SITE TECHNOLOGY DEPLOYMENT COST AND PERFORMANCE REPORT COMPARABILITY OF ISOCS INSTRUMENT IN RADIONUCLIDE CHARACTERICATION AT BROOKHAVEN NATIONAL LABORATORY

    Energy Technology Data Exchange (ETDEWEB)

    KALB,P.; LUCKETT,L.; MILLER,K.; GOGOLAK,C.; MILIAN,L.

    2001-03-01

    This report describes a DOE Accelerated Site Technology Deployment project being conducted at Brookhaven National Laboratory to deploy innovative, radiological, in situ analytical techniques. The technologies are being deployed in support of efforts to characterize the Brookhaven Graphite Research Reactor (BGRR) facility, which is currently undergoing decontamination and decommissioning. This report focuses on the deployment of the Canberra Industries In Situ Object Counting System (ISOCS) and assesses its data comparability to baseline methods of sampling and laboratory analysis. The battery-operated, field deployable gamma spectrometer provides traditional spectra of counts as a function of gamma energy. The spectra are then converted to radionuclide concentration by applying innovative efficiency calculations using monte carlo statistical methods and pre-defined geometry templates in the analysis software. Measurement of gamma emitting radionuclides has been accomplished during characterization of several BGRR components including the Pile Fan Sump, Above Ground Ducts, contaminated cooling fans, and graphite pile internals. Cs-137 is the predominant gamma-emitting radionuclide identified, with smaller quantities of Co-60 and Am-241 detected. The Project used the Multi-Agency Radiation Survey and Site Investigation Manual guidance and the Data Quality Objectives process to provide direction for survey planning and data quality assessment. Analytical results have been used to calculate data quality indicators (DQI) for the ISOCS measurements. Among the DQIs assessed in the report are sensitivity, accuracy, precision, bias, and minimum detectable concentration. The assessment of the in situ data quality using the DQIs demonstrates that the ISOCS data quality can be comparable to definitive level laboratory analysis when the field instrument is supported by an appropriate Quality Assurance Project Plan. A discussion of the results obtained by ISOCS analysis of

  3. Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping.

    Science.gov (United States)

    Frontera, Jennifer A; Moatti, Joseph; de los Reyes, Kenneth M; McCullough, Stephen; Moyle, Henry; Bederson, Joshua B; Patel, Aman

    2014-01-01

    Stent-assisted coiling (SAC) of unruptured intracranial aneurysms is a treatment alternative to clipping or coiling, although high complication and procedure-related mortality rates have been reported. A retrospective study was conducted of patients undergoing SAC, coiling or clipping of unruptured intracranial aneurysms between 2003 and 2010. Rates of residual aneurysm, recanalization, complications, cost (adjusted to 2010), length of stay (LOS) and outcome were compared between groups. Of 116 subjects, 47 underwent SAC, 33 coiling and 36 clipping. The groups were similar in age, gender and aneurysm location, although the SAC group had significantly larger aneurysms with wider necks (p=0.001). Patients who underwent SAC had more residual aneurysm after initial treatment than those treated with coiling or clipping (75%, 52% and 19%, respectively, p<0.0001), but this difference was smaller at follow-up angiography (50%, 50% and 17% residual, respectively) and was not significant after adjusting for baseline aneurysm and neck size. SAC was not associated with increased recanalization, requirement for additional treatment, mortality or complications after adjusting for aneurysm and neck size. Patients who underwent SAC and those who underwent coiling were more likely to have a good discharge disposition than patients treated with clipping (100% vs 91%, p=0.042). LOS was significantly shorter for patients who underwent SAC or coiling compared with those treated with clipping (p<0.0001). The overall direct cost was higher for patients who underwent SAC than for those treated with coiling or clipping (median $22 544 vs $12 933 vs $14 656, p=0.001), even after adjusting for aneurysm and neck size, LOS and retreatment. SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.

  4. Adipose tissue endocannabinoid system gene expression: depot differences and effects of diet and exercise

    Directory of Open Access Journals (Sweden)

    Yang Rongze

    2011-10-01

    Full Text Available Abstract Background Alterations of endocannabinoid system in adipose tissue play an important role in lipid regulation and metabolic dysfunction associated with obesity. The purpose of this study was to determine whether gene expression levels of cannabinoid type 1 receptor (CB1 and fatty acid amide hydrolase (FAAH are different in subcutaneous abdominal and gluteal adipose tissue, and whether hypocaloric diet and aerobic exercise influence subcutaneous adipose tissue CB1 and FAAH gene expression in obese women. Methods Thirty overweight or obese, middle-aged women (BMI = 34.3 ± 0.8 kg/m2, age = 59 ± 1 years underwent one of three 20-week weight loss interventions: caloric restriction only (CR, N = 9, caloric restriction plus moderate-intensity aerobic exercise (CRM, 45-50% HRR, N = 13, or caloric restriction plus vigorous-intensity aerobic exercise (CRV, 70-75% HRR, N = 8. Subcutaneous abdominal and gluteal adipose tissue samples were collected before and after the interventions to measure CB1 and FAAH gene expression. Results At baseline, FAAH gene expression was higher in abdominal, compared to gluteal adipose tissue (2.08 ± 0.11 vs. 1.78 ± 0.10, expressed as target gene/β-actin mRNA ratio × 10-3, P Conclusions There are depot differences in subcutaneous adipose tissue endocannabinoid system gene expression in obese individuals. Aerobic exercise training may preferentially modulate abdominal adipose tissue endocannabinoid-related gene expression during dietary weight loss. Trial Registration ClinicalTrials.gov: NCT00664729.

  5. Depot-Specific Changes in Fat Metabolism with Aging in a Type 2 Diabetic Animal Model.

    Science.gov (United States)

    Park, Se Eun; Park, Cheol-Young; Choi, Jung Mook; Chang, Eugene; Rhee, Eun-Jung; Lee, Won-Young; Oh, Ki Won; Park, Sung Woo; Kang, Eun Seok; Lee, Hyun Chul; Cha, Bong Soo

    2016-01-01

    Visceral fat accretion is a hallmark of aging and is associated with aging-induced metabolic dysfunction. PPARγ agonist was reported to improve insulin sensitivity by redistributing fat from visceral fat to subcutaneous fat. The purpose of this study was to investigate the underlying mechanisms by which aging affects adipose tissue remodeling in a type 2 diabetic animal model and through which PPARγ activation modulates aging-related fat tissue distribution. At the ages of 21, 31 and 43 weeks, OLETF rats as an animal model of type 2 diabetes were evaluated for aging-related effects on adipose tissue metabolism in subcutaneous and visceral fat depots. During aging, the ratio of visceral fat weight to subcutaneous fat weight (V/S ratio) increased. Aging significantly increased the mRNA expression of genes involved in lipogenesis such as lipoprotein lipase, fatty acid binding protein aP2, lipin 1, and diacylglycerol acyltransferase 1, which were more prominent in visceral fat than subcutaneous fat. The mRNA expression of adipose triglyceride lipase, which is involved in basal lipolysis and fatty acid recycling, was also increased, more in visceral fat compared to subcutaneous fat during aging. The mRNA levels of the genes associated with lipid oxidation were increased, whereas the mRNA levels of genes associated with energy expenditure showed no significant change during aging. PPARγ agonist treatment in OLETF rats resulted in fat redistribution with a decreasing V/S ratio and improved glucose intolerance. The genes involved in lipogenesis decreased in visceral fat of the PPARγ agonist-treated rats. During aging, fat distribution was changed by stimulating lipid uptake and esterification in visceral fat rather than subcutaneous fat, and by altering the lipid oxidation.

  6. Measures of quality, costs and equity in primary health care instruments developed to analyse and compare primary care in 35 countries

    NARCIS (Netherlands)

    Schäfer, Willemijn L. A.; Boerma, Wienke G. W.; Kringos, Dionne S.; de Ryck, Evelyne; Greß, Stefan; Heinemann, Stephanie; Murante, Anna Maria; Rotar-Pavlic, Danica; Schellevis, François G.; Seghieri, Chiara; van den Berg, Michael J.; Westert, Gert P.; Willems, Sara; Groenewegen, Peter P.

    2013-01-01

    The Quality and Costs of Primary Care in Europe (QUALICOPC) study aims to analyse and compare how primary health care systems in 35 countries perform in terms of quality, costs and equity. This article answers the question 'How can the organisation and delivery of primary health care and its

  7. The Cost- Effectiveness of Two Forms of Case Management Compared to a Control Group for Persons with Dementia and Their Informal Caregivers from a Societal Perspective

    NARCIS (Netherlands)

    Vroomen, Janet MacNeil; Bosmans, Judith E.; Eekhout, Iris; Joling, Karlijn J.; van Mierlo, Lisa D.; Meiland, Franka J. M.; van Hout, Hein P. J.; de Rooij, Sophia E.

    2016-01-01

    Objectives The objective of this article was to compare the costs and cost-effectiveness of the two most prominent types of case management in the Netherlands (intensive case management and linkage models) against no access to case management (control group) for people with already diagnosed

  8. Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to Farmácia Popular Program.

    Science.gov (United States)

    Silva, Rondineli Mendes da; Caetano, Rosângela

    2016-12-22

    To analyze the costs of public pharmaceutical services compared to Farmácia Popular Program (Popular Pharmacy Program). Comparison between prices paid by Aqui Tem Farmácia Popular Program (Farmácia Popular is available here) with the full costs of medicine provision by the Municipal Health Department of Rio de Janeiro. The comparison comprised 25 medicines supplied by both the municipal pharmaceutical service and Aqui Tem Farmácia Popular Program. Calculating the cost per pharmaceutical unit of each medicine included expenditure by Municipal Health Department of Rio de Janeiro with procurement (price), logistics, and local dispensation. The reference price of medicines paid by Aqui Tem Farmácia Popular was taken from the Brazilian Ministry of Health standard in force in 2012. Comparisons included full reference price; reference price minus 10.0% copayment by users; and maximum reference paid by the Ministry of Health (minus copayment and taxes). Simulations were carried out of the differences between the costs of Municipal Health Department of Rio de Janeiro with the common medicines and those potentially incurred based on the reference price of Aqui Tem Farmácia Popular. The Municipal Health Department of Rio de Janeiro spent R$28,526,526.57 with 25 medicines of the common list in 2012; 58.7% accounted for direct procurement costs. The estimated costs of the Health Department were generally lower than the reference prices of the Aqui Tem Farmácia Popular Program for 20 medicines, regardless of reference prices. The potential costs incurred by Health Department if expenditure of its consumption pattern were based on the reference prices of Aqui Tem Farmácia Popular would be R$124,170,777.76, considering the best scenario of payment by the Brazilian Ministry of Health (90.0% of the reference price, minus taxes). The difference in costs between public provision by Municipal Health Department of Rio de Janeiro and Farmácia Popular Program indicates that some

  9. Mindfulness-based cognitive therapy (MBCT) is cost-effective compared to a wait-list control for persistent pain in women treated for primary breast cancer

    DEFF Research Database (Denmark)

    Johannsen, M.; Sørensen, J.; O'Connor, M.

    2017-01-01

    Objective: To investigate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT) compared to a wait-list control group for pain in women treated for breast cancer. Methods: A total of 129 women were randomly allocated to MBCT or a wait-list control group. The primary outcome...... assumed. Conclusions: Our results suggest that MBCT is a cost-effective pain intervention for women treated for breast cancer. Future studies could include utility measures, indirect costs, and active control groups to increase the generalizability and pragmatic value of the results....... group (N:14/48; 29.2%) achieved an MCID in pain intensity (OR=2.71, P =.03). The MBCT was cost-effective with a probability of 85% with a value of an additional women achieving MCID set to zero remained cost-effective with a probability of 70% to 82% when smaller effect and higher MBCT costs were...

  10. Nurse staff allocation by nurse patient ratio vs. a computerized nurse dependency management system: a comparative cost analysis of Australian and New Zealand hospitals.

    Science.gov (United States)

    Heslop, Liza; Plummer, Virginia

    2012-01-01

    Coding, costing, and accounting for nursing care requirements in Australian public and private hospitals lacks systematic research. Nurse costing for two nurse staffing allocation methods--nurse patient ratios and a computerized nurse dependency management system--were compared. Retrospective nursing workload management data were obtained from hospital information systems in 21 acute care public and private hospitals in Australia and New Zealand. Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care. The comparison of costs for nursing staff by nurse-patient ratios and by a computerized nurse dependency management system demonstrated differences. The provision of nursing care using the computerized nurse dependency management system was, overall, lower in cost than for nurse-patient ratios.

  11. Cost-effectiveness of nurse-delivered cognitive behavioural therapy (CBT) compared to supportive listening (SL) for adjustment to multiple sclerosis.

    Science.gov (United States)

    Mosweu, I; Moss-Morris, R; Dennison, L; Chalder, T; McCrone, P

    2017-10-10

    Cognitive Behavioural Therapy (CBT) reduces distress in multiple sclerosis, and helps manage adjustment, but cost-effectiveness evidence is lacking. An economic evaluation was conducted within a multi-centre trial. 94 patients were randomised to either eight sessions of nurse-led CBT or supportive listening (SL). Costs were calculated from the health, social and indirect care perspectives, and combined with additional quality-adjusted life years (QALY) or improvement on the GHQ-12 score, to explore cost-effectiveness at 12 months. CBT had higher mean health costs (£1610, 95% CI, -£187 to 3771) and slightly better QALYs (0.0053, 95% CI, -0.059 to 0.103) compared to SL but these differences were not statistically significant. This yielded £301,509 per QALY improvement, indicating that CBT is not cost-effective according to established UK NHS thresholds. The extra cost per patient improvement on the GHQ-12 scale was £821 from the same perspective. Using a £20,000, threshold, CBT in this format has a 9% probability of being cost effective. Although subgroup analysis of patients with clinical levels of distress at baseline showed an improvement in the position of CBT compared to SL, CBT was still not cost-effective. Nurse delivered CBT is more effective in reducing distress among MS patients compared to SL, but is highly unlikely to be cost-effective using a preference-based measure of health (EQ-5D). Results from a disease-specific measure (GHQ-12) produced comparatively lower Incremental Cost-Effectiveness Ratios, but there is currently no acceptable willingness-to-pay threshold for this measure to guide decision-making.

  12. Financial Reporting Procedures for Defense Distribution Depots - Defense Logistics Agency Business Area of the Defense Business Operations Fund

    National Research Council Canada - National Science Library

    Young, Shelton

    1994-01-01

    In our audit of the FY 1993 Financial Statements for the Distribution Depots--Defense Logistics Agency Business Mea of the Defense Business Operations Fund, we evaluated procedures and controls used...

  13. To Ensure the Integrity of the Cryogenic Propellant Depot Tank Within the Expected Radiation and Space Debris Environment Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We intend to develop the technology for lightweight composite structure suitable for both cryogenic fuel depot storage as well as human in-space habitat. These will...

  14. Maternal obesity programs increased leptin gene expression in rat male offspring via epigenetic modifications in a depot-specific manner

    Directory of Open Access Journals (Sweden)

    Simon Lecoutre

    2017-08-01

    Conclusions: Consistent with the DOHaD hypothesis, persistent epigenetic remodeling occurs at regulatory regions especially within intergenic sequences, linked to higher leptin gene expression in adult HF offspring in a depot-specific manner.

  15. Planning Documents Known Releases SWMUs Tooele Army Depot Tooele, Utah. Volume 1: Corrective Measures Study Work Plan

    National Research Council Canada - National Science Library

    2000-01-01

    ...) at Tooele Army Depot (TEAD; formerly the North Area), Tooele, Utah. The CMS Work Plan addresses seven of the nine SWMUs that were identified in the Phase II Resource Conservation and Recovery Act (RCRA...

  16. COMPAR

    International Nuclear Information System (INIS)

    Kuefner, K.

    1976-01-01

    COMPAR works on FORTRAN arrays with four indices: A = A(i,j,k,l) where, for each fixed k 0 ,l 0 , only the 'plane' [A(i,j,k 0 ,l 0 ), i = 1, isub(max), j = 1, jsub(max)] is held in fast memory. Given two arrays A, B of this type COMPAR has the capability to 1) re-norm A and B ind different ways; 2) calculate the deviations epsilon defined as epsilon(i,j,k,l): =[A(i,j,k,l) - B(i,j,k,l)] / GEW(i,j,k,l) where GEW (i,j,k,l) may be chosen in three different ways; 3) calculate mean, standard deviation and maximum in the array epsilon (by several intermediate stages); 4) determine traverses in the array epsilon; 5) plot these traverses by a printer; 6) simplify plots of these traverses by the PLOTEASY-system by creating input data blocks for this system. The main application of COMPAR is given (so far) by the comparison of two- and three-dimensional multigroup neutron flux-fields. (orig.) [de

  17. Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology.

    Science.gov (United States)

    Sciacchitano, Salvatore; Lavra, Luca; Ulivieri, Alessandra; Magi, Fiorenza; De Francesco, Gian Paolo; Bellotti, Carlo; Salehi, Leila B; Trovato, Maria; Drago, Carlo; Bartolazzi, Armando

    2017-07-25

    Since it is impossible to recognize malignancy at fine needle aspiration (FNA) cytology in indeterminate thyroid nodules, surgery is recommended for all of them. However, cancer rate at final histology is blood assay.We performed systematic reviews and meta-analyses to compare their features, feasibility, diagnostic performance and cost. GEC, GEC+BRAF, M/F panel+miRNA GEC and M/F panel by NGS were the best in ruling-out malignancy (sensitivity = 90%, 89%, 89% and 90% respectively). BRAF and M/F panel alone and by NGS were the best in ruling-in malignancy (specificity = 100%, 93% and 93%). The M/F by NGS showed the highest accuracy (92%) and BRAF the highest diagnostic odds ratio (DOR) (247). GAL-3-ICC performed well as rule-out (sensitivity = 83%) and rule-in test (specificity = 85%), with good accuracy (84%) and high DOR (27) and is one of the cheapest (113 USD) and easiest one to be performed in different clinical settings.In conclusion, the more accurate molecular-based test-methods are still expensive and restricted to few, highly specialized and centralized laboratories. GAL-3-ICC, although limited by some false negatives, represents the most suitable screening test-method to be applied on a large-scale basis in the diagnostic algorithm of indeterminate thyroid lesions.

  18. The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study.

    Science.gov (United States)

    Heijnen, Ron W H; Evers, Silvia M A A; van der Weijden, Trudy D E M; Limburg, Martien; Schols, Jos M G A

    2010-05-26

    As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients.The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation. The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals. The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article. Current Controlled Trails ISRCTN58135104.

  19. Cost utility analysis of reduced intensity hematopoietic stem cell transplantation in adolescence and young adult with severe thalassemia compared to hypertransfusion and iron chelation program.

    Science.gov (United States)

    Sruamsiri, Rosarin; Chaiyakunapruk, Nathorn; Pakakasama, Samart; Sirireung, Somtawin; Sripaiboonkij, Nintita; Bunworasate, Udomsak; Hongeng, Suradej

    2013-02-05

    Hematopoieticic stem cell transplantation is the only therapeutic option that can cure thalassemia disease. Reduced intensity hematopoietic stem cell transplantation (RI-HSCT) has demonstrated a high cure rate with minimal complications compared to other options. Because RI-HSCT is very costly, economic justification for its value is needed. This study aimed to estimate the cost-utility of RI-HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for adolescent and young adult with severe thalassemia in Thailand. A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes using a societal perspective. All future costs and outcomes were discounted at a rate of 3% per annum. The efficacy of RI-HSCT was based a clinical trial including a total of 18 thalassemia patients. Utility values were derived directly from all patients using EQ-5D and SF-6D. Primary outcomes of interest were lifetime costs, quality adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in US ($) per QALY gained. One-way and probabilistic sensitivity analyses (PSA) were conducted to investigate the effect of parameter uncertainty. In base case analysis, the RI-HSCT group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was US $3,236 per QALY. The acceptability curve showed that the probability of RI-HSCT being cost-effective was 71% at the willingness to pay of 1 time of Thai Gross domestic product per capita (GDP per capita), approximately US $4,210 per QALY gained. The most sensitive parameter was utility of severe thalassemia patients without cardiac complication patients. At a societal willingness to pay of 1 GDP per capita, RI-HSCT was a cost-effective treatment for adolescent and young adult with severe thalassemia in Thailand compared to BT-ICT.

  20. Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation.

    Science.gov (United States)

    Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony Ft; Mulder, Cornelis L

    2016-01-01

    Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

  1. Differential sympathetic outflow to adipose depots is required for visceral fat loss in response to calorie restriction.

    Science.gov (United States)

    Sipe, L M; Yang, C; Ephrem, J; Garren, E; Hirsh, J; Deppmann, C D

    2017-04-10

    The sympathetic nervous system (SNS) regulates energy homeostasis in part by governing fatty acid liberation from adipose tissue. We first examined whether SNS activity toward discrete adipose depots changes in response to a weight loss diet in mice. We found that SNS activity toward each adipose depot is unique in timing, pattern of activation, and habituation with the most dramatic contrast between visceral and subcutaneous adipose depots. Sympathetic drive toward visceral epididymal adipose is more than doubled early in weight loss and then suppressed later in the diet when weight loss plateaued. Coincident with the decline in SNS activity toward visceral adipose is an increase in activity toward subcutaneous depots indicating a switch in lipolytic sources. In response to calorie restriction, SNS activity toward retroperitoneal and brown adipose depots is unaffected. Finally, pharmacological blockage of sympathetic activity on adipose tissue using the β3-adrenergic receptor antagonist, SR59230a, suppressed loss of visceral adipose mass in response to diet. These findings indicate that SNS activity toward discrete adipose depots is dynamic and potentially hierarchical. This pattern of sympathetic activation is required for energy liberation and loss of adipose tissue in response to calorie-restricted diet.

  2. A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital.

    Science.gov (United States)

    Jameson, K; Averley, P A; Shackley, P; Steele, J

    2007-09-22

    To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.

  3. Understanding of empty container movement: A study on a bottleneck at an off-dock depot

    Science.gov (United States)

    Zain, Rosmaizura Mohd; Rahman, Mohd Nizam Ab; Nopiah, Zulkifli Mohd; Saibani, Nizaroyani

    2014-09-01

    Port not only function as connections between marine and land transportation but also as core business areas. In a port terminal, available space is limited, but the influx of container is growing. The off-dock depot is one of the key supply chain players that hold empty containers in the inventory. Therefore, this paper aims to identify the main factors of bottlenecks or congestion that hinder the rapid movement of empty containers from the off-dock depot to the customers. Thirty interviews were conducted with individuals who are key players in the container supply chain. The data were analyzed using Atlas.ti software and the analytic hierarchy process to rank the priority factors of bottlenecks. Findings show that several pertinent factors act as barriers to the key players in the container movement in the day-to-day operations. In future studies, strategies to overcome fragmentation in the container supply chain and logistics must be determined.

  4. Fifteen Years of Web Based Data Management at Tooele Army Depot

    Science.gov (United States)

    2012-03-28

    And, Tooele Army Depot Goes Online Following an EPA audit of nine federal  facilities, Tooele Army Depot ( TEAD )  proactively begins the process of...District contracted with  Synectics to provide an innovative solution  allowing  TEAD  stakeholders to access the same  data the prime contractor was...Ellin, do you know llle project Suzan Hughes document for Parson’s TEAD SVYMU-58 Certified All the Data in One Place Laboratories & Contractors Legend

  5. Optimizing the Shunting Schedule of Electric Multiple Units Depot Using an Enhanced Particle Swarm Optimization Algorithm

    Directory of Open Access Journals (Sweden)

    Jiaxi Wang

    2016-01-01

    Full Text Available The shunting schedule of electric multiple units depot (SSED is one of the essential plans for high-speed train maintenance activities. This paper presents a 0-1 programming model to address the problem of determining an optimal SSED through automatic computing. The objective of the model is to minimize the number of shunting movements and the constraints include track occupation conflicts, shunting routes conflicts, time durations of maintenance processes, and shunting running time. An enhanced particle swarm optimization (EPSO algorithm is proposed to solve the optimization problem. Finally, an empirical study from Shanghai South EMU Depot is carried out to illustrate the model and EPSO algorithm. The optimization results indicate that the proposed method is valid for the SSED problem and that the EPSO algorithm outperforms the traditional PSO algorithm on the aspect of optimality.

  6. On the multiple depots vehicle routing problem with heterogeneous fleet capacity and velocity

    Science.gov (United States)

    Hanum, F.; Hartono, A. P.; Bakhtiar, T.

    2018-03-01

    This current manuscript concerns with the optimization problem arising in a route determination of products distribution. The problem is formulated in the form of multiple depots and time windowed vehicle routing problem with heterogeneous capacity and velocity of fleet. Model includes a number of constraints such as route continuity, multiple depots availability and serving time in addition to generic constraints. In dealing with the unique feature of heterogeneous velocity, we generate a number of velocity profiles along the road segments, which then converted into traveling-time tables. An illustrative example of rice distribution among villages by bureau of logistics is provided. Exact approach is utilized to determine the optimal solution in term of vehicle routes and starting time of service.

  7. Comparative consideration and design of a security depot for high radioactive glass-enclosed materials

    International Nuclear Information System (INIS)

    Jaroni, U.

    1985-01-01

    From the beginning of 1990 the COGEMA shall supply glass-enclosed high radioactive waste of the reprocessing of German fuel elements back to the Federal Republic of Germany. As to this time the final waste storage in the salt stock of Gorleben will not be available the glass cannisters have to be deposited above ground. First a comparison is made out of a number of proposed storage concepts for the deposition of HAW-glass blocks. The safety technical behaviour of the facility is considered. On the basis of the gained results a new facility design is presented, which can take 450 glass cannisters in a discoid built up cast-steel vessel and makes possible the utilization of the resulting radioactive heat of dissociation. During the development of this concept besides a compact, reasonable method of building and the thermodynamic behaviour of the storage the aspect of high security against release of radioactive materials was emphasized. (orig.) [de

  8. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

    NARCIS (Netherlands)

    Retèl, Valesca P.; van den Boer, Cindy; Steuten, Lotte M. G.; Okła, Sławomir; Hilgers, Frans J.; van den Brekel, Michiel W.

    2015-01-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore,

  9. The cost of karst subsidence and sinkhole collapse in the United States compared with other natural hazards

    Science.gov (United States)

    Weary, David J.

    2015-01-01

    Rocks with potential for karst formation are found in all 50 states. Damage due to karst subsidence and sinkhole collapse is a natural hazard of national scope. Repair of damage to buildings, highways, and other infrastructure represents a significant national cost. Sparse and incomplete data show that the average cost of karst-related damages in the United States over the last 15 years is estimated to be at least $300,000,000 per year and the actual total is probably much higher. This estimate is lower than the estimated annual costs for other natural hazards; flooding, hurricanes and cyclonic storms, tornadoes, landslides, earthquakes, or wildfires, all of which average over $1 billion per year. Very few state organizations track karst subsidence and sinkhole damage mitigation costs; none occurs at the Federal level. Many states discuss the karst hazard in their State hazard mitigation plans, but seldom include detailed reports of subsidence incidents or their mitigation costs. Most State highway departments do not differentiate karst subsidence or sinkhole collapse from other road repair costs. Amassing of these data would raise the estimated annual cost considerably. Information from insurance organizations about sinkhole damage claims and payouts is also not readily available. Currently there is no agency with a mandate for developing such data. If a more realistic estimate could be made, it would illuminate the national scope of this hazard and make comparison with costs of other natural hazards more realistic.

  10. Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients

    DEFF Research Database (Denmark)

    Lundqvist, C.; Beiske, A. G.; Reiertsen, O.

    2014-01-01

    Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication...

  11. Comparative Cost Study by Southeastern Regional Association of Physical Plant Administrators of Universities and Colleges Standards Committee.

    Science.gov (United States)

    Duke Univ., Durham, NC.

    Presented in this document are data pertaining to maintenance and operations costs at colleges and universities in the southeastern region of the U.S. The major accounts included in the cost analysis are: (1) physical plant administration, (2) building maintenance, (3) custodial services, (4) utilities, (5) landscape and grounds maintenance, and…

  12. Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars

    DEFF Research Database (Denmark)

    Petersen, L. B.; Rose Olsen, Kim; Christensen, J.

    2014-01-01

    Objectives: The aim of this prospective clinical study was to derive the absolute and relative costs of cone beam CT (CBCT) and panoramic imaging before removal of an impacted mandibular third molar. Furthermore, the study aimed to analyse the influence of different cost-setting scenarios...

  13. Obesity associated disease risk: the role of inherent differences and location of adipose depots.

    Science.gov (United States)

    Hill, Jessica H; Solt, Claudia; Foster, Michelle T

    2018-03-16

    Obesity and associated metabolic co-morbidities are a worldwide public health problem. Negative health outcomes associated with obesity, however, do not arise from excessive adiposity alone. Rather, deleterious outcomes of adipose tissue accumulation are a result of how adipocytes are distributed to individual regions in the body. Due to our increased understanding of the dynamic relationship that exists between specific adipose depots and disease risk, an accurate characterization of total body adiposity as well as location is required to properly evaluate a population's disease risk. Specifically, distinctive tissue depots within the body include the lower body, upper body and abdominal (deep and superficial) subcutaneous regions, as well as visceral (mesenteric and omental) regions. Upper body and visceral adipose tissues are highly associated with metabolic dysfunction and chronic disease development, whereas lower body gluteofemoral subcutaneous adipose tissue imparts protection against diet-induced metabolic derangement. Each adipose depot functions distinctly as an endocrine organ hence it has a different level of impact on health outcomes. Effluent from adipose tissue can modulate the functions of other tissues, whilst receiving differential communication from the rest of the body via central nervous system innervation, metabolites and other signaling molecules. More so, adipose depots contain a diverse reservoir of tissue-resident immune cells that play an integral part in both maintaining tissue homeostasis, as well as propagating metabolically-induced inflammation. Overall, the conceptualization of obesity and associated risks needs updating to reflect the complexities of obesity. We review adipose tissue characteristics that are linked to deleterious or beneficial adipose tissue distributions.

  14. Study of Using Excess Stock to Reduce Naval Aviation Depot-Level Repairable Piece Part Backorders

    Science.gov (United States)

    2016-12-01

    large retail store with a small shopping list of only automotive parts. The volume of automotive parts available on the shelf is only a fraction of...the overall store inventory, and the specific nature of the shopping list renders the non- automotive inventory moot. The pool of candidate matches is...DEPOT-LEVEL REPAIRABLE PIECE PART BACKORDERS December 2016 By: Jennifer L. Custard Quentin E. Lease Jan D. Schotman Advisors: Geraldo

  15. Cortisol response in healthy and diseased dogs after stimulation with a depot formulation of synthetic ACTH

    OpenAIRE

    Sieber-Ruckstuhl, N S; Burkhardt, W A; Hofer-Inteeworn, N; Riond, B; Rast, I T; Hofmann-Lehmann, R; Reusch, C E; Boretti, F S

    2015-01-01

    BACKGROUND The ACTH stimulation test is used to evaluate the adrenocortical reserve. Recently, the availability of the synthetic ACTH formulation was limited, causing major problems in clinical practice. OBJECTIVES The objective of this study was to evaluate poststimulation peak cortisol concentrations and the duration of the stimulatory effect of a depot ACTH preparation in dogs. ANIMALS Twenty-two healthy dogs, 10 dogs with suspected hypoadrenocorticism (HA) and 15 dogs with suspected ...

  16. Control of Adipocyte Differentiation in Different Fat Depots; Implications for Pathophysiology or Therapy

    Directory of Open Access Journals (Sweden)

    Xiuquan eMa

    2015-01-01

    Full Text Available Adipocyte differentiation and its impact on restriction or expansion of particular adipose tissue depots has physiological and pathophysiological significance in view of the different functions of these depots. Brown or beige fat [BAT] expansion can enhance thermogenesis, lipid oxidation, insulin sensitivity and glucose tolerance; conversely expanded visceral fat [VAT] is associated with insulin resistance, low grade inflammation, dyslipidaemia and cardiometabolic risk. The largest depot, subcutaneous white fat [WAT], has important beneficial characteristics including storage of lipid out of harms way and secretion of adipokines, especially leptin and adiponectin, with positive metabolic effects including lipid oxidation, energy utilisation, enhanced insulin action and an anti-inflammatory role. The absence of these functions in lipodystrophies leads to major metabolic disturbances. An ability to expand WAT adipocyte differentiation would seem an important defence mechanism against the detrimental effects of energy excess and limit harmful accumulation of lipid in ectopic sites, such as liver and muscle.Adipocyte differentiation involves a transcriptional cascade with PPARg being most important in WAT but less so in VAT, with increased angiogenesis also critical. The transcription factor, Islet1, is fairly specific to VAT and in vitro inhibits adipocyte differentiation. The physiological importance of Islet1 requires further study. Basic control of differentiation is similar in BAT but important differences include the effect of PGC-1a on mitochondrial biosynthesis and upregulation of UCP1; also PRDM16 plays a pivotal role in expression of the BAT phenotype.Modulation of the capacity or function of these different adipose tissue depots, by altering adipocyte differentiation or other means, holds promise for interventions that can be helpful in human disease, particularly cardiometabolic disorders associated with the world wide explosion of

  17. Moisture mapping of aeronautical museum depot and galleries by IR thermography

    OpenAIRE

    Ristić, Slavica; Polić-Radovanović, Suzana; Jegdić, Bore; Ristić, Radovan; Radojković, Bojana

    2012-01-01

    The paper presents the results of moisture detection in the depot and galleries of the Aeronautical Museum in Belgrade. The moisture and changeable temperature conditions are the main causes for corrosion in historical buildings and museum artifacts. The main purpose of the tests was to determine these conditions in the museum where very important metal artifacts are exhibited and deposed, including the only surviving example of the Fiat G50 aircraft, by applying passive IR thermography. The ...

  18. The relationship between fat depot-specific preadipocyte differentiation and metabolic syndrome in obese women

    Directory of Open Access Journals (Sweden)

    N V Mazurina

    2013-03-01

    Full Text Available Реферат по материалам статьи The relationship between fat depot-specific preadipocyte differentiation and metabolic syndrome in obese women. Park HТ, Lee ES, Cheon EP, Lee DR, Yang K-S, Kim YT, Hur JY, Kim SH, Lee KW, Kim T. Clinical Endocrinology 2012; 76, 59-66.

  19. The Economic Impact of Acetabular Labral Tears: A Cost-effectiveness Analysis Comparing Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Patients Without Osteoarthritis.

    Science.gov (United States)

    Lodhia, Parth; Gui, Chengcheng; Chandrasekaran, Sivashankar; Suarez-Ahedo, Carlos; Dirschl, Douglas R; Domb, Benjamin G

    2016-07-01

    Hip arthroscopic surgery has emerged as a successful procedure to manage acetabular labral tears and concurrent hip injuries, which if left untreated, may contribute to hip osteoarthritis (OA). Therefore, it is essential to analyze the economic impact of this treatment option. To investigate the cost-effectiveness of hip arthroscopic surgery versus structured rehabilitation alone for acetabular labral tears, to examine the effects of age on cost-effectiveness, and to estimate the rate of symptomatic OA and total hip arthroplasty (THA) in both treatment arms over a lifetime horizon. Economic and decision analysis; Level of evidence, 2. A cost-effectiveness analysis of hip arthroscopic surgery compared with structured rehabilitation for symptomatic labral tears was performed using a Markov decision model constructed over a lifetime horizon. It was assumed that patients did not have OA. Direct costs (in 2014 United States dollars), utilities of health states (in quality-adjusted life years [QALYs] gained), and probabilities of transitioning between health states were estimated from a comprehensive literature review. Costs were estimated using national averages of Medicare reimbursements, adjusted for all payers in the United States from a societal perspective. Utilities were estimated from the Harris Hip Score. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to determine the effect of uncertainty on the model outcomes. For a cohort representative of patients undergoing hip arthroscopic surgery at our facility, arthroscopic surgery was more costly (additional $2653) but generated more utility (additional 3.94 QALYs) compared with rehabilitation over a lifetime. The mean ICER was $754/QALY, well below the conventional willingness to pay of $50,000/QALY. Arthroscopic surgery was cost-effective for 94.5% of patients. Although arthroscopic surgery decreased in cost

  20. Use of external cost assessment and multi-criteria decision analysis for comparative evaluation of options for electricity supply

    International Nuclear Information System (INIS)

    Hirschberg, S.; Dones, R.; Gantner, U.

    2001-01-01

    The paper addresses external cost and multi-criteria analyses carried out for selected future electricity generating systems of interest under the Swiss conditions. The external cost estimates are based on an application of the 'impact pathway approach', enhanced by earlier experience from extensive Life Cycle Assessment (LCA). The estimated total costs, i.e. the sum of internal and external costs, may serve as a measure of economic and environmental efficiency of energy systems. The multi-criteria approach allows a more explicit consideration of the social dimension, which is highly important for the decision-making process. The applications of multi-criteria analyses illustrate the sensitivity of the results to the range of preferences expressed in the energy debate. Certain patterns in system ranking can be observed in spite of these sensitivities. Both total cost assessment and multi-criteria analysis are found to be useful, complementary instruments to support procedures for decision-making. (author)

  1. Cost utility analysis of knee prosthesis with complete microprocessor control (C-leg) compared with mechanical technology in trans-femoral amputees.

    Science.gov (United States)

    Gerzeli, Simone; Torbica, Aleksandra; Fattore, Giovanni

    2009-02-01

    The study determines the cost-utility of a unilateral electronic knee prosthesis (C-leg) compared to mechanical alternatives in trans-femoral amputees. For each type of prosthesis, 50 patients, treated in a major Italian centre, were enrolled. Quality adjusted life years (QALYs) were estimated from responses to EuroQol (EQ-5D). Healthcare and social costs were assessed for the estimated life cycle of the technologies (5 years). C-leg was associated with 0.09 more QALYs per patient per year (P = 0.007). For the 5-year period, the incremental cost-utility ratio of C-leg resulted in euro 35,971 per QALY from the healthcare system perspective. If non-healthcare costs and productivity losses are included, the two groups to have similar costs (euro 66,669 vs euro 66,927).

  2. Permanent Access to the Records of Science - The International Role of the e-Depot at the Koninklijke Bibliotheek, National Library of the Netherlands

    Directory of Open Access Journals (Sweden)

    Gerard van Trier

    2006-10-01

    safeguards the access that licensees have paid for. Primarily, long-term preservation is a way of managing risk and a kind of insurance against loss or disrupted access. The KB expects that worldwide permanent archiving of STM literature will be taken care of by a limited number of institutions dedicated to this task (Safe Places Model. Libraries should invest in a qualified archiving solution and should effectively demand archival deposit by publishers as a condition of licensing electronic journals. The KB’s e-Depot strategy for the coming years includes: Further developing the technical and organisational infrastructure, which is now put to an external audit. Continuing the Research & Development effort concentrating on the full range of available preservation techniques. The KB has developed its own R&D-programme and is an initiating partner in the European project PLANETS. Concluding archiving agreements with more of the major international scientific publishers. The KB would like to reach 80% coverage of the total world production of STM literature. Promoting the creation of a European infrastructure for long-term preservation and access to the records of science, including large scientific organisations like ESA, CERN and the British CCLRC, but also JISC, the European Science Foundation, the International Association of STM Publishers, and national libraries like The British Library and the KB. Discussing the feasibility of new business models to cover the costs of storage space, the processing and management of the material, and R&D efforts.

  3. Individualized Positron Emission Tomography–Based Isotoxic Accelerated Radiation Therapy Is Cost-Effective Compared With Conventional Radiation Therapy: A Model-Based Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bongers, Mathilda L., E-mail: ml.bongers@vumc.nl [Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands); Coupé, Veerle M.H. [Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands); De Ruysscher, Dirk [Radiation Oncology University Hospitals Leuven/KU Leuven, Leuven (Belgium); Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht (Netherlands); Oberije, Cary; Lambin, Philippe [Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht (Netherlands); Uyl-de Groot, Cornelia A. [Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands); Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam (Netherlands)

    2015-03-15

    Purpose: To evaluate long-term health effects, costs, and cost-effectiveness of positron emission tomography (PET)-based isotoxic accelerated radiation therapy treatment (PET-ART) compared with conventional fixed-dose CT-based radiation therapy treatment (CRT) in non-small cell lung cancer (NSCLC). Methods and Materials: Our analysis uses a validated decision model, based on data of 200 NSCLC patients with inoperable stage I-IIIB. Clinical outcomes, resource use, costs, and utilities were obtained from the Maastro Clinic and the literature. Primary model outcomes were the difference in life-years (LYs), quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness and cost/utility ratio (ICER and ICUR) of PET-ART versus CRT. Model outcomes were obtained from averaging the predictions for 50,000 simulated patients. A probabilistic sensitivity analysis and scenario analyses were carried out. Results: The average incremental costs per patient of PET-ART were €569 (95% confidence interval [CI] €−5327-€6936) for 0.42 incremental LYs (95% CI 0.19-0.61) and 0.33 QALYs gained (95% CI 0.13-0.49). The base-case scenario resulted in an ICER of €1360 per LY gained and an ICUR of €1744 per QALY gained. The probabilistic analysis gave a 36% probability that PET-ART improves health outcomes at reduced costs and a 64% probability that PET-ART is more effective at slightly higher costs. Conclusion: On the basis of the available data, individualized PET-ART for NSCLC seems to be cost-effective compared with CRT.

  4. Comparative life cycle assessment and life cycle costing of four disposal scenarios for used polyethylene terephthalate bottles in Mauritius.

    Science.gov (United States)

    Foolmaun, Rajendra Kumar; Ramjeeawon, Toolseeram

    2012-09-01

    The annual rise in population growth coupled with the flourishing tourism industry in Mauritius has lead to a considerable increase in the amount of solid waste generated. In parallel, the disposal of non-biodegradable wastes, especially plastic packaging and plastic bottles, has also shown a steady rise. Improper disposal of used polyethylene terephthalate (PET) bottles constitutes an eyesore to the environmental landscape and is a threat to the flourishing tourism industry. It is of utmost importance, therefore, to determine a suitable disposal method for used PET bottles which is not only environmentally efficient but is also cost effective. This study investigated the environmental impacts and the cost effectiveness of four selected disposal alternatives for used PET bottles in Mauritius. The four disposal routes investigated were: 100% landfilling; 75% incineration with energy recovery and 25% landfilling; 40% flake production (partial recycling) and 60% landfilling; and 75% flake production and 25% landfilling. Environmental impacts of the disposal alternatives were determined using ISO standardized life cycle assessment (LCA) and with the support of SimaPro 7.1 software. Cost effectiveness was determined using life cycle costing (LCC). Collected data were entered into a constructed Excel-based model to calculate the different cost categories, Net present values, damage costs and payback periods. LCA and LCC results indicated that 75% flake production and 25% landfilling was the most environmentally efficient and cost-effective disposal route for used PET bottles in Mauritius.

  5. A comparative analysis of the costs of onshore wind energy: Is there a case for community-specific policy support?

    International Nuclear Information System (INIS)

    Berka, Anna L.; Harnmeijer, Jelte; Roberts, Deborah; Phimister, Euan; Msika, Joshua

    2017-01-01

    There is growing policy interest in increasing the share of community-owned renewable energy generation. This study explores why and how the costs of community-owned projects differ from commercially-owned projects by examining the case of onshore wind in the UK. Based on cross-sectoral literature on the challenges of community ownership, cost differences are attributed to six facets of an organisation or project: internal processes, internal knowledge and skills, perceived local legitimacy of the project, perceived external legitimacy of the organisation, investor motivation and expectations, and finally, project scale. These facets impact not only development costs but also project development times and the probability that projects pass certain critical stages in the development process. Using survey-based and secondary cost data on community and commercial projects in the UK, a model is developed to show the overall impact of cost, time and risk differences on the value of a hypothetical 500 kW onshore wind project. The results show that the main factors accounting for differences are higher pre-planning costs and additional risks born by community projects, and suggest that policy interventions may be required to place community- owned projects on a level playing field with commercial projects. - Highlights: • Policy support for community energy projects should be targeted at reducing early costs and risk factors. • Hurdle rates are critical in determining the financial viability of projects. • Shared ownership arrangements may help remove some of key challenges to community-only projects.

  6. Is There a Limit to Growth? Comparing the Environmental Cost of an Airport’s Operations with Its Economic Benefit

    Directory of Open Access Journals (Sweden)

    Cherie Lu

    2017-11-01

    Full Text Available With the growing global awareness of the requirement for sustainable development, economic development is no longer the sole objective of business activities. The need to find a balance between environmental impacts and economic benefits is especially the case for airport operations in or around cities. This study measured the environmental costs and economic benefits and of an airport for a period of 10 years, using Taipei Songshan Airport for the empirical analysis, to examine whether the environmental costs could outweigh the economic benefits. Of all the environmental negative side effects, aircraft engine emissions and noise nuisance are considered the main sources of environmental impacts. The dose-response method and the hedonic price method, respectively, were used for estimating the social costs of these. Income generation from both direct and secondary employment is measured as economic benefits by applying the Garin-Lowry model, originally developed in 1966, for estimation of the employment multiplier. The results show that, in general, the operation of Taipei Songshan Airport brought more economic benefits than environmental costs. The sensitivity analysis of emissions and noise social cost parameters shows that the environmental costs might have exceeded the economic benefits in 2008 and 2009 in certain high emissions and noise social cost cases.

  7. Product Costing in FMT: Comparing Deterministic and Stochastic Models Using Computer-Based Simulation for an Actual Case Study

    DEFF Research Database (Denmark)

    Nielsen, Steen

    2000-01-01

    This paper expands the traditional product costing technique be including a stochastic form in a complex production process for product costing. The stochastic phenomenon in flesbile manufacturing technologies is seen as an important phenomenon that companies try to decreas og eliminate. DFM has ...... been used for evaluating the appropriateness of the firm's production capability. In this paper a simulation model is developed to analyze the relevant cost behaviour with respect to DFM and to develop a more streamlined process in the layout of the manufacturing process....

  8. Cost-effectiveness of single-dose tamsulosin and dutasteride combination therapy compared with tamsulosin monotherapy in patients with benign prostatic hyperplasia in the UK.

    Science.gov (United States)

    Walker, Anna; Doyle, Scott; Posnett, John; Hunjan, Manjit

    2013-09-01

    To estimate the long-term cost-effectiveness of single-dose dutasteride/tamsulosin combination therapy as a first-line treatment for benign prostatic hyperplasia (BPH) from the perspective of the UK National Health Service (NHS). A Markov state transition model was developed to estimate healthcare costs and patient outcomes, measured by quality-adjusted life years (QALYs), for patients aged ≥50 years with diagnosed BPH and moderate to severe symptoms. Costs and outcomes were estimated for two treatment comparators: oral, daily, single-dose combination therapy (dutasteride 0.5 mg + tamsulosin 0.4 mg), and oral daily tamsulosin (0.4 mg) over a period up to 25 years. The efficacy of comparators was taken from results of the Combination of Avodart and Tamsulosin (CombAT) trial. Cumulative discounted costs per patient were higher with combination therapy than with tamsulosin, but QALYs were also higher. After 25 years, the incremental cost-effectiveness ratio for combination therapy was £12,219, well within the threshold range (£20,000-£30,000 per QALY) typically applied in the NHS. Probabilistic sensitivity analysis showed that the probability of combination therapy being cost-effective given the threshold range is between 78% and 88%. Single-dose combination dutasteride/tamsulosin therapy has a high probability of being cost-effective in comparison to tamsulosin monotherapy in the UK's NHS. © 2013 BJU International.

  9. Positron emission tomography with selected mediastinoscopy compared to routine mediastinoscopy offers cost and clinical outcome benefits for pre-operative staging of non-small cell lung cancer

    International Nuclear Information System (INIS)

    Yap, Kelvin K.; Yap, Kenneth S.K.; Byrne, Amanda J.; Berlangieri, Salvatore U.; Poon, Aurora; Harris, Anthony; Tauro, Andrew; Mitchell, Paul; Knight, Simon R.; Clarke, Peter C.; Rowe, Christopher C.; Scott, Andrew M.

    2005-01-01

    18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is an important staging procedure in patients with non-small cell lung cancer (NSCLC). We aimed to demonstrate, through a decision tree model and the incorporation of real costs of each component, that routine FDG-PET imaging as a prelude to curative surgery will reduce requirements for routine mediastinoscopy and overall hospital costs. A decision tree model comparing routine whole-body FDG-PET imaging to routine staging mediastinoscopy was used, with baseline variables of sensitivity, specificity and prevalence of non-operable and metastatic disease obtained from institutional data and a literature review. Costings for hospital admissions for mediastinoscopy and thoracotomy of actual patients with NSCLC were determined. The overall and average cost of managing patients was then calculated over a range of FDG-PET costs to derive projected cost savings to the community. The prevalence of histologically proven mediastinal involvement in patients with NSCLC presenting for surgical assessment at our institution is 20%, and the prevalence of distant metastatic disease is 6%. Based on literature review, the pooled sensitivity and specificity of FDG-PET for detection of mediastinal spread are 84% and 89% respectively, and for mediastinoscopy, 81% and 100%. The average cost of mediastinoscopy for NSCLC in our institution is AUD$4,160, while that of thoracotomy is AUD$15,642. The cost of an FDG-PET scan is estimated to be AUD$1,500. Using these figures and the decision tree model, the average cost saving is AUD$2,128 per patient. Routine FDG-PET scanning with selective mediastinoscopy will save AUD$2,128 per patient and will potentially reduce inappropriate surgery. These cost savings remain robust over a wide range of disease prevalence and FDG-PET costs. (orig.)

  10. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event.

    Science.gov (United States)

    Lundström, Erik; Smits, Anja; Borg, Jörgen; Terént, Andreas

    2010-02-01

    The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no health economic studies on costs associated with spasticity after stroke. The objective of our study was to estimate direct costs of stroke with spasticity for patients surviving up to 1 year after the stroke event in comparison to costs of stroke without spasticity. A representative sample of patients with first-ever stroke hospitalized at Uppsala University Hospital was eligible for our cross-sectional survey. All direct costs during 1 year were identified for each patient, including costs for hospitalization (acute and rehabilitation), primary health care, medication, and costs for municipality services. Swedish currency was converted to Purchasing Power Parities US dollar (PPP$). Median age (interquartile range) was 73 years (18), and the proportion of women was 48%. The majority of the direct costs (78%) was associated with hospitalization, whereas 20% was associated with municipality services during 1 year after a first-ever stroke. Only 1% of all direct costs were related to primary health care and 1% to medication. The level of costs for patients with stroke was correlated with the presence of spasticity as measured with the modified Ashworth scale (r(s)=0.524) and with the degree of disability as measured with modified Rankin Scale (r(s)=0.624). The mean (median, interquartile range) direct cost for stroke patients with spasticity was PPP$ 84,195 (72,116, 53,707) compared with PPP$ 21,842 (12,385, 17,484) for patients with stroke without spasticity (Pstroke survivors are 4 times higher than direct costs for patients with stroke without spasticity during the first year after the event.

  11. Autologous Stem Cell Transplantation in Patients With Multiple Myeloma: An Activity-based Costing Analysis, Comparing a Total Inpatient Model Versus an Early Discharge Model.

    Science.gov (United States)

    Martino, Massimo; Console, Giuseppe; Russo, Letteria; Meliado', Antonella; Meliambro, Nicola; Moscato, Tiziana; Irrera, Giuseppe; Messina, Giuseppe; Pontari, Antonella; Morabito, Fortunato

    2017-08-01

    Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs. The TIM and EDOM models involved a total cost of €28,615.15 and €16,499.43, respectively. In the TIM model, the phase with the greatest economic impact was the posttransplant (recovery and hematologic engraftment) with 36.4% of the total cost, whereas in the EDOM model, the phase with the greatest economic impact was the pretransplant (chemo-mobilization, apheresis procedure, cryopreservation, and storage) phase, with 60.4% of total expenses. In an analysis of each episode, the TIM model comprised a higher absorption than the EDOM. In particular, the posttransplant represented 36.4% of the total costs in the TIM and 17.7% in EDOM model, respectively. The estimated reduction in cost per patient using an EDOM model was over €12,115.72. The repayment of the DRG in Calabrian Region for the ASCT procedure is €59,806. Given the real cost of the transplant, the estimated cost saving per patient is €31,190.85 in the TIM model and €43,306.57 in the EDOM model. In conclusion, the actual repayment of the DRG does not correspond to the real cost of the ASCT procedure in Italy. Moreover, using the EDOM, the cost of ASCT is approximately the half of the TIM model. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Comparative spectral analysis of commercial fuel-ethanol blends using a low-cost prototype FT-Raman spectrometer

    Science.gov (United States)

    Ortega Clavero, Valentin; Weber, Andreas; Schröder, Werner; Meyrueis, Patrick; Javahiraly, Nicolas

    2012-06-01

    The use of bio-fuels and fuel blends, specially in automotive industry, has been increasing substantially in recent years due to market prices and trends on sustainable development policies. Different spectral analysis techniques for quality control, production, purity, and counterfeit detection have been reported as non-invasive, fast, and price accessible. Raman spectra from three different commercial binary E10 fuel-ethanol blends has been obtained by using a low-cost Fourier-Transform Raman spectrometer (FT-Raman). Qualitative comparison between the commercial fuel blends and a laboratory-prepared fuel blend have been performed. The characteristic Raman lines from some additives contained in the commercial gasoline have been also observed. The spectral information is presented in the range of 0 cm-1 to 3500 cm-1 with a resolution of 1.66 cm-1. These Raman spectra shows reduced frequency deviation (less than 0.4 cm-1 when compared to standard Raman spectra from cyclohexane and toluene without compensation for instrumental response). Higher resolution values are possible, since the greater optical path lengths of the FT-Raman are achievable before the instrumental physical effects appear. The robust and highly flexible FT-Raman prototype proposed for the spectral analysis, consisting mainly of a Michelson interferometer and a self-designed photon counter, is able to deliver high resolution and precise Raman spectra with no additional complex hardware or software control. The mechanical and thermal disturbances affecting the FT-Raman system are mathematically compensated by extracting the optical path information from the generated interference pattern of a λ=632.8 nm Helium-Neon laser (HeNe laser), which is used at the spectrum evaluation.

  13. The adipose tissue of origin influences the biological potential of human adipose stromal cells isolated from mediastinal and subcutaneous fat depots

    Directory of Open Access Journals (Sweden)

    Camilla Siciliano

    2016-09-01

    Full Text Available Indirect evidence suggests that adipose tissue-derived stromal cells (ASCs possess different physiological and biological variations related to the anatomical localization of the adipose depots. Accordingly, to investigate the influence of the tissue origin on the intrinsic properties of ASCs and to assess their response to specific stimuli, we compared the biological, functional and ultrastructural properties of two ASC pools derived from mediastinal and subcutaneous depots (thoracic compartment by means of supplements such as platelet lysate (PL and FBS. Subcutaneous ASCs exhibited higher proliferative and clonogenic abilities than mediastinal counterpart, as well as increased secreted levels of IL-6 combined with lower amount of VEGF-C. In contrast, mediastinal ASCs displayed enhanced pro-angiogenic and adipogenic differentiation properties, increased cell diameter and early autophagic processes, highlighted by electron microscopy. Our results further support the hypothesis that the origin of adipose tissue significantly defines the biological properties of ASCs, and that a homogeneric function for all ASCs cannot be assumed.

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

    Directory of Open Access Journals (Sweden)

    Tu Hong-Anh

    2011-07-01

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

  15. Comparative study of conducting iliac angioplasties with digital subtraction and conventional angiography. Incidence on true (consumable) costs

    International Nuclear Information System (INIS)

    Brenot, P.; Raynaud, A.; Pernes, J.M.; Parola, J.L.; Gaux, J.C.

    1986-01-01

    Differences in time and cost were evaluated between the performance of iliac angioplasty with conventional (AC) and digital subtraction (AN) angiography, after a total of 27 angioplasties (13 with AC and 14 with AN). Excluding amortization of material and personnel costs, findings confirmed a certain number of advantages for AN: gain in time of about 34%, decrease of about 14% in charges, and notably of 83% in expenditure on films and 50% on contrast media [fr

  16. An update to "The cost-effectiveness of rotavirus vaccination: comparative analyses for five European countries and transferability in Europe".

    Science.gov (United States)

    Jit, Mark; Mangen, Marie-Josée J; Melliez, Hugues; Yazdanpanah, Yazdan; Bilcke, Joke; Salo, Heini; Edmunds, W John; Beutels, Philippe

    2010-11-03

    A cost-effectiveness analysis of rotavirus vaccination in Belgium, England and Wales, Finland, France and the Netherlands published in 2009 was updated based on recent studies on rotavirus burden of disease and vaccine efficacy. All the qualitative conclusions in the previous study were found to remain valid. Vaccination remains cost-effective in Finland only when using plausible tender prices. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Comparing compensation mussel production costs and traditional agricultural farmers willingness to pay to reduce nutrient loads in the Limfjord

    DEFF Research Database (Denmark)

    Frost, Hans Staby; Hasler, Berit; Hoff, Ayoe

    Nitrogen non-point pollution from agriculture is the dominating source of eutrophication of Danish fjords. Long-line mussel production is an alternative measure to costly agricultural measures to achieve good ecological status of fjords. This paper investigates farmers’ economic incentives to buy......-quotas between mussel farms and agriculture provides a potential for cost-effective mitigation of eutrophication in this type of fjords....

  18. Decision analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

    Science.gov (United States)

    Boyd, Kathleen A; Jones, Rob J; Paul, Jim; Birrell, Fiona; Briggs, Andrew H; Leung, Hing Y

    2015-01-01

    Objective To determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC). Design Cost-utility analysis using decision analytic modelling by a Markov model. Setting and methods Compared SC and androgen deprivation therapy (ADT) in a cohort of patients with RRPC (biopsy proven local recurrence, no evidence of metastatic disease). A literature review captured published data to inform the decision model, and resource use data were from the Scottish Prostate Cryotherapy Service. The model was run in monthly cycles for RRPC men, mean age of 70 years. The model was run over the patient lifetime, to assess changes in patient health states and the associated quality of life, survival and cost impacts. Results are reported in terms of the discounted incremental costs and discounted incremental quality-adjusted life years (QALYs) gained between the 2 alternative interventions. Probabilistic sensitivity analysis used a 10 000 iteration Monte Carlo simulation. Results SC has a high upfront treatment cost, but delays the ongoing monthly cost of ADT. SC is the dominant strategy over the patient lifetime; it is more effective with an incremental 0.56 QALY gain (95% CI 0.28 to 0.87), and less costly with a reduced lifetime cost of £29 719 (€37 619) (95% CI −51 985 to −9243). For a ceiling ratio of £30 000, SC has a 100% probability to be cost-effective. The cost neutral point was at 3.5 years, when the upfront cost of SC (plus any subsequent cumulative cost of side effects and ADT) equates the cumulative cost in the ADT arm. Limitations of our model may arise from its insensitivity to parameter or structural uncertainty. Conclusions The platform for SC versus ADT cost-effective analysis can be employed to evaluate other treatment modalities or strategies in RRPC. SC is the dominant strategy, costing less over a patient's lifetime with improvements in QALYs. Trial registration number This economic analysis

  19. Vanadate impedes adipogenesis in mesenchymal stem cells derived from different depots within bone.

    Directory of Open Access Journals (Sweden)

    Frans Alexander Jacobs

    2016-08-01

    Full Text Available Glucocorticoid induced osteoporosis (GIO is associated with an increase in bone marrow adiposity which skews the differentiation of mesenchymal stem cell (MSC progenitors away from osteoblastogenesis and towards adipogenesis. We have previously found that vanadate, a non-specific protein tyrosine phosphatase inhibitor, prevents GIO in rats, but it was unclear whether vanadate directly influenced adipogenesis in bone-derived MSCs. For the present study, we investigated the effect of vanadate on adipogenesis in primary rat MSCs derived from bone marrow (bmMSCs and from the proximal end of the femur (pfMSCs. By passage 3 after isolation, both cell populations expressed the MSC cell surface markers CD90 and CD106, but not the haematopoietic marker CD45. However, although variable, expression of the fibroblast marker CD26 was higher in pfMSCs than in bmMSCs. Differentiation studies using osteogenic and adipogenic induction media (OM and AM, respectively demonstrated that pfMSCs rapidly accumulated lipid droplets within 1 week of exposure to AM, while bmMSCs isolated from the same femur only formed lipid droplets after 3 weeks of AM treatment. Conversely, pfMSCs exposed to OM produced mineralized extracellular matrix (ECM after 3 weeks, compared to 1 week for OM-treated bmMSCs. Vanadate (10 µM added to AM resulted in a significant reduction in AM-induced intracellular lipid accumulation and expression of adipogenic gene markers (PPARγ2, aP2, adipsin in both pfMSCs and bmMSCs. Pharmacological concentrations of glucocorticoids (1 µM alone did not induce lipid accumulation in either bmMSCs or pfMSCs, but resulted in significant cell death in pfMSCs. Our findings demonstrate the existence of at least two fundamentally different MSC depots within the femur, and highlights the presence of MSCs capable of rapid adipogenesis within the proximal femur, an area prone to osteoporotic fractures. In addition, our results suggest that the increased bone marrow

  20. A Hybrid Dynamic Programming for Solving Fixed Cost Transportation with Discounted Mechanism

    OpenAIRE

    Farhad Ghassemi Tari

    2016-01-01

    The problem of allocating different types of vehicles for transporting a set of products from a manufacturer to its depots/cross docks, in an existing transportation network, to minimize the total transportation costs, is considered. The distribution network involves a heterogeneous fleet of vehicles, with a variable transportation cost and a fixed cost in which a discount mechanism is applied on the fixed part of the transportation costs. It is assumed that the number of available vehicles i...

  1. Cost-effectiveness and cost-benefit analyses of a multidisciplinary intervention compared with a brief intervention to facilitate return to work in sick-listed patients with low back pain.

    Science.gov (United States)

    Jensen, Chris; Nielsen, Claus Vinther; Jensen, Ole Kudsk; Petersen, Karin Dam

    2013-06-01

    Randomized clinical trial of 2 interventions in 351 employees sick listed due to low back pain (LBP) and a subsequent validation study (n = 120) to validate results from subgroup analyses in the original study. To compose health economic analyses (cost-effectiveness- and cost-benefit analyses) of multidisciplinary versus brief intervention by calculating health care sector costs and sick leave benefits. Both brief and multidisciplinary interventions have been reported to be superior relative to usual care when comparing intervention costs with saved costs for sick leave benefits. We reported similar return to work rates in a brief and a multidisciplinary intervention group, but different return to work rates in subgroups. The brief intervention comprised clinical examination and reassuring advice. The multidisciplinary intervention was conducted by a case manager and a team of specialists. The costs of medicine, health care services, and sick leave benefits were calculated on the basis of registers. The mean intervention cost per patient was € 1377 higher in the multidisciplinary intervention (n = 176) than in the brief intervention group (n = 175), and sick leave was not averted. However, sick leave was averted in a subgroup receiving the multidisciplinary intervention and the mean incremental intervention cost for 1 saved sick leave week in this subgroup (n = 60) of patients, who thought they were at risk of losing their job or had little influence on their work situation was € 217. The latter finding was verified in the validation study (n = 28). The brief intervention resulted in fewer sick leave weeks and was less expensive than the multidisciplinary intervention. The multidisciplinary intervention only outperformed the brief intervention in terms of costs in a subgroup of sick-listed employees who thought they were at risk of losing their job or had little influence on their work situation. 2.

  2. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...

  3. Economic impact study: neuromuscular training reduces the burden of injuries and costs compared to standard warm-up in youth soccer.

    Science.gov (United States)

    Marshall, Deborah A; Lopatina, Elena; Lacny, Sarah; Emery, Carolyn A

    2016-11-01

    There is randomised controlled trial (RCT) evidence that neuromuscular training (NMT) programmes can reduce the risk of injury in youth soccer. We evaluated the cost-effectiveness of such an NMT prevention strategy compared to a standard of practice warm-up. A cost-effectiveness analysis was conducted alongside a cluster RCT. Injury incidence rates were adjusted for cluster using Poisson regression analyses. Direct healthcare costs and injury incidence proportions were adjusted for cluster using bootstrapping. The joint uncertainty surrounding the cost and injury rate and proportion differences was estimated using bootstrapping with 10 000 replicates. Along with a 38% reduction in injury risk (rate difference=-1.27/1000 player hours (95% CI -0.33 to -2.2)), healthcare costs were reduced by 43% in the NMT group (-$689/1000 player hours (95% CI -$1741 to $234)) compared with the control group. 90% of the bootstrapped ratios were in the south-west quadrant of the cost-effectiveness plane, showing that the NMT programme was dominant (more effective and less costly) over standard warm-up. Projecting results onto 58 100 Alberta youth soccer players, an estimated 4965 injuries and over $2.7 million in healthcare costs would be conservatively avoided in one season with implementation of a neuromuscular training prevention programme. Implementation of an NMT prevention programme in youth soccer is effective in reducing the burden of injury and leads to considerable reduction in costs. These findings inform practice and policy supporting the implementation of NMT prevention strategies in youth soccer nationally and internationally. 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/.

  4. Simulation of empty container logistic management at depot

    Science.gov (United States)

    Sze, San-Nah; Sek, Siaw-Ying Doreen; Chiew, Kang-Leng; Tiong, Wei-King

    2017-07-01

    This study focuses on the empty container management problem in a deficit regional area. Deficit area is the area having more export activities than the import activities, which always have a shortage of empty container. This environment has challenged the trading companies in the decision making in distributing the empty containers. A simulation model that fit to the environment is developed. Besides, a simple heuristic algorithm with some hard and soft constraints consideration are proposed to plan the logistic of empty container supply. Then, the feasible route with the minimum cost will be determined by applying the proposed heuristic algorithm. The heuristic algorithm can be divided into three main phases which are data sorting, data assigning and time window updating.

  5. Employment-based reinforcement of adherence to depot naltrexone in unemployed opioid-dependent adults: a randomized controlled trial.

    Science.gov (United States)

    Everly, Jeffrey J; DeFulio, Anthony; Koffarnus, Mikhail N; Leoutsakos, Jeannie-Marie S; Donlin, Wendy D; Aklin, Will M; Umbricht, Annie; Fingerhood, Michael; Bigelow, George E; Silverman, Kenneth

    2011-07-01

    Naltrexone can be used to treat opioid dependence, but patients refuse to take it. Extended-release depot formulations may improve adherence, but long-term adherence rates to depot naltrexone are not known. This study determined long-term rates of adherence to depot naltrexone and whether employment-based reinforcement can improve adherence. Participants who were inducted onto oral naltrexone were assigned randomly to contingency (n = 18) or prescription (n = 17) groups. Participants were offered six depot naltrexone injections and invited to work at the therapeutic workplace on week days for 26 weeks, where they earned stipends for participating in job skills training. Contingency participants were required to accept naltrexone injections to maintain workplace access and to maintain maximum pay. Prescription participants could work independently of whether they accepted injections. The therapeutic workplace, a model employment-based intervention for drug addiction and unemployment. Opioid-dependent unemployed adults. Depot naltrexone injections accepted and opiate-negative urine samples. Contingency participants accepted significantly more naltrexone injections than prescription participants (81% versus 42%), and were more likely to accept all injections (66% versus 35%). At monthly assessments (with missing urine samples imputed as positive), the groups provided similar percentages of samples negative for opiates (74% versus 62%) and for cocaine (56% versus 54%). Opiate-positive samples were more likely when samples were also positive for cocaine. Employment-based reinforcement can maintain adherence to depot naltrexone. Future research should determine whether persistent cocaine use compromises naltrexone's effect on opiate use. Workplaces may be useful for promoting sustained adherence to depot naltrexone. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

  6. Characterization of stromal vascular fraction and adipose stem cells from subcutaneous, preperitoneal and visceral morbidly obese human adipose tissue depots.

    Science.gov (United States)

    Silva, Karina Ribeiro; Côrtes, Isis; Liechocki, Sally; Carneiro, João Regis Ivar; Souza, Antônio Augusto Peixoto; Borojevic, Radovan; Maya-Monteiro, Clarissa Menezes; Baptista, Leandra Santos

    2017-01-01

    The pathological condition of obesity is accompanied by a dysfunctional adipose tissue. We postulate that subcutaneous, preperitoneal and visceral obese abdominal white adipose tissue depots could have stromal vascular fractions (SVF) with distinct composition and adipose stem cells (ASC) that would differentially account for the pathogenesis of obesity. In order to evaluate the distribution of SVF subpopulations, samples of subcutaneous, preperitoneal and visceral adipose tissues from morbidly obese women (n = 12, BMI: 46.2±5.1 kg/m2) were collected during bariatric surgery, enzymatically digested and analyzed by flow cytometry (n = 12). ASC from all depots were evaluated for morphology, surface expression, ability to accumulate lipid after induction and cytokine secretion (n = 3). A high content of preadipocytes was found in the SVF of subcutaneous depot (p = 0.0178). ASC from the three depots had similar fibroblastoid morphology with a homogeneous expression of CD34, CD146, CD105, CD73 and CD90. ASC from the visceral depot secreted the highest levels of IL-6, MCP-1 and G-CSF (p = 0.0278). Interestingly, preperitoneal ASC under lipid accumulation stimulus showed the lowest levels of all the secreted cytokines, except for adiponectin that was enhanced (p = 0.0278). ASC from preperitoneal adipose tissue revealed the less pro-inflammatory properties, although it is an internal adipose depot. Conversely, ASC from visceral adipose tissue are the most pro-inflammatory. Therefore, ASC from subcutaneous, visceral and preperitoneal adipose depots could differentially contribute to the chronic inflammatory scenario of obesity.

  7. Latest results of the international discussion on the social costs of energy - how does wind compare today?

    International Nuclear Information System (INIS)

    Hohmeyer, O.H.

    1990-01-01

    A first analysis of the social costs of competing technologies for electric power generation published in 1988 has induced a rather controversial scientific discussion about the magnitude of and the possible ways to incorporate cost elements not included in energy prices into decisions on energy systems. Different research projects following up a number of controversial or unanswered questions in the field of social costs have been started in the Federal Republic of Germany (FRG), in Europe and overseas. A first ''counter-study'' has been published in the FRG in 1989. The paper summarizes the latest results of international scientific discussion and research and sketches possible future trends in this field and the practical and political implementation of its results. A first estimate of the consideration of global warming effects due to conventional electricity generation is included in addition to recalculated results on topics addressed by the author in 1988. It concludes that the figures calculated in 1988 have been underestimating the magnitude of the costs not included in the energy prices and that new calculations including further results on CO 2 lead to significantly higher figures. The difference of the costs not included in the price of conventional electricity and wind energy rises from 8.4 to 14 Pf/kWh on average with an estimated range of 4.7 to 25.4 Pf/kWh (1 DM = 100 pf = 0.5 ECU). Considering the full costs of electricity generation it can be concluded that wind energy is one of the most economical ways to produce electricity today. Political considerations on how to take social costs of electricity generation into account have reached some definite conclusions in some states of the USA. The paper gives a short sketch of these activities. (Author)

  8. Comparative cost assessment of the Kato-Katz and FLOTAC techniques for soil-transmitted helminth diagnosis in epidemiological surveys

    Directory of Open Access Journals (Sweden)

    Speich Benjamin

    2010-08-01

    Full Text Available Abstract Background The Kato-Katz technique is widely used for the diagnosis of soil-transmitted helminthiasis in epidemiological surveys and is believed to be an inexpensive method. The FLOTAC technique shows a higher sensitivity for the diagnosis of light-intensity soil-transmitted helminth infections but is reported to be more complex and expensive. We assessed the costs related to the collection, processing and microscopic examination of stool samples using the Kato-Katz and FLOTAC techniques in an epidemiological survey carried out in Zanzibar, Tanzania. Methods We measured the time for the collection of a single stool specimen in the field, transfer to a laboratory, preparation and microscopic examination using standard protocols for the Kato-Katz and FLOTAC techniques. Salaries of health workers, life expectancy and asset costs of materials, and infrastructure costs were determined. The average cost for a single or duplicate Kato-Katz thick smears and the FLOTAC dual or double technique were calculated. Results The average time needed to collect a stool specimen and perform a single or duplicate Kato-Katz thick smears or the FLOTAC dual or double technique was 20 min and 34 sec (20:34 min, 27:21 min, 28:14 min and 36:44 min, respectively. The total costs for a single and duplicate Kato-Katz thick smears were US$ 1.73 and US$ 2.06, respectively, and for the FLOTAC double and dual technique US$ 2.35 and US$ 2.83, respectively. Salaries impacted most on the total costs of either method. Conclusions The time and cost for soil-transmitted helminth diagnosis using either the Kato-Katz or FLOTAC method in epidemiological surveys are considerable. Our results can help to guide healthcare decision makers and scientists in budget planning and funding for epidemiological surveys, anthelminthic drug efficacy trials and monitoring of control interventions.

  9. Cost effectiveness of transcatheter aortic valve replacement compared to medical management in inoperable patients with severe aortic stenosis: Canadian analysis based on the PARTNER Trial Cohort B findings.

    Science.gov (United States)

    Hancock-Howard, Rebecca L; Feindel, Christopher M; Rodes-Cabau, Josep; Webb, John G; Thompson, Ann K; Banz, Kurt

    2013-01-01

    The only effective treatment for severe aortic stenosis (AS) is valve replacement. However, many patients with co-existing conditions are ineligible for surgical valve replacement, historically leaving medical management (MM) as the only option which has a poor prognosis. Transcatheter Aortic Valve Replacement (TAVR) is a less invasive replacement method. The objective was to estimate cost-effectiveness of TAVR via transfemoral access vs MM in surgically inoperable patients with severe AS from the Canadian public healthcare system perspective. A cost-effectiveness analysis of TAVR vs MM was conducted using a deterministic decision analytic model over a 3-year time horizon. The PARTNER randomized controlled trial results were used to estimate survival, utilities, and some resource utilization. Costs included the valve replacement procedure, complications, hospitalization, outpatient visits/tests, and home/nursing care. Resources were valued (2009 Canadian dollars) using costs from the Ontario Case Costing Initiative (OCCI), Ontario Ministry of Health and Long-Term Care and Ontario Drug Benefits Formulary, or were estimated using relative costs from a French economic evaluation or clinical experts. Costs and outcomes were discounted 5% annually. The effect of uncertainty in model parameters was explored in deterministic and probabilistic sensitivity analysis. The incremental cost-effectiveness ratio (ICER) was $32,170 per quality-adjusted life year (QALY) gained for TAVR vs MM. When the time horizon was shortened to 24 and 12 months, the ICER increased to $52,848 and $157,429, respectively. All other sensitivity analysis returned an ICER of less than $50,000/QALY gained. A limitation was lack of availability of Canadian-specific resource and cost data for all resources, leaving one to rely on clinical experts and data from France to inform certain parameters. Based on the results of this analysis, it can be concluded that TAVR is cost-effective compared to MM for the

  10. The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Walter Obiero

    Full Text Available Male circumcision (MC reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC method. The PrePex male circumcision (PMC method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method.Data were obtained from the Nyanza Reproductive Health Society (NRHS, an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars.Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively.The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.

  11. Comparative cost-effectiveness of two interventions to promote work functioning by targeting mental health complaints among nurses: pragmatic cluster randomised trial.

    Science.gov (United States)

    Noben, Cindy; Smit, Filip; Nieuwenhuijsen, Karen; Ketelaar, Sarah; Gärtner, Fania; Boon, Brigitte; Sluiter, Judith; Evers, Silvia

    2014-10-01

    The specific job demands of working in a hospital may place nurses at elevated risk for developing distress, anxiety and depression. Screening followed by referral to early interventions may reduce the incidence of these health problems and promote work functioning. To evaluate the comparative cost-effectiveness of two strategies to promote work functioning among nurses by reducing symptoms of mental health complaints. Three conditions were compared: the control condition consisted of online screening for mental health problems without feedback about the screening results. The occupational physician condition consisted of screening, feedback and referral to the occupational physician for screen-positive nurses. The third condition included screening, feedback, and referral to e-mental health. The study was designed as an economic evaluation alongside a pragmatic cluster randomised controlled trial with randomisation at hospital-ward level. The study included 617 nurses in one academic medical centre in the Netherlands. Treatment response was defined as an improvement on the Nurses Work Functioning Questionnaire of at least 40% between baseline and follow-up. Total per-participant costs encompassed intervention costs, direct medical and non-medical costs, and indirect costs stemming from lost productivity due to absenteeism and presenteeism. All costs were indexed for the year 2011. At 6 months follow-up, significant improvement in work functioning occurred in 20%, 24% and 16% of the participating nurses in the control condition, the occupational physician condition and the e-mental health condition, respectively. In these conditions the total average annualised costs were €1752, €1266 and €1375 per nurse. The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant, suggesting cost savings of €5049 per treatment responder. The incremental cost-effectiveness ratio for the e-mental health

  12. Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care.

    Science.gov (United States)

    De Allegri, Manuela; Marschall, Paul; Flessa, Steffen; Tiendrebéogo, Justin; Kouyaté, Bocar; Jahn, Albrecht; Müller, Olaf

    2010-01-01

    Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge by developing such a comparative cost analysis, looking at the cost per ITN distributed for two alternative interventions: subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care (ANC). The study was conducted in rural Burkina Faso, where the two interventions were carried out alongside one another in 2006/07. Cost information was collected prospectively to derive both a financial analysis adopting a provider's perspective and an economic analysis adopting a societal perspective. The average financial cost per ITN distributed was US$8.08 and US$7.21 for sales supported by social marketing and free distribution through ANC, respectively. The average economic cost per ITN distributed was US$4.81 for both interventions. Contrary to common belief, costs did not differ substantially between the two interventions. Due to the district's ability to rely fully on the use of existing resources, financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign. This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities. Given restricted budgets, however, free distribution programmes are unlikely to be feasible.

  13. A cost-minimisation analysis comparing moxifloxacin with levofloxacin plus ceftriaxone for the treatment of patients with community-acquired pneumonia in Germany: results from the MOTIV trial.

    Science.gov (United States)

    Lloyd, A; Holman, A; Evers, T

    2008-05-01

    This study presents a cost-minimisation analysis of moxifloxacin compared to combination treatment with levofloxacin and ceftriaxone in patients hospitalised with community-acquired pneumonia (CAP) in Germany. In the MOTIV study, 738 adult patients with CAP requiring hospitalisation and initial parenteral antibiotic therapy were randomised to sequential IV/oral therapy with either moxifloxacin (n = 368), or levofloxacin and ceftriaxone (n = 365). The primary effectiveness endpoint was the proportion of patients demonstrating clinical improvement 5-7 days after the completion of study treatment. Subgroup analysis considered patients with severe CAP according to pneumonia severity index (PSI) risk class IV and V, microbiologically proven infection, a history of chronic obstructive pulmonary disease, and a history of cardiovascular disease. The analysis included the cost of study medication, hospital stay, readmission and inpatient procedures and diagnostics. Event frequency in the study was multiplied by German unit costs to estimate per-patient expenditure. The analysis was conducted from a hospital perspective. Sensitivity analysis investigated the effect of costing from an insurer perspective. No significant difference was found in the percentage of successfully treated patients. Average per patient cost was euro 2190 for the moxifloxacin group, and euro 2619 for the levofloxacin + ceftriaxone group (difference -euro 430, 95% CI: -euro 138, -euro 740; p < 0.05). Variability in total costs was wide, with some patients accruing up to euro 18,000. Medication cost was significantly lower with moxifloxacin than levofloxacin + ceftriaxone (-euro 470, 95% CI: -euro 522, -euro 421), and accounted for between 15 and 30% of total costs. In this analysis of patients hospitalised with CAP in Germany, treatment with moxifloxacin was significantly less costly than treatment with levofloxacin and ceftriaxone.

  14. NATO Independent Cost Estimating and the Role of Life Cycle Cost Analysis in Managing the Defence Enterprise (Estimation independante des couts de l’OTAN et role de l’analyse des couts globaux de possesssion au sen de l’OTAN)

    Science.gov (United States)

    2012-08-01

    system O&S costs. VA- MOSC provides the direct O&S costs of weapon systems, some linked indirect costs (e.g., ship depot overhead), and related non...Rotterdam and Johann de Witt were selected and their data pulled from VA- MOSC . • The work breakdown structures (WBS) for each element were analysed so

  15. Comparing the Costs and Revenues of Transformation to Continuous Cover Forestry for Sitka Spruce in Great Britain

    Directory of Open Access Journals (Sweden)

    Owen Davies

    2015-07-01

    Full Text Available Recently continuous cover forestry (CCF has become an accepted approach to forest management in Britain, but uncertainty about its economic consequences may be a barrier to its wider use. A study was carried out to examine the costs and revenues of transforming a stand of Sitka spruce (Picea sitchensis (Bong. Carr. to CCF. The main conclusion is that transformation to CCF need not be more costly than clearfelling and replanting if natural regeneration is successful and the aim is to produce a simple canopy structure. The long-term value of transformation to a more complex canopy structure, with three or more strata, is lower and the extra costs need to be justified in terms of management objectives. The main output from the study is an analysis spreadsheet that empowers practitioners and policy makers to investigate the effects of costs, revenues and discount rates on estimates of net present value over 20 years, 100 years and in perpetuity, to suit local conditions. This paper summarises the method and results of the study in a British context, sets these in a wider international context, and considers the merits, applications and possible further developments of the approach.

  16. Comparing compensation mussel production costs and traditional agricultural farmers willingness to pay to reduce nutrient loads in the Limfjord

    DEFF Research Database (Denmark)

    Frost, Hans Staby; Hasler, Berit; Hoff, Ayoe

    Nitrogen non-point pollution from agriculture is the dominating source of eutrophication of Danish fjords. Long-line mussel production is an alternative measure to costly agricultural measures to achieve good ecological status of fjords. This paper investigates farmers’ economic incentives to buy...

  17. A comparative cost analysis of robotic-assisted surgery versus laparoscopic surgery and open surgery: the necessity of investing knowledgeably.

    Science.gov (United States)

    Tedesco, Giorgia; Faggiano, Francesco C; Leo, Erica; Derrico, Pietro; Ritrovato, Matteo

    2016-11-01

    Robotic surgery has been proposed as a minimally invasive surgical technique with advantages for both surgeons and patients, but is associated with high costs (installation, use and maintenance). The Health Technology Assessment Unit of the Bambino Gesù Children's Hospital sought to investigate the economic sustainability of robotic surgery, having foreseen its impact on the hospital budget METHODS: Break-even and cost-minimization analyses were performed. A deterministic approach for sensitivity analysis was applied by varying the values of parameters between pre-defined ranges in different scenarios to see how the outcomes might differ. The break-even analysis indicated that at least 349 annual interventions would need to be carried out to reach the break-even point. The cost-minimization analysis showed that robotic surgery was the most expensive procedure among the considered alternatives (in terms of the contribution margin). Robotic surgery is a good clinical alternative to laparoscopic and open surgery (for many pediatric operations). However, the costs of robotic procedures are higher than the equivalent laparoscopic and open surgical interventions. Therefore, in the short run, these findings do not seem to support the decision to introduce a robotic system in our hospital.

  18. Weighing the Costs and Benefits of Renewables Portfolio Standards:A Comparative Analysis of State-Level Policy Impact Projections

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Cliff; Wiser, Ryan; Bolinger, Mark

    2007-01-16

    State renewables portfolio standards (RPS) have emerged as one of the most important policy drivers of renewable energy capacity expansion in the U.S. Collectively, these policies now apply to roughly 40% of U.S. electricity load, and may have substantial impacts on electricity markets, ratepayers, and local economies. As RPS policies have been proposed or adopted in an increasing number of states, a growing number of studies have attempted to quantify the potential impacts of these policies, focusing primarily on projecting cost impacts, but sometimes also estimating macroeconomic and environmental effects. This report synthesizes and analyzes the results and methodologies of 28 distinct state or utility-level RPS cost impact analyses completed since 1998. Together, these studies model proposed or adopted RPS policies in 18 different states. We highlight the key findings of these studies on the costs and benefits of RPS policies, examine the sensitivity of projected costs to model assumptions, assess the attributes of different modeling approaches, and suggest possible areas of improvement for future RPS analysis.

  19. Comparing Green and Grey Infrastructure Using Life Cycle Cost and Environmental Impact: A Rain Garden Case Study in Cincinnati, OH.

    Science.gov (United States)

    Green infrastructure is quickly gaining ground as a less costly, greener alternative to traditional methods of stormwater management. One popular form of green infrastructure is the use of rain gardens to capture and infiltrate stormwater in to the ground. We used life cycle asse...

  20. Comparing Biologic Cost Per Treated Patient Across Indications Among Adult US Managed Care Patients: A Retrospective Cohort Study.

    Science.gov (United States)

    Gu, Tao; Shah, Neel; Deshpande, Gaurav; Tang, Derek H; Eisenberg, Debra F

    2016-12-01

    The relative cost of biologics in the treatment of autoimmune disorders, including rheumatoid arthritis, psoriatic arthritis, psoriasis, and ankylosing spondylitis, is a key consideration for managed care payers. Our objective was to estimate biologic costs and treatment patterns in US managed care patients with rheumatoid arthritis, psoriatic arthritis, psoriasis, and/or ankylosing spondylitis. This retrospective study used administrative claims data from the HealthCore Integrated Research Database (HIRD SM ) for adults with rheumatoid arthritis, psoriatic arthritis, psoriasis, and/or ankylosing spondylitis who received abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab between 1 July 2009 and 31 January 2013. Biologic costs (based on drug utilization) and treatment patterns (discontinued, restarted after a >45-day gap, switched to another biologic, or persisted without switching or stopping) were analyzed for the first year post-index. Most of the 24,460 patients received etanercept (48 %), adalimumab (29 %), or infliximab (12 %) as the index biologic. On the index date, 44 % were new to biologic therapy and 56 % were continuing biologic therapy. Biologic cost per treated patient for 1 year was as follows: etanercept $US24,859, adalimumab $US26,537, and infliximab $US26,468. Treatment patterns across indications for etanercept, adalimumab, and infliximab were as follows: persistent (52, 49, 67 %), restarted (23, 21, 12 %), switched (12, 13, 11 %), and discontinued (14, 18, 10 %). These findings from a large health benefits organization in the USA are similar to those of several previous cost analyses assessing different populations, which demonstrates the external validity of the results from the previous studies, both over time and across large populations.

  1. On farm evaluation of the effect of low cost drip irrigation on water and crop productivity compared to conventional surface irrigation system

    Science.gov (United States)

    Maisiri, N.; Senzanje, A.; Rockstrom, J.; Twomlow, S. J.

    This on-farm research study was carried out at Zholube irrigation scheme in a semi-arid agro tropical climate of Zimbabwe to determine how low cost drip irrigation technologies compare with conventional surface irrigation systems in terms of water and crop productivity. A total of nine farmers who were practicing surface irrigation were chosen to participate in the study. The vegetable English giant rape ( Brassica napus) was grown under the two irrigation systems with three fertilizer treatments in each system: ordinary granular fertilizer, liquid fertilizer (fertigation) and the last treatment with no fertilizer. These trials were replicated three times in a randomized block design. Biometric parameters of leaf area index (LAI) and fresh weight of the produce, water use efficiency (WUE) were used to compare the performance of the two irrigation systems. A water balance of the inflows and outflows was kept for analysis of WUE. The economic profitability and the operation, maintenance and management requirements of the different systems were also evaluated. There was no significant difference in vegetable yield between the irrigation systems at 8.5 ton/ha for drip compared to 7.8 ton/ha in surface irrigation. There were significant increases in yields due to use of fertilizers. Drip irrigation used about 35% of the water used by the surface irrigation systems thus giving much higher water use efficiencies. The leaf area indices were comparable in both systems with the same fertilizer treatment ranging between 0.05 for surface without fertilizer to 6.8 for low cost drip with fertigation. Low cost drip systems did not reflect any labour saving especially when manually lifting the water into the drum compared to the use of siphons in surface irrigation systems. The gross margin level for surface irrigation was lower than for low cost drip irrigation but the gross margin to total variable cost ratio was higher in surface irrigation systems, which meant that surface

  2. Comparing the cost-effectiveness of linezolid to trimethoprim/sulfamethoxazole plus rifampicin for the treatment of methicillin-resistant Staphylococcus aureus infection: a healthcare system perspective.

    Science.gov (United States)

    von Dach, E; Morel, C M; Murthy, A; Pagani, L; Macedo-Vinas, M; Olearo, F; Harbarth, S

    2017-09-01

    Few industry-independent studies have been conducted to compare the relative costs and benefits of drugs to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies-linezolid versus trimethoprim-sulfamethoxazole plus rifampicin-for the treatment of MRSA infection. We used cost and effectiveness data from a previously conducted clinical trial, complementing with other data from published literature, to compare the two regimens from a healthcare system perspective. Effectiveness was expressed in terms of quality-adjusted life-years (QALYs). Several sensitivity analyses were performed using Monte Carlo simulation, to measure the effect of potential parameter changes on the base-case model results, including potential differences related to type of infection and drug toxicity. Treatment of MRSA infection with trimethoprim-sulfamethoxazole plus rifampicin and linezolid were found to cost on average €146 and €2536, and lead to a gain of 0.916 and 0.881 QALYs, respectively. Treatment with trimethoprim-sulfamethoxazole plus rifampicin was found to be more cost-effective than linezolid in the base case and remained dominant over linezolid in most alternative scenarios, including different types of MRSA infection and potential disadvantages in terms of toxicity. With a willingness-to-pay threshold of €0, €50 000 and €200 000 per QALY gained, trimethoprim-sulfamethoxazole plus rifampicin was dominant in 100%, 96% and 85% of model iterations. A 95% discount on the current purchasing price of linezolid would be needed when it goes off-patent for it to represent better value for money compared with trimethoprim-sulfamethoxazole plus rifampicin. Combined treatment of trimethoprim-sulfamethoxazole plus rifampicin is more cost-effective than linezolid in the treatment of MRSA infection. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. A Comparative Study of Financial Data Sources for Critical Access Hospitals: Audited Financial Statements, the Medicare Cost Report, and the Internal Revenue Service Form 990

    Science.gov (United States)

    Ozmeral, Alisha Bhadelia; Reiter, Kristin L.; Holmes, George M.; Pink, George H.

    2012-01-01

    Purpose: Medicare Cost Reports (MCR), Internal Revenue Service Form 990s (IRS 990), and Audited Financial Statements (AFS) vary in their content, detail, purpose, timeliness, and certification. The purpose of this study was to compare selected financial data elements and characterize the extent of differences in financial data and ratios across…

  4. Developing a framework to assess the cost-effectiveness of COMPARE -A global platform for the exchange of sequence-based pathogen data

    DEFF Research Database (Denmark)

    Alleweldt, F.; Kara, Sami; Osinski, A.

    2017-01-01

    implementation of NGS also depends on its cost-effectiveness. COMPARE - short for 'Collaborative Management Platform for detection and Analyses of (Re-) emerging and foodborne outbreaks' - is a major project, funded by the European Union, to develop a global platform for sharing and analysing NGS data...

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

    NARCIS (Netherlands)

    Hitzert, Marit F.; Hermus, Marieke A. A.; Boesveld, Inge I.C.; Franx, Arie; van der Pal-de Bruin, Karin M.; Steegers, Eric A. P.; Van Den Akker-Van Marle, Eiske M.E.

    2017-01-01

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

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    NARCIS (Netherlands)

    M.F. Hitzert (Marit); M.A.A. Hermus (Marieke A.A.); Boesveld, I.I.C. (Inge I.C.); A. Franx (Arie); K.M. van der Pal-De Bruin (Karin); E.A.P. Steegers (Eric); Van Den Akker-Van Marle, E.M.E. (Eiske M.E.)

    2017-01-01

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

  8. Costs of managing adverse events in the treatment of first-line metastatic renal cell carcinoma: Bevacizumab in combination with interferon-α2a compared with sunitinib

    NARCIS (Netherlands)

    G.H.J. Mickisch; M. Gore (Martin); B. Escudier (B.); G. Procopio (G.); S. Walzer (S.); M.J.C. Nuijten (Mark)

    2010-01-01

    textabstractBackground: Bevacizumab plus interferon-α2a (IFN) prolongs progression-free survival to>10 months, which is comparable with sunitinib as first-line treatment of metastatic renal cell carcinoma (RCC). The two regimens have different tolerability profiles; therefore, costs for managing

  9. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation

    Directory of Open Access Journals (Sweden)

    Teddy Oosterhuis

    2017-07-01

    Trial registration: Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017 Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy 63: 144–153

  10. Cost-Utility Analysis of Lipegfilgrastim Compared to Pegfilgrastim for the Prophylaxis of Chemotherapy-Induced Neutropenia in Patients with Stage II-IV Breast Cancer

    Directory of Open Access Journals (Sweden)

    Esse I. H. Akpo

    2017-09-01

    Full Text Available Background: Lipegfilgrastim (Lonquex® has demonstrated to be non-inferior to pegfilgrastim (Neulasta® in reducing the duration of severe neutropenia (SN in patients with stage II−IV breast cancer. Compared to pegfilgrastim, lipegfilgrastim also demonstrated statistically significant lower time to ANC recovery in cycles 1–3, lower incidence of SN in cycle 2 and lower depth of absolute neutrophil count (ANC nadir in cycles 2 and 3. The aim of this study was to quantify the cost utility of lipegfilgrastim compared to pegfilgrastim in stage II−IV breast cancer patients, taking the perspective of the Belgian payer over a lifetime horizon.Methods: Two Markov models were developed to track on- and post-chemotherapy related complications, including SN, febrile neutropenia (FN, chemotherapy dose delay, chemotherapy relative dose intensity of less than 85%, infection, death rates, and quality-adjusted life years (QALYs. Data on costs (2015 value and effects were obtained from literature, national references, and complemented by a survey of clinical experts using a modified Delphi method. Both deterministic and probabilistic sensitivity analyses were carried out. Outcomes measures included costs, QALYs and life-years (LY.Results: At current equivalent price of €1,169, treatment with lipegfilgrastim was associated with overall costs of €9,845 vs. €10,208 for pegfilgrastim and overall QALYs of 13.977 vs. 13.925 for pegfilgrastim. Life expectancy was increased by 21 days (or 0.058 LY gained. The difference in costs stem from avoided infection, SN and FN cases in the lipegfilgrastim compared to the pegfilgrastim group. Similarly, the difference in QALYs was explained by the difference in the number of patients in the chemotherapy/G-CSF Markov state followed by infection and FN between lipegfilgrastim and pegfilgrastim. The probability of lipegfilgrastim to be cost-effective compared to pegfilgrastim was 68, 79, and 83% at the willingness

  11. Cortisol Response in Healthy and Diseased Dogs after Stimulation with a Depot Formulation of Synthetic ACTH.

    Science.gov (United States)

    Sieber-Ruckstuhl, N S; Burkhardt, W A; Hofer-Inteeworn, N; Riond, B; Rast, I T; Hofmann-Lehmann, R; Reusch, C E; Boretti, F S

    2015-01-01

    The ACTH stimulation test is used to evaluate the adrenocortical reserve. Recently, the availability of the synthetic ACTH formulation was limited, causing major problems in clinical practice. The objective of this study was to evaluate poststimulation peak cortisol concentrations and the duration of the stimulatory effect of a depot ACTH preparation in dogs. Twenty-two healthy dogs, 10 dogs with suspected hypoadrenocorticism (HA) and 15 dogs with suspected hyperadrenocorticism (HC). Prospective study. An ACTH stimulation test using a synthetic depot tetracosactide, administered intramuscularly (5 μg/kg or at least 0.1 mL) was performed. Blood samples for determination of cortisol were taken immediately before and 1, 2, 3, 4, 6, and 24 hours after stimulation. Peak cortisol concentrations were reached after 2-4 hours in all dogs. Cortisol concentrations 1 hour after stimulation were >9 μg/dL in all healthy dogs and >5 μg/dL in all dogs in which HA was excluded. None of the dogs with HA showed a cortisol-increase above the detection-limit of the assay. After 6 hours, cortisol concentrations had decreased in the healthy and HC group and were back to baseline after 24 hours. The depot formulation can be used in place of the short-acting ACTH to evaluate the adrenocortical reserve. Blood for peak cortisol concentrations should be drawn 3 hours after stimulation in cases in which HC is suspected; in HA-suspected cases, blood sampling can take place after 1 hour. As the stimulatory effect is gone after 24 hours, interference with other hormonal tests is unlikely after that time. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  12. Direct evidence of brown adipocytes in different fat depots in children.

    Directory of Open Access Journals (Sweden)

    Denise Rockstroh

    Full Text Available Recent studies suggested the persistence of brown adipocytes in adult humans, as opposed to being exclusively present in infancy. In this study, we investigated the presence of brown-like adipocytes in adipose tissue (AT samples of children and adolescents aged 0 to 18 years and evaluated the association with age, location, and obesity. For this, we analysed AT samples from 131 children and 23 adults by histological, immunohistochemical and expression analyses. We detected brown-like and UCP1 positive adipocytes in 10.3% of 87 lean children (aged 0.3 to 10.7 years and in one overweight infant, whereas we did not find brown adipocytes in obese children or adults. In our samples, the brown-like adipocytes were interspersed within white AT of perirenal, visceral and also subcutaneous depots. Samples with brown-like adipocytes showed an increased expression of UCP1 (>200fold, PRDM16 (2.8fold, PGC1α and CIDEA while other brown/beige selective markers, such as PAT2, P2RX5, ZIC1, LHX8, TMEM26, HOXC9 and TBX1 were not significantly different between UCP1 positive and negative samples. We identified a positive correlation between UCP1 and PRDM16 within UCP1 positive samples, but not with any other brown/beige marker. In addition, we observed significantly increased PRDM16 and PAT2 expression in subcutaneous and visceral AT samples with high UCP1 expression in adults. Our data indicate that brown-like adipocytes are present well beyond infancy in subcutaneous depots of non-obese children. The presence was not restricted to typical perirenal locations, but they were also interspersed within WAT of visceral and subcutaneous depots.

  13. National Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, Brian; Halverson, Mark A.; Myer, Michael; Loper, Susan A.; Richman, Eric E.; Elliott, Douglas B.; Mendon, Vrushali V.; Rosenberg, Michael I.

    2013-11-30

    Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components, initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.

  14. Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, Brian A.; Halverson, Mark A.; Myer, Michael; Cho, Hee Jin; Loper, Susan A.; Richman, Eric E.; Elliott, Douglas B.; Mendon, Vrushali V.; Rosenberg, Michael I.

    2013-06-18

    Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components, initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.

  15. A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study).

    Science.gov (United States)

    Kenny, Christopher; Devane, Declan; Normand, Charles; Clarke, Mike; Howard, Aoife; Begley, Cecily

    2015-11-01

    to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. two maternity units in Ireland, with 'alongside' midwife-led units. all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks׳ gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated ׳alongside׳ the consultant-led units, throughout pregnancy, birth and postnatal. mean difference in clinician salaries, cost of care based on managers׳ data, known costs of postnatal bed days and costs of key interventions were measured. the average cost of caring for a woman allocated to the midwife-led units was €2598, compared to €2780 in the consultant-led units (average difference €182 per woman, analysed by 'intention to treat'). care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Fuel cell system economics: comparing the costs of generating power with stationary and motor vehicle PEM fuel cell systems

    International Nuclear Information System (INIS)

    Lipman, Timothy E.; Edwards, Jennifer L.; Kammen, Daniel M.

    2004-01-01

    This investigation examines the economics of producing electricity from proton-exchange membrane (PEM) fuel cell systems under various conditions, including the possibility of using fuel cell vehicles (FCVs) to produce power when they are parked at office buildings and residences. The analysis shows that the economics of both stationary fuel cell and FCV-based power vary significantly with variations in key input variables such as the price of natural gas, electricity prices, fuel cell and reformer system costs, and fuel cell system durability levels. The 'central case' results show that stationary PEM fuel cell systems can supply electricity for offices and homes in California at a net savings when fuel cell system costs reach about $6000 for a 5 kW home system ($1200/kW) and $175,000 for a 250 kW commercial system ($700/kW) and assuming somewhat favorable natural gas costs of $6/GJ at residences and $4/GJ at commercial buildings. Grid-connected FCVs in commercial settings can also potentially supply electricity at competitive rates, in some cases producing significant annual benefits. Particularly attractive is the combination of net metering along with time-of-use electricity rates that allow power to be supplied to the utility grid at the avoided cost of central power plant generation. FCV-based power at individual residences does not appear to be as attractive, at least where FCV power can only be used directly or banked with the utility for net metering and not sold in greater quantity, due to the low load levels at these locations that provide a poor match to automotive fuel cell operation, higher natural gas prices than are available at commercial settings, and other factors

  17. Is There a Limit to Growth? Comparing the Environmental Cost of an Airport’s Operations with Its Economic Benefit

    OpenAIRE

    Cherie Lu

    2017-01-01

    With the growing global awareness of the requirement for sustainable development, economic development is no longer the sole objective of business activities. The need to find a balance between environmental impacts and economic benefits is especially the case for airport operations in or around cities. This study measured the environmental costs and economic benefits and of an airport for a period of 10 years, using Taipei Songshan Airport for the empirical analysis, to examine whether the e...

  18. Increasing biomass utilisation in energy systems: A comparative study of CO2 reduction and cost for different bioenergy processing options

    International Nuclear Information System (INIS)

    Wahlund, Bertil; Yan Jinyue; Westermark, Mats

    2004-01-01

    Emissions of greenhouse gases, such as CO 2 , need to be greatly reduced to avoid the risk of a harmful climate change. One powerful way to mitigate emissions is to switch fuels from fossil fuels to renewable energy, such as biomass. In this paper, we systematically investigate several bioenergy processing options, quantify the reduction rate and calculate the specific cost of reduction. This paper addresses the issue of which option Sweden should concentrate on to achieve the largest CO 2 reduction at the lowest cost. The results show that the largest and most long-term sustainable CO 2 reduction would be achieved by refining the woody biomass to fuel pellets for coal substitution, which have been done in Sweden. Refining to motor fuels, such as methanol, DME and ethanol, gives only half of the reduction and furthermore at a higher specific cost. Biomass refining into pellets enables transportation over long distances and seasonal storage, which is crucial for further utilisation of the woody biomass potential

  19. Cost-effectiveness of targeted vaccination to protect new-borns against pertussis: comparing neonatal, maternal, and cocooning vaccination strategies.

    Science.gov (United States)

    Lugnér, Anna K; van der Maas, Nicoline; van Boven, Michiel; Mooi, Frits R; de Melker, Hester E

    2013-11-04

    Pertussis (whooping cough) is a severe infectious disease in infants less than 6 months old. Mass vaccination programmes have been unable to halt transmission effectively. Strategies to protect new-borns against infection include vaccination of the neonate or the mother directly after birth (cocooning), or the mother during pregnancy (maternal). Here we investigate the cost-effectiveness of these three strategies in the Netherlands. Costs for health care utilization and productivity losses, as well as impact on quality of life were calculated for a 10-year vaccination programme, assuming that vaccine-induced immunity lasts 5 years. Cocooning was the most attractive option from a cost-effectiveness viewpoint (€89,000/QALY). However, both cocooning and maternal vaccination would reduce the disease burden in infants and mothers vaccinated (about 17-20 QALY/year). Specifically, with a persistent epidemic as seen in 2012, there is need for reconsidering the vaccination schedules against pertussis in order to increase protection of the vulnerable new-borns. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Modelling the Impact and Cost-Effectiveness of Biomarker Tests as Compared with Pathogen-Specific Diagnostics in the Management of Undifferentiated Fever in Remote Tropical Settings.

    Directory of Open Access Journals (Sweden)

    Yoel Lubell

    Full Text Available Malaria accounts for a small fraction of febrile cases in increasingly large areas of the malaria endemic world. Point-of-care tests to improve the management of non-malarial fevers appropriate for primary care are few, consisting of either diagnostic tests for specific pathogens or testing for biomarkers of host response that indicate whether antibiotics might be required. The impact and cost-effectiveness of these approaches are relatively unexplored and methods to do so are not well-developed.We model the ability of dengue and scrub typhus rapid tests to inform antibiotic treatment, as compared with testing for elevated C-Reactive Protein (CRP, a biomarker of host-inflammation. Using data on causes of fever in rural Laos, we estimate the proportion of outpatients that would be correctly classified as requiring an antibiotic and the likely cost-effectiveness of the approaches.Use of either pathogen-specific test slightly increased the proportion of patients correctly classified as requiring antibiotics. CRP testing was consistently superior to the pathogen-specific tests, despite heterogeneity in causes of fever. All testing strategies are likely to result in higher average costs, but only the scrub typhus and CRP tests are likely to be cost-effective when considering direct health benefits, with median cost per disability adjusted life year averted of approximately $48 USD and $94 USD, respectively.Testing for viral infections is unlikely to be cost-effective when considering only direct health benefits to patients. Testing for prevalent bacterial pathogens can be cost-effective, having the benefit of informing not only whether treatment is required, but also as to the most appropriate antibiotic; this advantage, however, varies widely in response to heterogeneity in causes of fever. Testing for biomarkers of host inflammation is likely to be consistently cost-effective despite high heterogeneity, and can also offer substantial reductions in

  1. Modelling the Impact and Cost-Effectiveness of Biomarker Tests as Compared with Pathogen-Specific Diagnostics in the Management of Undifferentiated Fever in Remote Tropical Settings.

    Science.gov (United States)

    Lubell, Yoel; Althaus, Thomas; Blacksell, Stuart D; Paris, Daniel H; Mayxay, Mayfong; Pan-Ngum, Wirichada; White, Lisa J; Day, Nicholas P J; Newton, Paul N

    2016-01-01

    Malaria accounts for a small fraction of febrile cases in increasingly large areas of the malaria endemic world. Point-of-care tests to improve the management of non-malarial fevers appropriate for primary care are few, consisting of either diagnostic tests for specific pathogens or testing for biomarkers of host response that indicate whether antibiotics might be required. The impact and cost-effectiveness of these approaches are relatively unexplored and methods to do so are not well-developed. We model the ability of dengue and scrub typhus rapid tests to inform antibiotic treatment, as compared with testing for elevated C-Reactive Protein (CRP), a biomarker of host-inflammation. Using data on causes of fever in rural Laos, we estimate the proportion of outpatients that would be correctly classified as requiring an antibiotic and the likely cost-effectiveness of the approaches. Use of either pathogen-specific test slightly increased the proportion of patients correctly classified as requiring antibiotics. CRP testing was consistently superior to the pathogen-specific tests, despite heterogeneity in causes of fever. All testing strategies are likely to result in higher average costs, but only the scrub typhus and CRP tests are likely to be cost-effective when considering direct health benefits, with median cost per disability adjusted life year averted of approximately $48 USD and $94 USD, respectively. Testing for viral infections is unlikely to be cost-effective when considering only direct health benefits to patients. Testing for prevalent bacterial pathogens can be cost-effective, having the benefit of informing not only whether treatment is required, but also as to the most appropriate antibiotic; this advantage, however, varies widely in response to heterogeneity in causes of fever. Testing for biomarkers of host inflammation is likely to be consistently cost-effective despite high heterogeneity, and can also offer substantial reductions in over-use of

  2. PENGARUH PENGOLAHAN AIR DI DEPOT AIR MINUM ISI ULANG DALAM MENORMALKAN DERAJAT KEASAMAN (pH)

    OpenAIRE

    Athena Athena; Sukar Sukar; Hendro M.; D. Anwar M.

    2012-01-01

    In 2003, it had been performed a study to assess drinking water quality produced by drinking water refill depot (AMIU) in Jabotabek. The objective of the study is to evaluate the effect of drinking water treatment process of the AMIU in normalizing of acidity level, especially for pH parameter. Water pH level is necessary to assess in line with the determination  of its use, for household use as drinking water or for the AMIU for raw material. According to laboratory analysis result, it can b...

  3. Pengaruh Pengolahan Air Di Depot Air Minum Isi Ulang Dalam Menormalkan Derajat Keasaman (Ph)

    OpenAIRE

    Athena, Athena; Sukar, Sukar; M., Hendro; M., D. Anwar

    2005-01-01

    In 2003, it had been performed a study to assess drinking water quality produced by drinking water refill depot (AMIU) in Jabotabek. The objective of the study is to evaluate the effect of drinking water treatment process of the AMIU in normalizing of acidity level, especially for pH parameter. Water pH level is necessary to assess in line with the determination of its use, for household use as drinking water or for the AMIU for raw material. According to laboratory analysis result, it can b...

  4. Anaphylaxis Triggered by Benzyl Benzoate in a Preparation of Depot Testosterone Undecanoate

    Directory of Open Access Journals (Sweden)

    Gregory S. Y. Ong

    2012-01-01

    Full Text Available We report the first case of an anaphylactic reaction to Reandron 1000 (depot testosterone undecanoate with a castor oil and benzyl benzoate vehicle. While considered to have a favourable safety profile, serious complications such as oil embolism and anaphylaxis can occur. In our patient, skin testing identified benzyl benzoate to be the trigger, with no reaction to castor oil or testosterone undecanoate components. As benzyl benzoate exists in multiple pharmaceuticals, foods, and cosmetics, individual components of pharmaceuticals should be tested when investigating drug allergies. Doctors should be alert to the potential for serious reactions to any of the components of Reandron 1000.

  5. KANDUNGAN Pb, Cd, Hg DALAM AIR MINUM DARI DEPOT AIR MINUM ISI ULANG DI JAKARTA, TANGERANG, DAN BEKASI

    Directory of Open Access Journals (Sweden)

    Athena Athena

    2012-11-01

    Full Text Available A study on chemical quality of drinking water from reffil depots was done in Jakarta, Tangerang, and Bekasi in 2003 to determine the contents of heavy metals such as lead (Pb, cadmium, (Cd, and Mercury (Hg. A total of 38 refill depots was selected as samples. Data were collected by water sampling collection and water analysis, and interview with operators and association personal using questionairs. Water samples were analyzed using Atomic Absorption Spectrophotometer (AAS to examine the contents of their heavy metals based on raw water and drinking water standards. The results showed that the treatment processed were filtration and disinfection. However, the contents of heavy metals in the two types of water samples still complied with the standards stated in Health Ministerial Decree no 906 in the year 2002.   Keywords: heavy metals, drinking water, drinking water refill depots

  6. Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain.

    Science.gov (United States)

    Hansen, Ryan N; Pham, An T; Lovelace, Belinda; Balaban, Stela; Wan, George J

    2017-10-01

    Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07). Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

  7. Comparing off-pump and on-pump clinical outcomes and costs for diabetic cardiac surgery patients.

    Science.gov (United States)

    Shroyer, A Laurie W; Hattler, Brack; Wagner, Todd H; Baltz, Janet H; Collins, Joseph F; Carr, Brendan M; Almassi, G Hossein; Quin, Jacquelyn A; Hawkins, Robert B; Kozora, Elizabeth; Bishawi, Muath; Ebrahimi, Ramin; Grover, Frederick L

    2014-07-01

    Observational studies have documented an off-pump over on-pump advantage for high-risk patients, including diabetic patients. Randomized trials have not confirmed this advantage. The VA Randomization On Versus Off Bypass (ROOBY) trial randomly assigned 2,203 coronary artery bypass graft surgery (CABG) patients at 18 sites to either on-pump (n=1,099) or off-pump (n=1,104) procedures. An a priori ROOBY aim was to evaluate treatment impact on diabetic patients. Actively treated diabetic patients (n=835, receiving oral hypoglycemic or insulin medications) received off-pump CABG (n=402) or on-pump CABG (n=433). The primary ROOBY trial endpoints were a short-term composite (30-day operative death or major complications) and a 1-year composite (death, nonfatal acute myocardial infarction, or repeat revascularization). Secondary ROOBY endpoints included 1-year all-cause death, 1-year graft patency, 1-year changes from baseline in neurocognitive status and health-related quality of life, and costs. Diabetic patients' risk factors at baseline were balanced across treatments. For diabetic patients, the primary short-term composite outcome rate showed a worse trend for off-pump (8.0%) than on-pump (3.9%, p=0.013), with no difference in the 1-year primary composite outcome or 1-year death rate. One-year patency was 83.1% off-pump versus 88.4% on-pump (p=0.004). No differences were found in neurocognitive, health-related quality of life, discharge cost, and 1-year cumulative cost. Concordant with the ROOBY trial's overall findings, off-pump CABG yielded no advantage over on-pump CABG for actively treated diabetic patients. The 1-year graft patency was lower and the short-term composite trended higher for off-pump CABG, with no other significant outcome or cost differences. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Design of Hybrid Gels Based on Gellan-Cholesterol Derivative and P90G Liposomes for Drug Depot Applications

    Directory of Open Access Journals (Sweden)

    Nicole Zoratto

    2017-05-01

    Full Text Available Gels are extensively studied in the drug delivery field because of their potential benefits in therapeutics. Depot gel systems fall in this area, and the interest in their development has been focused on long-lasting, biocompatible, and resorbable delivery devices. The present work describes a new class of hybrid gels that stem from the interaction between liposomes based on P90G phospholipid and the cholesterol derivative of the polysaccharide gellan. The mechanical properties of these gels and the delivery profiles of the anti-inflammatory model drug diclofenac embedded in such systems confirmed the suitability of these hybrid gels as a good candidate for drug depot applications.

  9. Prospective randomized controlled study comparing low-cost LED and conventional phototherapy for treatment of neonatal hyperbilirubinemia.

    Science.gov (United States)

    Viau Colindres, Johanna; Rountree, Corey; Destarac, Marie André; Cui, Yiwen; Pérez Valdez, Manuel; Herrera Castellanos, Mario; Mirabal, Yvette; Spiegel, Garrett; Richards-Kortum, Rebecca; Oden, Maria

    2012-06-01

    Our objective was to carry out a prospective, randomized, single-blind study to evaluate whether light emitting diode (LED) phototherapy using a low-cost set of lights is as effective as conventional phototherapy in treating hyperbilirubinemia in neonates. The study included 45 pre-term neonates requiring phototherapy as per American Academy of Pediatrics guidelines; participants were randomized to receive phototherapy using LED-based lights, conventional fluorescent blue lights or conventional halogen lights. There were no statistically significant differences in the average bilirubin levels at the onset, at the maximum and at the end of treatment, nor in the duration of phototherapy treatment and the rate of decrease in bilirubin levels in the neonates receiving conventional fluorescent blue light, conventional halogen light and LED phototherapy. (Differences were considered significant at p LED phototherapy, respectively. The average duration of phototherapy treatment in the three groups was 108.8 ± 85.9 h, 92.8 ± 38.1 h, 110.4 ± 42.6 h, respectively. In this pilot study, LED phototherapy using a simple, low-cost set of lights was as effective as conventional phototherapy in the treatment of neonatal hyperbilirubinemia. LED phototherapy lights that deliver 30-40 µW cm(-2 )nm(-1) can be assembled in small quantities for phototherapy to be safely and reliably delivered in low-resource settings.

  10. Comparing yield and relative costs of WHO TB screening algorithms in selected risk groups among people aged 65 years and over in China, 2013.

    Directory of Open Access Journals (Sweden)

    Canyou Zhang

    Full Text Available To calculate the yield and cost per diagnosed tuberculosis (TB case for three World Health Organization screening algorithms and one using the Chinese National TB program (NTP TB suspect definitions, using data from a TB prevalence survey of people aged 65 years and over in China, 2013.This was an analytic study using data from the above survey. Risk groups were defined and the prevalence of new TB cases in each group calculated. Costs of each screening component were used to give indicative costs per case detected. Yield, number needed to screen (NNS and cost per case were used to assess the algorithms.The prevalence survey identified 172 new TB cases in 34,250 participants. Prevalence varied greatly in different groups, from 131/100,000 to 4651/ 100,000. Two groups were chosen to compare the algorithms. The medium-risk group (living in a rural area: men, or previous TB case, or close contact or a BMI <18.5, or tobacco user had appreciably higher cost per case (USD 221, 298 and 963 in the three algorithms than the high-risk group (all previous TB cases, all close contacts. (USD 72, 108 and 309 but detected two to four times more TB cases in the population. Using a Chest x-ray as the initial screening tool in the medium risk group cost the most (USD 963, and detected 67% of all the new cases. Using the NTP definition of TB suspects made little difference.To "End TB", many more TB cases have to be identified. Screening only the highest risk groups identified under 14% of the undetected cases,. To "End TB", medium risk groups will need to be screened. Using a CXR for initial screening results in a much higher yield, at what should be an acceptable cost.

  11. A Study to Compare the Cost of Operation and Maintenance in Green Building Index (GBI and Non-Green Building Index (Non-GBI Rated Building in Malaysia

    Directory of Open Access Journals (Sweden)

    Ping Lee Zheng

    2016-01-01

    Full Text Available Urges for sustainable development had pushed the government and professional bodies to respond and react by implementing regulations where possible to direct development in that manner. However, the outcome in most financial conferences and dialogues on sustainable buildings flagged on high construction and maintenance cost. Thus, this study is conducted to collect and analyze actual building operation and maintenance cost between GBI and Non-GBI rated buildings in Malaysia which are more than 2 years fully operated buildings. There are two categories of selected buildings which are residential and non-residential type of building. Each category of the building consists of similar building’s characteristic such as geographic location, mode of operation, building heights, total numbers of floors and units. The scope of building’s maintenance for this study is mainly on wear and tear of the wall painting, electrical light fittings, ceiling panels, roofing system and mechanical services like water pump system are recorded for their replacement frequency of service and the cost involved within a consistent period of 12 months operation at cost percentage saving of 78.9% and 40.4% for residential and non-residential buildings respectively compare against Non-GBI rated buildings. Electricity consumption for GBI rated buildings are lower than Non-GBI rated buildings which recorded at the cost variance of 23.8% and 6.3% and water consumption at 35.9% and 44.0% for the above mentioned two main categories of selected case study buildings. Results from this study conclude major savings on residential buildings category in term of maintenance cost and electricity consumption for GBI rated buildings. Whereby, non-residential category of buildings, GBI rated building had been proven to obtain significant savings in terms of maintenance cost and water consumption.

  12. Comparing the life cycle costs of using harvest residue as feedstock for small- and large-scale bioenergy systems (part II)

    International Nuclear Information System (INIS)

    Cleary, Julian; Wolf, Derek P.; Caspersen, John P.

    2015-01-01

    In part II of our two-part study, we estimate the nominal electricity generation and GHG (greenhouse gas) mitigation costs of using harvest residue from a hardwood forest in Ontario, Canada to fuel (1) a small-scale (250 kW e ) combined heat and power wood chip gasification unit and (2) a large-scale (211 MW e ) coal-fired generating station retrofitted to combust wood pellets. Under favorable operational and regulatory conditions, generation costs are similar: 14.1 and 14.9 cents per kWh (c/kWh) for the small- and large-scale facilities, respectively. However, GHG mitigation costs are considerably higher for the large-scale system: $159/tonne of CO 2 eq., compared to $111 for the small-scale counterpart. Generation costs increase substantially under existing conditions, reaching: (1) 25.5 c/kWh for the small-scale system, due to a regulation mandating the continual presence of an operating engineer; and (2) 22.5 c/kWh for the large-scale system due to insufficient biomass supply, which reduces plant capacity factor from 34% to 8%. Limited inflation adjustment (50%) of feed-in tariff rates boosts these costs by 7% to 11%. Results indicate that policy generalizations based on scale require careful consideration of the range of operational/regulatory conditions in the jurisdiction of interest. Further, if GHG mitigation is prioritized, small-scale systems may be more cost-effective. - Highlights: • Generation costs for two forest bioenergy systems of different scales are estimated. • Nominal electricity costs are 14.1–28.3 cents/kWh for the small-scale plant. • Nominal electricity costs are 14.9–24.2 cents/kWh for the large-scale plant. • GHG mitigation costs from displacing coal and LPG are $111-$281/tonne of CO 2 eq. • High sensitivity to cap. factor (large-scale) and labor requirements (small-scale)

  13. SeqDepot: streamlined database of biological sequences and precomputed features.

    Science.gov (United States)

    Ulrich, Luke E; Zhulin, Igor B

    2014-01-15

    Assembling and/or producing integrated knowledge of sequence features continues to be an onerous and redundant task despite a large number of existing resources. We have developed SeqDepot-a novel database that focuses solely on two primary goals: (i) assimilating known primary sequences with predicted feature data and (ii) providing the most simple and straightforward means to procure and readily use this information. Access to >28.5 million sequences and 300 million features is provided through a well-documented and flexible RESTful interface that supports fetching specific data subsets, bulk queries, visualization and searching by MD5 digests or external database identifiers. We have also developed an HTML5/JavaScript web application exemplifying how to interact with SeqDepot and Perl/Python scripts for use with local processing pipelines. Freely available on the web at http://seqdepot.net/. RESTaccess via http://seqdepot.net/api/v1. Database files and scripts maybe downloaded from http://seqdepot.net/download.

  14. A two-stage approach to the depot shunting driver assignment problem with workload balance considerations.

    Science.gov (United States)

    Wang, Jiaxi; Gronalt, Manfred; Sun, Yan

    2017-01-01

    Due to its environmentally sustainable and energy-saving characteristics, railway transportation nowadays plays a fundamental role in delivering passengers and goods. Emerged in the area of transportation planning, the crew (workforce) sizing problem and the crew scheduling problem have been attached great importance by the railway industry and the scientific community. In this paper, we aim to solve the two problems by proposing a novel two-stage optimization approach in the context of the electric multiple units (EMU) depot shunting driver assignment problem. Given a predefined depot shunting schedule, the first stage of the approach focuses on determining an optimal size of shunting drivers. While the second stage is formulated as a bi-objective optimization model, in which we comprehensively consider the objectives of minimizing the total walking distance and maximizing the workload balance. Then we combine the normalized normal constraint method with a modified Pareto filter algorithm to obtain Pareto solutions for the bi-objective optimization problem. Furthermore, we conduct a series of numerical experiments to demonstrate the proposed approach. Based on the computational results, the regression analysis yield a driver size predictor and the sensitivity analysis give some interesting insights that are useful for decision makers.

  15. The disposal of low and intermediate-level radioactive wastes: the Elstow Storage Depot

    International Nuclear Information System (INIS)

    1983-10-01

    This document explains the role of NIREX (Nuclear Industry Radioactive Waste Executive) in planning for the safe disposal of low and intermediate-level radioactive wastes and outlines the plans for the investigation and possible development of a new shallow repository at the CEGB's Elstow Storage Depot, Bedfordshire. The site is conveniently located and is situated on a suitable geologic formation, the Oxford Clay. The next step is for NIREX to undertake site investigations and assess in detail the site's suitability. On the basis of this assessment NIREX will either confirm its interest in the site or reject it as unsuitable. If the site proves to be adequate for the development of a shallow repository then NIREX will seek the necessary planning approvals and authorisations for such a development. The development would involve the construction of new buildings and a programme of trench excavation, waste positioning and trench closure. Existing tenants at the Depot will be accommodated as far as possible. The existing road and rail networks would be used for delivering the packaged wastes. In designing and operating any repository the safety of the public and workforce, both now and in the future, will be of paramount importance. (author)

  16. A two-stage approach to the depot shunting driver assignment problem with workload balance considerations.

    Directory of Open Access Journals (Sweden)

    Jiaxi Wang

    Full Text Available Due to its environmentally sustainable and energy-saving characteristics, railway transportation nowadays plays a fundamental role in delivering passengers and goods. Emerged in the area of transportation planning, the crew (workforce sizing problem and the crew scheduling problem have been attached great importance by the railway industry and the scientific community. In this paper, we aim to solve the two problems by proposing a novel two-stage optimization approach in the context of the electric multiple units (EMU depot shunting driver assignment problem. Given a predefined depot shunting schedule, the first stage of the approach focuses on determining an optimal size of shunting drivers. While the second stage is formulated as a bi-objective optimization model, in which we comprehensively consider the objectives of minimizing the total walking distance and maximizing the workload balance. Then we combine the normalized normal constraint method with a modified Pareto filter algorithm to obtain Pareto solutions for the bi-objective optimization problem. Furthermore, we conduct a series of numerical experiments to demonstrate the proposed approach. Based on the computational results, the regression analysis yield a driver size predictor and the sensitivity analysis give some interesting insights that are useful for decision makers.

  17. Cost-Effectiveness of Nivolumab-Ipilimumab Combination Therapy Compared with Monotherapy for First-Line Treatment of Metastatic Melanoma in the United States.

    Science.gov (United States)

    Oh, Anna; Tran, Dang M; McDowell, Leann C; Keyvani, Dor; Barcelon, Jay Andrew; Merino, Oscar; Wilson, Leslie

    2017-06-01

    The approval of new immunotherapies has dramatically changed the treatment landscape of metastatic melanoma. These survival gains come with trade-offs in side effects and costs, as well as important considerations for third-party payer systems, physicians, and patients. To develop a Markov model to determine the cost-effectiveness of nivolumab, ipilimumab, and nivolumab-ipilimumab combination as firstline therapy in metastatic melanoma, while accounting for differential effectiveness in programmed death-ligand 1 (PD-L1) positive and negative patients. A 3-state Markov model (PD-L1 positive stable disease, PD-L1 negative stable disease, and progression and/or death) was developed using a U.S. societal perspective with a lifetime time horizon of 14.5 years. Transition probabilities were calculated from progression-free (PF) survival data reported in the CheckMate-067 trial. Costs were expressed in 2015 U.S. dollars and were determined using national sources. Adverse event (AE) management was determined using immune-related AE (irAE) data from CheckMate-067, irAE management guides for nivolumab and ipilimumab, and treatment guidelines. Utilities were obtained from published literature, using melanoma-specific studies when available, and were weighted based on incidence and duration of irAEs. Base case, one-way sensitivity, and probabilistic sensitivity analyses were conducted. Nivolumab-ipilimumab combination therapy was not the cost-effective choice ($454,092 per PF quality-adjusted life-year [QALY]) compared with nivolumab monotherapy in a base case analysis at a willingness-to-pay threshold of $100,000 per PFQALY. Combination therapy and nivolumab monotherapy were cost-effective choices compared with ipilimumab monotherapy. PD-L1 positive status, utility of nivolumab and combination therapy, and medication costs contributed the most uncertainty to the model. In a population of 100% PD-L1 negative patients, nivolumab was still the optimal treatment, but combination

  18. Comparing control strategies against foot-and-mouth disease: will vaccination be cost-effective in Denmark?

    Science.gov (United States)

    Boklund, A; Halasa, T; Christiansen, L E; Enøe, C

    2013-09-01

    almost the same preventive effect. Implementing additional control measures either 14 days after detection of the first infected herd or when 10 herds have been diagnosed would be more efficient than implementing additional control measures when more herds have been diagnosed. Protective vaccination scenarios would never be cost-effective, whereas depopulation or suppressive vaccination scenarios would most often be recommended. Looking at the median estimates of the cost-benefit analysis, depopulation in zones would most often be recommended, although, in extreme epidemics, suppressive vaccination scenarios could be less expensive. The vast majority of the costs and losses associated with a Danish epidemic could be attributed to export losses. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. No-cost manual method for preparation of tissue microarrays having high quality comparable to semiautomated methods.

    Science.gov (United States)

    Foda, Abd Al-Rahman Mohammad

    2013-05-01

    Manual tissue microarray (TMA) construction had been introduced to avoid the high cost of automated and semiautomated techniques. The cheapest and simplest technique for constructing manual TMA was that of using mechanical pencil tips. This study was carried out to modify this method, aiming to raise its quality to reach that of expensive ones. Some modifications were introduced to Shebl's technique. Two conventional mechanical pencil tips of different diameters were used to construct the recipient blocks. A source of mild heat was used, and blocks were incubated at 38°C overnight. With our modifications, 3 high-density TMA blocks were constructed. We successfully performed immunostaining without substantial tissue loss. Our modifications increased the number of cores per block and improved the stability of the cores within the paraffin block. This new, modified technique is a good alternative for expensive machines in many laboratories.

  20. Next-generation phage display: integrating and comparing available molecular tools to enable cost-effective high-throughput analysis.

    Science.gov (United States)

    Dias-Neto, Emmanuel; Nunes, Diana N; Giordano, Ricardo J; Sun, Jessica; Botz, Gregory H; Yang, Kuan; Setubal, João C; Pasqualini, Renata; Arap, Wadih

    2009-12-17

    Combinatorial phage display has been used in the last 20 years in the identification of protein-ligands and protein-protein interactions, uncovering relevant molecular recognition events. Rate-limiting steps of combinatorial phage display library selection are (i) the counting of transducing units and (ii) the sequencing of the encoded displayed ligands. Here, we adapted emerging genomic technologies to minimize such challenges. We gained efficiency by applying in tandem real-time PCR for rapid quantification to enable bacteria-free phage display library screening, and added phage DNA next-generation sequencing for large-scale ligand analysis, reporting a fully integrated set of high-throughput quantitative and analytical tools. The approach is far less labor-intensive and allows rigorous quantification; for medical applications, including selections in patients, it also represents an advance for quantitative distribution analysis and ligand identification of hundreds of thousands of targeted particles from patient-derived biopsy or autopsy in a longer timeframe post library administration. Additional advantages over current methods include increased sensitivity, less variability, enhanced linearity, scalability, and accuracy at much lower cost. Sequences obtained by qPhage plus pyrosequencing were similar to a dataset produced from conventional Sanger-sequenced transducing-units (TU), with no biases due to GC content, codon usage, and amino acid or peptide frequency. These tools allow phage display selection and ligand analysis at >1,000-fold faster rate, and reduce costs approximately 250-fold for generating 10(6) ligand sequences. Our analyses demonstrates that whereas this approach correlates with the traditional colony-counting, it is also capable of a much larger sampling, allowing a faster, less expensive, more accurate and consistent analysis of phage enrichment. Overall, qPhage plus pyrosequencing is superior to TU-counting plus Sanger sequencing and is

  1. Next-generation phage display: integrating and comparing available molecular tools to enable cost-effective high-throughput analysis.

    Directory of Open Access Journals (Sweden)

    Emmanuel Dias-Neto

    2009-12-01

    Full Text Available Combinatorial phage display has been used in the last 20 years in the identification of protein-ligands and protein-protein interactions, uncovering relevant molecular recognition events. Rate-limiting steps of combinatorial phage display library selection are (i the counting of transducing units and (ii the sequencing of the encoded displayed ligands. Here, we adapted emerging genomic technologies to minimize such challenges.We gained efficiency by applying in tandem real-time PCR for rapid quantification to enable bacteria-free phage display library screening, and added phage DNA next-generation sequencing for large-scale ligand analysis, reporting a fully integrated set of high-throughput quantitative and analytical tools. The approach is far less labor-intensive and allows rigorous quantification; for medical applications, including selections in patients, it also represents an advance for quantitative distribution analysis and ligand identification of hundreds of thousands of targeted particles from patient-derived biopsy or autopsy in a longer timeframe post library administration. Additional advantages over current methods include increased sensitivity, less variability, enhanced linearity, scalability, and accuracy at much lower cost. Sequences obtained by qPhage plus pyrosequencing were similar to a dataset produced from conventional Sanger-sequenced transducing-units (TU, with no biases due to GC content, codon usage, and amino acid or peptide frequency. These tools allow phage display selection and ligand analysis at >1,000-fold faster rate, and reduce costs approximately 250-fold for generating 10(6 ligand sequences.Our analyses demonstrates that whereas this approach correlates with the traditional colony-counting, it is also capable of a much larger sampling, allowing a faster, less expensive, more accurate and consistent analysis of phage enrichment. Overall, qPhage plus pyrosequencing is superior to TU-counting plus Sanger

  2. COST-EFFECTIVENESS OF APIXABAN AS COMPARED WITH WARFARIN AND ACETYLSALICYLIC ACID IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-09-01

    Full Text Available Background. For prevention of thromboembolic events in patients with non-valvular atrial fibrillation (NVAF the following types of antithrombotic therapy are used: anticoagulant therapy with vitamin K antagonists (such as warfarin, antiplatelet therapy (such as acetylsalicylic acid and novel oral anticoagulants such as apixaban, rivaroxaban and dabigatran. Administration of vitamin K antagonists (VKA is complicated by the need for individual dose adjustment and frequent monitoring of international normalized ratio (INR. Both warfarin and acetylsalicylic acid are widely used for thrombosis prevention in patients with NVAF in the Russian Federation.Aim. To evaluate the cost-effectiveness ratio of apixaban compared with warfarin and acetylsalicylic acid in patients with NVAF from the Russian Federation national health care system perspective.Material and methods. This analysis used a Markov model that allowed estimation of the incremental cost-effectiveness ratio (ICER for apixaban as compared with warfarin and acetylsalicylic acid over lifetime horizon in VKA suitable and VKA unsuitable patients with NVAF respectively. The model enclosed cardiovascular event rates based on the results of the randomized clinical trials comparing clinical effectiveness and safety of apixaban with warfarin (ARISTOTLE and acetylsalicylic acid (AVERROES. The following cardiovascular events were taken into consideration: ischemic and hemorrhagic stroke, systemic embolism, intracranial hemorrhage, other major bleeds, clinically relevant non-major bleeds and myocardial infarction. Direct medical costs were determined based on the rates of the compulsory national medical insurance system. The price of the antithrombotic drugs was taken as a weighted average tender price for the year 2013. In the model both costs and benefits (quality-adjusted life years and life-years were discounted at 3.5%. Cost-effectiveness threshold was set at 1.4 million rubles per quality

  3. COST-EFFECTIVENESS OF APIXABAN AS COMPARED WITH WARFARIN AND ACETYLSALICYLIC ACID IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2014-01-01

    Full Text Available Background. For prevention of thromboembolic events in patients with non-valvular atrial fibrillation (NVAF the following types of antithrombotic therapy are used: anticoagulant therapy with vitamin K antagonists (such as warfarin, antiplatelet therapy (such as acetylsalicylic acid and novel oral anticoagulants such as apixaban, rivaroxaban and dabigatran. Administration of vitamin K antagonists (VKA is complicated by the need for individual dose adjustment and frequent monitoring of international normalized ratio (INR. Both warfarin and acetylsalicylic acid are widely used for thrombosis prevention in patients with NVAF in the Russian Federation.Aim. To evaluate the cost-effectiveness ratio of apixaban compared with warfarin and acetylsalicylic acid in patients with NVAF from the Russian Federation national health care system perspective.Material and methods. This analysis used a Markov model that allowed estimation of the incremental cost-effectiveness ratio (ICER for apixaban as compared with warfarin and acetylsalicylic acid over lifetime horizon in VKA suitable and VKA unsuitable patients with NVAF respectively. The model enclosed cardiovascular event rates based on the results of the randomized clinical trials comparing clinical effectiveness and safety of apixaban with warfarin (ARISTOTLE and acetylsalicylic acid (AVERROES. The following cardiovascular events were taken into consideration: ischemic and hemorrhagic stroke, systemic embolism, intracranial hemorrhage, other major bleeds, clinically relevant non-major bleeds and myocardial infarction. Direct medical costs were determined based on the rates of the compulsory national medical insurance system. The price of the antithrombotic drugs was taken as a weighted average tender price for the year 2013. In the model both costs and benefits (quality-adjusted life years and life-years were discounted at 3.5%. Cost-effectiveness threshold was set at 1.4 million rubles per quality

  4. Systematic Review and Cost Analysis Comparing Use of Chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

    Science.gov (United States)

    Lee, Ingi; Agarwal, Rajender K.; Lee, Bruce Y.; Fishman, Neil O.; Umscheid, Craig A.

    2013-01-01

    Objective To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost. Methods We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses. Results Nine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51–0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35–0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16–$26 per surgical case and $349,904–$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances. Conclusions Preoperative skin antisepsis

  5. Agriculture, trade and the environment: Linkages in the dairy sector - a comparative study of the cost impact of manure management regulations

    DEFF Research Database (Denmark)

    Andersen, M. S.; Gyldenkærne, S.

    2003-01-01

    as the regulations that concern the storage, disposal and application of manure because nutrient overload is commonly viewed as the key environmental issue of the livestock industry. We identify and compare regulations in Denmark and the Netherlands (both part of the European Union) with Canada (case of Ontario......), Switzerland, Japan and New Zealand. Using Denmark as a baseline case, we analyze how the regulatory requirements in the other countries would affect producer costs....

  6. A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany.

    Science.gov (United States)

    Petry, Karl Ulrich; Barth, Cordula; Wasem, Jürgen; Neumann, Anja

    2017-05-01

    We modelled human papilloma virus (HPV) primary screening scenarios compared with Pap cytology to evaluate clinical effectiveness and projected annual costs in Germany. A Markov cohort model was built to compare the budget impact of annual Pap cytology with different 5-yearly HPV screening scenarios: (1) a positive HPV test followed by Pap cytology; (2) a positive HPV test followed by p16/Ki-67 dual-stained cytology; (3) a positive HPV test followed by colposcopy if HPV-16/18-positive or p16/Ki-67 dual-stained cytology if positive for other subtypes; (4) co-testing with HPV and Pap. Screening scenarios were based on a 10-year horizon. All HPV screening scenarios in the model were associated with fewer deaths from missed diagnosis of cervical cancer compared with Pap screening; 10-year totals n=172-344 (1.5-3 per 100,000) versus n=477 (4.1 per 100,000), respectively. Total annual costs were lower with HPV screening than Pap cytology. The projected average annual cost for HPV screening ranged from €117 million to €136 million compared with €177 million for Pap screening, representing annual savings of €41-60 million. The greatest clinical impact was achieved with primary HPV screening (with genotyping) followed by colposcopy for HPV 16/18-positive women or p16/Ki-67 dual-stained cytology for women positive for other HPV subtypes. Screening strategies including primary HPV testing for high-risk subtypes (HPV-16/18) in conjunction with p16/Ki-67 dual-stained cytology can improve the detection of cervical cancer at a lower total annual cost than conventional Pap cytology screening. Copyright © 2017. Published by Elsevier B.V.

  7. Comparing the cost-effectiveness of disease-modifying drugs for the first-line treatment of relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Goldberg, Lawrence D D; Edwards, Natalie C; Fincher, Contessa; Doan, Quan V; Al-Sabbagh, Ahmad; Meletiche, Dennis M

    2009-09-01

    Multiple sclerosis (MS) is an inflammatory autoimmune disorder of the central nervous system that primarily afflicts young adults. Approximately 400,000 people in the United States are affected by MS. Although several forms of MS exist, the most common course is known as relapsing-remitting MS (RRMS), which affects about 85% of MS patients. This form of MS is characterized by relapses of neurologic symptoms followed by periods of recovery. Progression of disease can lead to increasingly severe disability. Since the introduction of immunomodulatory biologic agents, such as interferon betas and glatiramer acetate, treatment has helped to change the course of the disease. Under budgetary constraints, health services payers are challenged to differentiate the economic value of these agents for formulary selection and/or placement. The primary objective of this analysis was to evaluate the 2-year cost-effectiveness of 4 disease modifying drugs (DMDs) used as first-line treatment of RRMS: glatiramer acetate, interferon (IFN) Beta-1a IM injection, IFN Beta-1a SC injection, and IFN Beta-1b SC injection. An Excel-based model was developed to compare the relative effectiveness and cost components of relapses, disability progression, and DMDs in the treatment of RRMS over a 2-year time horizon. The relative risk reduction (RRR) method was used to compare reduction in relapse rates and disease progression data from pivotal randomized double-blind placebo-controlled clinical trials of the DMDs. RRRs for relapses and disability progression, respectively, were calculated as the relative difference (treatment vs. placebo) in relapse rates and disease progression rates from placebo-controlled clinical trials. These RRRs were applied to the weighted average rates of relapse and number of disability progression steps seen in the placebo arms of the pivotal studies. The evaluation was conducted from the perspective of a U.S. health care payer (only direct medical costs considered

  8. Policies for Positioning Empty Containers in an Inland Multi-depot System

    DEFF Research Database (Denmark)

    Dang, Vinh Quang; Nielsen, Izabela Ewa; Yun, Won-Young

    2011-01-01

    costs. Different optimal policies are obtained corresponding to different methods of inland positioning and they are then compared with those of non-inland-positioning (NIP) policy so as to prove the effectiveness of the proposed approach. A simulation-based genetic algorithm is developed to find...

  9. Lifetime Costs and Outcomes of Repair of Tetralogy of Fallot Compared to Natural Progression of the Disease: Great Ormond Street Hospital Cohort

    Science.gov (United States)

    Hunter, Rachael Maree; Isaac, Mark; Frigiola, Alessandra; Blundell, David; Brown, Kate; Bull, Kate

    2013-01-01

    Background Tetralogy of Fallot is a congenital heart disease that requires surgical repair without which survival through childhood is extremely rare. The aim of this paper is to use data from the mandatory follow-up of patients with Tetralogy of Fallot to model the health-related costs and outcomes over the first 55-years of life. Method A decision analytical model was developed to establish costs and outcomes for patients up to 55 years after diagnosis and first repair of Tetralogy of Fallot compared to natural progression. Data from Adult Congenital Heart Disease (ACHD) centres that follow up Tetralogy of Fallot patients and Great Ormond Street Hospital (GOSH), London, United Kingdom (UK) medical records was used to establish the cost and effectiveness of current interventions. Data from a Czech cohort was used for the natural, no intervention condition. Results The average cost per patient of a repair for Tetralogy of Fallot was £26,938 (SE = £4,140). The full life time cost per patient, with no discount rate, was £65,310 (95% CI £64,981–£65,729); £56,559 discounted (95% CI £56,159–£56,960). Patients