Minimal performances of high Tc wires for cost effective SMES compared with low Tc's

International Nuclear Information System (INIS)

Levillain, C.; Therond, P.G.

1996-01-01

On the basis of a 22MJ/10MVA unit without stray field, the authors determine minimal performances for High T c Superconducting (HTS) wires, in order to obtain HTS Superconducting Magnetic Energy Storage (SMES) competitive compared with Low T c Superconducting (LTS) ones. The cost equation mainly considers the wire volume, the fabrication process and losses. They then recommend HTS critical current densities and operating magnetic fields close to the present state of the art for short samples. A 30% gain for HTS SMES compared with LTS one could be expected

The Cost-Effectiveness of Investments to Meet the Guiding Principles for High-Performance Sustainable Buildings on the PNNL Campus

Energy Technology Data Exchange (ETDEWEB)

Cort, Katherine A.; Judd, Kathleen S.

2014-08-29

As part its campus sustainability efforts, Pacific Northwest National Laboratory (PNNL) has invested in eight new and existing buildings to ensure they meet the U.S. Department of Energy’s requirements for high performance sustainable buildings (HPSB) at DOE sites. These investments are expected to benefit PNNL by reducing the total life-cycle cost of facilities, improving energy efficiency and water conservation, and making buildings safer and healthier for the occupants. This study examines the cost-effectiveness of the implementing measures that meet the criteria for HPSBs in 3 different types of buildings on the PNNL campus: offices, scientific laboratories, and data centers. In each of the three case studies examined the investments made to achieve HPSB status demonstrated a high return on the HPSB investments that have taken place in these varied environments. Simple paybacks for total investments in the three case study buildings ranged from just 2 to 5 years; savings-to-investment ratios all exceeded the desirable threshold of 1; and the net present values associated with these investments were all positive.

The CBS-The Most Cost Effective and High Performance Carbon Beam Source Dedicated for a New Generation Cancer Therapy

CERN Document Server

Kumada, Masayuki; Leivichev, E B; Parkhomchuk, Vasily; Podgorny, Fedor; Rastigeev, Sergey; Reva, Vladimir B; Skrinsky, Aleksander Nikolayevich; Vostrikov, Vladimir

2005-01-01

A Carbon ion beam is a superior tool to x-rays or a proton beam in both physical and biological doses in treating a cancer. A Carbon beam has an advantage in treating radiation resistant and deep-seated tumors. Its radiological effect is of a mitotic independent nature. These features improve hypofractionation, typically reducing the number of irradiations per patient from 35 to a few. It has been shown that a superior QOL(Quality Of Life) therapy is possible by a carbon beam.The only drawback is its high cost. Nevertheless, tens of Prefectures and organizations are eagerly considering the possibility of having a carbon ion therapy facility in Japan. Germany, Austria, Italy, China, Taiwan and Korea also desire to have one.A carbon beam accelerator of moderate cost is about 100 Million USD. With the "CBS" design philosophy, which will be described in this paper, the cost could be factor of 2 or 3 less, while improving its performance more than standard designs. Novel extraction techniques, a new approach to a ...

High performance homes

DEFF Research Database (Denmark)

Beim, Anne; Vibæk, Kasper Sánchez

2014-01-01

Can prefabrication contribute to the development of high performance homes? To answer this question, this chapter defines high performance in more broadly inclusive terms, acknowledging the technical, architectural, social and economic conditions under which energy consumption and production occur....... Consideration of all these factors is a precondition for a truly integrated practice and as this chapter demonstrates, innovative project delivery methods founded on the manufacturing of prefabricated buildings contribute to the production of high performance homes that are cost effective to construct, energy...

Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence

Directory of Open Access Journals (Sweden)

Williams Brian G

2005-12-01

Full Text Available Abstract Background The HIV epidemic has caused a dramatic increase in tuberculosis (TB in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited. Methods Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices and effects (TB cases averted, deaths averted, DALYs gained of these strategies in Kenya during the period 2004–2023. Results The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure; the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels. Conclusion To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably

Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

Directory of Open Access Journals (Sweden)

Ramponi F

2016-09-01

Full Text Available Francesco Ramponi,1,2 Claudio Ronco,1,3 Giacomo Mason,1 Enrico Rettore,4 Daniele Marcelli,5,6 Francesca Martino,1,3 Mauro Neri,1,7 Alejandro Martin-Malo,8 Bernard Canaud,5,9 Francesco Locatelli10 1International Renal Research Institute (IRRIV, San Bortolo Hospital, Vicenza, 2Department of Economics and Management, University of Padova, Padova, 3Department of Nephrology, San Bortolo Hospital, Vicenza, 4Department of Sociology and Social Research, University of Trento, FBK-IRVAPP & IZA, Trento, Italy; 5Europe, Middle East, Africa and Latin America Medical Board, Fresenius Medical Care,, Bad Homburg, Germany; 6Danube University, Krems, Austria; 7Department of Management and Engineering, University of Padova, Vicenza, Italy; 8Nephrology Unit, Reina Sofia University Hospital, Córdoba, Spain; 9School of Medicine, Montpellier University, Montpellier, France; 10Department of Nephrology, Manzoni Hospital, Lecco, Italy Background: Clinical studies suggest that hemodiafiltration (HDF may lead to better clinical outcomes than high-flux hemodialysis (HF-HD, but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1 estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2 simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3 application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different

The relationships between OHS prevention costs, safety performance, employee satisfaction and accident costs.

Science.gov (United States)

Bayram, Metin; Ünğan, Mustafa C; Ardıç, Kadir

2017-06-01

Little is known about the costs of safety. A literature review conducted for this study indicates there is a lack of survey-based research dealing with the effects of occupational health and safety (OHS) prevention costs. To close this gap in the literature, this study investigates the interwoven relationships between OHS prevention costs, employee satisfaction, OHS performance and accident costs. Data were collected from 159 OHS management system 18001-certified firms operating in Turkey and analyzed through structural equation modeling. The findings indicate that OHS prevention costs have a significant positive effect on safety performance, employee satisfaction and accident costs savings; employee satisfaction has a significant positive effect on accident costs savings; and occupational safety performance has a significant positive effect on employee satisfaction and accident costs savings. Also, the results indicate that safety performance and employee satisfaction leverage the relationship between prevention costs and accident costs.

Analysis of the Effect of Employee Costs on Company Performance

Directory of Open Access Journals (Sweden)

Željko Požega

2010-07-01

Full Text Available The goal of every economic entity is to accomplish an optimal system of compensation management and to reach maximum returns through optimal employee investment, raising their motivation and knowledge as well as developing their abilities and skills. In order to reach this goal of maximizing company performance it is necessary to systematically approach the management of human resources within a certain economic entity and to create the fairest material and non-material reward and punishment system by using compensation management methods. This in turn will bring about a positive working atmosphere in the company, where employees will rapidly and easily adjust to changes, interact and co-operate with one another at a high level. This research, which studies the effect of employee costs on company performance, is divided into three chapters. The first chapter provides a brief theoretical overview of the importance of compensation management in human resources administration and reaching business efficiency, i.e. the different possibilities of creating a reward and punishment system in a company which aims to organise an optimal working atmosphere. The second chapter demonstrates the applied methodology and illustrates the information from different companies, which has been used in this research and analysis. The information comprises statistical data of employee costs, income, profits and losses from a sample of companies from the Republic of Croatia in 2008. The third part deals with the analysis and interpretation of the research results which show the effect of employee costs on the income and company performance, also expressed per employee. The goal of this research is to test the hypothesis that companies with higher employee cost, i.e. with higher investment in human resources, on average obtain a higher income and a higher profit per employee and are more efficient and more successful on the market. From the given hypothesis, one can

EFFECT OF COST INCREMENT DISTRIBUTION PATTERNS ON THE PERFORMANCE OF JIT SUPPLY CHAIN

Directory of Open Access Journals (Sweden)

Ayu Bidiawati J.R

2008-01-01

Full Text Available Cost is an important consideration in supply chain (SC optimisation. This is due to emphasis placed on cost reduction in order to optimise profit. Some researchers use cost as one of their performance measures and others propose ways of accurately calculating cost. As product moves across SC, the product cost also increases. This paper studied the effect of cost increment distribution patterns on the performance of a JIT Supply Chain. In particular, it is necessary to know if inventory allocation across SC needs to be modified to accommodate different cost increment distribution patterns. It was found that funnel is still the best card distribution pattern for JIT-SC regardless the cost increment distribution patterns used.

Performance and Costs of Ductless Heat Pumps in Marine-Climate High-Performance Homes -- Habitat for Humanity The Woods

Energy Technology Data Exchange (ETDEWEB)

Lubliner, Michael [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Howard, Luke [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Hales, David [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Kunkle, Rick [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Gordon, Andy [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program; Spencer, Melinda [Building America Partnership for Improved Residential Construction, Olympia, WA (United States). Washington States Univ. Energy Program

2016-02-18

The Woods is a Habitat for Humanity (HFH) community of ENERGY STAR Homes Northwest (ESHNW)-certified homes located in the marine climate of Tacoma/Pierce County, Washington. This research report builds on an earlier preliminary draft 2014 BA report, and includes significant billing analysis and cost effectiveness research from a collaborative, ongoing Ductless Heat Pump (DHP)research effort for Tacoma Public Utilities (TPU) and Bonneville Power Administration (BPA). This report focuses on the results of field testing, modeling, and monitoring of ductless mini-split heat pump hybrid heating systems in seven homes built and first occupied at various times between September 2013 and October 2014. The report also provides WSU documentation of high-performance home observations, lessons learned, and stakeholder recommendations for builders of affordable high-performance housing such as HFH. Tacoma Public Utilities (TPU) and Bonneville Power Administration (BPA). This report focuses on the results of field testing, modeling, and monitoring of ductless mini-split heat pump hybrid heating systems in seven homes built and first occupied at various times between September 2013 and October 2014. The report also provides WSU documentation of high-performance home observations, lessons learned, and stakeholder recommendations for builders of affordable high-performance housing such as HFH.

Cost-effectiveness Analysis for Technology Acquisition.

Science.gov (United States)

Chakravarty, A; Naware, S S

2008-01-01

In a developing country with limited resources, it is important to utilize the total cost visibility approach over the entire life-cycle of the technology and then analyse alternative options for acquiring technology. The present study analysed cost-effectiveness of an "In-house" magnetic resonance imaging (MRI) scan facility of a large service hospital against outsourcing possibilities. Cost per unit scan was calculated by operating costing method and break-even volume was calculated. Then life-cycle cost analysis was performed to enable total cost visibility of the MRI scan in both "In-house" and "outsourcing of facility" configuration. Finally, cost-effectiveness analysis was performed to identify the more acceptable decision option. Total cost for performing unit MRI scan was found to be Rs 3,875 for scans without contrast and Rs 4,129 with contrast. On life-cycle cost analysis, net present value (NPV) of the "In-house" configuration was found to be Rs-(4,09,06,265) while that of "outsourcing of facility" configuration was Rs-(5,70,23,315). Subsequently, cost-effectiveness analysis across eight Figures of Merit showed the "In-house" facility to be the more acceptable option for the system. Every decision for acquiring high-end technology must be subjected to life-cycle cost analysis.

High performance homes

DEFF Research Database (Denmark)

Beim, Anne; Vibæk, Kasper Sánchez

2014-01-01

. Consideration of all these factors is a precondition for a truly integrated practice and as this chapter demonstrates, innovative project delivery methods founded on the manufacturing of prefabricated buildings contribute to the production of high performance homes that are cost effective to construct, energy...

Dutch elm disease control: performance and costs

Science.gov (United States)

William N., Jr. Cannon; David P. Worley

1980-01-01

Municipal programs to suppress Dutch elm disease have had highly variable results. Performance as measured by tree mortality was unrelated to control strategies. Costs for control programs were 37 to 76 percent less than costs without control programs in the 15-year time-span of the study. Only those municipalities that conducted a high-performance program could be...

A low-cost high-performance embedded platform for accelerator controls

International Nuclear Information System (INIS)

Cleva, Stefano; Bogani, Alessio Igor; Pivetta, Lorenzo

2012-01-01

Over the last years the mobile and hand-held device market has seen a dramatic performance improvement of the microprocessors employed for these systems. As an interesting side effect, this brings the opportunity of adopting these microprocessors to build small low-cost embedded boards, featuring lots of processing power and input/output capabilities. Moreover, being capable of running a full featured operating system such as Gnu/Linux, and even a control system toolkit such as Tango, these boards can also be used in control systems as front-end or embedded computers. In order to evaluate the feasibility of this idea, an activity has started at Elettra to select, evaluate and validate a commercial embedded device able to guarantee production grade reliability, competitive costs and an open source platform. The preliminary results of this work are presented. (author)

Effect of fastskin suits on performance, drag, and energy cost of swimming.

Science.gov (United States)

Chatard, Jean-Claude; Wilson, Barry

2008-06-01

To investigate the effect of fastskin suits on 25- to 800-m performances, drag, and energy cost of swimming. The performances, stroke rate and distance per stroke, were measured for 14 competitive swimmers in a 25-m pool, when wearing a normal suit (N) and when wearing a full-body suit (FB) or a waist-to-ankle suit (L). Passive drag, oxygen uptake, blood lactate, and the perceived exertion were measured in a flume. There was a 3.2% +/- 2.4% performance benefit for all subjects over the six distances covered at maximal speed wearing FB and L when compared with N. When wearing L, the gain was significantly lower (1.8% +/- 2.5%, P energy cost of swimming was significantly reduced when wearing FB and L by 4.5% +/- 5.4% and 5.5% +/- 3.1%, respectively (P energy cost of submaximal swimming and an increased distance per stroke, at the same stroke rates, and reduced freestyle performance time.

A low cost, high performance, 1.2m off-axis telescope built with NG-Xinetics silicon carbide

Science.gov (United States)

Rey, Justin J.; Wellman, John A.; Egan, Richard G.; Wollensak, Richard J.

2011-09-01

The search for extrasolar habitable planets is one of three major astrophysics priorities identified for the next decade. These missions demand very high performance visible-wavelength optical imaging systems. Such high performance space telescopes are typically extremely expensive and can be difficult for government agencies to afford in today's economic climate, and most lower cost systems offer little benefit because they fall short on at least one of the following three key performance parameters: imaging wavelength, total system-level wavefront error and aperture diameter. Northrop Grumman Xinetics has developed a simple, lightweight, low-cost telescope design that will address the near-term science objectives of this astrophysics theme with the required optical performance, while reducing the telescope cost by an order of magnitude. Breakthroughs in SiC mirror manufacturing, integrated wavefront sensing, and high TRL deformable mirror technology have finally been combined within the same organization to offer a complete end-to-end telescope system in the lower end of the Class D cost range. This paper presents the latest results of real OAP polishing and metrology data, an optimized optical design, and finite element derived WFE

Bevacizumab in Treatment of High-Risk Ovarian Cancer—A Cost-Effectiveness Analysis

Science.gov (United States)

Herzog, Thomas J.; Hu, Lilian; Monk, Bradley J.; Kiet, Tuyen; Blansit, Kevin; Kapp, Daniel S.; Yu, Xinhua

2014-01-01

Objective. The objective of this study was to evaluate a cost-effectiveness strategy of bevacizumab in a subset of high-risk advanced ovarian cancer patients with survival benefit. Methods. A subset analysis of the International Collaboration on Ovarian Neoplasms 7 trial showed that additions of bevacizumab (B) and maintenance bevacizumab (mB) to paclitaxel (P) and carboplatin (C) improved the overall survival (OS) of high-risk advanced cancer patients. Actual and estimated costs of treatment were determined from Medicare payment. Incremental cost-effectiveness ratio per life-year saved was established. Results. The estimated cost of PC is $535 per cycle; PCB + mB (7.5 mg/kg) is $3,760 per cycle for the first 6 cycles and then $3,225 per cycle for 12 mB cycles. Of 465 high-risk stage IIIC (>1 cm residual) or stage IV patients, the previously reported OS after PC was 28.8 months versus 36.6 months in those who underwent PCB + mB. With an estimated 8-month improvement in OS, the incremental cost-effectiveness ratio of B was $167,771 per life-year saved. Conclusion. In this clinically relevant subset of women with high-risk advanced ovarian cancer with overall survival benefit after bevacizumab, our economic model suggests that the incremental cost of bevacizumab was approximately $170,000. PMID:24721817

Low-cost high-quality crystalline germanium based flexible devices

KAUST Repository

Nassar, Joanna M.

2014-06-16

High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

Low-cost high-quality crystalline germanium based flexible devices

KAUST Repository

Nassar, Joanna M.; Hussain, Aftab M.; Rojas, Jhonathan Prieto; Hussain, Muhammad Mustafa

2014-01-01

High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer

International Nuclear Information System (INIS)

Coy, Peter; Schaafsma, Joseph; Schofield, John A.

2000-01-01

Purpose: To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated. Methods and Materials: Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992. Results: The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37,134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective. Conclusion: The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50,000/QALY benchmark often cited for cost-effective care

Performance management and cost effectiveness of public services : empirical evidence from Dutch municipalities

NARCIS (Netherlands)

de Groot, Hans; van Hulst, B.L.

2011-01-01

The performance of public organizations is one of the key topics in public administration research. Cost-effectiveness as a dimension of performance has hardly been studied in this literature, however. Many governments currently are cutting budgets on an unprecedented scale after the world-wide

The Cost-Effectiveness of Raising Teacher Quality

Science.gov (United States)

Yeh, Stuart S.

2009-01-01

Econometric studies suggest that student achievement may be improved if high-performing teachers are substituted for low-performing teachers. Drawing upon a recent study linking teacher performance on licensure exams with gains in student achievement, an analysis was conducted to determine the cost-effectiveness of requiring teacher applicants to…

The high intensity solar cell: Key to low cost photovoltaic power

Science.gov (United States)

Sater, B. L.; Goradia, C.

1975-01-01

The design considerations and performance characteristics of the 'high intensity' (HI) solar cell are presented. A high intensity solar system was analyzed to determine its cost effectiveness and to assess the benefits of further improving HI cell efficiency. It is shown that residential sized systems can be produced at less than $1000/kW peak electric power. Due to their superior high intensity performance characteristics compared to the conventional and VMJ cells, HI cells and light concentrators may be the key to low cost photovoltaic power.

High-performance integrated field-effect transistor-based sensors

Energy Technology Data Exchange (ETDEWEB)

Adzhri, R., E-mail: adzhri@gmail.com [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); Md Arshad, M.K., E-mail: mohd.khairuddin@unimap.edu.my [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); School of Microelectronic Engineering (SoME), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); Gopinath, Subash C.B., E-mail: subash@unimap.edu.my [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); School of Bioprocess Engineering (SBE), Universiti Malaysia Perlis (UniMAP), Arau, Perlis (Malaysia); Ruslinda, A.R., E-mail: ruslinda@unimap.edu.my [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); Fathil, M.F.M., E-mail: faris.fathil@gmail.com [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); Ayub, R.M., E-mail: ramzan@unimap.edu.my [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); Nor, M. Nuzaihan Mohd, E-mail: m.nuzaihan@unimap.edu.my [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia); Voon, C.H., E-mail: chvoon@unimap.edu.my [Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Kangar, Perlis (Malaysia)

2016-04-21

Field-effect transistors (FETs) have succeeded in modern electronics in an era of computers and hand-held applications. Currently, considerable attention has been paid to direct electrical measurements, which work by monitoring changes in intrinsic electrical properties. Further, FET-based sensing systems drastically reduce cost, are compatible with CMOS technology, and ease down-stream applications. Current technologies for sensing applications rely on time-consuming strategies and processes and can only be performed under recommended conditions. To overcome these obstacles, an overview is presented here in which we specifically focus on high-performance FET-based sensor integration with nano-sized materials, which requires understanding the interaction of surface materials with the surrounding environment. Therefore, we present strategies, material depositions, device structures and other characteristics involved in FET-based devices. Special attention was given to silicon and polyaniline nanowires and graphene, which have attracted much interest due to their remarkable properties in sensing applications. - Highlights: • Performance of FET-based biosensors for the detection of biomolecules is presented. • Silicon nanowire, polyaniline and graphene are the highlighted nanoscaled materials as sensing transducers. • The importance of surface material interaction with the surrounding environment is discussed. • Different device structure architectures for ease in fabrication and high sensitivity of sensing are presented.

High-performance integrated field-effect transistor-based sensors

International Nuclear Information System (INIS)

Adzhri, R.; Md Arshad, M.K.; Gopinath, Subash C.B.; Ruslinda, A.R.; Fathil, M.F.M.; Ayub, R.M.; Nor, M. Nuzaihan Mohd; Voon, C.H.

2016-01-01

Field-effect transistors (FETs) have succeeded in modern electronics in an era of computers and hand-held applications. Currently, considerable attention has been paid to direct electrical measurements, which work by monitoring changes in intrinsic electrical properties. Further, FET-based sensing systems drastically reduce cost, are compatible with CMOS technology, and ease down-stream applications. Current technologies for sensing applications rely on time-consuming strategies and processes and can only be performed under recommended conditions. To overcome these obstacles, an overview is presented here in which we specifically focus on high-performance FET-based sensor integration with nano-sized materials, which requires understanding the interaction of surface materials with the surrounding environment. Therefore, we present strategies, material depositions, device structures and other characteristics involved in FET-based devices. Special attention was given to silicon and polyaniline nanowires and graphene, which have attracted much interest due to their remarkable properties in sensing applications. - Highlights: • Performance of FET-based biosensors for the detection of biomolecules is presented. • Silicon nanowire, polyaniline and graphene are the highlighted nanoscaled materials as sensing transducers. • The importance of surface material interaction with the surrounding environment is discussed. • Different device structure architectures for ease in fabrication and high sensitivity of sensing are presented.

Cost-effectiveness of root caries preventive treatments.

Science.gov (United States)

Schwendicke, Falk; Göstemeyer, Gerd

2017-01-01

With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments. Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed. In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option. Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations. Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Performance-based, cost- and time-effective PCB analytical methodology

International Nuclear Information System (INIS)

Alvarado, J. S.

1998-01-01

Laboratory applications for the analysis of PCBs (polychlorinated biphenyls) in environmental matrices such as soil/sediment/sludge and oil/waste oil were evaluated for potential reduction in waste, source reduction, and alternative techniques for final determination. As a consequence, new procedures were studied for solvent substitution, miniaturization of extraction and cleanups, minimization of reagent consumption, reduction of cost per analysis, and reduction of time. These new procedures provide adequate data that meet all the performance requirements for the determination of PCBs. Use of the new procedures reduced costs for all sample preparation techniques. Time and cost were also reduced by combining the new sample preparation procedures with the power of fast gas chromatography. Separation of Aroclor 1254 was achieved in less than 6 min by using DB-1 and SPB-608 columns. With the greatly shortened run times, reproducibility can be tested quickly and consequently with low cost. With performance-based methodology, the applications presented here can be applied now, without waiting for regulatory approval

Controlling Capital Costs in High Performance Office Buildings: A Review of Best Practices for Overcoming Cost Barriers

Energy Technology Data Exchange (ETDEWEB)

Pless, S.; Torcellini, P.

2012-05-01

This paper presents a set of 15 best practices for owners, designers, and construction teams of office buildings to reach high performance goals for energy efficiency, while maintaining a competitive budget. They are based on the recent experiences of the owner and design/build team for the Research Support Facility (RSF) on National Renewable Energy Facility's campus in Golden, CO, which show that achieving this outcome requires each key integrated team member to understand their opportunities to control capital costs.

Low-Cost, High-Performance Hall Thruster Support System

Science.gov (United States)

Hesterman, Bryce

2015-01-01

Colorado Power Electronics (CPE) has built an innovative modular PPU for Hall thrusters, including discharge, magnet, heater and keeper supplies, and an interface module. This high-performance PPU offers resonant circuit topologies, magnetics design, modularity, and a stable and sustained operation during severe Hall effect thruster current oscillations. Laboratory testing has demonstrated discharge module efficiency of 96 percent, which is considerably higher than current state of the art.

III-V/Active-Silicon Integration for Low-Cost High-Performance Concentrator Photovoltaics

Energy Technology Data Exchange (ETDEWEB)

Ringel, Steven [The Ohio State Univ., Columbus, OH (United States); Carlin, John A [The Ohio State Univ., Columbus, OH (United States); Grassman, Tyler [The Ohio State Univ., Columbus, OH (United States)

2018-04-17

This FPACE project was motivated by the need to establish the foundational pathway to achieve concentrator solar cell efficiencies greater than 50%. At such an efficiency, DOE modeling projected that a III-V CPV module cost of $0.50/W or better could be achieved. Therefore, the goal of this project was to investigate, develop and advance a III-V/Si mulitjunction (MJ) CPV technology that can simultaneously address the primary cost barrier for III-V MJ solar cells while enabling nearly ideal MJ bandgap profiles that can yield efficiencies in excess of 50% under concentrated sunlight. The proposed methodology was based on use of our recently developed GaAsP metamorphic graded buffer as a pathway to integrate unique GaAsP and Ga-rich GaInP middle and top junctions having bandgaps that are adjustable between 1.45 – 1.65 eV and 1.9 – 2.1 eV, respectively, with an underlying, 1.1 eV active Si subcell/substrate. With this design, the Si can be an active component sub-cell due to the semi-transparent nature of the GaAsP buffer with respect to Si as well as a low-cost alternative substrate that is amenable to scaling with existing Si foundry infrastructure, providing a reduction in materials cost and a low cost path to manufacturing at scale. By backside bonding of a SiGe, a path to exceed 50% efficiency is possible. Throughout the course of this effort, an expansive range of new understanding was achieved that has stimulated worldwide efforts in III-V/Si PV R&D that spanned materials development, metamorphic device optimization, and complete III-V/Si monolithic integration. Highlights include the demonstration of the first ideal GaP/Si interfaces grown by industry-standard MOCVD processes, the first high performance metamorphic tunnel junctions designed for III-V/Si integration, record performance of specific metamorphic sub-cell designs, the first fully integrated GaInP/GaAsP/Si double (1.7 eV/1.1 eV) and triple (1.95 eV/1.5 eV/1.1 eV) junction solar cells, the first

Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

Science.gov (United States)

Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K

2015-02-01

Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

Polypyrrole/sargassum activated carbon modified stainless-steel sponge as high-performance and low-cost bioanode for microbial fuel cells

Science.gov (United States)

Wu, Gaoming; Bao, Han; Xia, Zheng; Yang, Bin; Lei, Lecheng; Li, Zhongjian; Liu, Chunxian

2018-04-01

Anode materials, as the core component of microbial fuel cells (MFCs), have huge impacts on power generation performance and overall cost. Stainless-steel sponge (SS) can be a promising material for MFC anodes, due to its open continuous three-dimensional structure, high conductivity and low cost. However, poor biocompatibility limits its application. In this paper, a polypyrrole/sargassum activated carbon modified SS anode (Ppy/SAC/SS) is developed by electrochemical polymerization of pyrrole on the SS with the SAC as a dopant. The maximum power density achieved with the Ppy/SAC/SS anode is 45.2 W/m3, which is increased by 2 orders of magnitude and 2.9 times compared with an unmodified SS anode and a solely Ppy modified SS anode (Ppy/SS), respectively. In addition, the Ppy/SAC layer effectively eliminates electrochemical corrosion of the SS substrate. Electrochemical impedance spectroscopy reveals that Ppy/SAC modification decreases electron transfer resistance between the bacteria and the electrode. Furthermore, in vivo fluorescence imaging indicates that a more uniform biofilm is formed on the Ppy/SAC/SS compared to the unmodified SS and Ppy/SS. Due to the low cost of the materials, easy fabrication process and relatively high performance, our developed Ppy/SAC/SS can be a cost efficient anode material for MFCs in practical applications.

Cost and performance of innovative remediation technologies

International Nuclear Information System (INIS)

Cummings, J.B.; Kingscott, J.W.; Fiedler, L.D.

1995-01-01

The selection and use of more cost-effective remedies requires better access to data on the performance and cost of technologies used in the field. To make data more widely available, the US Environmental Protection Agency is working jointly with member agencies of the Federal Remediation Technologies Round table to publish case studies of full-scale remediation and demonstration projects. EPA, DoD, and DOE have published case studies of cleanup projects primarily consisting of bioremediation, soil vapor extraction, and thermal desorption. Within the limits of this initial data set, the paper evaluates technology performance and cost. In the analysis of cost factors, the paper shows the use of a standardized Work Breakdown Structure (WBS). Use of the WBS will be important in future reporting of completed projects to facilitate cost comparison. The paper notes the limits to normalization and thus cross-site comparison which can be achieved using the WBS. The paper identifies conclusions from initial efforts to compile cost and performance data, highlights the importance of such efforts to the overall remediation effort, and discusses future cost and performance documentation efforts

Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment.

Directory of Open Access Journals (Sweden)

Smita Nayak

Full Text Available Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA, and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs; and incremental cost-effectiveness ratios (ICERs in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days. When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost

A new approach to cost effective projects: High performance project teams

International Nuclear Information System (INIS)

Chambers, N.C.

1994-01-01

In low oil price environment in which environmental conditions are more challenging, reservoir characteristics less favourable and political risk increasing, successful projects are required in such cases. The present paper deals with the visionary process of establishing high performance project teams. According to the author, such project teams embody dynamic recognition of holism. Holism is achieved as an output from the process of establishing the drivers and enablers for success on a project. They are given birth during the unfolding of the operators development plans and contracting strategy. The paper discusses the main drivers of project teams comprising purpose and performance goals, selection, common approach, commitment and accountability, and financial alignment

A new approach to cost effective projects: High performance project teams

Energy Technology Data Exchange (ETDEWEB)

Chambers, N.C. [Brown and Root Energy Services (United Kingdom)

1994-12-31

In low oil price environment in which environmental conditions are more challenging, reservoir characteristics less favourable and political risk increasing, successful projects are required in such cases. The present paper deals with the visionary process of establishing high performance project teams. According to the author, such project teams embody dynamic recognition of holism. Holism is achieved as an output from the process of establishing the drivers and enablers for success on a project. They are given birth during the unfolding of the operators development plans and contracting strategy. The paper discusses the main drivers of project teams comprising purpose and performance goals, selection, common approach, commitment and accountability, and financial alignment

Performance and Complexity Co-evaluation of the Advanced Video Coding Standard for Cost-Effective Multimedia Communications

Directory of Open Access Journals (Sweden)

Saponara Sergio

2004-01-01

Full Text Available The advanced video codec (AVC standard, recently defined by a joint video team (JVT of ITU-T and ISO/IEC, is introduced in this paper together with its performance and complexity co-evaluation. While the basic framework is similar to the motion-compensated hybrid scheme of previous video coding standards, additional tools improve the compression efficiency at the expense of an increased implementation cost. As a first step to bridge the gap between the algorithmic design of a complex multimedia system and its cost-effective realization, a high-level co-evaluation approach is proposed and applied to a real-life AVC design. An exhaustive analysis of the codec compression efficiency versus complexity (memory and computational costs project space is carried out at the early algorithmic design phase. If all new coding features are used, the improved AVC compression efficiency (up to 50% compared to current video coding technology comes with a complexity increase of a factor 2 for the decoder and larger than one order of magnitude for the encoder. This represents a challenge for resource-constrained multimedia systems such as wireless devices or high-volume consumer electronics. The analysis also highlights important properties of the AVC framework allowing for complexity reduction at the high system level: when combining the new coding features, the implementation complexity accumulates, while the global compression efficiency saturates. Thus, a proper use of the AVC tools maintains the same performance as the most complex configuration while considerably reducing complexity. The reported results provide inputs to assist the profile definition in the standard, highlight the AVC bottlenecks, and select optimal trade-offs between algorithmic performance and complexity.

[Financing, organization, costs and services performance of the Argentinean health sub-systems.

Science.gov (United States)

Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

2016-01-01

To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

Nested Interrupt Analysis of Low Cost and High Performance Embedded Systems Using GSPN Framework

Science.gov (United States)

Lin, Cheng-Min

Interrupt service routines are a key technology for embedded systems. In this paper, we introduce the standard approach for using Generalized Stochastic Petri Nets (GSPNs) as a high-level model for generating CTMC Continuous-Time Markov Chains (CTMCs) and then use Markov Reward Models (MRMs) to compute the performance for embedded systems. This framework is employed to analyze two embedded controllers with low cost and high performance, ARM7 and Cortex-M3. Cortex-M3 is designed with a tail-chaining mechanism to improve the performance of ARM7 when a nested interrupt occurs on an embedded controller. The Platform Independent Petri net Editor 2 (PIPE2) tool is used to model and evaluate the controllers in terms of power consumption and interrupt overhead performance. Using numerical results, in spite of the power consumption or interrupt overhead, Cortex-M3 performs better than ARM7.

Highly dispersed Co0.5Zn0.5Fe2O4/polypyrrole nanocomposites for cost-effective, high-performance defluoridation using a magnetically controllable microdevice

International Nuclear Information System (INIS)

Wang, Gang; Shi, Guoying; Mu, Qinghui; Zhang, Qinghong; Wang, Hongzhi; Li, Yaogang

2012-01-01

Highlights: ► Highly dispersed CZFO/PPy nanocomposites are synthesized in microfluidic reactor. ► The as-synthesized nanocomposites behave as a high performance adsorbent. ► The magnetic microdevice has advantages over traditional methods for defluoridation. - Abstract: Highly dispersed Co 0.5 Zn 0.5 Fe 2 O 4 /polypyrrole (CZFO/PPy) nanocomposites with enhanced electromagnetic properties and large surface area were rapidly and controllably prepared using microfluidic reactors. A novel magnetically controllable microdevice using the new adsorbent in a highly dispersed form was assembled and used for fluoride adsorption. Compared with traditional adsorption methods, the device displayed high adsorption efficiency and capacity. The adsorbents were regenerated with no significant loss in defluoridation ability, which indicates that the device is a realistic and highly efficient alternative way of removing fluoride pollution at low cost.

Design, performance and cost of energy from high concentration and flat-plate utility-scale PV systems

International Nuclear Information System (INIS)

Stolte, W.J.; Whisnant, R.A.; McGowin, C.R.

1993-01-01

This paper presents the results of a recent study to assess the near-term cost of power in central station applications. Three PV technologies were evaluated: Fresnel-lens high-concentration photovoltaic (HCPV), central receiver HCPV, and flat-plate PV using thin-film copper indium diselenide (CIS) cell technology. Baseline assumptions included PV cell designs and performances projected for the 1995 timeframe, 25 and 100 MW/year cell manufacturing rates, 50 MW power plant size, and mature technology cost and performance estimates. The plant design characteristics are highlighted. Potential sites were evaluated and selected for the PV power plants (Carrisa Plains, CA and Apalachicola, FL) and cell manufacturing plants (Dallas-Fort Worth, TX). Conceptual designs and cost estimates were developed for the plants and their components. Plant performance was modeled and the designs were optimized to minimize levelized energy costs. Overall, the flat plate design exhibited the lowest energy costs among the designs evaluated. Its levelized energy costs at the Carrisa Plains site were estimated to be 11.8 and 10.8 cents/kWh (1990 $) for 25 and 100 MW/year module production rates, respectively. This meets the 12 cents/kWh DOE near-term goal. The energy cost of the Fresnel lens plant (at Carrisa Plains and a 100 MW/year cell production rate) was estimated to be 12.4 cents/kWh and the corresponding central receiver energy cost was estimated to be 13.1 cents/kWh, both of which are very close to the DOE goal. Further design optimization efforts are still warranted and can be expected to reduce plant capital costs

Cost-effectiveness of national health insurance programs in high-income countries: A systematic review.

Directory of Open Access Journals (Sweden)

Son Nghiem

Full Text Available National health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries.A literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library, was conducted from April to October 2015.Two reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts.Studies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another.Data on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs.Four studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY. Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions

High Performance Electronics on Flexible Silicon

KAUST Repository

Sevilla, Galo T.

2016-09-01

Over the last few years, flexible electronic systems have gained increased attention from researchers around the world because of their potential to create new applications such as flexible displays, flexible energy harvesters, artificial skin, and health monitoring systems that cannot be integrated with conventional wafer based complementary metal oxide semiconductor processes. Most of the current efforts to create flexible high performance devices are based on the use of organic semiconductors. However, inherent material\\'s limitations make them unsuitable for big data processing and high speed communications. The objective of my doctoral dissertation is to develop integration processes that allow the transformation of rigid high performance electronics into flexible ones while maintaining their performance and cost. In this work, two different techniques to transform inorganic complementary metal-oxide-semiconductor electronics into flexible ones have been developed using industry compatible processes. Furthermore, these techniques were used to realize flexible discrete devices and circuits which include metal-oxide-semiconductor field-effect-transistors, the first demonstration of flexible Fin-field-effect-transistors, and metal-oxide-semiconductors-based circuits. Finally, this thesis presents a new technique to package, integrate, and interconnect flexible high performance electronics using low cost additive manufacturing techniques such as 3D printing and inkjet printing. This thesis contains in depth studies on electrical, mechanical, and thermal properties of the fabricated devices.

The costs and cost-effectiveness of an integrated sepsis treatment protocol.

Science.gov (United States)

Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

2008-04-01

Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

Development of high-performance printed organic field-effect transistors and integrated circuits.

Science.gov (United States)

Xu, Yong; Liu, Chuan; Khim, Dongyoon; Noh, Yong-Young

2015-10-28

Organic electronics is regarded as an important branch of future microelectronics especially suited for large-area, flexible, transparent, and green devices, with their low cost being a key benefit. Organic field-effect transistors (OFETs), the primary building blocks of numerous expected applications, have been intensively studied, and considerable progress has recently been made. However, there are still a number of challenges to the realization of high-performance OFETs and integrated circuits (ICs) using printing technologies. Therefore, in this perspective article, we investigate the main issues concerning developing high-performance printed OFETs and ICs and seek strategies for further improvement. Unlike many other studies in the literature that deal with organic semiconductors (OSCs), printing technology, and device physics, our study commences with a detailed examination of OFET performance parameters (e.g., carrier mobility, threshold voltage, and contact resistance) by which the related challenges and potential solutions to performance development are inspected. While keeping this complete understanding of device performance in mind, we check the printed OFETs' components one by one and explore the possibility of performance improvement regarding device physics, material engineering, processing procedure, and printing technology. Finally, we analyze the performance of various organic ICs and discuss ways to optimize OFET characteristics and thus develop high-performance printed ICs for broad practical applications.

Cost sharing and HEDIS performance.

Science.gov (United States)

Chernew, Michael; Gibson, Teresa B

2008-12-01

Physicians, health plans, and health systems are increasingly evaluated and rewarded based on Health Plan Effectiveness Data and Information Set (HEDIS) and HEDIS-like performance measures. Concurrently, employers and health plans continue to try to control expenditures by increasing out-of-pocket costs for patients. The authors use fixed-effect logit models to assess how rising copayment rates for physician office visits and prescription drugs affect performance on HEDIS measures. Findings suggest that the increase in copayment rates lowers performance scores, demonstrating the connection between financial aspects of plan design and quality performance, and highlighting the potential weakness of holding plans and providers responsible for performance when payers and benefit plan managers also influence performance. Yet the effects are not consistent across all domains and, in many cases, are relatively modest in magnitude. This may reflect the HEDIS definitions and suggests that more sensitive measures may capture the impact of benefit design changes on performance.

Cost and cost-effectiveness of conventional and liquid-based ...

African Journals Online (AJOL)

Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data ...

Cost and performance analysis of physical security systems

International Nuclear Information System (INIS)

Hicks, M.J.; Yates, D.; Jago, W.H.

1997-01-01

CPA - Cost and Performance Analysis - is a prototype integration of existing PC-based cost and performance analysis tools: ACEIT (Automated Cost Estimating Integrated Tools) and ASSESS (Analytic System and Software for Evaluating Safeguards and Security). ACE is an existing DOD PC-based tool that supports cost analysis over the full life cycle of a system; that is, the cost to procure, operate, maintain and retire the system and all of its components. ASSESS is an existing DOE PC-based tool for analysis of performance of physical protection systems. Through CPA, the cost and performance data are collected into Excel workbooks, making the data readily available to analysts and decision makers in both tabular and graphical formats and at both the system and subsystem levels. The structure of the cost spreadsheets incorporates an activity-based approach to cost estimation. Activity-based costing (ABC) is an accounting philosophy used by industry to trace direct and indirect costs to the products or services of a business unit. By tracing costs through security sensors and procedures and then mapping the contributions of the various sensors and procedures to system effectiveness, the CPA architecture can provide security managers with information critical for both operational and strategic decisions. The architecture, features and applications of the CPA prototype are presented. 5 refs., 3 figs

Cost-effectiveness Analysis with Influence Diagrams.

Science.gov (United States)

Arias, M; Díez, F J

2015-01-01

Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision trees.

Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

Science.gov (United States)

Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

2018-06-01

Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis.

Science.gov (United States)

Swart, Eric; Vasudeva, Eshan; Makhni, Eric C; Macaulay, William; Bozic, Kevin J

2016-01-01

Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to "break even", and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on

Low-Cost Superconducting Wire for Wind Generators: High Performance, Low Cost Superconducting Wires and Coils for High Power Wind Generators

Energy Technology Data Exchange (ETDEWEB)

None

2012-01-01

REACT Project: The University of Houston will develop a low-cost, high-current superconducting wire that could be used in high-power wind generators. Superconducting wire currently transports 600 times more electric current than a similarly sized copper wire, but is significantly more expensive. The University of Houston’s innovation is based on engineering nanoscale defects in the superconducting film. This could quadruple the current relative to today’s superconducting wires, supporting the same amount of current using 25% of the material. This would make wind generators lighter, more powerful and more efficient. The design could result in a several-fold reduction in wire costs and enable their commercial viability of high-power wind generators for use in offshore applications.

High Performance, Low Cost Hydrogen Generation from Renewable Energy

Energy Technology Data Exchange (ETDEWEB)

Ayers, Katherine [Proton OnSite; Dalton, Luke [Proton OnSite; Roemer, Andy [Proton OnSite; Carter, Blake [Proton OnSite; Niedzwiecki, Mike [Proton OnSite; Manco, Judith [Proton OnSite; Anderson, Everett [Proton OnSite; Capuano, Chris [Proton OnSite; Wang, Chao-Yang [Penn State University; Zhao, Wei [Penn State University

2014-02-05

Renewable hydrogen from proton exchange membrane (PEM) electrolysis is gaining strong interest in Europe, especially in Germany where wind penetration is already at critical levels for grid stability. For this application as well as biogas conversion and vehicle fueling, megawatt (MW) scale electrolysis is required. Proton has established a technology roadmap to achieve the necessary cost reductions and manufacturing scale up to maintain U.S. competitiveness in these markets. This project represents a highly successful example of the potential for cost reduction in PEM electrolysis, and provides the initial stack design and manufacturing development for Proton’s MW scale product launch. The majority of the program focused on the bipolar assembly, from electrochemical modeling to subscale stack development through prototyping and manufacturing qualification for a large active area cell platform. Feasibility for an advanced membrane electrode assembly (MEA) with 50% reduction in catalyst loading was also demonstrated. Based on the progress in this program and other parallel efforts, H2A analysis shows the status of PEM electrolysis technology dropping below $3.50/kg production costs, exceeding the 2015 target.

Cost-effective improvements of a rotating platform by integration of a high-accuracy inclinometer and encoders for attitude evaluation

International Nuclear Information System (INIS)

Wen, Chenyang; He, Shengyang; Hu, Peida; Bu, Changgen

2017-01-01

Attitude heading reference systems (AHRSs) based on micro-electromechanical system (MEMS) inertial sensors are widely used because of their low cost, light weight, and low power. However, low-cost AHRSs suffer from large inertial sensor errors. Therefore, experimental performance evaluation of MEMS-based AHRSs after system implementation is necessary. High-accuracy turntables can be used to verify the performance of MEMS-based AHRSs indoors, but they are expensive and unsuitable for outdoor tests. This study developed a low-cost two-axis rotating platform for indoor and outdoor attitude determination. A high-accuracy inclinometer and encoders were integrated into the platform to improve the achievable attitude test accuracy. An attitude error compensation method was proposed to calibrate the initial attitude errors caused by the movements and misalignment angles of the platform. The proposed attitude error determination method was examined through rotating experiments, which showed that the standard deviations of the pitch and roll errors were 0.050° and 0.090°, respectively. The pitch and roll errors both decreased to 0.024° when the proposed attitude error determination method was used. This decrease validates the effectiveness of the compensation method. Experimental results demonstrated that the integration of the inclinometer and encoders improved the performance of the low-cost, two-axis, rotating platform in terms of attitude accuracy. (paper)

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

Science.gov (United States)

2014-01-01

Background Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Methods Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Results Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. Conclusions The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova.

Science.gov (United States)

Kempers, Jari; Ketting, Evert; Lesco, Galina

2014-07-21

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH

The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency.

Science.gov (United States)

Cressman, Sonya; Peacock, Stuart J; Tammemägi, Martin C; Evans, William K; Leighl, Natasha B; Goffin, John R; Tremblay, Alain; Liu, Geoffrey; Manos, Daria; MacEachern, Paul; Bhatia, Rick; Puksa, Serge; Nicholas, Garth; McWilliams, Annette; Mayo, John R; Yee, John; English, John C; Pataky, Reka; McPherson, Emily; Atkar-Khattra, Sukhinder; Johnston, Michael R; Schmidt, Heidi; Shepherd, Frances A; Soghrati, Kam; Amjadi, Kayvan; Burrowes, Paul; Couture, Christian; Sekhon, Harmanjatinder S; Yasufuku, Kazuhiro; Goss, Glenwood; Ionescu, Diana N; Hwang, David M; Martel, Simon; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Tsao, Ming-Sound; Lam, Stephen

2017-08-01

Lung cancer risk prediction models have the potential to make programs more affordable; however, the economic evidence is limited. Participants in the National Lung Cancer Screening Trial (NLST) were retrospectively identified with the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The high-risk subgroup was assessed for lung cancer incidence and demographic characteristics compared with those in the low-risk subgroup and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), which is an observational study that was high-risk-selected in Canada. A comparison of high-risk screening versus standard care was made with a decision-analytic model using data from the NLST with Canadian cost data from screening and treatment in the PanCan study. Probabilistic and deterministic sensitivity analyses were undertaken to assess uncertainty and identify drivers of program efficiency. Use of the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial with a threshold set at 2% over 6 years would have reduced the number of individuals who needed to be screened in the NLST by 81%. High-risk screening participants in the NLST had more adverse demographic characteristics than their counterparts in the PanCan study. High-risk screening would cost $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained and would be considered cost-effective at a willingness-to-pay threshold of $100,000 in Canadian dollars per quality-adjusted life-year gained with a probability of 0.62. Cost-effectiveness was driven primarily by non-lung cancer outcomes. Higher noncurative drug costs or current costs for immunotherapy and targeted therapies in the United States would render lung cancer screening a cost-saving intervention. Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and

Cost-effectiveness of minimally invasive sacroiliac joint fusion

Science.gov (United States)

Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

2016-01-01

Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

High-throughput and automated diagnosis of antimicrobial resistance using a cost-effective cellphone-based micro-plate reader

Science.gov (United States)

Feng, Steve; Tseng, Derek; di Carlo, Dino; Garner, Omai B.; Ozcan, Aydogan

2016-12-01

Routine antimicrobial susceptibility testing (AST) can prevent deaths due to bacteria and reduce the spread of multi-drug-resistance, but cannot be regularly performed in resource-limited-settings due to technological challenges, high-costs, and lack of trained professionals. We demonstrate an automated and cost-effective cellphone-based 96-well microtiter-plate (MTP) reader, capable of performing AST without the need for trained diagnosticians. Our system includes a 3D-printed smartphone attachment that holds and illuminates the MTP using a light-emitting-diode array. An inexpensive optical fiber-array enables the capture of the transmitted light of each well through the smartphone camera. A custom-designed application sends the captured image to a server to automatically determine well-turbidity, with results returned to the smartphone in ~1 minute. We tested this mobile-reader using MTPs prepared with 17 antibiotics targeting Gram-negative bacteria on clinical isolates of Klebsiella pneumoniae, containing highly-resistant antimicrobial profiles. Using 78 patient isolate test-plates, we demonstrated that our mobile-reader meets the FDA-defined AST criteria, with a well-turbidity detection accuracy of 98.21%, minimum-inhibitory-concentration accuracy of 95.12%, and a drug-susceptibility interpretation accuracy of 99.23%, with no very major errors. This mobile-reader could eliminate the need for trained diagnosticians to perform AST, reduce the cost-barrier for routine testing, and assist in spatio-temporal tracking of bacterial resistance.

Cost-effectiveness of high-efficiency appliances in the U.S. residential sector: A case study

International Nuclear Information System (INIS)

McNeil, Michael A.; Bojda, Nicholas

2012-01-01

This paper presents an analysis of the cost-effectiveness of high-efficiency appliances in the U.S. residential sector using cost and efficiency data developed as part of the regulatory process of the U.S. Department of Energy's Appliances and Commercial Equipment Standards Program. These data are presented as a case study in the development of an ‘efficiency technology database’ which can be expanded and published as a resource to other researchers and policy makers seeking scenarios that optimize efficiency policies and forecast their likely impacts on energy demand and greenhouse gas emissions. The use of this data to evaluate cost-effectiveness according to a variety of metrics is demonstrated using the example of one refrigerator–freezer product class. Cost-effectiveness is then evaluated in terms of cost of conserved energy for refrigerators, room air conditioners, water heaters, cooking equipment, central air conditioners and gas furnaces. The resulting potential of cost-effective improvement ranges from 1% to 53% of energy savings, with a typical potential of 15–20%. - Highlights: ► We determined the potential for cost-effective efficiency for residential appliances. ► We cover 6 appliance groups using cost of conserved energy as a metric for cost-effectiveness. ► Data are source from the DOE's Appliance and Commercial Equipment Standards Program. ► Between 15% and 20% additional cost-effective efficiency improvement is possible.

High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions.

Science.gov (United States)

Owens, Douglas K; Qaseem, Amir; Chou, Roger; Shekelle, Paul

2011-02-01

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit. Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs. This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.

High Thermal Conductivity and High Wear Resistance Tool Steels for cost-effective Hot Stamping Tools

Science.gov (United States)

Valls, I.; Hamasaiid, A.; Padré, A.

2017-09-01

In hot stamping/press hardening, in addition to its shaping function, the tool controls the cycle time, the quality of the stamped components through determining the cooling rate of the stamped blank, the production costs and the feasibility frontier for stamping a given component. During the stamping, heat is extracted from the stamped blank and transported through the tool to the cooling medium in the cooling lines. Hence, the tools’ thermal properties determine the cooling rate of the blank, the heat transport mechanism, stamping times and temperature distribution. The tool’s surface resistance to adhesive and abrasive wear is also an important cost factor, as it determines the tool durability and maintenance costs. Wear is influenced by many tool material parameters, such as the microstructure, composition, hardness level and distribution of strengthening phases, as well as the tool’s working temperature. A decade ago, Rovalma developed a hot work tool steel for hot stamping that features a thermal conductivity of more than double that of any conventional hot work tool steel. Since that time, many complimentary grades have been developed in order to provide tailored material solutions as a function of the production volume, degree of blank cooling and wear resistance requirements, tool geometries, tool manufacturing method, type and thickness of the blank material, etc. Recently, Rovalma has developed a new generation of high thermal conductivity, high wear resistance tool steel grades that enable the manufacture of cost effective tools for hot stamping to increase process productivity and reduce tool manufacturing costs and lead times. Both of these novel grades feature high wear resistance and high thermal conductivity to enhance tool durability and cut cycle times in the production process of hot stamped components. Furthermore, one of these new grades reduces tool manufacturing costs through low tool material cost and hardening through readily

High-performance mass storage system for workstations

Science.gov (United States)

Chiang, T.; Tang, Y.; Gupta, L.; Cooperman, S.

1993-01-01

media, and the tapes are used as backup media. The storage system is managed by the IEEE mass storage reference model-based UniTree software package. UniTree software will keep track of all files in the system, will automatically migrate the lesser used files to archive media, and will stage the files when needed by the system. The user can access the files without knowledge of their physical location. The high-performance mass storage system developed by Loral AeroSys will significantly boost the system I/O performance and reduce the overall data storage cost. This storage system provides a highly flexible and cost-effective architecture for a variety of applications (e.g., realtime data acquisition with a signal and image processing requirement, long-term data archiving and distribution, and image analysis and enhancement).

Bayesian cost-effectiveness analysis with the R package BCEA

CERN Document Server

Baio, Gianluca; Heath, Anna

2017-01-01

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

Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

Science.gov (United States)

Saulle, Rosella; Semyonov, Leda; La Torre, Giuseppe

2013-01-01

The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs. PMID:24253053

Predicting Future High-Cost Schizophrenia Patients Using High-Dimensional Administrative Data

Directory of Open Access Journals (Sweden)

Yajuan Wang

2017-06-01

Full Text Available BackgroundThe burden of serious and persistent mental illness such as schizophrenia is substantial and requires health-care organizations to have adequate risk adjustment models to effectively allocate their resources to managing patients who are at the greatest risk. Currently available models underestimate health-care costs for those with mental or behavioral health conditions.ObjectivesThe study aimed to develop and evaluate predictive models for identification of future high-cost schizophrenia patients using advanced supervised machine learning methods.MethodsThis was a retrospective study using a payer administrative database. The study cohort consisted of 97,862 patients diagnosed with schizophrenia (ICD9 code 295.* from January 2009 to June 2014. Training (n = 34,510 and study evaluation (n = 30,077 cohorts were derived based on 12-month observation and prediction windows (PWs. The target was average total cost/patient/month in the PW. Three models (baseline, intermediate, final were developed to assess the value of different variable categories for cost prediction (demographics, coverage, cost, health-care utilization, antipsychotic medication usage, and clinical conditions. Scalable orthogonal regression, significant attribute selection in high dimensions method, and random forests regression were used to develop the models. The trained models were assessed in the evaluation cohort using the regression R2, patient classification accuracy (PCA, and cost accuracy (CA. The model performance was compared to the Centers for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC model.ResultsAt top 10% cost cutoff, the final model achieved 0.23 R2, 43% PCA, and 63% CA; in contrast, the CMS-HCC model achieved 0.09 R2, 27% PCA with 45% CA. The final model and the CMS-HCC model identified 33 and 22%, respectively, of total cost at the top 10% cost cutoff.ConclusionUsing advanced feature selection leveraging detailed

Techno-Economic Feasibility of Highly Efficient Cost-Effective Thermoelectric-SOFC Hybrid Power Generation Systems

Energy Technology Data Exchange (ETDEWEB)

Jifeng Zhang; Jean Yamanis

2007-09-30

Solid oxide fuel cell (SOFC) systems have the potential to generate exhaust gas streams of high temperature, ranging from 400 to 800 C. These high temperature gas streams can be used for additional power generation with bottoming cycle technologies to achieve higher system power efficiency. One of the potential candidate bottoming cycles is power generation by means of thermoelectric (TE) devices, which have the inherent advantages of low noise, low maintenance and long life. This study was to analyze the feasibility of combining coal gas based SOFC and TE through system performance and cost techno-economic modeling in the context of multi-MW power plants, with 200 kW SOFC-TE module as building blocks. System and component concepts were generated for combining SOFC and TE covering electro-thermo-chemical system integration, power conditioning system (PCS) and component designs. SOFC cost and performance models previously developed at United Technologies Research Center were modified and used in overall system analysis. The TE model was validated and provided by BSST. The optimum system in terms of energy conversion efficiency was found to be a pressurized SOFC-TE, with system efficiency of 65.3% and cost of $390/kW of manufacturing cost. The pressurization ratio was approximately 4 and the assumed ZT of the TE was 2.5. System and component specifications were generated based on the modeling study. The major technology and cost barriers for maturing the system include pressurized SOFC stack using coal gas, the high temperature recycle blowers, and system control design. Finally, a 4-step development roadmap is proposed for future technology development, the first step being a 1 kW proof-of-concept demonstration unit.

Low Cost High Performance Generator Technology Program. Volume 2. Design study

International Nuclear Information System (INIS)

1975-06-01

The systems studies directed towards up-rating the performance of an RTG using selenide thermoelectrics and a heat source with improved safety are reported. The resulting generator design, designated LCHPG, exhibits conversion efficiency of greater than 10 percent, a specific power of 3 W/lb., and a cost of $6,000/W(e). In the course of system analyses, the significant development activities required to achieve this performance by the 1980 time period are identified

Effect of the Enabling Perception of Costing Systems by Managers in the Performance of their Tasks

Directory of Open Access Journals (Sweden)

Guilherme Eduardo de Souza

2017-12-01

Full Text Available The goal of this study is to analyze the effect of the enabling perception of costing systems by managers in the performance of their tasks, mediated by the intensity in of use of these costing systems and the level of psychological empowerment. The research was carried out through a survey of 62 companies listed in the Perfil das Empresas com Projetos Aprovados ou em Implantação na Zona Franca de Manaus Profile of Companies, in 2014. With a view to analyzing the hypotheses replicated from Mahama’s and Cheng’s (2013 study, the Structural Equations Modeling technique wasused. The research results show that the managers’ enabling perception of costing systems does not affect their  intensity of use, but it impacts on psychological empowerment, and this is directly reflected in the performance of tasks, indicating that the greater the empowerment, the better manager performance will be. It isconcluded that the model partially supports the relationships delineated and that the antecedents related to the costing systems require further study.

Low cost high performance uncertainty quantification

KAUST Repository

Bekas, C.; Curioni, A.; Fedulova, I.

2009-01-01

Uncertainty quantification in risk analysis has become a key application. In this context, computing the diagonal of inverse covariance matrices is of paramount importance. Standard techniques, that employ matrix factorizations, incur a cubic cost

Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients.

Science.gov (United States)

Tuffaha, Haitham W; Roberts, Shelley; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A

2016-06-01

To evaluate the cost-effectiveness of nutritional support compared with standard care in preventing pressure ulcers (PrUs) in high-risk hospitalized patients. An economic model using data from a systematic literature review. A meta-analysis of randomized controlled trials on the efficacy of nutritional support in reducing the incidence of PrUs was conducted. Modeled cohort of hospitalized patients at high risk of developing PrUs and malnutrition simulated during their hospital stay and up to 1 year. Standard care included PrU prevention strategies, such as redistribution surfaces, repositioning, and skin protection strategies, along with standard hospital diet. In addition to the standard care, the intervention group received nutritional support comprising patient education, nutrition goal setting, and the consumption of high-protein supplements. The analysis was from a healthcare payer perspective. Key outcomes of the model included the average costs and quality-adjusted life years. Model results were tested in univariate sensitivity analyses, and decision uncertainty was characterized using a probabilistic sensitivity analysis. Compared with standard care, nutritional support was cost saving at AU $425 per patient and marginally more effective with an average 0.005 quality-adjusted life years gained. The probability of nutritional support being cost-effective was 87%. Nutritional support to prevent PrUs in high-risk hospitalized patients is cost-effective with substantial cost savings predicted. Hospitals should implement the recommendations from the current PrU practice guidelines and offer nutritional support to high-risk patients.

Cost-effective conservation of an endangered frog under uncertainty.

Science.gov (United States)

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

2016-04-01

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

Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

Science.gov (United States)

Lam, Hwai-Tai Chen

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

Cost-effectiveness of rotavirus vaccination in Albania.

Science.gov (United States)

Ahmeti, Albana; Preza, Iria; Simaku, Artan; Nelaj, Erida; Clark, Andrew David; Felix Garcia, Ana Gabriela; Lara, Carlos; Hoestlandt, Céline; Blau, Julia; Bino, Silvia

2015-05-07

Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively. From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases

Costs of examinations performed in a hospital laboratory in Chile.

Science.gov (United States)

Andrade, Germán Lobos; Palma, Carolina Salas

2018-01-01

To determine the total average costs related to laboratory examinations performed in a hospital laboratory in Chile. Retrospective study with data from July 2014 to June 2015. 92 examinations classified in ten groups were selected according to the analysis methodology. The costs were estimated as the sum of direct and indirect laboratory costs and indirect institutional factors. The average values obtained for the costs according to examination group (in USD) were: 1.79 (clinical chemistry), 10.21 (immunoassay techniques), 13.27 (coagulation), 26.06 (high-performance liquid chromatography), 21.2 (immunological), 3.85 (gases and electrolytes), 156.48 (cytogenetic), 1.38 (urine), 4.02 (automated hematological), 4.93 (manual hematological). The value, or service fee, returned to public institutions who perform laboratory services does not adequately reflect the true total average production costs of examinations.

Laser Cladding of CPM Tool Steels on Hardened H13 Hot-Work Steel for Low-Cost High-Performance Automotive Tooling

Science.gov (United States)

Chen, J.; Xue, L.

2012-06-01

This paper summarizes our research on laser cladding of high-vanadium CPM® tool steels (3V, 9V, and 15V) onto the surfaces of low-cost hardened H13 hot-work tool steel to substantially enhance resistance against abrasive wear. The results provide great potential for fabricating high-performance automotive tooling (including molds and dies) at affordable cost. The microstructure and hardness development of the laser-clad tool steels so obtained are presented as well.

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

Science.gov (United States)

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

2017-10-09

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

Planning for high performance project teams

International Nuclear Information System (INIS)

Reed, W.; Keeney, J.; Westney, R.

1997-01-01

Both industry-wide research and corporate benchmarking studies confirm the significant savings in cost and time that result from early planning of a project. Amoco's Team Planning Workshop combines long-term strategic project planning and short-term tactical planning with team building to provide the basis for high performing project teams, better project planning, and effective implementation of the Amoco Common Process for managing projects

Comparative costs and cost-effectiveness of behavioural interventions as part of HIV prevention strategies.

Science.gov (United States)

Hsu, Justine; Zinsou, Cyprien; Parkhurst, Justin; N'Dour, Marguerite; Foyet, Léger; Mueller, Dirk H

2013-01-01

Behavioural interventions have been widely integrated in HIV/AIDS social marketing prevention strategies and are considered valuable in settings with high levels of risk behaviours and low levels of HIV/AIDS awareness. Despite their widespread application, there is a lack of economic evaluations comparing different behaviour change communication methods. This paper analyses the costs to increase awareness and the cost-effectiveness to influence behaviour change for five interventions in Benin. Cost and cost-effectiveness analyses used economic costs and primary effectiveness data drawn from surveys. Costs were collected for provider inputs required to implement the interventions in 2009 and analysed by 'person reached'. Cost-effectiveness was analysed by 'person reporting systematic condom use'. Sensitivity analyses were performed on all uncertain variables and major assumptions. Cost-per-person reached varies by method, with public outreach events the least costly (US$2.29) and billboards the most costly (US$25.07). Influence on reported behaviour was limited: only three of the five interventions were found to have a significant statistical correlation with reported condom use (i.e. magazines, radio broadcasts, public outreach events). Cost-effectiveness ratios per person reporting systematic condom use resulted in the following ranking: magazines, radio and public outreach events. Sensitivity analyses indicate rankings are insensitive to variation of key parameters although ratios must be interpreted with caution. This analysis suggests that while individual interventions are an attractive use of resources to raise awareness, this may not translate into a cost-effective impact on behaviour change. The study found that the extensive reach of public outreach events did not seem to influence behaviour change as cost-effectively when compared with magazines or radio broadcasts. Behavioural interventions are context-specific and their effectiveness influenced by a

Project materials [Commercial High Performance Buildings Project

Energy Technology Data Exchange (ETDEWEB)

None

2001-01-01

The Consortium for High Performance Buildings (ChiPB) is an outgrowth of DOE'S Commercial Whole Buildings Roadmapping initiatives. It is a team-driven public/private partnership that seeks to enable and demonstrate the benefit of buildings that are designed, built and operated to be energy efficient, environmentally sustainable, superior quality, and cost effective.

Sensitive high performance liquid chromatographic method for the ...

African Journals Online (AJOL)

A new simple, sensitive, cost-effective and reproducible high performance liquid chromatographic (HPLC) method for the determination of proguanil (PG) and its metabolites, cycloguanil (CG) and 4-chlorophenylbiguanide (4-CPB) in urine and plasma is described. The extraction procedure is a simple three-step process ...

Cost performance assessment of in situ vitrification

International Nuclear Information System (INIS)

Showalter, W.E.; Letellier, B.C.; Booth, S.R.; Barnes-Smith, P.

1992-01-01

In situ vitrification (ISV) is a thermal treatment technology with promise for the destruction or immobilization of hazardous materials in contaminated soils. It has developed over the past decade to a level of maturity where meaningful cost effectiveness studies may be performed. The ISV process melts 4 to 25 m 2 of undisturbed soil to a maximum depth of 6 m into an obsidian-like glass waste form by applying electric current (3750 kill) between symmetrically spaced electrodes. Temperatures of approximately 2000 degree C drive off and destroy complex organics which are captured in an off-gas treatment system, while radio-nuclides are incorporated into the homogeneous glass monolith. A comparative life-cycle cost evaluation between mobile rotary kiln incineration and ISV was performed to quantitatively identify appropriate performance regimes and components of cost which are sensitive to the implementation of each technology. Predictions of melt times and power consumption were obtained from an ISV performance model over ranges of several parameters including electrode spacing, soil moisture, melt depth, electrical resistivity, and soil density. These data were coupled with manpower requirements, capitalization costs, and a melt placement optimization routine to allow interpolation over a wide variety of site characteristics. For the purpose of this study, a single site scenario representative of a mixed waste evaporation pond was constructed. Preliminary comparisons between ISV and incineration show that while operating costs are comparable, ISV avoids secondary treatment and monitored storage of radioactive waste that would be required following conventional incineration. It is the long term storage of incinerated material that is the most expensive component

Cost-effectiveness of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infections among high-risk neutropenic patients in Spain

Directory of Open Access Journals (Sweden)

Grau Santiago

2012-04-01

Full Text Available Abstract Background We evaluated the cost-effectiveness of posaconazole compared with standard azole therapy (SAT; fluconazole or itraconazole for the prevention of invasive fungal infections (IFI and the reduction of overall mortality in high-risk neutropenic patients with acute myelogenous leukaemia (AML or myelodysplastic syndromes (MDS. The perspective was that of the Spanish National Health Service (NHS. Methods A decision-analytic model, based on a randomised phase III trial, was used to predict IFI avoided, life-years saved (LYS, total costs, and incremental cost-effectiveness ratio (ICER; incremental cost per LYS over patients' lifetime horizon. Data for the analyses included life expectancy, procedures, and costs associated with IFI and the drugs (in euros at November 2009 values which were obtained from the published literature and opinions of an expert committee. A probabilistic sensitivity analysis (PAS was performed. Results Posaconazole was associated with fewer IFI (0.05 versus 0.11, increased LYS (2.52 versus 2.43, and significantly lower costs excluding costs of the underlying condition (€6,121 versus €7,928 per patient relative to SAT. There is an 85% probability that posaconazole is a cost-saving strategy compared to SAT and a 97% probability that the ICER for posaconazole relative to SAT is below the cost per LYS threshold of €30,000 currently accepted in Spain. Conclusions Posaconazole is a cost-saving prophylactic strategy (lower costs and greater efficacy compared with fluconazole or itraconazole in high-risk neutropenic patients.

A review on cost-effectiveness and cost-utility of psychosocial care in cancer patients

Directory of Open Access Journals (Sweden)

Femke Jansen

2016-01-01

Full Text Available Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies, group interventions (four studies, individual psychological support (two studies, and individual psycho-education (one study. Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]. One study did both. Costs included were intervention costs (three studies, intervention and direct medical costs (five studies, or intervention, direct medical, and direct nonmedical costs (three studies. In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.

Training effectiveness vs. cost effectiveness: The next millennium challenge

International Nuclear Information System (INIS)

Coe, Richard P.

2003-01-01

With the advent of the new millennium and energy deregulation, organizations will be challenged to be cost competitive and profitable. Deregulation in the US energy industry will force utilities and, more specifically, commercial nuclear power production to unprecedented cost control measures. It will also renew the fires of debate about costs vs. safety. With personnel costs being the single largest expenditure for most organizations management will be faced with constant dilemmas of competition for scarce resources. Salaries, benefits and training costs will be under greater scrutiny. Training resources and programs will face increased pressure to be job related, based on conservative requirements and more cost effective than in the past. For nearly two decades the US National Academy for Nuclear Training (NANT) has developed and used industry-wide accreditation and evaluation standards based on the Systematic Approach to Training (SAT). This process assures that existing and emerging technical training is constantly reviewed and evaluated against standardized criteria to assure job relatedness and enhanced job performance. The process also requires management to approve, actively participate in and support the training of NPP personnel. Instructors must be highly skilled and well trained in the SAT process and various instructional strategies. The SAT process is grounded in five interlocking keystone steps; Analysis - Design - Development - Implementation - Evaluation (ADDIE). Evaluation of training is often said to be the most crucial and most difficult step. Here is where an organization determines if the training is effective and meeting the legitimate needs of all of the stakeholders. This QA/QC aspect of training must be an ongoing process involving management, instructors and the students. It is only through the discipline of an SAT based evaluation process that an organization can truly determine if the training is efficient, effective, cost effective and

Low Cost Metal Carbide Nanocrystals as Binding and Electrocatalytic Sites for High Performance Li-S Batteries.

Science.gov (United States)

Zhou, Fei; Li, Zheng; Luo, Xuan; Wu, Tong; Jiang, Bin; Lu, Lei-Lei; Yao, Hong-Bin; Antonietti, Markus; Yu, Shu-Hong

2018-02-14

Lithium sulfur (Li-S) batteries are considered as promising energy storage systems for the next generation of batteries due to their high theoretical energy densities and low cost. Much effort has been made to improve the practical energy densities and cycling stability of Li-S batteries via diverse designs of materials nanostructure. However, achieving simultaneously good rate capabilities and stable cycling of Li-S batteries is still challenging. Herein, we propose a strategy to utilize a dual effect of metal carbide nanoparticles decorated on carbon nanofibers (MC NPs-CNFs) to realize high rate performance, low hysteresis, and long cycling stability of Li-S batteries in one system. The adsorption experiments of lithium polysulfides (LiPS) to MC NPs and corresponding theoretical calculations demonstrate that LiPS are likely to be adsorbed and diffused on the surface of MC NPs because of their moderate chemical bonding. MC NPs turn out to have also an electrocatalytic role and accelerate electrochemical redox reactions of LiPS, as proven by cyclic voltammetry analysis. The fabricated Li-S batteries based on the W 2 C NPs-CNFs hybrid electrodes display not only high specific capacity of 1200 mAh/g at 0.2C but also excellent rate performance and cycling stability, for example, a model setup can be operated at 1C for 500 cycles maintaining a final specific capacity of 605 mAh/g with a degradation rate as low as 0.06%/cycle.

A Low-Cost and High-Performance Sulfonated Polyimide Proton-Conductive Membrane for Vanadium Redox Flow/Static Batteries.

Science.gov (United States)

Li, Jinchao; Yuan, Xiaodong; Liu, Suqin; He, Zhen; Zhou, Zhi; Li, Aikui

2017-09-27

A novel side-chain-type fluorinated sulfonated polyimide (s-FSPI) membrane is synthesized for vanadium redox batteries (VRBs) by high-temperature polycondensation and grafting reactions. The s-FSPI membrane has a vanadium ion permeability that is over an order of magnitude lower and has a proton selectivity that is 6.8 times higher compared to those of the Nafion 115 membrane. The s-FSPI membrane possesses superior chemical stability compared to most of the linear sulfonated aromatic polymer membranes reported for VRBs. Also, the vanadium redox flow/static batteries (VRFB/VRSB) assembled with the s-FSPI membranes exhibit stable battery performance over 100- and 300-time charge-discharge cycling tests, respectively, with significantly higher battery efficiencies and lower self-discharge rates than those with the Nafion 115 membranes. The excellent physicochemical properties and VRB performance of the s-FSPI membrane could be attributed to the specifically designed molecular structure with the hydrophobic trifluoromethyl groups and flexible sulfoalkyl pendants being introduced on the main chains of the membrane. Moreover, the cost of the s-FSPI membrane is only one-fourth that of the commercial Nafion 115 membrane. This work opens up new possibilities for fabricating high-performance proton-conductive membranes at low costs for VRBs.

Cost-effectiveness of annual versus biennial screening mammography for women with high mammographic breast density.

Science.gov (United States)

Pataky, Reka; Ismail, Zahra; Coldman, Andrew J; Elwood, Mark; Gelmon, Karen; Hedden, Lindsay; Hislop, Greg; Kan, Lisa; McCoy, Bonnie; Olivotto, Ivo A; Peacock, Stuart

2014-12-01

The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50-79 with dense breast tissue. A Markov model was constructed based on screening, diagnostic, and treatment pathways for the population-based screening and cancer care programme in British Columbia, Canada. Model probabilities and screening costs were calculated from screening programme data. Costs for breast cancer treatment were calculated from treatment data, and utility values were obtained from the literature. Incremental cost-effectiveness was expressed as cost per quality adjusted life year (QALY), and probabilistic sensitivity analysis was conducted. Compared with biennial screening, annual screening generated an additional 0.0014 QALYs (95% CI: -0.0480-0.0359) at a cost of $819 ($ = Canadian dollars) per patient (95% CI: 506-1185), resulting in an incremental cost effectiveness ratio of $565,912/QALY. Annual screening had a 37.5% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY. There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

DEFF Research Database (Denmark)

Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian Schultz

2011-01-01

.9) than in low transmission setting (US$1.78). At a willingness to pay of US$2.8, RDT remained cost effective up to a threshold value of the cost of treatment of US$4.7. CONCLUSION: RDT was cost effective in both low and high transmission settings. With a global campaign to reduce the costs of AL and RDT......ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...... departments were enrolled from March 2010 to February 2011. Of these, a random sample of 1,627 was selected to measure additional socio-economic characteristics. Costing was performed following the standard step-down cost allocation and the ingredients approach. Effectiveness was measured as the number...

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

Energy Technology Data Exchange (ETDEWEB)

Lstiburek, Joseph [Building Science Corporation, Westford, MA (United States)

2017-01-01

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamily units that satisfies the requirements of ASHRAE 62.2-2016.

Second Generation Novel High Temperature Commercial Receiver & Low Cost High Performance Mirror Collector for Parabolic Solar Trough

Energy Technology Data Exchange (ETDEWEB)

Stettenheim, Joel [Norwich Technologies, White River Junction, VT (United States)

2016-02-29

Norwich Technologies (NT) is developing a disruptively superior solar field for trough concentrating solar power (CSP). Troughs are the leading CSP technology (85% of installed capacity), being highly deployable and similar to photovoltaic (PV) systems for siting. NT has developed the SunTrap receiver, a disruptive alternative to vacuum-tube concentrating solar power (CSP) receivers, a market currently dominated by the Schott PTR-70. The SunTrap receiver will (1) operate at higher temperature (T) by using an insulated, recessed radiation-collection system to overcome the energy losses that plague vacuum-tube receivers at high T, (2) decrease acquisition costs via simpler structure, and (3) dramatically increase reliability by eliminating vacuum. It offers comparable optical efficiency with thermal loss reduction from ≥ 26% (at presently standard T) to ≥ 55% (at high T), lower acquisition costs, and near-zero O&M costs.

Processing bulk natural wood into a high-performance structural material

Science.gov (United States)

Song, Jianwei; Chen, Chaoji; Zhu, Shuze; Zhu, Mingwei; Dai, Jiaqi; Ray, Upamanyu; Li, Yiju; Kuang, Yudi; Li, Yongfeng; Quispe, Nelson; Yao, Yonggang; Gong, Amy; Leiste, Ulrich H.; Bruck, Hugh A.; Zhu, J. Y.; Vellore, Azhar; Li, Heng; Minus, Marilyn L.; Jia, Zheng; Martini, Ashlie; Li, Teng; Hu, Liangbing

2018-02-01

Synthetic structural materials with exceptional mechanical performance suffer from either large weight and adverse environmental impact (for example, steels and alloys) or complex manufacturing processes and thus high cost (for example, polymer-based and biomimetic composites). Natural wood is a low-cost and abundant material and has been used for millennia as a structural material for building and furniture construction. However, the mechanical performance of natural wood (its strength and toughness) is unsatisfactory for many advanced engineering structures and applications. Pre-treatment with steam, heat, ammonia or cold rolling followed by densification has led to the enhanced mechanical performance of natural wood. However, the existing methods result in incomplete densification and lack dimensional stability, particularly in response to humid environments, and wood treated in these ways can expand and weaken. Here we report a simple and effective strategy to transform bulk natural wood directly into a high-performance structural material with a more than tenfold increase in strength, toughness and ballistic resistance and with greater dimensional stability. Our two-step process involves the partial removal of lignin and hemicellulose from the natural wood via a boiling process in an aqueous mixture of NaOH and Na2SO3 followed by hot-pressing, leading to the total collapse of cell walls and the complete densification of the natural wood with highly aligned cellulose nanofibres. This strategy is shown to be universally effective for various species of wood. Our processed wood has a specific strength higher than that of most structural metals and alloys, making it a low-cost, high-performance, lightweight alternative.

Can We Build a Truly High Performance Computer Which is Flexible and Transparent?

KAUST Repository

Rojas, Jhonathan Prieto

2013-09-10

State-of-the art computers need high performance transistors, which consume ultra-low power resulting in longer battery lifetime. Billions of transistors are integrated neatly using matured silicon fabrication process to maintain the performance per cost advantage. In that context, low-cost mono-crystalline bulk silicon (100) based high performance transistors are considered as the heart of today\\'s computers. One limitation is silicon\\'s rigidity and brittleness. Here we show a generic batch process to convert high performance silicon electronics into flexible and semi-transparent one while retaining its performance, process compatibility, integration density and cost. We demonstrate high-k/metal gate stack based p-type metal oxide semiconductor field effect transistors on 4 inch silicon fabric released from bulk silicon (100) wafers with sub-threshold swing of 80 mV dec(-1) and on/off ratio of near 10(4) within 10% device uniformity with a minimum bending radius of 5 mm and an average transmittance of similar to 7% in the visible spectrum.

Cost effectiveness of prophylaxis in dental practice to prevent infective endocarditis.

Science.gov (United States)

Gould, I M; Buckingham, J K

1993-01-01

BACKGROUND--Although antimicrobial prophylaxis for infective endocarditis (IE) is common practice for many dental procedures, there is little information on whether it represents value for money. A study was performed to evaluate the effectiveness of prophylaxis for all at risk patients in routine dental practice with published data from the United Kingdom. METHODS--The risk of contracting infective endocarditis was calculated from published data to find (for high risk patients) both the annual number of deaths attributable to infective endocarditis and the number of high risk dental procedures performed without prophylaxis. Costs are estimated by examining the notes of 63 patients with proved IE during the decade 1980-90. RESULTS--Such prophylaxis is highly cost effective before dental extractions, but its value for other invasive dental procedures is unproved. It was calculated that, for every 10,000 extractions in at risk patients, appropriate prophylaxis will prevent 5.7 deaths and a further 22.85 cases of non-fatal IE. This represents a saving in the costs of hospital care of 289,600 pounds for 10,000 extractions. CONCLUSION--Prophylaxis to prevent IE in at risk patients undergoing dental extraction is highly cost effective. Net savings each year throughout the United Kingdom, that might be achieved by improving the existing proportion of such patients given antibiotics from its present level of about 50% would amount to 2.5 million pounds and would prevent over 50 deaths. PMID:8038004

The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women.

Directory of Open Access Journals (Sweden)

Caitlin J McCabe

Full Text Available BACKGROUND: In HIV-infected pregnant women, viral suppression prevents mother-to-child HIV transmission. Directly observed highly-active antiretroviral therapy (HAART enhances virological suppression, and could prevent transmission. Our objective was to project the effectiveness and cost-effectiveness of directly observed administration of antiretroviral drugs in pregnancy. METHODS AND FINDINGS: A mathematical model was created to simulate cohorts of one million asymptomatic HIV-infected pregnant women on HAART, with women randomly assigned self-administered or directly observed antiretroviral therapy (DOT, or no HAART, in a series of Monte Carlo simulations. Our primary outcome was the quality-adjusted life expectancy in years (QALY of infants born to HIV-infected women, with the rates of Caesarean section and HIV-transmission after DOT use as intermediate outcomes. Both self-administered HAART and DOT were associated with decreased costs and increased life-expectancy relative to no HAART. The use of DOT was associated with a relative risk of HIV transmission of 0.39 relative to conventional HAART; was highly cost-effective in the cohort as a whole (cost-utility ratio $14,233 per QALY; and was cost-saving in women whose viral loads on self-administered HAART would have exceeded 1000 copies/ml. Results were stable in wide-ranging sensitivity analyses, with directly observed therapy cost-saving or highly cost-effective in almost all cases. CONCLUSIONS: Based on the best available data, programs that optimize adherence to HAART through direct observation in pregnancy have the potential to diminish mother-to-child HIV transmission in a highly cost-effective manner. Targeted use of DOT in pregnant women with high viral loads, who could otherwise receive self-administered HAART would be a cost-saving intervention. These projections should be tested with randomized clinical trials.

The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women.

Science.gov (United States)

McCabe, Caitlin J; Goldie, Sue J; Fisman, David N

2010-04-13

In HIV-infected pregnant women, viral suppression prevents mother-to-child HIV transmission. Directly observed highly-active antiretroviral therapy (HAART) enhances virological suppression, and could prevent transmission. Our objective was to project the effectiveness and cost-effectiveness of directly observed administration of antiretroviral drugs in pregnancy. A mathematical model was created to simulate cohorts of one million asymptomatic HIV-infected pregnant women on HAART, with women randomly assigned self-administered or directly observed antiretroviral therapy (DOT), or no HAART, in a series of Monte Carlo simulations. Our primary outcome was the quality-adjusted life expectancy in years (QALY) of infants born to HIV-infected women, with the rates of Caesarean section and HIV-transmission after DOT use as intermediate outcomes. Both self-administered HAART and DOT were associated with decreased costs and increased life-expectancy relative to no HAART. The use of DOT was associated with a relative risk of HIV transmission of 0.39 relative to conventional HAART; was highly cost-effective in the cohort as a whole (cost-utility ratio $14,233 per QALY); and was cost-saving in women whose viral loads on self-administered HAART would have exceeded 1000 copies/ml. Results were stable in wide-ranging sensitivity analyses, with directly observed therapy cost-saving or highly cost-effective in almost all cases. Based on the best available data, programs that optimize adherence to HAART through direct observation in pregnancy have the potential to diminish mother-to-child HIV transmission in a highly cost-effective manner. Targeted use of DOT in pregnant women with high viral loads, who could otherwise receive self-administered HAART would be a cost-saving intervention. These projections should be tested with randomized clinical trials.

High Efficiency, Low Cost Scintillators for PET

International Nuclear Information System (INIS)

Kanai Shah

2007-01-01

Inorganic scintillation detectors coupled to PMTs are an important element of medical imaging applications such as positron emission tomography (PET). Performance as well as cost of these systems is limited by the properties of the scintillation detectors available at present. The Phase I project was aimed at demonstrating the feasibility of producing high performance scintillators using a low cost fabrication approach. Samples of these scintillators were produced and their performance was evaluated. Overall, the Phase I effort was very successful. The Phase II project will be aimed at advancing the new scintillation technology for PET. Large samples of the new scintillators will be produced and their performance will be evaluated. PET modules based on the new scintillators will also be built and characterized

The effectiveness of Renewable Portfolio Standard banding and carve-outs in supporting high-cost types of renewable electricity

International Nuclear Information System (INIS)

Buckman, Greg

2011-01-01

Renewable Portfolio Standards (RPSs) are renewable electricity (RES-E) subsidy mechanisms in which governments mandate how much RES-E should be generated and markets determine the cost of the subsidy needed to generate the RES-E. Two modifications of the RPS that can help support high-cost types of RES-E are banding, where governments mandate higher multiples of RPS tradable certificates for high-cost types of RES-E, and carve-outs, where governments prescribe parts of a RPS target that can be met only by a particular type, or types, of RES-E. This paper analyses the design and generation performance of banding, as used in the UK, with some reference to Italy; and carve-outs, as used in the USA. To date, there is insufficient experience of either device to reach firm conclusions about their generation effectiveness. However, there is early, tentative evidence that banding is successful at supporting high-cost types of RES-E in the UK. Carve-outs are not being fully exploited in US states that use a RPS mechanism, and Italy is using banding in a fairly insignificant way. Though both devices have different design strengths and weaknesses, and either could be adapted to specific RPS markets, banding is probably the better device for supporting high-cost RES-E. - Highlights: → I analysed three countries that use either Renewable Portfolio Standards banding or carve-outs. → I assess whether banding or carve-outs have diversified renewable electricity generation. → There's insufficient banding/carve-out experience to reach firm diversification conclusions. → There's early evidence that the UK banding is diversifying its renewable electricity.

Design of a cost-effective laser spot tracker

Science.gov (United States)

Artan, Göktuǧ Gencehan; Sari, Hüseyin

2017-05-01

One of the most important aspects of guided systems is detection. The most convenient detection in the sense of precision can be achieved with a laser spot tracker. This study deals with a military grade, high performance and cost-effective laser spot tracker for a guided system. The aim is to develop a high field of view system that will detect a laser spot from a distance of 3 kilometers in which the target is designated from 3 kilometers with a laser. The study basically consists of the system design, modeling, producing and the conducting performance tests of the whole system.

Longitudinal analysis of high-technology medical services and hospital financial performance.

Science.gov (United States)

Zengul, Ferhat D; Weech-Maldonado, Robert; Ozaydin, Bunyamin; Patrician, Patricia A; OʼConnor, Stephen J

U.S. hospitals have been investing in high-technology medical services as a strategy to improve financial performance. Despite the interest in high-tech medical services, there is not much information available about the impact of high-tech services on financial performance. The aim of this study was to examine the impact of high-tech medical services on financial performance of U.S. hospitals by using the resource-based view of the firm as a conceptual framework. Fixed-effects regressions with 2 years lagged independent variables using a longitudinal panel sample of 3,268 hospitals (2005-2010). It was hypothesized that hospitals with rare or large numbers (breadth) of high-tech medical services will experience better financial performance. Fixed effects regression results supported the link between a larger breadth of high-tech services and total margin, but only among not-for-profit hospitals. Both breadth and rareness of high-tech services were associated with high total margin among not-for-profit hospitals. Neither breadth nor rareness of high-tech services was associated with operating margin. Although breadth and rareness of high-tech services resulted in lower expenses per inpatient day among not-for-profit hospitals, these lower costs were offset by lower revenues per inpatient day. Enhancing the breadth of high-tech services may be a legitimate organizational strategy to improve financial performance, especially among not-for-profit hospitals. Hospitals may experience increased productivity and efficiency, and therefore lower inpatient operating costs, as a result of newer technologies. However, the negative impact on operating revenue should caution hospital administrators about revenue reducing features of these technologies, which may be related to the payer mix that these technologies may attract. Therefore, managers should consider both the cost and revenue implications of these technologies.

A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases

International Nuclear Information System (INIS)

Mehta, Minesh; Noyes, William; Craig, Bruce; Lamond, John; Auchter, Richard; French, Molly; Johnson, Mark; Levin, Allan; Badie, Behnam; Robbins, Ian; Kinsella, Timothy

1997-01-01

Purpose: The median survival of well-selected patients with single-brain metastases treated with whole-brain irradiation and resection or radiosurgery is comparable, although a randomized trial of these two modalities has not been performed. In this era of cost containment, it is imperative that health-care professionals make fiscally prudent decisions. The present environment necessitates a critical appraisal of apparently equi-efficacious therapeutic modalities, and it is within this context that we present a comparison of the actual costs of resection and radiosurgery for brain metastases. Methods and Materials: Survival and quality of life outcome data for radiation alone or with surgery were obtained from two randomized trials, and radiosurgical results were obtained from a multiinstitutional analysis that specifically evaluated patients meeting surgical criteria. Only linear accelerator radiosurgery data were considered. Cost analysis was performed from a societal view point, and the following parameters were evaluated: actual cost, cost ratios, cost effectiveness, incremental cost effectiveness, cost utility, incremental cost utility, and national cost burden. The computerized billing records for all patients undergoing resection or radiosurgery for single-brain metastases from January 1989 to July 1994 were reviewed. A total of 46 resections and 135 radiosurgery procedures were performed. During the same time period, 454 patients underwent whole-brain radiation alone. An analysis of the entire bill was performed for each procedure, and each itemized cost was assigned a proportionate figure. The relative cost ratios of resection and radiosurgery were compared using the Wilcoxon rank sum test. Cost effectiveness of each modality, defined as the cost per year of median survival, was evaluated. Incremental cost effectiveness, defined as the additional cost per year of incremental gain in median survival, compared to the next least expensive modality, was also

Development of low-cost, high-performance non-evaporable getter (NEG) pumps

Energy Technology Data Exchange (ETDEWEB)

Mase, Kazuhiko, E-mail: mase@post.kek.jp [Institute of Materials Structure Science, KEK, 1-1 Oho, Tsukuba 305-0801 (Japan); SOKENDAI (The Graduate University for Advanced Studies), 1-1 Oho, Tsukuba 305-0801 (Japan); Tanaka, Masato [Faculty of Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku 263-8522 (Japan); Ida, Naoya [Faculty of Science and Technology, Hirosaki University, 1 Bunkyocho, Hirosaki 036-8560 (Japan); Kodama, Hiraku [Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama 240-8501 (Japan); Kikuchi, Takashi [Institute of Materials Structure Science, KEK, 1-1 Oho, Tsukuba 305-0801 (Japan)

2016-07-27

Low-cost, high-performance non-evaporable getter (NEG) pumps were constructed using commercial NEG pills comprising 70 wt% Zr, 24.6 wt% V, and 5.4 wt% Fe, a conflat flange with an outer diameter of 70, 152, or 203 mm (DN 40 CF, DN 100 CF, and DN 160 CF, respectively), and a tantalum heater. After activation at 400 °C for 30 min, the pumping speeds of a DN 40 CF NEG pump measured with the orifice method were 47–40, 8–6, 24–17, and 19–15 L/s for H{sub 2}, N{sub 2}, CO, and CO{sub 2} gasses, respectively. NEG pumps using DN 100 CF and DN 160 CF were also developed, and their pumping speeds are estimated. These NEG pumps are favorable alternatives to sputtering ion pumps in VSX beamlines because they do not produce hydrocarbons except during the activation period. The NEG pumps can also be used for accelerators, front ends, end stations, and differential pumping systems.

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

Science.gov (United States)

Brown, Nadia J; David, Michael; Cuttle, Leila; Kimble, Roy M; Rodger, Sylvia; Higashi, Hideki

2015-07-01

To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care. Copyright © 2015. Published by Elsevier Inc.

Cost and performance analysis of physical security systems

International Nuclear Information System (INIS)

Hicks, M.J.; Yates, D.; Jago, W.H.; Phillips, A.W.

1998-04-01

Analysis of cost and performance of physical security systems can be a complex, multi-dimensional problem. There are a number of point tools that address various aspects of cost and performance analysis. Increased interest in cost tradeoffs of physical security alternatives has motivated development of an architecture called Cost and Performance Analysis (CPA), which takes a top-down approach to aligning cost and performance metrics. CPA incorporates results generated by existing physical security system performance analysis tools, and utilizes an existing cost analysis tool. The objective of this architecture is to offer comprehensive visualization of complex data to security analysts and decision-makers

Construction cost impact analysis of the U.S. Department of Energy mandatory performance standards for new federal commercial and multi-family, high-rise residential buildings

International Nuclear Information System (INIS)

Di Massa, F.V.; Hadley, D.L.; Halverson, M.A.

1993-12-01

In accordance with federal legislation, the U.S. Department of Energy (DOE) has conducted a project to demonstrate use of its Energy Conservation Voluntary Performance Standards for Commercial and Multi-Family High-Rise Residential Buildings; Mandatory for New Federal Buildings; Interim Rule (referred to in this report as DOE-1993). A key requisite of the legislation requires DOE to develop commercial building energy standards that are cost effective. During the demonstration project, DOE specifically addressed this issue by assessing the impacts of the standards on (1) construction costs, (2) builders (and especially small builders) of multi-family, high-rise buildings, and (3) the ability of low-to moderate-income persons to purchase or rent units in such buildings. This document reports on this project

High Performance Commercial Fenestration Framing Systems

Energy Technology Data Exchange (ETDEWEB)

Mike Manteghi; Sneh Kumar; Joshua Early; Bhaskar Adusumalli

2010-01-31

A major objective of the U.S. Department of Energy is to have a zero energy commercial building by the year 2025. Windows have a major influence on the energy performance of the building envelope as they control over 55% of building energy load, and represent one important area where technologies can be developed to save energy. Aluminum framing systems are used in over 80% of commercial fenestration products (i.e. windows, curtain walls, store fronts, etc.). Aluminum framing systems are often required in commercial buildings because of their inherent good structural properties and long service life, which is required from commercial and architectural frames. At the same time, they are lightweight and durable, requiring very little maintenance, and offer design flexibility. An additional benefit of aluminum framing systems is their relatively low cost and easy manufacturability. Aluminum, being an easily recyclable material, also offers sustainable features. However, from energy efficiency point of view, aluminum frames have lower thermal performance due to the very high thermal conductivity of aluminum. Fenestration systems constructed of aluminum alloys therefore have lower performance in terms of being effective barrier to energy transfer (heat loss or gain). Despite the lower energy performance, aluminum is the choice material for commercial framing systems and dominates the commercial/architectural fenestration market because of the reasons mentioned above. In addition, there is no other cost effective and energy efficient replacement material available to take place of aluminum in the commercial/architectural market. Hence it is imperative to improve the performance of aluminum framing system to improve the energy performance of commercial fenestration system and in turn reduce the energy consumption of commercial building and achieve zero energy building by 2025. The objective of this project was to develop high performance, energy efficient commercial

Effect of Climate Change and Transaction Costs on Performance of a Groundwater Market

Science.gov (United States)

Khan, H. F.; Brown, C.

2017-12-01

With surface water resources becoming increasingly stressed, groundwater extraction, much of it unmanaged, has increased globally. Incentive-based policies, such as the cap-and-trade system, have been shown to be useful in the context of groundwater management. Previous research has shown that optimal groundwater markets (i.e. incentives-based policy) outperforms water quotas (command and control policy) with regards to both economic and environmental outcomes. In this work, we investigate whether these advantages of a water market over water quotas hold when assumptions of perfect information are violated due to climate change and hydrogeologic heterogeneity. We also assess whether the benefits of a cap-and-trade system outweigh the costs of implementing it, and how changes in future climate affect the performance a cap-and trade system. We use a sub-basin of the Republican River Basin, overlying the Ogallala aquifer in the High Plains of the United States, as a case study. We develop a multi-agent system model where individual benefits of each self-interested agent are maximized subject to bounds on irrigation requirements and water use permits. This economic model is coupled with a calibrated physically based groundwater model for the study region. Results show that permitting farmers to trade results in increased economic benefits and reduced environmental violations. However, the benefits of trading are dependent on the total allocations and the resulting level of water demand. We quantify third party impacts and environmental externalities for different water allocations, and highlight the unequal distributional effects of uniform water allocations resulting in `winners' and `losers'. The study reveals that high transaction costs can reduce the efficiency of the cap-and-trade system even below that of water quotas. Future changes in climate are shown to significantly influence the dynamics of the water market, and emphasize the need to address climate

Low Cost High Performance Nanostructured Spectrally Selective Coating

Energy Technology Data Exchange (ETDEWEB)

Jin, Sungho [Univ. of California, San Diego, CA (United States)

2017-04-05

Sunlight absorbing coating is a key enabling technology to achieve high-temperature high-efficiency concentrating solar power operation. A high-performance solar absorbing material must simultaneously meet all the following three stringent requirements: high thermal efficiency (usually measured by figure of merit), high-temperature durability, and oxidation resistance. The objective of this research is to employ a highly scalable process to fabricate and coat black oxide nanoparticles onto solar absorber surface to achieve ultra-high thermal efficiency. Black oxide nanoparticles have been synthesized using a facile process and coated onto absorber metal surface. The material composition, size distribution and morphology of the nanoparticle are guided by numeric modeling. Optical and thermal properties have been both modeled and measured. High temperature durability has been achieved by using nanocomposites and high temperature annealing. Mechanical durability on thermal cycling have also been investigated and optimized. This technology is promising for commercial applications in next-generation high-temperature concentration solar power (CSP) plants.

Cost-effectiveness of minimally invasive sacroiliac joint fusion

Directory of Open Access Journals (Sweden)

Cher DJ

2015-12-01

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

The Cost-Effectiveness of Antibiotic Prophylaxis for Patients at Risk of Infective Endocarditis.

Science.gov (United States)

Franklin, Matthew; Wailoo, Allan; Dayer, Mark J; Jones, Simon; Prendergast, Bernard; Baddour, Larry M; Lockhart, Peter B; Thornhill, Martin H

2016-11-15

In March 2008, the National Institute for Health and Care Excellence recommended stopping antibiotic prophylaxis (AP) for those at risk of infective endocarditis (IE) undergoing dental procedures in the United Kingdom, citing a lack of evidence of efficacy and cost-effectiveness. We have performed a new economic evaluation of AP on the basis of contemporary estimates of efficacy, adverse events, and resource implications. A decision analytic cost-effectiveness model was used. Health service costs and benefits (measured as quality-adjusted life-years) were estimated. Rates of IE before and after the National Institute for Health and Care Excellence guidance were available to estimate prophylactic efficacy. AP adverse event rates were derived from recent UK data, and resource implications were based on English Hospital Episode Statistics. AP was less costly and more effective than no AP for all patients at risk of IE. The results are sensitive to AP efficacy, but efficacy would have to be substantially lower for AP not to be cost-effective. AP was even more cost-effective in patients at high risk of IE. Only a marginal reduction in annual IE rates (1.44 cases in high-risk and 33 cases in all at-risk patients) would be required for AP to be considered cost-effective at £20 000 ($26 600) per quality-adjusted life-year. Annual cost savings of £5.5 to £8.2 million ($7.3-$10.9 million) and health gains >2600 quality-adjusted life-years could be achieved from reinstating AP in England. AP is cost-effective for preventing IE, particularly in those at high risk. These findings support the cost-effectiveness of guidelines recommending AP use in high-risk individuals. © 2016 The Authors.

Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

Science.gov (United States)

Fleck, Leonard M

2018-04-01

Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

Coaxial MoS2@Carbon Hybrid Fibers: A Low-Cost Anode Material for High-Performance Li-Ion Batteries

Directory of Open Access Journals (Sweden)

Rui Zhou

2017-02-01

Full Text Available A low-cost bio-mass-derived carbon substrate has been employed to synthesize MoS2@carbon composites through a hydrothermal method. Carbon fibers derived from natural cotton provide a three-dimensional and open framework for the uniform growth of MoS2 nanosheets, thus hierarchically constructing coaxial architecture. The unique structure could synergistically benefit fast Li-ion and electron transport from the conductive carbon scaffold and porous MoS2 nanostructures. As a result, the MoS2@carbon composites—when serving as anodes for Li-ion batteries—exhibit a high reversible specific capacity of 820 mAh·g−1, high-rate capability (457 mAh·g−1 at 2 A·g−1, and excellent cycling stability. The use of bio-mass-derived carbon makes the MoS2@carbon composites low-cost and promising anode materials for high-performance Li-ion batteries.

Effect of canister size on costs of disposal of SRP high-level wastes

International Nuclear Information System (INIS)

McDonell, W.R.

1982-01-01

The current plan for managing the high-level nuclear wastes at the Savannah River Plant (SRP) calls for processing them into solid forms contained in stainless steel canisters for eventual disposal in a federal geologic repository. A new SRP facility called the Defense Waste Processing Facility (DWPF) is being designed for the onsite waste processing operations. Preliminary evaluations indicate that costs of the overall disposal operation will depend significantly on the size of the canisters, which determines the number of waste forms to be processed. The objective of this study was to evaluate the effects of canister size on costs of DWPF process operations, including canister procurement, waste solidification, and interim storage, on offsite transport, and on repository costs of disposal, including provision of suitable waste packages

Cost-effectiveness of peer role play and standardized patients in undergraduate communication training.

Science.gov (United States)

Bosse, Hans Martin; Nickel, Martin; Huwendiek, Sören; Schultz, Jobst Hendrik; Nikendei, Christoph

2015-10-24

The few studies directly comparing the methodological approach of peer role play (RP) and standardized patients (SP) for the delivery of communication skills all suggest that both methods are effective. In this study we calculated the costs of both methods (given comparable outcomes) and are the first to generate a differential cost-effectiveness analysis of both methods. Medical students in their prefinal year were randomly assigned to one of two groups receiving communication training in Pediatrics either with RP (N = 34) or 19 individually trained SP (N = 35). In an OSCE with standardized patients using the Calgary-Cambridge Referenced Observation Guide both groups achieved comparable high scores (results published). In this study, corresponding costs were assessed as man-hours resulting from hours of work of SP and tutors. A cost-effectiveness analysis was performed. Cost-effectiveness analysis revealed a major advantage for RP as compared to SP (112 vs. 172 man hours; cost effectiveness ratio .74 vs. .45) at comparable performance levels after training with both methods. While both peer role play and training with standardized patients have their value in medical curricula, RP has a major advantage in terms of cost-effectiveness. This could be taken into account in future decisions.

Costs and cost-effectiveness of periviable care.

Science.gov (United States)

Caughey, Aaron B; Burchfield, David J

2014-02-01

With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.

Cost-effectiveness of surveillance programs for families at high and moderate risk of hereditary non-polyposis colorectal cancer

DEFF Research Database (Denmark)

Olsen, Kim R.; Bojesen, Stig E.; Gerdes, Anne-Marie M.

2007-01-01

for the group at high risk. The aim of the present study is to determine cost-effectiveness of surveillance programs where families at both high and moderate risk of HNPCC participate. METHODS: A decision analytic model (Markov model) is developed to assess surveillance programs where families at high......OBJECTIVES: Surveillance programs are recommended to both families at high risk (Amsterdam-positive families with known- and unknown mutation) and moderate risk (families not fulfilling all Amsterdam criteria) of colorectal cancer (CRC). Cost-effectiveness has so far only been estimated...

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

Science.gov (United States)

Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

Offering lung cancer screening to high-risk medicare beneficiaries saves lives and is cost-effective: an actuarial analysis.

Science.gov (United States)

Pyenson, Bruce S; Henschke, Claudia I; Yankelevitz, David F; Yip, Rowena; Dec, Ellynne

2014-08-01

By a wide margin, lung cancer is the most significant cause of cancer death in the United States and worldwide. The incidence of lung cancer increases with age, and Medicare beneficiaries are often at increased risk. Because of its demonstrated effectiveness in reducing mortality, lung cancer screening with low-dose computed tomography (LDCT) imaging will be covered without cost-sharing starting January 1, 2015, by nongrandfathered commercial plans. Medicare is considering coverage for lung cancer screening. To estimate the cost and cost-effectiveness (ie, cost per life-year saved) of LDCT lung cancer screening of the Medicare population at high risk for lung cancer. Medicare costs, enrollment, and demographics were used for this study; they were derived from the 2012 Centers for Medicare & Medicaid Services (CMS) beneficiary files and were forecast to 2014 based on CMS and US Census Bureau projections. Standard life and health actuarial techniques were used to calculate the cost and cost-effectiveness of lung cancer screening. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures. Approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately 3 years. Based on our analysis, the average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. LDCT screening for lung cancer in Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years is low cost, at approximately $1 per member per month. This assumes that 50% of these patients were screened. Such screening is also highly cost-effective, at <$19,000 per life-year saved. If all eligible Medicare

Ground Glass Pozzolan in Conventional, High, and Ultra-High Performance Concrete

Directory of Open Access Journals (Sweden)

Tagnit-Hamou Arezki

2018-01-01

Full Text Available Ground-glass pozzolan (G obtained by grinding the mixed-waste glass to same fineness of cement can act as a supplementary-cementitious material (SCM, given that it is an amorphous and a pozzolanic material. The G showed promising performances in different concrete types such as conventional concrete (CC, high-performance concrete (HPC, and ultra-high performance concrete (UHPC. The current paper reports on the characteristics and performance of G in these concrete types. The use of G provides several advantages (technological, economical, and environmental. It reduces the production cost of concrete and decrease the carbon footprint of a traditional concrete structures. The rheology of fresh concrete can be improved due to the replacement of cement by non-absorptive glass particles. Strength and rigidity improvements in the concrete containing G are due to the fact that glass particles act as inclusions having a very high strength and elastic modulus that have a strengthening effect on the overall hardened matrix.

[Can Topical Negative Pressure Therapy be Performed as a Cost-Effective General Surgery Procedure in the German DRG System?].

Science.gov (United States)

Hirche, Z; Xiong, L; Hirche, C; Willis, S

2016-04-01

Topical negative pressure therapy (TNPT) has been established for surgical wound therapy with different indications. Nevertheless, there is only sparse evidence regarding its therapeutic superiority or cost-effectiveness in the German DRG system (G-DRG). This study was designed to analyse the cost-effectiveness of TNPT in the G-DRG system with a focus on daily treatment costs and reimbursement in a general surgery care setting. In this retrospective study, we included 176 patients, who underwent TNPT between 2007 and 2011 for general surgery indications. Analysis of the cost-effectiveness involved 149 patients who underwent a simulation to calculate the reimbursement with or without TNPT by a virtual control group in which the TNP procedure was withdrawn for DRG calculation. This was followed by a calculation of costs for wound dressings and TNPT rent and material costs. Comparison between the "true" and the virtual group enabled calculation of the effective remaining surplus per case. Total reimbursement by included TNPT cases was 2,323 ,70.04 €. Costs for wound dressings and TNPT rent were 102,669.20 €. In 41 cases there was a cost-effectiveness (27.5%) with 607,422.03 € with TNP treatment, while the control group without TNP generated revenues of 442,015.10 €. Costs for wound dressings and TNPT rent were 47,376.68 €. In the final account we could generate a cost-effectiveness of 6759 € in 5 years per 149 patients by TNPT. In 108 cases there was no cost-effectiveness (72.5%). TNPT applied in a representative general surgery setting allows for wound therapy without a major financial burden. Based on the costs for wound dressings and TNPT rent, a primarily medically based decision when to use TNPT can be performed in a balanced product cost accounting. This study does not analyse the superiority of TNPT in wound care, so further prospective studies are required which focus on therapeutic superiority and cost-effectiveness. Georg Thieme

Flash memories economic principles of performance, cost and reliability optimization

CERN Document Server

Richter, Detlev

2014-01-01

The subject of this book is to introduce a model-based quantitative performance indicator methodology applicable for performance, cost and reliability optimization of non-volatile memories. The complex example of flash memories is used to introduce and apply the methodology. It has been developed by the author based on an industrial 2-bit to 4-bit per cell flash development project. For the first time, design and cost aspects of 3D integration of flash memory are treated in this book. Cell, array, performance and reliability effects of flash memories are introduced and analyzed. Key performance parameters are derived to handle the flash complexity. A performance and array memory model is developed and a set of performance indicators characterizing architecture, cost and durability is defined.   Flash memories are selected to apply the Performance Indicator Methodology to quantify design and technology innovation. A graphical representation based on trend lines is introduced to support a requirement based pr...

Cost analysis when open surgeons perform minimally invasive hysterectomy.

Science.gov (United States)

Shepherd, Jonathan P; Kantartzis, Kelly L; Ahn, Ki Hoon; Bonidie, Michael J; Lee, Ted

2014-01-01

The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics. Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P depreciation included (P < .001) but similar costs if these variables were excluded. Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy.

High-temperature electrochemical performance of low-cost La–Ni–Fe based hydrogen storage alloys with different preparation methods

Energy Technology Data Exchange (ETDEWEB)

Wang, Qiannan [Department of Advanced Energy Materials, College of Materials Science and Engineering, Sichuan University, Chengdu 610065 (China); Zhu, Ding [Institute of New Energy and Low-Carbon Technology, Sichuan University, Chengdu 610065 (China); Zhou, Wanhai; Zhong, Chenglin; Wu, Chaoling [Department of Advanced Energy Materials, College of Materials Science and Engineering, Sichuan University, Chengdu 610065 (China); Chen, Yungui, E-mail: ygchen60@aliyun.com [Department of Advanced Energy Materials, College of Materials Science and Engineering, Sichuan University, Chengdu 610065 (China); Institute of New Energy and Low-Carbon Technology, Sichuan University, Chengdu 610065 (China)

2016-04-15

Highlights: • Effects of four different preparation processes were studied at 20/60 °C. • All NS + HT, RS and RS + HT processes can optimize the thermodynamic performance. • The HT process can provoke the precipitation of A{sub 2}B{sub 7} and leads to a poor cycling life. • Al exhibits the most remarkable dissolution for all the alloys, especially at 60 °C. - Abstract: In order to optimize the microstructure and high temperature electrochemical performances of low-cost AB{sub 5}-type Ml(NiMnAl){sub 4.2}Co{sub 0.3}Fe{sub 0.5} hydrogen storage electrode alloys, four different preparation methods including normal solidification (NS), normal solidification and 900 °C heat treatment (NS + HT), rapid solidification (RS), rapid solidification and 900 °C heat treatment (RS + HT) were adopted in this work. All alloys exhibit CaCu{sub 5} type hexagonal structure and there is a small amount of A{sub 2}B{sub 7} phase in NS + HT and RS + HT alloys. It is found the using of HT process can decrease the hydrogen equilibrium plateau pressure, the plateau slope and hysteresis at 40, 60 and 80 °C. The NS + HT and RS + HT alloys also possess better activation, high rate discharge performance, larger discharge capacity, but poor cycling performance due to the existence of A{sub 2}B{sub 7} phase which can accelerate dissolution of Ni, Mn and Fe elements in KOH alkaline electrolyte. The RS process can make alloy exhibit the best cycling performance especially at 60 °C.

Clinical effectiveness and cost-effectiveness of fissure sealants in children and adolescents with a high caries risk

Directory of Open Access Journals (Sweden)

Neusser, Silke

2014-10-01

Full Text Available [english] In Germany, the application of resin-based pits and fissures sealants on the occlusal surfaces of permanent molars is part of individual prophylaxis for children and adolescents between six and 18 years. The individual prophylaxis is covered by the Statutory Health Insurance since 1993.The report addresses questions on medical effectiveness, cost-effectiveness, as well as ethical, social, and legal implications of pit and fissure sealants in preventing dental caries for children and adolescents at high caries risk. The results of the studies indicate a protective effect of pit and fissure sealants, particularly for children and adolescents at high caries risk. Additionally, the economic evaluation suggests a tendency for cost savings in this group. Nevertheless, a general expansion of the intervention cannot be recommended. All studies show a risk of bias in favour of pit and fissure sealing and a limited transferability to the German health care system. Studies included in the economic evaluation revealed methodological flaws. Both the economic models and primary studies do not provide reliable results.

Cost-Effectiveness of Computed Tomographic Colonography: A Prospective Comparison with Colonoscopy

International Nuclear Information System (INIS)

Arnesen, R.B.; Ginnerup-Pedersen, B.; Poulsen, P.B.; Benzon, K. von; Adamsen, S.; Laurberg, S.; Hart-Hansen, O.

2007-01-01

Purpose: To estimate the cost-effectiveness of detecting colorectal polyps with computed tomographic colonography (CTC) and subsequent polypectomy with primary colonoscopy (CC), using CC as the alternative strategy. Material and Methods: A marginal analysis was performed regarding 103 patients who had had CTC prior to same-day CC at two hospitals, H-I (n 53) and H-II (n = 50). The patients were randomly chosen from surveillance and symptomatic study populations (148 at H-I and 231 at H-II). Populations, organizations, and procedures were compared. Cost data on time consumption, medication, and minor equipment were collected prospectively, while data on salaries and major equipment were collected retrospectively. The effect was the (previously published) sensitivities of CTC and CC for detection of colorectal polyps ≥6 mm (H-I, n = 148) or ≥5 mm (H-II, n = 231). Results: Thirteen patients at each center had at least one colorectal polyp ≥6 mm or ≥5 mm. CTC was the cost-effective alternative at H-I (Euro 187 vs. Euro 211), while CC was the cost-effective alternative at H-II (Euro 239 vs. Euro 192). The cost-effectiveness (costs per finding) mainly depended on the sensitivity of CTC and CC, but the depreciation of equipment and the staff's use of time were highly influential as well. Conclusion: Detection of colorectal polyps ≥6 mm or ≥5 mm with CTC, followed by polypectomy by CC, can be performed cost-effectively at some institutions with the appropriate hardware and organization keywords

Cost-effectiveness of rosuvastatin in comparison with generic atorvastatin and simvastatin in a Swedish population at high risk of cardiovascular events

Directory of Open Access Journals (Sweden)

Gandhi SK

2012-01-01

Full Text Available Sanjay K Gandhi1, Marie M Jensen2, Kathleen M Fox3, Lee Smolen4, Anders G Olsson5, Thomas Paulsson61AstraZeneca LP, Wilmington, DE, USA; 2AstraZeneca, Lund, Sweden; 3Strategic HealthCare Solution, Monkton, MD; 4Medical Decision Modeling Inc, Indianapolis, IN, USA; 5Department of Medical and Health Sciences, Linkoping University, and Stockholm Heart Center, Stockholm; 6AstraZeneca, Sodertalje, SwedenBackground: To assess the long-term cost-effectiveness of rosuvastatin therapy compared with generic simvastatin and generic atorvastatin in reducing the incidence of cardiovascular events and mortality in a Swedish population with Framingham risk ≥20%.Methods: A probabilistic Monte Carlo simulation model based on data from JUPITER (the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin was used to estimate the long-term cost-effectiveness of rosuvastatin 20 mg daily versus simvastatin or atorvastatin 40 mg for the prevention of cardiovascular death and morbidity. The three-stage model included cardiovascular event prevention simulating the 4 years of JUPITER, initial prevention beyond the trial, and subsequent cardiovascular event prevention. A Swedish health care payer perspective (direct costs only was modeled for a lifetime horizon, with 2008/2009 as the costing period. Univariate and probabilistic sensitivity analyses were performed.Results: The incremental cost per quality-adjusted life-year (QALY gained with rosuvastatin 20 mg over simvastatin or atorvastatin 40 mg ranged from SEK88,113 (rosuvastatin 20 mg versus simvastatin 40 mg; Framingham risk ≥30%; net avoidance of 34 events/1000 patients to SEK497,542 (versus atorvastatin 40 mg: Framingham risk ≥20%; net avoidance of 11 events/1000 patients over a lifetime horizon. Probabilistic sensitivity analyses indicated that at a willingness-to-pay threshold of SEK500,000/QALY, rosuvastatin 20 mg would be cost-effective for approximately 75%–85

Considerations on a Cost Model for High-Field Dipole Arc Magnets for FCC

CERN Document Server

AUTHOR|(CDS)2078700; Durante, Maria; Lorin, Clement; Martinez, Teresa; Ruuskanen, Janne; Salmi, Tiina; Sorbi, Massimo; Tommasini, Davide; Toral, Fernando

2017-01-01

In the frame of the European Circular Collider (EuroCirCol), a conceptual design study for a post-Large Hadron Collider (LHC) research infrastructure based on an energy-frontier 100 TeV circular hadron collider [1]–[3], a cost model for the high-field dipole arc magnets is being developed. The aim of the cost model in the initial design phase is to provide the basis for sound strategic decisions towards cost effective designs, in particular: (A) the technological choice of superconducting material and its cost, (B) the target performance of Nb$_{3}$Sn superconductor, (C) the choice of operating temperature (D) the relevant design margins and their importance for cost, (E) the nature and extent of grading, and (F) the aperture’s influence on cost. Within the EuroCirCol study three design options for the high field dipole arc magnets are under study: cos − θ [4], block [5], and common-coil [6]. Here, in the advanced design phase, a cost model helps to (1) identify the cost drivers and feed-back this info...

Considerations on a Cost Model for High-Field Dipole Arc Magnets for FCC

CERN Document Server

AUTHOR|(CDS)2078700; Durante, Maria; Lorin, Clement; Martinez, Teresa; Ruuskanen, Janne; Salmi, Tiina; Sorbi, Massimo; Tommasini, Davide; Toral, Fernando

2017-01-01

In the frame of the European Circular Collider (EuroCirCol), a conceptual design study for a post-Large Hadron Collider (LHC) research infrastructure based on an energy-frontier 100 TeV circular hadron collider [1]–[3], a cost model for the high-field dipole arc magnets is being developed. The aim of the cost model in the initial design phase is to provide the basis for sound strategic decisions towards cost effective designs, in particular: (A) the technological choice of superconducting material and its cost, (B) the target performance of Nb3Sn superconductor, (C) the choice of operating temperature (D) the relevant design margins and their importance for cost, (E) the nature and extent of grading, and (F) the aperture’s influence on cost. Within the EuroCirCol study three design options for the high field dipole arc magnets are under study: cos − θ [4], block [5], and common-coil [6]. Here, in the advanced design phase, a cost model helps to (1) identify the cost drivers and feed-back this informati...

Delivering high performance BWR fuel reliably

International Nuclear Information System (INIS)

Schardt, J.F.

1998-01-01

Utilities are under intense pressure to reduce their production costs in order to compete in the increasingly deregulated marketplace. They need fuel, which can deliver high performance to meet demanding operating strategies. GE's latest BWR fuel design, GE14, provides that high performance capability. GE's product introduction process assures that this performance will be delivered reliably, with little risk to the utility. (author)

The cost-effectiveness of intervening in low and high HIV prevalence areas in South Africa

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Josue Mbonigaba

2013-05-01

Full Text Available This research compared the cost-effectiveness of a set of HIV/AIDS interventions in a low HIV prevalence area (LPA and in a high HIV prevalence area (HPA in South Africa. The rationale for this analysis was to assess the interaction dynamics between a specific HIV/AIDS intervention and an area of implementation and the effects of these dynamics on the cost-effectiveness of such an HIV/AIDS intervention. A pair of Markov models was evaluated for each intervention; one model for a HPA and another for an LPA and the cost-effectiveness of that intervention was compared across an LPA and a HPA. The baseline costs and health outcomes in each area were collected from the literature. To depict interaction dynamics between an HIV/AIDS intervention and an area of implementation, baseline health outcomes collected in each area, were adjusted over time based on the patterns of the projections observed in the AIDS model of the Actuarial Society of South Africa (ASSA2008. The study found that the VCT and treatment of STDs were equally cost-effective in an LPA and in a HPA while PMTCT and HAART were more cost-effective in an LPA than in a HPA. As a policy proposal, resources earmarked to non-ARV based interventions (VCT and treatment of STDs should  be equally shared across an LPA and a HPA while  more of the resources reserved for ARV-based interventions (PMTCT and HAART should go in an LPA in order to increase efficiency.

[Pay for performance explained by transaction costs theory].

Science.gov (United States)

Gorbaneff, Yuri; Cortes, Ariel; Torres, Sergio; Yepes, Francisco

2011-01-01

To evaluate the ability of transaction costs theory to explain incentives in the health care chain. We performed a case study of CPS, a health insurance company in Bogota (Colombia), which preferred not to publish its name. CPS moves in the environment of high transaction costs and uses the hybrid form of governance at the outpatient level. Incentive intensity, administrative control and the contract all agree with the theory. At the hospital level, the market is used, despite greater uncertainty. Because of the discrete form (1.0) of the incentives and the absence of administrative control, it is difficult for CPS to relate payment to hospital performance. Transaction costs theory explains the configuration of incentives. Another contribution made by this theory to the literature is the criterion to differentiate between the market and the hybrid. We propose that the market uses discrete-type (1.0) incentives, while the hybrid uses continuous, commission-like incentives. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.

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Joakim Ramsberg

Full Text Available OBJECTIVE: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression. DESIGN: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine. The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year. DATA SOURCES: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources. RESULTS: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine. CONCLUSION: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

Cost-effectiveness of tubal patency tests.

Science.gov (United States)

Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J

2013-04-01

Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013

Cost-Effectiveness Data Regarding Spinal Cord Stimulation for Low Back Pain.

Science.gov (United States)

Hoelscher, Christian; Riley, Jonathan; Wu, Chengyuan; Sharan, Ashwini

2017-07-15

Review of published literature pertaining to spinal cord stimulation (SCS) cost data analysis. To acquire, organize, and succinctly summarize the available literature regarding the costs associated with, and the cost-effectiveness of, SCS. Chronic back and limb pain is a pervasive complaint in modern society, with estimated annual costs of medical care greater than $100 billion. The traditional standard medical management with or without intermittent surgical decompression/fusion has been plagued by high costs and inconsistent results, leading to poor patient satisfaction and functional outcome, and questions from policy makers regarding use of limited healthcare resources. Neuromodulation techniques, including SCS have recently become more common in the treatment of chronic back/leg pain, with clinical studies showing a high degree of efficacy in alleviating otherwise intractable pain. Given the relatively high upfront costs associated with the hardware and implantation, policy makers have, however, questioned their use in the framework of cost-containment and resource utilization. We reviewed the available literature summarizing cost data of SCS in chronic back and limb pain, as an understanding of these data will be vital to justify continued payment for this expensive, but often very effective, treatment modality. We performed a PubMed literature search utilizing the following terms: "spinal cord stimulation," "SCS," "financial," "cost," "cost-effectiveness," and "cost-utility." All studies published in English and containing complete or partial cost evaluations of SCS for chronic back and limb pain were included. The search revealed 21 studies that evaluated cost data, with or without outcomes analysis and cost-utility analysis, for patients with chronic back and limb pain. The overwhelming majority of data presented shows that SCS is not only an effective treatment option for these patients, but also represents cost savings and efficient use of healthcare

Strategic cost management, contingent factors and performance in services

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Odysseas Pavlatos

2018-06-01

Full Text Available The purpose of this paper is to investigate the relationship between contextual factors identified from contingency-based research, the extent of the use of strategic cost management (SCM techniques and business performance in services. An empirical survey was conducted on a sample of 88 services in Greece. The analysis of the survey data indicates that the use of strategic cost management techniques in services can be considered quite satisfactory. By drawing on the grounds of contingency theory, five factors were identified as potentially exhibiting an emergent relationship with strategic cost management. The five factors are; (1 Perceived environmental uncertainty, (2 Structure, (3 Organizational life cycle stage, (4 Strategy and (5 Size. The survey revealed that SCM usage is positively affected by these five contingent factors, while SCM usage, in turn, positively affects performance. A significant mediating effect of SCM usage on performance is evident.

Carbon footprint and cost-effectiveness of cataract surgery.

Science.gov (United States)

Venkatesh, Rengaraj; van Landingham, Suzanne W; Khodifad, Ashish M; Haripriya, Aravind; Thiel, Cassandra L; Ramulu, Pradeep; Robin, Alan L

2016-01-01

This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

Systematic review of the cost-effectiveness of transcatheter interventions for valvular heart disease.

Science.gov (United States)

Gialama, Fotini; Prezerakos, Panagiotis; Apostolopoulos, Vasilis; Maniadakis, Nikolaos

2018-04-01

Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) are increasingly used for managing patients with valvular heart disease to whom surgery presents a high-risk. As these are costly procedures, a systematic review of studies concerned with their economic assessment was undertaken. The search was performed in PubMed and the Cochrane Library and followed recommended methodological steps. Studies were screened and their data were retrieved and were synthesized using a narrative approach. Twenty-four, good to high quality, evaluations were identified, representing different viewpoints, modelling techniques and willingness-to-pay thresholds. Studies show that in high-risk patients with symptomatic aortic stenosis, TAVI may be cost-effective compared with medical management (MM) across many health care settings. In contrast, studies of TAVI compared with surgical aortic valve replacement (SAVR) yield conflicting and inconclusive results. The limited data available show that TMVR may also be cost-effective relative to MM in mitral valve disease. Existing evidence indicates that transcatheter techniques may be cost-effective options, relative to MM, in high-risk patients with valvular disease. Nonetheless, more research is needed to establish their economic value further, to investigate the drives of cost-effectiveness, and to evaluate surgical with transcatheter techniques in aortic valvular disease.

Cost-Effectiveness of Highly Active Antiretroviral Therapy in South Africa.

Directory of Open Access Journals (Sweden)

2005-12-01

Full Text Available BACKGROUND: Little information exists on the impact of highly active antiretroviral therapy (HAART on health-care provision in South Africa despite increasing scale-up of access to HAART and gradual reduction in HAART prices. METHODS AND FINDINGS: Use and cost of services for 265 HIV-infected adults without AIDS (World Health Organization [WHO] stage 1, 2, or 3 and 27 with AIDS (WHO stage 4 receiving HAART between 1995 and 2000 in Cape Town were compared with HIV-infected controls matched for baseline WHO stage, CD4 count, age, and socioeconomic status, who did not receive antiretroviral therapy (ART; No-ART group. Costs of service provision (January 2004 prices, US$1 = 7.6 Rand included local unit costs, and two scenarios for HAART prices for WHO recommended first-line regimens: scenario 1 used current South African public-sector ART drug prices of $730 per patient-year (PPY, whereas scenario 2 was based on the anticipated public-sector price for locally manufactured drug of $181 PPY. All analyses are presented in terms of patients without AIDS and patients with AIDS. For patients without AIDS, the mean number of inpatient days PPY was 1.08 (95% confidence interval [CI]: 0.97-1.19 for the HAART group versus 3.73 (95% CI: 3.55-3.97 for the No-ART group, and 8.71 (95% CI: 8.40-9.03 versus 4.35 (95% CI: 4.12-5.61, respectively, for mean number of outpatient visits PPY. Average service provision PPY was $950 for the No-ART group versus $1,342 and $793 PPY for the HAART group for scenario 1 and 2, respectively, whereas the incremental cost per life-year gained (LYG was $1,622 for scenario 1 and $675 for scenario 2. For patients with AIDS, mean inpatients days PPY was 2.04 (95% CI: 1.63-2.52 for the HAART versus 15.36 (95% CI: 13.97-16.85 for the No-ART group. Mean outpatient visits PPY was 7.62 (95% CI: 6.81-8.49 compared with 6.60 (95% CI: 5.69-7.62 respectively. Average service provision PPY was $3,520 for the No-ART group versus $1,513 and $964

Cost-effectiveness of highly active antiretroviral therapy in South Africa.

Directory of Open Access Journals (Sweden)

Motasim Badri

2006-01-01

Full Text Available Little information exists on the impact of highly active antiretroviral therapy (HAART on health-care provision in South Africa despite increasing scale-up of access to HAART and gradual reduction in HAART prices.Use and cost of services for 265 HIV-infected adults without AIDS (World Health Organization [WHO] stage 1, 2, or 3 and 27 with AIDS (WHO stage 4 receiving HAART between 1995 and 2000 in Cape Town were compared with HIV-infected controls matched for baseline WHO stage, CD4 count, age, and socioeconomic status, who did not receive antiretroviral therapy (ART; No-ART group. Costs of service provision (January 2004 prices, USD 1 = 7.6 Rand included local unit costs, and two scenarios for HAART prices for WHO recommended first-line regimens: scenario 1 used current South African public-sector ART drug prices of $730 per patient-year (PPY, whereas scenario 2 was based on the anticipated public-sector price for locally manufactured drug of $181 PPY. All analyses are presented in terms of patients without AIDS and patients with AIDS. For patients without AIDS, the mean number of inpatient days PPY was 1.08 (95% confidence interval [CI]: 0.97-1.19 for the HAART group versus 3.73 (95% CI: 3.55-3.97 for the No-ART group, and 8.71 (95% CI: 8.40-9.03 versus 4.35 (95% CI: 4.12-5.61, respectively, for mean number of outpatient visits PPY. Average service provision PPY was $950 for the No-ART group versus $1,342 and $793 PPY for the HAART group for scenario 1 and 2, respectively, whereas the incremental cost per life-year gained (LYG was $1,622 for scenario 1 and $675 for scenario 2. For patients with AIDS, mean inpatients days PPY was 2.04 (95% CI: 1.63-2.52 for the HAART versus 15.36 (95% CI: 13.97-16.85 for the No-ART group. Mean outpatient visits PPY was 7.62 (95% CI: 6.81-8.49 compared with 6.60 (95% CI: 5.69-7.62 respectively. Average service provision PPY was $3,520 for the No-ART group versus $1,513 and $964 for the HAART group for scenario 1

How to perform a cost-effectiveness analysis with surrogate endpoint: renal denervation in patients with resistant hypertension (DENERHTN) trial as an example.

Science.gov (United States)

Bulsei, Julie; Darlington, Meryl; Durand-Zaleski, Isabelle; Azizi, Michel

2018-04-01

Whilst much uncertainty exists as to the efficacy of renal denervation (RDN), the positive results of the DENERHTN study in France confirmed the interest of an economic evaluation in order to assess efficiency of RDN and inform local decision makers about the costs and benefits of this intervention. The uncertainty surrounding both the outcomes and the costs can be described using health economic methods such as the non-parametric bootstrap. Internationally, numerous health economic studies using a cost-effectiveness model to assess the impact of RDN in terms of cost and effectiveness compared to antihypertensive medical treatment have been conducted. The DENERHTN cost-effectiveness study was the first health economic evaluation specifically designed to assess the cost-effectiveness of RDN using individual data. Using the DENERHTN results as an example, we provide here a summary of the principle methods used to perform a cost-effectiveness analysis.

Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran.

Science.gov (United States)

Javanbakht, Mehdi; Moradi-Lakeh, Maziar; Yaghoubi, Mohsen; Esteghamati, Abdoulreza; Mansour Ghanaie, Roxana; Mahmoudi, Sussan; Shamshiri, Ahmad-Reza; Zahraei, Seyed Mohsen; Baxter, Louise; Shakerian, Sareh; Chaudhri, Irtaza; Fleming, Jessica A; Munier, Aline; Baradaran, Hamid R

2015-05-07

Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to

Cost-effectiveness of particle therapy: Current evidence and future needs

International Nuclear Information System (INIS)

Pijls-Johannesma, Madelon; Pommier, Pascal; Lievens, Yolande

2008-01-01

Purpose: Questions are being raised regarding the cost of particle therapy (PT), and with them criticism that PT is too expensive to allow the expected gain in effectiveness. This paper aims to get more insight in the cost and cost-effectiveness of particle therapy and to discuss a future strategy that allows for critical assessment of this health technology. Material and methods: A systematic literature review based on an earlier published comprehensive review was performed and updated until June 1st 2008. Besides, current business plans of PT projects were examined. Additionally, results retrieved from a cost-simulation tool developed under auspice of the ENLIGHT were discussed. Results: The current literature on cost-effectiveness of PT is scarce, non-comparable, and largely not performed according to standard health technology assessment criteria. Besides, different perspectives for cost evaluations have been used, making it difficult to compare and to determine the relative impact in terms of costs for this new treatment modality. Conclusions: Evidence on the cost-effectiveness of PT is scarce. Adequate reimbursement is necessary to support such innovative yet costly treatments. For now, model-based economic evaluations performed at least from a health care perspective may help us to gain evidence-based insight into cost-effectiveness

Delivering high performance BWR fuel reliably

Energy Technology Data Exchange (ETDEWEB)

Schardt, J.F. [GE Nuclear Energy, Wilmington, NC (United States)

1998-07-01

Utilities are under intense pressure to reduce their production costs in order to compete in the increasingly deregulated marketplace. They need fuel, which can deliver high performance to meet demanding operating strategies. GE's latest BWR fuel design, GE14, provides that high performance capability. GE's product introduction process assures that this performance will be delivered reliably, with little risk to the utility. (author)

Male circumcision at different ages in Rwanda: a cost-effectiveness study.

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Agnes Binagwaho

2010-01-01

Full Text Available BACKGROUND: There is strong evidence showing that male circumcision (MC reduces HIV infection and other sexually transmitted infections (STIs. In Rwanda, where adult HIV prevalence is 3%, MC is not a traditional practice. The Rwanda National AIDS Commission modelled cost and effects of MC at different ages to inform policy and programmatic decisions in relation to introducing MC. This study was necessary because the MC debate in Southern Africa has focused primarily on MC for adults. Further, this is the first time, to our knowledge, that a cost-effectiveness study on MC has been carried out in a country where HIV prevalence is below 5%. METHODS AND FINDINGS: A cost-effectiveness model was developed and applied to three hypothetical cohorts in Rwanda: newborns, adolescents, and adult men. Effectiveness was defined as the number of HIV infections averted, and was calculated as the product of the number of people susceptible to HIV infection in the cohort, the HIV incidence rate at different ages, and the protective effect of MC; discounted back to the year of circumcision and summed over the life expectancy of the circumcised person. Direct costs were based on interviews with experienced health care providers to determine inputs involved in the procedure (from consumables to staff time and related prices. Other costs included training, patient counselling, treatment of adverse events, and promotion campaigns, and they were adjusted for the averted lifetime cost of health care (antiretroviral therapy [ART], opportunistic infection [OI], laboratory tests. One-way sensitivity analysis was performed by varying the main inputs of the model, and thresholds were calculated at which each intervention is no longer cost-saving and at which an intervention costs more than one gross domestic product (GDP per capita per life-year gained. RESULTS: Neonatal MC is less expensive than adolescent and adult MC (US$15 instead of US$59 per procedure and is cost

Assessing value in breast reconstruction: A systematic review of cost-effectiveness studies.

Science.gov (United States)

Sheckter, Clifford C; Matros, Evan; Momeni, Arash

2018-03-01

Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high-value care models. A systematic review of PubMed, Web of Science, and the Cost-Effectiveness Analysis Registry was conducted. Two reviewers independently evaluated all publications up until August 17, 2017. After removal of duplicates, 1996 records were screened, from which 53 studies underwent full text review. All the 13 studies included for final analysis mention an incremental cost-effectiveness ratio. Five studies evaluated the cost-effectiveness of technologies including acellular dermal matrix (ADM) in staged prosthetic reconstruction, ADM in direct-to-implant (DTI) reconstruction, preoperative computed tomography angiography in autologous reconstruction, indocyanine green dye angiography in evaluating anastomotic patency, and abdominal mesh reinforcement in abdominal tissue transfer. The remaining eight studies evaluated the cost-effectiveness of different reconstruction methods. Cost-effective strategies included free vs. pedicled abdominal tissue transfer, DTI vs. staged prosthetic reconstruction, and fascia-sparing variants of free abdominal tissue transfer. Current evidence demonstrates multiple cost-effective technologies and methods in accomplishing successful breast reconstruction. Plastic surgeons should be well informed of such economic models when engaging payers and policymakers in discussions regarding high-value breast reconstruction. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted.

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Peter J Neumann

Full Text Available Calculating the cost per disability-adjusted life years (DALYs averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve population health. However, there has been no systematic attempt to characterize the literature and its evolution.We conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases "disability-adjusted" or "DALY". Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000-2009 and 2010-2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low to 7 (high, and examined the correlation between diseases researched and the burden of disease in different world regions.We identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%, followed by non-communicable diseases (28%. A high proportion of studies evaluated primary prevention strategies (59%. Pharmaceutical interventions were commonly assessed (32% followed by immunizations (28%. Adherence to good practices for conducting and reporting cost-effectiveness analysis varied considerably. Studies mainly included

Device Characterization of High Performance Quantum Dot Comb Laser

KAUST Repository

Rafi, Kazi

2012-02-01

The cost effective comb based laser sources are considered to be one of the prominent emitters used in optical communication (OC) and photonic integrated circuits (PIC). With the rising demand for delivering triple-play services (voice, data and video) in FTTH and FTTP-based WDM-PON networks, metropolitan area network (MAN), and short-reach rack-to-rack optical computer communications, a versatile and cost effective WDM transmitter design is required, where several DFB lasers can be replaced by a cost effective broadband comb laser to support on-chip optical signaling. Therefore, high performance quantum dot (Q.Dot) comb lasers need to satisfy several challenges before real system implementations. These challenges include a high uniform broadband gain spectrum from the active layer, small relative intensity noise with lower bit error rate (BER) and better temperature stability. Thus, such short wavelength comb lasers offering higher bandwidth can be a feasible solution to address these challenges. However, they still require thorough characterization before implementation. In this project, we briefly characterized the novel quantum dot comb laser using duty cycle based electrical injection and temperature variations where we have observed the presence of reduced thermal conductivity in the active layer. This phenomenon is responsible for the degradation of device performance. Hence, different performance trends, such as broadband emission and spectrum stability were studied with pulse and continuous electrical pumping. The tested comb laser is found to be an attractive solution for several applications but requires further experiments in order to be considered for photonic intergraded circuits and to support next generation computer-communications.

Can a Costly Intervention Be Cost-effective?

Science.gov (United States)

Foster, E. Michael; Jones, Damon

2009-01-01

Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

U.S. DOE Progress Towards Developing Low-Cost, High Performance, Durable Polymer Electrolyte Membranes for Fuel Cell Applications.

Science.gov (United States)

Houchins, Cassidy; Kleen, Greg J; Spendelow, Jacob S; Kopasz, John; Peterson, David; Garland, Nancy L; Ho, Donna Lee; Marcinkoski, Jason; Martin, Kathi Epping; Tyler, Reginald; Papageorgopoulos, Dimitrios C

2012-12-18

Low cost, durable, and selective membranes with high ionic conductivity are a priority need for wide-spread adoption of polymer electrolyte membrane fuel cells (PEMFCs) and direct methanol fuel cells (DMFCs). Electrolyte membranes are a major cost component of PEMFC stacks at low production volumes. PEMFC membranes also impose limitations on fuel cell system operating conditions that add system complexity and cost. Reactant gas and fuel permeation through the membrane leads to decreased fuel cell performance, loss of efficiency, and reduced durability in both PEMFCs and DMFCs. To address these challenges, the U.S. Department of Energy (DOE) Fuel Cell Technologies Program, in the Office of Energy Efficiency and Renewable Energy, supports research and development aimed at improving ion exchange membranes for fuel cells. For PEMFCs, efforts are primarily focused on developing materials for higher temperature operation (up to 120 °C) in automotive applications. For DMFCs, efforts are focused on developing membranes with reduced methanol permeability. In this paper, the recently revised DOE membrane targets, strategies, and highlights of DOE-funded projects to develop new, inexpensive membranes that have good performance in hot and dry conditions (PEMFC) and that reduce methanol crossover (DMFC) will be discussed.

Analyzing the Cost-Effectiveness of Instruction Expenditures towards High School Completion among Oahu's Public School Districts

Science.gov (United States)

Ng, Larson S. W. M.

2011-01-01

The following study attempted to ascertain the instructional cost-effectiveness of public high school teachers towards high school completion through a financially based econometric analysis. Essentially, public high school instruction expenditures and completer data were collected from 2000 to 2007 and bivariate interaction analyzed through a…

The high intensity solar cell - Key to low cost photovoltaic power

Science.gov (United States)

Sater, B. L.; Goradia, C.

1975-01-01

This paper discusses the problems associated with conventional solar cells at high intensities and presents the design considerations and performance characteristics of the 'high intensity' (HI) solar cell which appears to eliminate the major problems. Test data obtained at greater than 250 AM1 suns gave a peak output power density of 2 W per sq cm at an efficiency exceeding 6% with an unoptimized cell operating at over 100 C. It appears that operation at 1000 AM1 suns at efficiencies greater than 10% is possible. At 1000 AM1 suns and 10% efficiency, the HI cell manufacturing cost is estimated to be $0.25/watt, with multi-megawatt annual production capability already existing within the industrial sector. A high intensity solar system was also analyzed to determine its cost effectiveness and to assess the benefits of further improving HI cell efficiency.

Cost-effectiveness of the Norwegian breast cancer screening program.

Science.gov (United States)

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

2017-02-15

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

Symmetric Sodium-Ion Capacitor Based on Na0.44MnO2 Nanorods for Low-Cost and High-Performance Energy Storage.

Science.gov (United States)

Chen, Zhongxue; Yuan, Tianci; Pu, Xiangjun; Yang, Hanxi; Ai, Xinping; Xia, Yongyao; Cao, Yuliang

2018-04-11

Batteries and electrochemical capacitors play very important roles in the portable electronic devices and electric vehicles and have shown promising potential for large-scale energy storage applications. However, batteries or capacitors alone cannot meet the energy and power density requirements because rechargeable batteries have a poor power property, whereas supercapacitors offer limited capacity. Here, a novel symmetric sodium-ion capacitor (NIC) is developed based on low-cost Na 0.44 MnO 2 nanorods. The Na 0.44 MnO 2 with unique nanoarchitectures and iso-oriented feature offers shortened diffusion path lengths for both electronic and Na + transport and reduces the stress associated with Na + insertion and extraction. Benefiting from these merits, the symmetric device achieves a high power density of 2432.7 W kg -1 , an improved energy density of 27.9 Wh kg -1 , and a capacitance retention of 85.2% over 5000 cycles. Particularly, the symmetric NIC based on Na 0.44 MnO 2 permits repeatedly reverse-polarity characteristics, thus simplifying energy management system and greatly enhancing the safety under abuse condition. This cost-effective, high-safety, and high-performance symmetric NIC can balance the energy and power density between batteries and capacitors and serve as an electric power source for future low-maintenance large-scale energy storage systems.

Highlighting High Performance: Whitman Hanson Regional High School; Whitman, Massachusetts

Energy Technology Data Exchange (ETDEWEB)

2006-06-01

This brochure describes the key high-performance building features of the Whitman-Hanson Regional High School. The brochure was paid for by the Massachusetts Technology Collaborative as part of their Green Schools Initiative. High-performance features described are daylighting and energy-efficient lighting, indoor air quality, solar and wind energy, building envelope, heating and cooling systems, water conservation, and acoustics. Energy cost savings are also discussed.

High performance flexible CMOS SOI FinFETs

KAUST Repository

Fahad, Hossain M.

2014-06-01

We demonstrate the first ever CMOS compatible soft etch back based high performance flexible CMOS SOI FinFETs. The move from planar to non-planar FinFETs has enabled continued scaling down to the 14 nm technology node. This has been possible due to the reduction in off-state leakage and reduced short channel effects on account of the superior electrostatic charge control of multiple gates. At the same time, flexible electronics is an exciting expansion opportunity for next generation electronics. However, a fully integrated low-cost system will need to maintain ultra-large-scale-integration density, high performance and reliability - same as today\\'s traditional electronics. Up until recently, this field has been mainly dominated by very weak performance organic electronics enabled by low temperature processes, conducive to low melting point plastics. Now however, we show the world\\'s highest performing flexible version of 3D FinFET CMOS using a state-of-the-art CMOS compatible fabrication technique for high performance ultra-mobile consumer applications with stylish design. © 2014 IEEE.

Optimization Method of a Low Cost, High Performance Ceramic Proppant by Orthogonal Experimental Design

Science.gov (United States)

Zhou, Y.; Tian, Y. M.; Wang, K. Y.; Li, G.; Zou, X. W.; Chai, Y. S.

2017-09-01

This study focused on optimization method of a ceramic proppant material with both low cost and high performance that met the requirements of Chinese Petroleum and Gas Industry Standard (SY/T 5108-2006). The orthogonal experimental design of L9(34) was employed to study the significance sequence of three factors, including weight ratio of white clay to bauxite, dolomite content and sintering temperature. For the crush resistance, both the range analysis and variance analysis reflected the optimally experimental condition was weight ratio of white clay to bauxite=3/7, dolomite content=3 wt.%, temperature=1350°C. For the bulk density, the most important factor was the sintering temperature, followed by the dolomite content, and then the ratio of white clay to bauxite.

Growth Performance, Haematological Indices and Cost Benefits of ...

African Journals Online (AJOL)

Lenovo pc

Effect of replacing dietary maize with cassava peel meal (CPM) supplemented with Allzyme® SSF (SSF) on the growth performance, haematological indices and cost benefits of growing pigs was investigated. Chemical composition of CPM and diets used were determined using standard procedures. Twenty-four growing ...

A Cost-Effectiveness Analysis Model for Evaluating and Planning Secondary Vocational Programs

Science.gov (United States)

Kim, Jin Eun

1977-01-01

This paper conceptualizes a cost-effectiveness analysis and describes a cost-effectiveness analysis model for secondary vocational programs. It generates three kinds of cost-effectiveness measures: program effectiveness, cost efficiency, and cost-effectiveness and/or performance ratio. (Author)

Assessing the interaction effect of cost control systems and information technology integration on manufacturing plant financial performance

OpenAIRE

Maiga, Adam S; Nilsson, Anders; Jacobs, Fred

2014-01-01

The interface between management control and information technology is an under-developed research area with a knowledge gap concerning its implications for financial performance. This study contributes to bridging this gap by investigates the interaction effect of cost control systems and information technology integration on manufacturing plant financial performance. We surveyed a sample of 518 managers of U.S. manufacturing plants, approximately evenly distributed between those using activ...

Understanding the Effects of Sampling on Healthcare Risk Modeling for the Prediction of Future High-Cost Patients

Science.gov (United States)

Moturu, Sai T.; Liu, Huan; Johnson, William G.

Rapidly rising healthcare costs represent one of the major issues plaguing the healthcare system. Data from the Arizona Health Care Cost Containment System, Arizona's Medicaid program provide a unique opportunity to exploit state-of-the-art machine learning and data mining algorithms to analyze data and provide actionable findings that can aid cost containment. Our work addresses specific challenges in this real-life healthcare application with respect to data imbalance in the process of building predictive risk models for forecasting high-cost patients. We survey the literature and propose novel data mining approaches customized for this compelling application with specific focus on non-random sampling. Our empirical study indicates that the proposed approach is highly effective and can benefit further research on cost containment in the healthcare industry.

Quality upgrading and cost reducing effects of using an operation control system for performance of maintenance tasks

International Nuclear Information System (INIS)

Ramler, K.

1996-01-01

According to available results, the use of an operation control system has come up to expections with respect to a quality enhancement of maintenance work. The tasks are performed more safely and there is more insight into the processes. so that, as indirect results, cost savings and rationalisation effects are to be expected. However, the cost savings achieved through the operation control system for maintenance tasks will remain modest. The truly cost-effective optimisation potentials in the maintenance area primarily consist in a reduction of preventive measures to the required scope, i.e reduction of the envisaged quantity of processes for maintenance and recurrent inspection. In order to extend savings to the organisational level, with respect to personnel expenditure, by DP supported maintenance planning, a suitable optimisation of the organisational structure and personnel employment is inevitable, because otherwise the rationalisation potentials will remain utopia. (orig.) [de

Annual Report, Fall 2016: Identifying Cost Effective Tank Waste Characterization Approaches

Energy Technology Data Exchange (ETDEWEB)

Reboul, S. H. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); DiPrete, D. P. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2016-12-12

This report documents the activities that were performed during the second year of a project undertaken to improve the cost effectiveness and timeliness of SRNL’s tank closure characterization practices. The activities performed during the first year of the project were previously reported in SRNL-STI-2015-00144. The scope of the second year activities was divided into the following three primary tasks: 1) develop a technical basis and strategy for improving the cost effectiveness and schedule of SRNL’s tank closure characterization program; 2) initiate the design and assembly of a new waste removal system for improving the throughput and reducing the personnel dose associated with extraction chromatography radiochemical separations; and 3) develop and perform feasibility testing of three alternative radiochemical separation protocols holding promise for improving high resource demand/time consuming tank closure sample analysis methods.

Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China.

Science.gov (United States)

Zhang, Qian; Liu, Yi-Jun; Hu, Shang-Ying; Zhao, Fang-Hui

2016-11-04

Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine

Simple, cost effective & result oriented framework for supplier performance measurement in sports goods manufacturing industry

Directory of Open Access Journals (Sweden)

2011-09-01

Full Text Available The emergences of global markets have increased competition worldwide. For the Sports Goods Manufacturing Industry which is considered to be an intensive supplier base industry with limited resources to sustain in what is already a very competitive market there is a need for the entire supply chain viz. raw material and machinery suppliers and manufacturers to measure their supplier's performance to reduce business risks and revenue losses. How to design & execute a simple, cost effective & result oriented Framework for Supplier Performance Measurement for sports goods manufacturing small - medium enterprises is the main aim of this research paper.

A low-cost, Nist-traceable, high performance dielectric resonator Master Oscillator

International Nuclear Information System (INIS)

Doolittle, L.R.; Hovater, C.; Merminga, L.; Musson, J.; Wiseman, W.

1999-01-01

The current CEBAF Master Oscillator (MO) uses a quartz-based 10 MHz reference to synthesize 70 MHz and 499 MHz, which are then distributed to each of the klystron galleries on site. Due to the specialized nature of CEBAF's MO requirements, it has been determined that an in-house design and fabrication would provide a cost-effective alternative to purchasing or modifying vendor equipment. A Global Positioning System (GPS) disciplined, Direct Digital Synthesis (DDS) based MO is proposed which incorporates low-cost consumer RF components, designed for cellular communications. A 499 MHz Dielectric Resonant Oscillator (DRO) Voltage Controlled Oscillator (VCO) is phase-locked to a GPS-disciplined 10 MHz reference, and micro-tuned via a DDS, in an effort to achieve the lowest phase noise possible

Overview of the Performance and Cost Effectiveness of Small Arsenic Removal Technologies

Science.gov (United States)

Presentation provides information on the performance and cost of primarily four arsenic removal technologies; adsorptive media, iron removal, coagulation/filtration and the combination system of iron removal followed by adsorptive media.

Cost-effectiveness of minimally invasive sacroiliac joint fusion.

Science.gov (United States)

Cher, Daniel J; Frasco, Melissa A; Arnold, Renée Jg; Polly, David W

2016-01-01

Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. To determine the cost-effectiveness of minimally invasive SIJ fusion. Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) dysfunction due to degenerative sacroiliitis or SIJ disruption.

Cost-Effective Class-Imbalance Aware CNN for Vehicle Localization and Categorization in High Resolution Aerial Images

Directory of Open Access Journals (Sweden)

Feimo Li

2017-05-01

Full Text Available Joint vehicle localization and categorization in high resolution aerial images can provide useful information for applications such as traffic flow structure analysis. To maintain sufficient features to recognize small-scaled vehicles, a regions with convolutional neural network features (R-CNN -like detection structure is employed. In this setting, cascaded localization error can be averted by equally treating the negatives and differently typed positives as a multi-class classification task, but the problem of class-imbalance remains. To address this issue, a cost-effective network extension scheme is proposed. In it, the correlated convolution and connection costs during extension are reduced by feature map selection and bi-partite main-side network construction, which are realized with the assistance of a novel feature map class-importance measurement and a new class-imbalance sensitive main-side loss function. By using an image classification dataset established from a set of traditional real-colored aerial images with 0.13 m ground sampling distance which are taken from the height of 1000 m by an imaging system composed of non-metric cameras, the effectiveness of the proposed network extension is verified by comparing with its similarly shaped strong counter-parts. Experiments show an equivalent or better performance, while requiring the least parameter and memory overheads are required.

Development of a high performance liquid chromatography method ...

African Journals Online (AJOL)

Development of a high performance liquid chromatography method for simultaneous ... Purpose: To develop and validate a new low-cost high performance liquid chromatography (HPLC) method for ..... Several papers have reported the use of ...

Divided Attention in Younger and Older Adults: Effects of Strategy and Relatedness on Memory Performance and Secondary Task Costs

Science.gov (United States)

Naveh-Benjamin, Moshe; Craik, Fergus I. M.; Guez, Jonathan; Kreuger, Sharyn

2005-01-01

Divided attention at encoding leads to a significant decline in memory performance, whereas divided attention during retrieval has relatively little effect; nevertheless, retrieval carries significant secondary task costs, especially for older adults. The authors further investigated the effects of divided attention in younger and older adults by…

Micromachined high-performance RF passives in CMOS substrate

International Nuclear Information System (INIS)

Li, Xinxin; Ni, Zao; Gu, Lei; Wu, Zhengzheng; Yang, Chen

2016-01-01

This review systematically addresses the micromachining technologies used for the fabrication of high-performance radio-frequency (RF) passives that can be integrated into low-cost complementary metal-oxide semiconductor (CMOS)-grade (i.e. low-resistivity) silicon wafers. With the development of various kinds of post-CMOS-compatible microelectromechanical systems (MEMS) processes, 3D structural inductors/transformers, variable capacitors, tunable resonators and band-pass/low-pass filters can be compatibly integrated into active integrated circuits to form monolithic RF system-on-chips. By using MEMS processes, including substrate modifying/suspending and LIGA-like metal electroplating, both the highly lossy substrate effect and the resistive loss can be largely eliminated and depressed, thereby meeting the high-performance requirements of telecommunication applications. (topical review)

Discovery of high-performance low-cost n-type Mg3Sb2-based thermoelectric materials with multi-valley conduction bands

DEFF Research Database (Denmark)

Zhang, Jiawei; Song, Lirong; Pedersen, Steffen Hindborg

2017-01-01

Widespread application of thermoelectric devices for waste heat recovery requires low-cost high-performance materials. The currently available n-type thermoelectric materials are limited either by their low efficiencies or by being based on expensive, scarce or toxic elements. Here we report a low-cost...... because of the multi-valley band behaviour dominated by a unique near-edge conduction band with a sixfold valley degeneracy. This makes Te-doped Mg3Sb1.5Bi0.5 a promising candidate for the low- and intermediate-temperature thermoelectric applications....

The Effects of Cost Leadership Strategy and Product Differentiation Strategy on the Performance of Firms

OpenAIRE

Hashem Valipour; Hamid Birjandi; Samira Honarbakhsh

2012-01-01

This study empirically investigates the effects of business strategies on the relationship between financial leverage and the performance of firms. The research data is collected from 45 firms in the Tehran Security Exchange (TSE) during 2003-2010.The statistical technique is used to examine the assumption of multiple regressions. To test the assumptions, firms were divided into 2 groups: firms with cost leadership strategy and firms with product differentiation strategy. The results indicate...

Cost-effectiveness optimization of a solar hot water heater with integrated storage system

International Nuclear Information System (INIS)

Kamaruzzaman Sopian; Syahri, M.; Shahrir, A.; Mohd Yusof Othman; Baharuddin Yatim

2006-01-01

Solar processes are generally characterized by high first cost and low operating costs. Therefore, the basic economic problem is one of comparing an initial known investment with estimated future operating cost. This paper present the cost-benefit ratio of solar collector with integrated storage system. Evaluation of the annual cost (AC) and the annual energy gain (AEG) of the collector are performed and the ratio of AC/AEG or the cost benefit ratio is presented for difference combination of mass flow rate, solar collector length and channel depth. Using these cost-effectiveness curves, the user can select optimum design features, which correspond to minimum AC/AEG

U.S. DOE Progress Towards Developing Low-Cost, High Performance, Durable Polymer Electrolyte Membranes for Fuel Cell Applications

Directory of Open Access Journals (Sweden)

Dimitrios C. Papageorgopoulos

2012-12-01

Full Text Available Low cost, durable, and selective membranes with high ionic conductivity are a priority need for wide-spread adoption of polymer electrolyte membrane fuel cells (PEMFCs and direct methanol fuel cells (DMFCs. Electrolyte membranes are a major cost component of PEMFC stacks at low production volumes. PEMFC membranes also impose limitations on fuel cell system operating conditions that add system complexity and cost. Reactant gas and fuel permeation through the membrane leads to decreased fuel cell performance, loss of efficiency, and reduced durability in both PEMFCs and DMFCs. To address these challenges, the U.S. Department of Energy (DOE Fuel Cell Technologies Program, in the Office of Energy Efficiency and Renewable Energy, supports research and development aimed at improving ion exchange membranes for fuel cells. For PEMFCs, efforts are primarily focused on developing materials for higher temperature operation (up to 120 °C in automotive applications. For DMFCs, efforts are focused on developing membranes with reduced methanol permeability. In this paper, the recently revised DOE membrane targets, strategies, and highlights of DOE-funded projects to develop new, inexpensive membranes that have good performance in hot and dry conditions (PEMFC and that reduce methanol crossover (DMFC will be discussed.

Is screening for pancreatic cancer in high-risk groups cost-effective?

DEFF Research Database (Denmark)

Jørgensen, Maiken Thyregod; Gerdes, Anne-Marie; Sørensen, Jan

2016-01-01

OBJECTIVE: Pancreatic cancer (PC) is the fourth leading cause of cancer death worldwide, symptoms are few and diffuse, and when the diagnosis has been made only 10-15% would benefit from resection. Surgery is the only potentially curable treatment for pancreatic cancer, and the prognosis seems to......$ per QALY. CONCLUSIONS: With a threshold value of 50,000 US$ per QALY this screening program appears to constitute a cost-effective intervention although screening of HP patients appears to be less cost-effective than FPC patients....... with Hereditary pancreatitis or with a disposition of HP and 40 first-degree relatives of patients with Familial Pancreatic Cancer (FPC) were screened for development of Pancreatic Ductal Adenocarcinoma (PDAC) with yearly endoscopic ultrasound. The cost-effectiveness of screening in comparison with no......-screening was assessed by the incremental cost-utility ratio (ICER). RESULTS: By screening the FPC group we identified 2 patients with PDAC who were treated by total pancreatectomy. One patient is still alive, while the other died after 7 months due to cardiac surgery complications. Stratified analysis of patients...

Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis.

Science.gov (United States)

Lindemark, Frode; Haaland, Øystein A; Kvåle, Reidar; Flaatten, Hans; Norheim, Ole F; Johansson, Kjell A

2017-08-21

Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more

The effects of regional insolation differences upon advanced solar thermal electric power plant performance and energy costs

Science.gov (United States)

Latta, A. F.; Bowyer, J. M.; Fujita, T.

1979-01-01

This paper presents the performance and cost of four 10-MWe advanced solar thermal electric power plants sited in various regions of the continental United States. Each region has different insolation characteristics which result in varying collector field areas, plant performance, capital costs, and energy costs. The paraboloidal dish, central receiver, cylindrical parabolic trough, and compound parabolic concentrator (CPC) comprise the advanced concepts studied. This paper contains a discussion of the regional insolation data base, a description of the solar systems' performances and costs, and a presentation of a range for the forecast cost of conventional electricity by region and nationally over the next several decades.

Hybrid Microscopy: Enabling Inexpensive High-Performance Imaging through Combined Physical and Optical Magnifications.

Science.gov (United States)

Zhang, Yu Shrike; Chang, Jae-Byum; Alvarez, Mario Moisés; Trujillo-de Santiago, Grissel; Aleman, Julio; Batzaya, Byambaa; Krishnadoss, Vaishali; Ramanujam, Aishwarya Aravamudhan; Kazemzadeh-Narbat, Mehdi; Chen, Fei; Tillberg, Paul W; Dokmeci, Mehmet Remzi; Boyden, Edward S; Khademhosseini, Ali

2016-03-15

To date, much effort has been expended on making high-performance microscopes through better instrumentation. Recently, it was discovered that physical magnification of specimens was possible, through a technique called expansion microscopy (ExM), raising the question of whether physical magnification, coupled to inexpensive optics, could together match the performance of high-end optical equipment, at a tiny fraction of the price. Here we show that such "hybrid microscopy" methods--combining physical and optical magnifications--can indeed achieve high performance at low cost. By physically magnifying objects, then imaging them on cheap miniature fluorescence microscopes ("mini-microscopes"), it is possible to image at a resolution comparable to that previously attainable only with benchtop microscopes that present costs orders of magnitude higher. We believe that this unprecedented hybrid technology that combines expansion microscopy, based on physical magnification, and mini-microscopy, relying on conventional optics--a process we refer to as Expansion Mini-Microscopy (ExMM)--is a highly promising alternative method for performing cost-effective, high-resolution imaging of biological samples. With further advancement of the technology, we believe that ExMM will find widespread applications for high-resolution imaging particularly in research and healthcare scenarios in undeveloped countries or remote places.

Cost-optimal energy performance renovation measures of educational buildings in cold climate

International Nuclear Information System (INIS)

Niemelä, Tuomo; Kosonen, Risto; Jokisalo, Juha

2016-01-01

Highlights: • The proposed national nZEB target can be cost-effectively achieved in renovations. • Energy saving potential of HVAC systems is significant compared to the building envelope. • Modern renewable energy production technologies are cost-efficient and recommendable. • Improving the indoor climate conditions in deep renovations is recommendable. • Simulation-based optimization method is efficient in building performance analyzes. - Abstract: The paper discusses cost-efficient energy performance renovation measures for typical educational buildings built in the 1960s and 1970s in cold climate regions. The study analyzes the impact of different energy renovation measures on the energy efficiency and economic viability in a Finnish case study educational building located in Lappeenranta University of Technology (LUT) campus area. The main objective of the study was to determine the cost-optimal energy performance renovation measures to meet the proposed national nearly zero-energy building (nZEB) requirements, which are defined according to the primary energy consumption of buildings. The main research method of the study was simulation-based optimization (SBO) analysis, which was used to determine the cost-optimal renovation solutions. The results of the study indicate that the minimum national energy performance requirement of new educational buildings (E_p_r_i_m_a_r_y ⩽ 170 kWh/(m"2,a)) can be cost-effectively achieved in deep renovations of educational buildings. In addition, the proposed national nZEB-targets are also well achievable, while improving the indoor climate (thermal comfort and indoor air quality) conditions significantly at the same time. Cost-effective solutions included renovation of the original ventilation system, a ground source heat pump system with relatively small dimensioning power output, new energy efficient windows and a relatively large area of PV-panels for solar-based electricity production. The results and

Development of cost-effective Nb3Sn conductors for the next generation hadron colliders

International Nuclear Information System (INIS)

Scanlan, R.M.; Dietderich, D.R.; Zeitlin, B.A.

2001-01-01

Significant progress has been made in demonstrating that reliable, efficient high field dipole magnets can be made with Nb 3 Sn superconductors. A key factor in determining whether these magnets will be a cost-effective solution for the next generation hadron collider is the conductor cost. Consequently, DOE initiated a conductor development program to demonstrate that Nb 3 Sn can be improved to reach a cost/performance value of $1.50/kA-m at 12T, 4.2K. The first phase of this program was initiated in Jan 2000, with the goal of improving the key properties of interest for accelerator dipole magnets--high critical current density and low magnetization. New world record critical current densities have been reported recently, and it appears that significant potential exists for further improvement. Although new techniques for compensating for magnetization effects have reduced the requirements somewhat, techniques for lowering the effective filament size while maintaining these high Jc values are a program priority. The next phase of this program is focused on reducing the conductor cost through substitution of lower cost raw materials and through process improvements. The cost drivers for materials and fabrication have been identified, and projects are being initiated to demonstrate cost reductions

High-Level Disinfection of Otorhinolaryngology Clinical Instruments: An Evaluation of the Efficacy and Cost-effectiveness of Instrument Storage.

Science.gov (United States)

Yalamanchi, Pratyusha; Yu, Jason; Chandler, Laura; Mirza, Natasha

2018-01-01

Objectives Despite increasing interest in individual instrument storage, risk of bacterial cross-contamination of otorhinolaryngology clinic instruments has not been assessed. This study is the first to determine the clinical efficacy and cost-effectiveness of standard high-level disinfection and clinic instrument storage. Methods To assess for cross-contamination, surveillance cultures of otorhinolaryngology clinic instruments subject to standard high-level disinfection and storage were obtained at the start and end of the outpatient clinical workday. Rate of microorganism recovery was compared with cultures of instruments stored in individual peel packs and control cultures of contaminated instruments. Based on historical clinic data, the direct allocation method of cost accounting was used to determine aggregate raw material cost and additional labor hours required to process and restock peel-packed instruments. Results Among 150 cultures of standard high-level disinfected and co-located clinic instruments, 3 positive bacterial cultures occurred; 100% of control cultures were positive for bacterial species ( P cost of individual semicritical instrument storage at $97,852.50 per year. Discussion With in vitro inoculation of >200 otorhinolaryngology clinic instruments, this study demonstrates that standard high-level disinfection and storage are equally efficacious to more time-consuming and expensive individual instrument storage protocols, such as peel packing, with regard to bacterial contamination. Implications for Practice Standard high-level disinfection and storage are equally effective to labor-intensive and costly individual instrument storage protocols.

Economics of human performance and systems total ownership cost.

Science.gov (United States)

Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z

2012-01-01

Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.

A high performance cost-effective digital complex correlator for an X-band polarimetry survey.

Science.gov (United States)

Bergano, Miguel; Rocha, Armando; Cupido, Luís; Barbosa, Domingos; Villela, Thyrso; Boas, José Vilas; Rocha, Graça; Smoot, George F

2016-01-01

The detailed knowledge of the Milky Way radio emission is important to characterize galactic foregrounds masking extragalactic and cosmological signals. The update of the global sky models describing radio emissions over a very large spectral band requires high sensitivity experiments capable of observing large sky areas with long integration times. Here, we present the design of a new 10 GHz (X-band) polarimeter digital back-end to map the polarization components of the galactic synchrotron radiation field of the Northern Hemisphere sky. The design follows the digital processing trends in radio astronomy and implements a large bandwidth (1 GHz) digital complex cross-correlator to extract the Stokes parameters of the incoming synchrotron radiation field. The hardware constraints cover the implemented VLSI hardware description language code and the preliminary results. The implementation is based on the simultaneous digitized acquisition of the Cartesian components of the two linear receiver polarization channels. The design strategy involves a double data rate acquisition of the ADC interleaved parallel bus, and field programmable gate array device programming at the register transfer mode. The digital core of the back-end is capable of processing 32 Gbps and is built around an Altera field programmable gate array clocked at 250 MHz, 1 GSps analog to digital converters and a clock generator. The control of the field programmable gate array internal signal delays and a convenient use of its phase locked loops provide the timing requirements to achieve the target bandwidths and sensitivity. This solution is convenient for radio astronomy experiments requiring large bandwidth, high functionality, high volume availability and low cost. Of particular interest, this correlator was developed for the Galactic Emission Mapping project and is suitable for large sky area polarization continuum surveys. The solutions may also be adapted to be used at signal processing

Quality assurance of Vari-source high dose rate (HDR) brachytherapy- remote after loader and cost effectiveness of Vari-source HDR- brachytherapy: NORI, Islamabad experience

International Nuclear Information System (INIS)

Ahmad, N.; Mahmood, H.; Jafri, S.R.A.

2004-01-01

A quality control of Vari-Source high dose rate (HDR) remote after loading brachytherapy machine was carried out and the cost effectiveness of HDR brachytherapy machine was also evaluated considering the cost of ten Iridium-192 wire sources at Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan. A total number of 253 intracavitary insertions were done in 98 patients from October 1996 to May 2001. The results of the quality control tests performed during 1996 to 2001 were within the acceptable limits. The cost effectiveness of Vari-Source HDR brachytherapy machine was also evaluated. The average cost per patient was calculated as US$ 491. Small number of patients was treated as the machine was used for gynecologic malignancies only. The objective was to assess the quality control status of HDR brachytherapy machine on patient treatment day, source exchange day and periodic day (monthly basis). It was found that the cost per patient can be minimized if other type of cancer patients are also treated on Vari-Source HDR machine. (author)

Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico.

Directory of Open Access Journals (Sweden)

Jochen Profit

2010-12-01

Full Text Available Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs, and incremental cost-effectiveness ratios (ICERs for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses

Cost and Performance Model for Photovoltaic Systems

Science.gov (United States)

Borden, C. S.; Smith, J. H.; Davisson, M. C.; Reiter, L. J.

1986-01-01

Lifetime cost and performance (LCP) model assists in assessment of design options for photovoltaic systems. LCP is simulation of performance, cost, and revenue streams associated with photovoltaic power systems connected to electric-utility grid. LCP provides user with substantial flexibility in specifying technical and economic environment of application.

Comparing the relative cost-effectiveness of diagnostic studies: a new model

International Nuclear Information System (INIS)

Patton, D.D.; Woolfenden, J.M.; Wellish, K.L.

1986-01-01

We have developed a model to compare the relative cost-effectiveness of two or more diagnostic tests. The model defines a cost-effectiveness ratio (CER) for a diagnostic test as the ratio of effective cost to base cost, only dollar costs considered. Effective cost includes base cost, cost of dealing with expected side effects, and wastage due to imperfect test performance. Test performance is measured by diagnostic utility (DU), a measure of test outcomes incorporating the decision-analytic variables sensitivity, specificity, equivocal fraction, disease probability, and outcome utility. Each of these factors affecting DU, and hence CER, is a local, not universal, value; these local values strongly affect CER, which in effect becomes a property of the local medical setting. When DU = +1 and there are no adverse effects, CER = 1 and the patient benefits from the test dollar for dollar. When there are adverse effects effective cost exceeds base cost, and for an imperfect test DU 1. As DU approaches 0 (worthless test), CER approaches infinity (no effectiveness at any cost). If DU is negative, indicating that doing the test at all would be detrimental, CER also becomes negative. We conclude that the CER model is a useful preliminary method for ranking the relative cost-effectiveness of diagnostic tests, and that the comparisons would best be done using local values; different groups might well arrive at different rankings. (Author)

Low–Cost Bio-Based Carbon Fiber for High-Temperature Processing

Energy Technology Data Exchange (ETDEWEB)

Naskar, Amit K. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Akato, Kokouvi M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Tran, Chau D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Paul, Ryan M. [GrafTech International Holdings, Inc., Brooklyn Heights, OH (United States); Dai, Xuliang [GrafTech International Holdings, Inc., Brooklyn Heights, OH (United States)

2017-02-01

GrafTech International Holdings Inc. (GTI), worked with Oak Ridge National Laboratory (ORNL) under CRADA No. NFE-15-05807 to develop lignin-based carbon fiber (LBCF) technology and to demonstrate LBCF performance in high-temperature products and applications. This work was unique and different from other reported LBCF work in that this study was application-focused and scalability-focused. Accordingly, the executed work was based on meeting criteria based on technology development, cost, and application suitability. The focus of this work was to demonstrate lab-scale LBCF from at least 4 different precursor feedstock sources that could meet the estimated production cost of $5.00/pound and have ash level of less than 500 ppm in the carbonized insulation-grade fiber. Accordingly, a preliminary cost model was developed based on publicly available information. The team demonstrated that 4 lignin samples met the cost criteria, as highlighted in Table 1. In addition, the ash level for the 4 carbonized lignin samples were below 500 ppm. Processing asreceived lignin to produce a high purity lignin fiber was a significant accomplishment in that most industrial lignin, prior to purification, had greater than 4X the ash level needed for this project, and prior to this work there was not a clear path of how to achieve the purity target. The lab scale development of LBCF was performed with a specific functional application in mind, specifically for high temperature rigid insulation. GTI is currently a consumer of foreignsourced pitch and rayon based carbon fibers for use in its high temperature insulation products, and the motivation was that LBCF had potential to decrease costs and increase product competitiveness in the marketplace through lowered raw material costs, lowered energy costs, and decreased environmental footprint. At the end of this project, the Technology Readiness Level (TRL) remained at 5 for LBCF in high temperature insulation.

Cost-effectiveness performance analysis of organic Rankine cycle for low grade heat utilization coupling with operation condition

International Nuclear Information System (INIS)

Wang, Dongxiang; Ling, Xiang; Peng, Hao

2013-01-01

This paper analyzed the influence of working fluids selection and operation conditions on the cost-effectiveness performance and net power output of an ORC for low grade heat utilization. A net power output model has been proposed theoretically and compared with the theoretical data calculated from thermodynamic analysis, exhibiting excellent agreements with the theoretical data. The proposed net power output model theoretically indicates that Jacob number and the ratio of evaporating temperature and heat rejected temperature play essential roles in discriminating the net power output among various working fluids at the same operation condition. For a given condensing and evaporating temperature, it can be concluded theoretically that fluid with low Jacob number will show attractive performance in an ORC. The maximum net power output is determined by the heat source rather than working fluids with a low inlet temperature of heat source. Cost-effectiveness performance analysis reveals that the maximum net power output and the best CEP cannot be achieved at the same time and compromise must be made when choosing the most suitable organic working fluids in different ORC designs. -- Highlights: • A net power output model is proposed and compared with theoretical data. • For fixed operation condition, low Ja fluid shows attractive performance in ORC. • The heat source rather than working fluid determines ORC performance at low T hs,in • The peak W net and best CEP cannot be achieved at the same time, compromise must be made

Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?

Science.gov (United States)

Tan, Elise Chia-Hui; Pwu, Raoh-Fang; Chen, Duan-Rung; Yang, Ming-Chin

2014-03-01

In October 2001, a pay-for-performance (P4P) program for diabetes was implemented by the National Health Insurance (NHI), a single-payer program, in Taiwan. However, only limited information is available regarding the influence of this program on the patient's health-related quality of life. The aim of this study was to estimate the costs and consequences of enrolling patients in the P4P program from a single-payer perspective. A retrospective observational study of 529 diabetic patients was conducted between 2004 and 2005. The data used in the study were obtained from the National Health Interview Survey (NHIS) in Taiwan. Direct cost data were obtained from NHI claims data, which were linked to respondents in the NHIS using scrambled individual identification. The generic SF36 health instrument was employed to measure the quality-of-life-related health status and transformed into a utility index. Patients enrolled in the P4P program for at least 3 months were categorized as the P4P group. Following propensity score matching, 260 patients were included in the study. Outcomes included life-years, quality-adjusted life-years (QALYs), diabetes-related medical costs, overall medical costs, and incremental cost-effectiveness ratios (ICERs). A single-payer perspective was assumed, and costs were expressed in US dollars. Nonparametric bootstrapping was conducted to estimate confidence intervals for cost-effectiveness ratios. Following matching, no significant difference was noted between two groups with regard to the patients' age, gender, education, family income, smoking status, BMI, or whether insulin was used. The P4P group had an increase of 0.08 (95 % CI 0.077-0.080) in QALYs, and the additional diabetes-related medical cost was US$422.74 (95 % CI US$413.58-US$435.05), yielding an ICER of US$5413.93 (95 % CI US$5226.83-US$5562.97) per QALY gained. Our results provides decision makers with valuable information regarding the impact of the P4P program of diabetes care

Multijunction Photovoltaic Technologies for High-Performance Concentrators: Preprint

Energy Technology Data Exchange (ETDEWEB)

McConnell, R.; Symko-Davies, M.

2006-05-01

Multijunction solar cells provide high-performance technology pathways leading to potentially low-cost electricity generated from concentrated sunlight. The National Center for Photovoltaics at the National Renewable Energy Laboratory has funded different III-V multijunction solar cell technologies and various solar concentration approaches. Within this group of projects, III-V solar cell efficiencies of 41% are close at hand and will likely be reported in these conference proceedings. Companies with well-developed solar concentrator structures foresee installed system costs of $3/watt--half of today's costs--within the next 2 to 5 years as these high-efficiency photovoltaic technologies are incorporated into their concentrator photovoltaic systems. These technology improvements are timely as new large-scale multi-megawatt markets, appropriate for high performance PV concentrators, open around the world.

Development of New Low-Cost, High-Performance, PV Module Encapsulant/Packaging Materials: Final Technical Progress Report, 22 October 2002 - 15 November 2007

Energy Technology Data Exchange (ETDEWEB)

Tucker, R.

2008-04-01

Report on objectives to work with U.S.-based PV module manufacturers (c-Si, a-Si, CIS, other thin films) to develop/qualify new low-cost, high-performance PV module encapsulant/packaging materials, and processes using the packaging materials.

Fuel ethanol from cane molasses in Thailand: Environmental and cost performance

International Nuclear Information System (INIS)

Nguyen, Thu Lan T.; Gheewala, Shabbir H.

2008-01-01

In the context of the world's energy crisis and environmental concerns, crop-based ethanol has emerged as an energy alternative, the use of which can help reduce oil imports as well as emissions of CO 2 and other air pollutants. However, a clear disadvantage of ethanol is its high cost over gasoline under the current pricing scheme that does not include externalities. The intent of this study is to perform a life cycle analysis comparing environmental and cost performance of molasses-based E10 with those of CG. The results show that although E10 provides reduction in fossil energy use, petroleum use, CO 2 and NO x emissions, its total social costs are higher than those of gasoline due to higher direct production costs and external costs for other air emissions, e.g. CH 4 , N 2 O, CO, SO 2 , VOC and PM 10 . An analysis of projection scenarios shows that technological innovations towards cleaner production help maximize ethanol's benefits whilst minimizing its limitations

Cost-effective data storage/archival subsystem for functional PACS

Science.gov (United States)

Chen, Y. P.; Kim, Yongmin

1993-09-01

Not the least of the requirements of a workable PACS is the ability to store and archive vast amounts of information. A medium-size hospital will generate between 1 and 2 TBytes of data annually on a fully functional PACS. A high-speed image transmission network coupled with a comparably high-speed central data storage unit can make local memory and magnetic disks in the PACS workstations less critical and, in an extreme case, unnecessary. Under these circumstances, the capacity and performance of the central data storage subsystem and database is critical in determining the response time at the workstations, thus significantly affecting clinical acceptability. The central data storage subsystem not only needs to provide sufficient capacity to store about ten days worth of images (five days worth of new studies, and on the average, about one comparison study for each new study), but also supplies images to the requesting workstation in a timely fashion. The database must provide fast retrieval responses upon users' requests for images. This paper analyzes both advantages and disadvantages of multiple parallel transfer disks versus RAID disks for short-term central data storage subsystem, as well as optical disk jukebox versus digital recorder tape subsystem for long-term archive. Furthermore, an example high-performance cost-effective storage subsystem which integrates both the RAID disks and high-speed digital tape subsystem as a cost-effective PACS data storage/archival unit are presented.

Cost-effectiveness of norovirus vaccination in children in Peru.

Science.gov (United States)

Mirelman, Andrew J; Ballard, Sarah Blythe; Saito, Mayuko; Kosek, Margaret N; Gilman, Robert H

2015-06-17

With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru's routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher. Published

POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia.

Science.gov (United States)

Miller, Heidi J; Neupane, Ruel; Fayezizadeh, Mojtaba; Majumder, Arnab; Marks, Jeffrey M

2017-04-01

Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015. Cost of LM was set to 1, and other procedures are presented as percentage change. Cost-effectiveness was calculated based on cost, number of interventions required for optimal results for dilations and injections and efficacy reported in the current literature. Incremental cost-effectiveness ratio was calculated by a cost-utility analysis using quality-adjusted life year gained, defined as a symptom-free year in a patient with achalasia. Average number of interventions required was 2.3 dilations or two injections for efficacies of 80 and 61 %, respectively. POEM cost 1.058 times the cost of LM, and PD and BI cost 0.559 and 0.448 times the cost of LM. Annual cost per cure over a period of 4 years for POEM, and LM were consistently equivalent, trending the same as PD although this has a lower initial cost. The cost per cure of BI remains stable over 3 years and then doubles. The cost-effectiveness of POEM and LM is equivalent. Myotomy, either surgical or endoscopic, is more cost-effective than BI due to high failure rates of the economical intervention. When treatment is being considered BI should be utilized in patients with less than 2-year life expectancy. Pneumatic dilations are cost-effective and are an acceptable approach to treatment of achalasia, although myotomy has a lower relapse rate and is cost-effective compared to PD after 2 years.

The Effects of Assertive Training on Performance in Highly Anxious Adolescents.

Science.gov (United States)

Wehr, Sara H.; Kaufman, Melvin E.

1987-01-01

Investigated the effects of assertive training on measures of assertiveness, state anxiety, and mathematics performance in highly anxious ninth graders (N=96). Found that assertive training resulted in increased assertiveness and decreased state anxiety, with no significant effect on mathematics performance, and no significant effect due to sex.…

Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors

NARCIS (Netherlands)

Kampshoff, C. S.; van Dongen, J. M.; van Mechelen, W.; Schep, G.; Vreugdenhil, A.; Twisk, J. W.R.; Bosmans, J. E.; Brug, J.; Chinapaw, M. J.M.; Buffart, Laurien M.

Purpose: This study aimed to evaluate the long-term effectiveness and cost-effectiveness of high intensity (HI) versus low-to-moderate intensity (LMI) exercise on physical fitness, fatigue, and health-related quality of life (HRQoL) in cancer survivors. Methods: Two hundred seventy-seven cancer

A high-performance, low-cost, leading edge discriminator

Indian Academy of Sciences (India)

Home; Journals; Pramana – Journal of Physics; Volume 65; Issue 2 ... commercial discriminators. A low-cost discriminator is an essential requirement of the GRAPES-3 experiment where a large number of discriminator channels are used.

Activity based costing the performance breakthrough

CERN Document Server

Turney, Peter B B

1996-01-01

Activity-based costing is a method of measuring the cost and performance of activities, products and customers. It is increasingly being seen as a more accurate method of costing than conventional costing systems, which are being superseded by the fact that automation means that direct material and labour consumption is now a far less accurate means of apportioning overheads. This practical book outlines why conventional cost systems fail, before going on to cover the advantages of activity-based costing, and describing how to put the system in place successfully, and how to apply the lessons learnt quickly. The book takes the reader step-by-step through the various processes involved, from setting up the system, through its operation, to evaluation of the results.

Pursuing Photovoltaic Cost-Effectiveness

DEFF Research Database (Denmark)

Yang, Yongheng; Koutroulis, Eftichios; Sangwongwanich, Ariya

2017-01-01

loading of the power devices. However, its feasibility is challenged by the associated energy losses. An increase of the inverter lifetime and a reduction of the energy yield can alter the cost of energy, demanding an optimization of the power limitation. Therefore, aiming at minimizing the Levelized Cost...... be flexibly performed. As an advanced control strategy, the Absolute Active Power Control (AAPC) can effectively solve the overloading issues by limiting the maximum possible PV power to a certain level (i.e., the power limitation), and also benefit the inverter reliability due to the reduction in the thermal...... performance in terms of LCOE and energy production can be obtained by enabling the AAPC strategy, compared to the conventional PV inverter operating only in the maximum power point tracking mode. In the presented case study, the minimum of the LCOE is achieved for the PV system when the power limit...

High performance parallel computers for science

International Nuclear Information System (INIS)

Nash, T.; Areti, H.; Atac, R.; Biel, J.; Cook, A.; Deppe, J.; Edel, M.; Fischler, M.; Gaines, I.; Hance, R.

1989-01-01

This paper reports that Fermilab's Advanced Computer Program (ACP) has been developing cost effective, yet practical, parallel computers for high energy physics since 1984. The ACP's latest developments are proceeding in two directions. A Second Generation ACP Multiprocessor System for experiments will include $3500 RISC processors each with performance over 15 VAX MIPS. To support such high performance, the new system allows parallel I/O, parallel interprocess communication, and parallel host processes. The ACP Multi-Array Processor, has been developed for theoretical physics. Each $4000 node is a FORTRAN or C programmable pipelined 20 Mflops (peak), 10 MByte single board computer. These are plugged into a 16 port crossbar switch crate which handles both inter and intra crate communication. The crates are connected in a hypercube. Site oriented applications like lattice gauge theory are supported by system software called CANOPY, which makes the hardware virtually transparent to users. A 256 node, 5 GFlop, system is under construction

Cost-effectiveness analysis of sensor-augmented pump therapy with low glucose-suspend in patients with type 1 diabetes mellitus and high risk of hypoglycemia in Spain.

Science.gov (United States)

Conget, Ignacio; Martín-Vaquero, Pilar; Roze, Stéphane; Elías, Isabel; Pineda, Cristina; Álvarez, María; Delbaere, Alexis; Ampudia-Blasco, Francisco Javier

2018-05-19

To compare the cost-effectiveness of sensor-augmented pump therapy (SAP) [continuous subcutaneous insulin infusion (CSII) plus real-time continuous glucose monitoring (RT-CGM)] with low glucose suspend (MiniMed™ Veo™) and CSII alone in patients with type 1 diabetes mellitus (T1DM) at high risk of hypoglycemia in Spain. The IQVIA CORE Diabetes Model was used to estimate healthcare outcomes as life-years gained (LYGs) and quality-adjusted life years (QALYs), and to project lifetime costs. Information about efficacy, resource utilization, and unit costs (€2016) was taken from published sources and validated by an expert panel. Analyses were performed from both the Spanish National Health System (NHS) perspective and the societal perspective. From the NHS perspective, SAP with low glucose suspend was associated to a €47,665 increase in direct healthcare costs and to increases of 0.19 LYGs and 1.88 QALYs, both discounted, which resulted in an incremental cost-effectiveness ratio (ICER) of €25,394/QALY. From the societal perspective, SAP with low glucose suspend increased total costs (including direct and indirect healthcare costs) by €41,036, with a resultant ICER of €21,862/QALY. Considering the willingness-to-pay threshold of €30,000/QALY in Spain, SAP with low glucose suspend represents a cost-effective option from both the NHS and societal perspectives. Sensitivity analyses confirmed the robustness of the model. From both the Spanish NHS perspective and the societal perspective, SAP with low glucose suspend is a cost-effective option for the treatment of T1DM patients at high risk of hypoglycemia. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects.

Science.gov (United States)

Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

2017-09-27

To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades-while not inexpensive-contributed to greater system efficiency and modest savings. © Mwencha et al.

Highlighting High Performance: Blackstone Valley Regional Vocational Technical High School; Upton, Massachusetts

Energy Technology Data Exchange (ETDEWEB)

2006-10-01

This brochure describes the key high-performance building features of the Blackstone Valley High School. The brochure was paid for by the Massachusetts Technology Collaborative as part of their Green Schools Initiative. High-performance features described are daylighting and energy-efficient lighting, indoor air quality, solar energy, building envelope, heating and cooling systems, and water conservation. Energy cost savings are also discussed.

Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses.

Science.gov (United States)

Elbert, Niels J; van Os-Medendorp, Harmieke; van Renselaar, Wilco; Ekeland, Anne G; Hakkaart-van Roijen, Leona; Raat, Hein; Nijsten, Tamar E C; Pasmans, Suzanne G M A

2014-04-16

eHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking. We conducted a systematic review of systematic reviews and meta-analyses on the effectiveness/cost-effectiveness of eHealth interventions in patients with somatic diseases to analyze whether, and to what possible extent, the outcome of recent research supports or differs from previous conclusions. Literature searches were performed in PubMed, EMBASE, The Cochrane Library, and Scopus for systematic reviews and meta-analyses on eHealth interventions published between August 2009 and December 2012. Articles were screened for relevance based on preset inclusion and exclusion criteria. Citations of residual articles were screened for additional literature. Included papers were critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement before data were extracted. Based on conclusions drawn by the authors of the included articles, reviews and meta-analyses were divided into 1 of 3 groups: suitable, promising, or limited evidence on effectiveness/cost-effectiveness. Cases of uncertainty were resolved by consensus discussion. Effect sizes were extracted from papers that included a meta-analysis. To compare our results with previous findings, a trend analysis was performed. Our literature searches yielded 31 eligible reviews, of which 20 (65%) reported on costs. Seven papers (23%) concluded that eHealth is effective/cost-effective, 13 (42%) underlined that evidence is promising, and others found limited or inconsistent proof. Methodological quality of the included reviews and meta-analyses was generally considered high. Trend analysis showed a considerable accumulation of literature on eHealth. However, a similar percentage of papers concluded that eHealth is effective/cost-effective or

Implementation and Operational Research: A Cost-Effective, Clinically Actionable Strategy for Targeting HIV Preexposure Prophylaxis to High-Risk Men Who Have Sex With Men.

Science.gov (United States)

Ross, Eric L; Cinti, Sandro K; Hutton, David W

2016-07-01

Preexposure prophylaxis (PrEP) is effective at preventing HIV infection among men who have sex with men (MSM), but there is uncertainty about how to identify high-risk MSM who should receive PrEP. We used a mathematical model to assess the cost-effectiveness of using the HIV Incidence Risk Index for MSM (HIRI-MSM) questionnaire to target PrEP to high-risk MSM. We simulated strategies of no PrEP, PrEP available to all MSM, and eligibility thresholds set to HIRI-MSM scores between 5 and 45, in increments of 5 (where a higher score predicts greater HIV risk). Based on the iPrEx, IPERGAY, and PROUD trials, we evaluated PrEP efficacies from 44% to 86% and annual costs from $5900 to 8700. We designate strategies with incremental cost-effectiveness ratio (ICER) ≤$100,000/quality-adjusted life-year (QALY) as "cost-effective." Over 20 years, making PrEP available to all MSM is projected to prevent 33.5% of new HIV infections, with an ICER of $1,474,000/QALY. Increasing the HIRI-MSM score threshold reduces the prevented infections, but improves cost-effectiveness. A threshold score of 25 is projected to be optimal (most QALYs gained while still being cost-effective) over a wide range of realistic PrEP efficacies and costs. At low cost and high efficacy (IPERGAY), thresholds of 15 or 20 are optimal across a range of other input assumptions; at high cost and low efficacy (iPrEx), 25 or 30 are generally optimal. The HIRI-MSM provides a clinically actionable means of guiding PrEP use. Using a score of 25 to determine PrEP eligibility could facilitate cost-effective use of PrEP among high-risk MSM who will benefit from it most.

Effects of waste content of glass waste forms on Savannah River high-level waste disposal costs

International Nuclear Information System (INIS)

McDonell, W.R.; Jantzen, C.M.

1985-01-01

Effects of the waste content of glass waste forms of Savannah River high-level waste disposal costs are evaluated by their impact on the number of waste canisters produced. Changes in waste content affect onsite Defense Waste Processing Facility (DWPF) costs as well as offsite shipping and repository emplacement charges. A nominal 1% increase over the 28 wt % waste loading of DWPF glass would reduce disposal costs by about $50 million for Savannah River wastes generated to the year 2000. Waste form modifications under current study include adjustments of glass frit content to compensate for added salt decontamination residues and increased sludge loadings in the DWPF glass. Projected cost reductions demonstrate significant incentives for continued optimization of the glass waste loadings. 13 refs., 3 figs., 3 tabs

Performance and cost assessment of solar driven humidification dehumidification desalination system

International Nuclear Information System (INIS)

Zubair, M. Ifras; Al-Sulaiman, Fahad A.; Antar, M.A.; Al-Dini, Salem A.; Ibrahim, Nasiru I.

2017-01-01

Highlights: • Optimization of a new HDH system integrated solar evacuated tubes collectors was conducted. • The mathematical models developed for the collector and the HDH system were validated. • A multi-location analysis was then performed for six locations in Saudi Arabia. • Sharurah was found to have the highest annual output and Dhahran the lowest at 19,445 and 16,430 L. • The cost per liter of water produced varies from $0.032 to $0.038, depends on the location. - Abstract: A humidification-dehumidification (HDH) desalination system integrated with solar evacuated tubes was optimized. Then, the optimized system was assessed for the operation in different geographical locations, and the rate of freshwater production and cost per liter were determined in each location. The system design proposed in this paper uses a heat pipe design evacuated tube collector, which performs significantly better based on cost. An HDH desalination system with a closed-air/open-water loop, connected to the collector, was evaluated to determine the optimum operating parameters and the system performance during daytime (from 8 am to 3 pm), as well as the average day of each month for an entire year. The impact of the effectiveness of the humidifier and the dehumidifier, as well as, the number of collectors, were also studied. The analyses were performed for Dhahran, Jeddah, Riyadh, Sharurah, Qassim, and Tabuk to determine the effects of varying the geographical location. Sharurah has the highest calculated productivity of freshwater and Dhahran has the lowest at 19,445 and 16,430 L, respectively. To have a comprehensive study of the system proposed, a cost analysis was also performed to determine the feasibility of the system and the cost of water production. Results show that the price varied from $0.032 to $0.038 per liter for the locations evaluated.

Vasa previa screening strategies: a decision and cost-effectiveness analysis.

Science.gov (United States)

Sinkey, R G; Odibo, A O

2018-05-22

The aim of this study is to perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa among singleton pregnancies. A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios which occurred at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening pregnancies conceived by in vitro fertilization (IVF), and universal screening. Ultrasound-indicated screening was defined as performing a transvaginal ultrasound at the time of routine anatomy ultrasound in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion, or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality adjusted life years (QALY) in U.S. dollars. The analysis was from a healthcare system perspective with a willingness to pay (WTP) threshold of $100,000 per QALY selected. One-way and multivariate sensitivity analyses (Monte-Carlo simulation) were performed. This decision-analytic model demonstrated that screening pregnancies conceived by IVF was the most cost-effective strategy with an incremental cost effectiveness ratio (ICER) of $29,186.50 / QALY. Ultrasound-indicated screening was the second most cost-effective with an ICER of $56,096.77 / QALY. These data were robust to all one-way and multivariate sensitivity analyses performed. Within our baseline assumptions, transvaginal ultrasound screening for vasa previa appears to be most cost-effective when performed among IVF pregnancies. However, both IVF and ultrasound-indicated screening strategies fall within contemporary willingness-to-pay thresholds, suggesting that both strategies may be appropriate to apply in clinical practice. This article is protected by copyright. All rights reserved. This

[Costs of health. Costs-effectiveness in case of lifestyle changes].

Science.gov (United States)

Apor, Péter

2010-05-09

Economical burden for the individuals and for the national budgets of chronic cardio-vasculo-metabolic diseases is high and is rapidly increasing. Costs of treatments and prevention are very different in countries of diverse culture, ethnicity, social-economical situations, but prevention with healthy foods and with adequate physical activity are cheaper than medicines anywhere in the world. A great couple of studies approved cost-effectiveness of interventions directed to the change of life style factors. Cheaper is to influence the whole, yet healthy population, but interventions on people with high risk are more target-specific and usually more expensive. Enhanced physical activity (minimum 30 minutes five times per week with low-medium intensity, plus resistance exercises for maintain the muscle mass and force, plus stretching and calisthenics to maintain joints motility) can be promoted by few hundred-few ten hundred euros or dollars. Price of gain in Quality/Disability-Adjusted Life Years expressed as Incremental Cost Effectiveness/Utility Ratio is known, estimated or modelled, and offers a good value of money.

Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).

Science.gov (United States)

Sabin, Lora L; Knapp, Anna B; MacLeod, William B; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H; Gill, Christopher J

2012-01-01

The Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

Cost-effectiveness analysis of the optimal threshold of an automated immunochemical test for colorectal cancer screening: performances of immunochemical colorectal cancer screening.

Science.gov (United States)

Berchi, Célia; Guittet, Lydia; Bouvier, Véronique; Launoy, Guy

2010-01-01

Most industrialized countries, including France, have undertaken to generalize colorectal cancer screening using guaiac fecal occult blood tests (G-FOBT). However, recent researches demonstrate that immunochemical fecal occult blood tests (I-FOBT) are more effective than G-FOBT. Moreover, new generation I-FOBT benefits from a quantitative reading technique allowing the positivity threshold to be chosen, hence offering the best balance between effectiveness and cost. We aimed at comparing the cost and the clinical performance of one round of screening using I-FOBT at different positivity thresholds to those obtained with G-FOBT to determine the optimal cut-off for I-FOBT. Data were derived from an experiment conducted from June 2004 to December 2005 in Calvados (France) where 20,322 inhabitants aged 50-74 years performed both I-FOBT and G-FOBT. Clinical performance was assessed by the number of advanced tumors screened, including large adenomas and cancers. Costs were assessed by the French Social Security Board and included only direct costs. Screening using I-FOBT resulted in better health outcomes and lower costs than screening using G-FOBT for thresholds comprised between 75 and 93 ng/ml. I-FOBT at 55 ng/ml also offers a satisfactory alternative to G-FOBT, because it is 1.8-fold more effective than G-FOBT, without increasing the number of unnecessary colonoscopies, and at an extra cost of 2,519 euros per advanced tumor screened. The use of an automated I-FOBT at 75 ng/ml would guarantee more efficient screening than currently used G-FOBT. Health authorities in industrialized countries should consider the replacement of G-FOBT by an automated I-FOBT test in the near future.

Flexible and low-voltage integrated circuits constructed from high-performance nanocrystal transistors.

Science.gov (United States)

Kim, David K; Lai, Yuming; Diroll, Benjamin T; Murray, Christopher B; Kagan, Cherie R

2012-01-01

Colloidal semiconductor nanocrystals are emerging as a new class of solution-processable materials for low-cost, flexible, thin-film electronics. Although these colloidal inks have been shown to form single, thin-film field-effect transistors with impressive characteristics, the use of multiple high-performance nanocrystal field-effect transistors in large-area integrated circuits has not been shown. This is needed to understand and demonstrate the applicability of these discrete nanocrystal field-effect transistors for advanced electronic technologies. Here we report solution-deposited nanocrystal integrated circuits, showing nanocrystal integrated circuit inverters, amplifiers and ring oscillators, constructed from high-performance, low-voltage, low-hysteresis CdSe nanocrystal field-effect transistors with electron mobilities of up to 22 cm(2) V(-1) s(-1), current modulation >10(6) and subthreshold swing of 0.28 V dec(-1). We fabricated the nanocrystal field-effect transistors and nanocrystal integrated circuits from colloidal inks on flexible plastic substrates and scaled the devices to operate at low voltages. We demonstrate that colloidal nanocrystal field-effect transistors can be used as building blocks to construct complex integrated circuits, promising a viable material for low-cost, flexible, large-area electronics.

Dissociating Compatibility Effects and Distractor Costs in the Additional Singleton Paradigm

Directory of Open Access Journals (Sweden)

Charles eFolk

2013-07-01

Full Text Available The interpretation of identity compatibility effects associated with irrelevant items outside the nominal focus of attention has fueled much of the debate over early versus late selection and perceptual load theory. However, compatibility effects have also played a role in the debate over the extent to which the involuntary allocation of spatial attention (i.e., attentional capture is completely stimulus-driven or whether it is contingent on top-down control settings. For example, in the context of the additional singleton paradigm, irrelevant color singletons have been found to produce not only an overall cost in search performance but also significant compatibility effects. This combination of search costs and compatibility effects has been taken as evidence that spatial attention is indeed allocated in a bottom-up fashion to the salient but irrelevant singletons. However, it is possible that compatibility effects in the additional singleton paradigm reflect parallel processing of identity associated with low perceptual load rather than an involuntary shift of spatial attention. In the present experiments, manipulations of load were incorporated into the traditional additional singleton paradigm. Under low load conditions, both search costs and compatibility effects were obtained, replicating previous studies. Under high load conditions, search costs were still present, but compatibility effects were eliminated. This dissociation suggests that the costs associated with irrelevant singletons may reflect filtering processes rather than the allocation of spatial attention.

Cost-effective treatment of swine wastes through recovery of energy and nutrients.

Science.gov (United States)

Amini, Adib; Aponte-Morales, Veronica; Wang, Meng; Dilbeck, Merrill; Lahav, Ori; Zhang, Qiong; Cunningham, Jeffrey A; Ergas, Sarina J

2017-11-01

Wastes from concentrated animal feeding operations (CAFOs) are challenging to treat because they are high in organic matter and nutrients. Conventional swine waste treatment options in the U.S., such as uncovered anaerobic lagoons, result in poor effluent quality and greenhouse gas emissions, and implementation of advanced treatment introduces high costs. Therefore, the purpose of this paper is to evaluate the performance and life cycle costs of an alternative system for treating swine CAFO waste, which recovers valuable energy (as biogas) and nutrients (N, P, K + ) as saleable fertilizers. The system uses in-vessel anaerobic digestion (AD) for methane production and solids stabilization, followed by struvite precipitation and ion exchange (IX) onto natural zeolites (chabazite or clinoptilolite) for nutrient recovery. An alternative approach that integrated struvite recovery and IX into a single reactor, termed STRIEX, was also investigated. Pilot- and bench-scale reactor experiments were used to evaluate the performance of each stage in the treatment train. Data from these studies were integrated into a life cycle cost analysis (LCCA) to assess the cost-effectiveness of various process alternatives. Significant improvement in water quality, high methane production, and high nutrient recovery (generally over 90%) were observed with both the AD-struvite-IX process and the AD-STRIEX process. The LCCA showed that the STRIEX system can provide considerable financial savings compared to conventional systems. AD, however, incurs high capital costs compared to conventional anaerobic lagoons and may require larger scales to become financially attractive. Copyright © 2017 Elsevier Ltd. All rights reserved.

Understanding product cost vs. performance through an in-depth system Monte Carlo analysis

Science.gov (United States)

Sanson, Mark C.

2017-08-01

The manner in which an optical system is toleranced and compensated greatly affects the cost to build it. By having a detailed understanding of different tolerance and compensation methods, the end user can decide on the balance of cost and performance. A detailed phased approach Monte Carlo analysis can be used to demonstrate the tradeoffs between cost and performance. In complex high performance optical systems, performance is fine-tuned by making adjustments to the optical systems after they are initially built. This process enables the overall best system performance, without the need for fabricating components to stringent tolerance levels that often can be outside of a fabricator's manufacturing capabilities. A good performance simulation of as built performance can interrogate different steps of the fabrication and build process. Such a simulation may aid the evaluation of whether the measured parameters are within the acceptable range of system performance at that stage of the build process. Finding errors before an optical system progresses further into the build process saves both time and money. Having the appropriate tolerances and compensation strategy tied to a specific performance level will optimize the overall product cost.

Cost and performance analysis of conceptual designs of physical protection systems

International Nuclear Information System (INIS)

Hicks, M.J.; Snell, M.S.; Sandoval, J.S.; Potter, C.S.

1998-01-01

CPA -- Cost and Performance Analysis -- is a methodology that joins Activity Based Cost (ABC) estimation with performance based analysis of physical protection systems. CPA offers system managers an approach that supports both tactical decision making and strategic planning. Current exploratory applications of the CPA methodology are addressing analysis of alternative conceptual designs. To support these activities, the original architecture for CPA, is being expanded to incorporate results from a suite of performance and consequence analysis tools such as JTS (Joint Tactical Simulation), ERAD (Explosive Release Atmospheric Dispersion) and blast effect models. The process flow for applying CPA to the development and analysis conceptual designs is illustrated graphically

Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India.

Science.gov (United States)

Vassall, Anna; Pickles, Michael; Chandrashekar, Sudhashree; Boily, Marie-Claude; Shetty, Govindraj; Guinness, Lorna; Lowndes, Catherine M; Bradley, Janet; Moses, Stephen; Alary, Michel; Vickerman, Peter

2014-09-01

Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached. Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study). This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all

Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

Science.gov (United States)

Emmett, Susan D; Tucci, Debara L; Bento, Ricardo F; Garcia, Juan M; Juman, Solaiman; Chiossone-Kerdel, Juan A; Liu, Ta J; de Muñoz, Patricia Castellanos; Ullauri, Alejandra; Letort, Jose J; Mansilla, Teresita; Urquijo, Diana P; Aparicio, Maria L; Gong, Wenfeng; Francis, Howard W; Saunders, James E

2016-09-01

Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

Improving performance and reducing costs of cooling towers

International Nuclear Information System (INIS)

Bartz, J.A.

1992-01-01

Cooling towers represent a significant capital investment at a steam electric power station. In addition, deficiencies in thermal performance can result in major operating penalties of fuel cost, replacement energy, and capacity addition. This paper summarizes two recent EPRI research projects aimed at reducing thermal performance deficiencies and decreasing installed costs of evaporative cooling towers. First, EPRI Research Project 2113, Cooling Tower Performance Prediction and Improvement, is summarized. This project has resulted in published data sets on the measured thermal performance characteristics of a variety of cooling tower packings, computer codes to predict tower performance, and computer code validation through large-scale tower performance measurements. Principal results are contained in an EPRIGEMS software module, Cooling Tower Advisor. This PC- based software contains a tutorial plus codes to predict tower thermal performance, arranged in a user-friendly format. The second EPRI effort, Research Project 2819-10/11, Fabric Structures for Power Plant Applications, has resulted in designs and costs of large structures with shells constructed of recently-developed fabrics. Primary power plant applications for such structures are the shells of natural draft cooling towers and coal-pile covers. Fabric structures offer low initial cost, acceptable life, and seismic superiority, among other advantages. Detailed conceptual designs and installed cost data are reviewed. 8 refs., 9 figs., 3 tabs

Impact of automatic calibration techniques on HMD life cycle costs and sustainable performance

Science.gov (United States)

Speck, Richard P.; Herz, Norman E., Jr.

2000-06-01

Automatic test and calibration has become a valuable feature in many consumer products--ranging from antilock braking systems to auto-tune TVs. This paper discusses HMDs (Helmet Mounted Displays) and how similar techniques can reduce life cycle costs and increase sustainable performance if they are integrated into a program early enough. Optical ATE (Automatic Test Equipment) is already zeroing distortion in the HMDs and thereby making binocular displays a practical reality. A suitcase sized, field portable optical ATE unit could re-zero these errors in the Ready Room to cancel the effects of aging, minor damage and component replacement. Planning on this would yield large savings through relaxed component specifications and reduced logistic costs. Yet, the sustained performance would far exceed that attained with fixed calibration strategies. Major tactical benefits can come from reducing display errors, particularly in information fusion modules and virtual `beyond visual range' operations. Some versions of the ATE described are in production and examples of high resolution optical test data will be discussed.

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

NARCIS (Netherlands)

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

2007-01-01

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

A Systematic Review of the Cost-Effectiveness of Biologics for Ulcerative Colitis.

Science.gov (United States)

Stawowczyk, Ewa; Kawalec, Paweł

2018-04-01

assessments were also performed for adalimumab (50%) and golimumab (31%). Only three analyses were conducted for vedolizumab, whereas no relevant studies were found for etrolizumab and tofacitinib. The reporting quality of the included economic analyses was assessed as high, with an average score of 21 points per 24 maximum possible (range 14-23 points according to the ISPOR CHEERS statement checklist). In the case of most analyses, quality-adjusted life-years were used as a clinical outcome, and endpoints such as remission, response and mucosal healing were less common. The higher clinical effectiveness (based on response rates) of biological treatment over non-biological treatments was presented in revealed analyses. The incremental cost-utility ratios for biologics, compared with standard care, varied significantly between the studies and ranged from US$36,309 to US$456,979. The lowest value was obtained for infliximab and the highest for the treatment scheme including infliximab 5 mg/kg and infliximab 10 mg/kg + adalimumab. The change of utility weights and clinical parameters had the most significant influence on the results of the analysis; the variable related to surgery was the least sensitive. Limited data on the cost-effectiveness of UC therapy were identified. In the majority of studies, the lack of cost-effectiveness was revealed for biologics, which was associated with their high costs. Clinical outcomes are transferable to other countries and could be generalized; however, cost inputs are country-specific and therefore limit the transferability and generalizability of conclusions. The key drivers and variables that showed the greatest effect on the analysis results were utility weights and clinical parameters.

Cost-effectiveness of tobacco control policies and programmes targeting adolescents: a systematic review.

Science.gov (United States)

Leão, Teresa; Kunst, Anton E; Perelman, Julian

2018-02-01

Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association.

Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar

Science.gov (United States)

Schaetti, Christian; Weiss, Mitchell G.; Ali, Said M.; Chaignat, Claire-Lise; Khatib, Ahmed M.; Reyburn, Rita; Duintjer Tebbens, Radboud J.; Hutubessy, Raymond

2012-01-01

Background The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. Methodology/Principal Findings Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3). Conclusions/Significance Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness

Cost effectiveness of radon mitigation in Canada

International Nuclear Information System (INIS)

Letourneau, E.G.; Krewski, D.; Zielinski, J.M.; McGregor, R.G.

1992-01-01

This paper examines the cost effectiveness of comprehensive strategies for reducing exposure to radon gas in indoor air in Canadian homes. The analysis is conducted within the context of a general framework for risk management programme evaluation which includes well-known evaluation techniques such as cost effectiveness and cost-benefit analyses as special cases. Based on this analysis, it is clear that any comprehensive programme to reduce exposure to environmental radon will be extremely expensive, and may not be justifiable in terms of health impact, particularly when considered in relation to other public health programmes. Testing of homes at the point of sale and installing sub-slab suction equipment to reduce exposure to indoor radon where necessary appears to be a relatively cost-effective radon mitigation strategy. In general, radon mitigation was found to be most cost effective in cities with relatively high levels of radon. (author)

A Cost-effectiveness Analysis of Early vs Late Tracheostomy.

Science.gov (United States)

Liu, C Carrie; Rudmik, Luke

2016-10-01

The timing of tracheostomy in critically ill patients requiring mechanical ventilation is controversial. An important consideration that is currently missing in the literature is an evaluation of the economic impact of an early tracheostomy strategy vs a late tracheostomy strategy. To evaluate the cost-effectiveness of the early tracheostomy strategy vs the late tracheostomy strategy. This economic analysis was performed using a decision tree model with a 90-day time horizon. The economic perspective was that of the US health care third-party payer. The primary outcome was the incremental cost per tracheostomy avoided. Probabilities were obtained from meta-analyses of randomized clinical trials. Costs were obtained from the published literature and the Healthcare Cost and Utilization Project database. A multivariate probabilistic sensitivity analysis was performed to account for uncertainty surrounding mean values used in the reference case. The reference case demonstrated that the cost of the late tracheostomy strategy was $45 943.81 for 0.36 of effectiveness. The cost of the early tracheostomy strategy was $31 979.12 for 0.19 of effectiveness. The incremental cost-effectiveness ratio for the late tracheostomy strategy compared with the early tracheostomy strategy was $82 145.24 per tracheostomy avoided. With a willingness-to-pay threshold of $50 000, the early tracheostomy strategy is cost-effective with 56% certainty. The adaptation of an early vs a late tracheostomy strategy depends on the priorities of the decision-maker. Up to a willingness-to-pay threshold of $80 000 per tracheostomy avoided, the early tracheostomy strategy has a higher probability of being the more cost-effective intervention.

Cost and performance analysis of physical protection systems - a case study

International Nuclear Information System (INIS)

Hicks, M.J.; Snell, M.S.; Sandoval, J.S.; Potter, C.S.

1998-01-01

Design and analysis of physical protection systems requires (1) identification of mission critical assets; (2) identification of potential threats that might undermine mission capability; (3) identification of the consequences of loss of mission-critical assets (e.g., time and cost to recover required capability and impact on operational readiness); and (4) analysis of the effectiveness of physical protection elements. CPA -- Cost and Performance Analysis -- addresses the fourth of these four issues. CPA is a methodology that joins Activity Based Cost estimation with performance-based analysis of physical protection systems. CPA offers system managers an approach that supports both tactical decision making and strategic planning. Current exploratory applications of the CPA methodology address analysis of alternative conceptual designs. Hypothetical data is used to illustrate this process

Fundamental understanding and development of low-cost, high-efficiency silicon solar cells

Energy Technology Data Exchange (ETDEWEB)

ROHATGI,A.; NARASIMHA,S.; MOSCHER,J.; EBONG,A.; KAMRA,S.; KRYGOWSKI,T.; DOSHI,P.; RISTOW,A.; YELUNDUR,V.; RUBY,DOUGLAS S.

2000-05-01

The overall objectives of this program are (1) to develop rapid and low-cost processes for manufacturing that can improve yield, throughput, and performance of silicon photovoltaic devices, (2) to design and fabricate high-efficiency solar cells on promising low-cost materials, and (3) to improve the fundamental understanding of advanced photovoltaic devices. Several rapid and potentially low-cost technologies are described in this report that were developed and applied toward the fabrication of high-efficiency silicon solar cells.

A Low-Cost, High-Performance System for Fluorescence Lateral Flow Assays

Directory of Open Access Journals (Sweden)

Linda G. Lee

2013-10-01

Full Text Available We demonstrate a fluorescence lateral flow system that has excellent sensitivity and wide dynamic range. The illumination system utilizes an LED, plastic lenses and plastic and colored glass filters for the excitation and emission light. Images are collected on an iPhone 4. Several fluorescent dyes with long Stokes shifts were evaluated for their signal and nonspecific binding in lateral flow. A wide range of values for the ratio of signal to nonspecific binding was found, from 50 for R-phycoerythrin (R-PE to 0.15 for Brilliant Violet 605. The long Stokes shift of R-PE allowed the use of inexpensive plastic filters rather than costly interference filters to block the LED light. Fluorescence detection with R-PE and absorbance detection with colloidal gold were directly compared in lateral flow using biotinylated bovine serum albumen (BSA as the analyte. Fluorescence provided linear data over a range of 0.4–4,000 ng/mL with a 1,000-fold signal change while colloidal gold provided non-linear data over a range of 16–4,000 ng/mL with a 10-fold signal change. A comparison using human chorionic gonadotropin (hCG as the analyte showed a similar advantage in the fluorescent system. We believe our inexpensive yet high-performance platform will be useful for providing quantitative and sensitive detection in a point-of-care setting.

[Cost-Effectiveness and Cost-Utility Analyses of Antireflux Medicine].

Science.gov (United States)

Gockel, Ines; Lange, Undine Gabriele; Schürmann, Olaf; Jansen-Winkeln, Boris; Sibbel, Rainer; Lyros, Orestis; von Dercks, Nikolaus

2018-04-12

Laparoscopic antireflux surgery and medical therapy with proton pump inhibitors are gold standards of gastroesophageal reflux treatment. On account of limited resources and increasing healthcare needs and costs, in this analysis, not only optimal medical results, but also superiority in health economics of these 2 methods are evaluated. We performed an electronic literature survey in MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) as well as in the NHS Economic Evaluation Database, including studies published until 1/2017. Only studies considering the effect size of QALY (Quality-Adjusted Life Years) (with respect to different quality of life-scores) as primary outcome comparing laparoscopic fundoplication and medical therapy were included. Criteria of comparison were ICER (Incremental Cost-Effectiveness Ratio) and ICUR (Incremental Cost-Utility Ratio). Superiority of the respective treatment option for each publication was worked out. In total, 18 comparative studies were identified in the current literature with respect to above-mentioned search terms, qualifying for the defined inclusion criteria. Six studies were finally selected for analyses. Out of 6 publications, 3 showed superiority of laparoscopic fundoplication over long-term medical management based on current cost-effectiveness data. Limitations were related to different time intervals, levels of evidence of studies and underlying resources/costs of analyses, healthcare systems and applied quality of life instruments. Future prospective, randomized trials should examine this comparison in greater detail. Additionally, there is a large potential for further research in the health economics assessment of early diagnosis and prevention measures of reflux disease and Barrett's esophagus/carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.

Trojan Decommissioning Project Cost Performance

International Nuclear Information System (INIS)

Michael B. Lackey

2000-01-01

The Trojan nuclear plant (Trojan) was an 1160-MW(electric) four-loop pressurized water reactor located in Rainier, Oregon. The plant was permanently shut down in 1993 after ∼17 yr of commercial operation. The early plant closure was an economic decision. The key factors in the closure analysis were escalation of inspection and repair costs associated with steam generator tube cracking and the projected availability of inexpensive replacement power in the Pacific Northwest region of the United States. Since the plant closure, Portland General Electric (PGE) has been actively engaged in decommissioning. The Trojan Decommissioning Project currently has a forecast at completion of $429.7 million (all costs are in millions of 1997 dollars, unless otherwise noted). The cost performance of the Trojan Decommissioning Project to date is addressed, as well as the tools that are in place to provide cost control through completion of decommissioning

Introducing nonpoint source transferable quotas in nitrogen trading: The effects of transaction costs and uncertainty.

Science.gov (United States)

Zhou, Xiuru; Ye, Weili; Zhang, Bing

2016-03-01

Transaction costs and uncertainty are considered to be significant obstacles in the emissions trading market, especially for including nonpoint source in water quality trading. This study develops a nonlinear programming model to simulate how uncertainty and transaction costs affect the performance of point/nonpoint source (PS/NPS) water quality trading in the Lake Tai watershed, China. The results demonstrate that PS/NPS water quality trading is a highly cost-effective instrument for emissions abatement in the Lake Tai watershed, which can save 89.33% on pollution abatement costs compared to trading only between nonpoint sources. However, uncertainty can significantly reduce the cost-effectiveness by reducing trading volume. In addition, transaction costs from bargaining and decision making raise total pollution abatement costs directly and cause the offset system to deviate from the optimal state. While proper investment in monitoring and measuring of nonpoint emissions can decrease uncertainty and save on the total abatement costs. Finally, we show that the dispersed ownership of China's farmland will bring high uncertainty and transaction costs into the PS/NPS offset system, even if the pollution abatement cost is lower than for point sources. Copyright © 2015 Elsevier Ltd. All rights reserved.

Solution-Processed Donor-Acceptor Polymer Nanowire Network Semiconductors For High-Performance Field-Effect Transistors

Science.gov (United States)

Lei, Yanlian; Deng, Ping; Li, Jun; Lin, Ming; Zhu, Furong; Ng, Tsz-Wai; Lee, Chun-Sing; Ong, Beng S.

2016-01-01

Organic field-effect transistors (OFETs) represent a low-cost transistor technology for creating next-generation large-area, flexible and ultra-low-cost electronics. Conjugated electron donor-acceptor (D-A) polymers have surfaced as ideal channel semiconductor candidates for OFETs. However, high-molecular weight (MW) D-A polymer semiconductors, which offer high field-effect mobility, generally suffer from processing complications due to limited solubility. Conversely, the readily soluble, low-MW D-A polymers give low mobility. We report herein a facile solution process which transformed a lower-MW, low-mobility diketopyrrolopyrrole-dithienylthieno[3,2-b]thiophene (I) into a high crystalline order and high-mobility semiconductor for OFETs applications. The process involved solution fabrication of a channel semiconductor film from a lower-MW (I) and polystyrene blends. With the help of cooperative shifting motion of polystyrene chain segments, (I) readily self-assembled and crystallized out in the polystyrene matrix as an interpenetrating, nanowire semiconductor network, providing significantly enhanced mobility (over 8 cm2V−1s−1), on/off ratio (107), and other desirable field-effect properties that meet impactful OFET application requirements. PMID:27091315

High-Temperature-Short-Time Annealing Process for High-Performance Large-Area Perovskite Solar Cells.

Science.gov (United States)

Kim, Minjin; Kim, Gi-Hwan; Oh, Kyoung Suk; Jo, Yimhyun; Yoon, Hyun; Kim, Ka-Hyun; Lee, Heon; Kim, Jin Young; Kim, Dong Suk

2017-06-27

Organic-inorganic hybrid metal halide perovskite solar cells (PSCs) are attracting tremendous research interest due to their high solar-to-electric power conversion efficiency with a high possibility of cost-effective fabrication and certified power conversion efficiency now exceeding 22%. Although many effective methods for their application have been developed over the past decade, their practical transition to large-size devices has been restricted by difficulties in achieving high performance. Here we report on the development of a simple and cost-effective production method with high-temperature and short-time annealing processing to obtain uniform, smooth, and large-size grain domains of perovskite films over large areas. With high-temperature short-time annealing at 400 °C for 4 s, the perovskite film with an average domain size of 1 μm was obtained, which resulted in fast solvent evaporation. Solar cells fabricated using this processing technique had a maximum power conversion efficiency exceeding 20% over a 0.1 cm 2 active area and 18% over a 1 cm 2 active area. We believe our approach will enable the realization of highly efficient large-area PCSs for practical development with a very simple and short-time procedure. This simple method should lead the field toward the fabrication of uniform large-scale perovskite films, which are necessary for the production of high-efficiency solar cells that may also be applicable to several other material systems for more widespread practical deployment.

Data Sets Replicas Placements Strategy from Cost-Effective View in the Cloud

Directory of Open Access Journals (Sweden)

Xiuguo Wu

2016-01-01

Full Text Available Replication technology is commonly used to improve data availability and reduce data access latency in the cloud storage system by providing users with different replicas of the same service. Most current approaches largely focus on system performance improvement, neglecting management cost in deciding replicas number and their store places, which cause great financial burden for cloud users because the cost for replicas storage and consistency maintenance may lead to high overhead with the number of new replicas increased in a pay-as-you-go paradigm. In this paper, towards achieving the approximate minimum data sets management cost benchmark in a practical manner, we propose a replicas placements strategy from cost-effective view with the premise that system performance meets requirements. Firstly, we design data sets management cost models, including storage cost and transfer cost. Secondly, we use the access frequency and the average response time to decide which data set should be replicated. Then, the method of calculating replicas’ number and their store places with minimum management cost is proposed based on location problem graph. Both the theoretical analysis and simulations have shown that the proposed strategy offers the benefits of lower management cost with fewer replicas.

Cost-Effectiveness Analysis of Different Genetic Testing Strategies for Lynch Syndrome in Taiwan.

Directory of Open Access Journals (Sweden)

Ying-Erh Chen

Full Text Available Patients with Lynch syndrome (LS have a significantly increased risk of developing colorectal cancer (CRC and other cancers. Genetic screening for LS among patients with newly diagnosed CRC aims to identify mutations in the disease-causing genes (i.e., the DNA mismatch repair genes in the patients, to offer genetic testing for relatives of the patients with the mutations, and then to provide early prevention for the relatives with the mutations. Several genetic tests are available for LS, such as DNA sequencing for MMR genes and tumor testing using microsatellite instability and immunohistochemical analyses. Cost-effectiveness analyses of different genetic testing strategies for LS have been performed in several studies from different countries such as the US and Germany. However, a cost-effectiveness analysis for the testing has not yet been performed in Taiwan. In this study, we evaluated the cost-effectiveness of four genetic testing strategies for LS described in previous studies, while population-specific parameters, such as the mutation rates of the DNA mismatch repair genes and treatment costs for CRC in Taiwan, were used. The incremental cost-effectiveness ratios based on discounted life years gained due to genetic screening were calculated for the strategies relative to no screening and to the previous strategy. Using the World Health Organization standard, which was defined based on Taiwan's Gross Domestic Product per capita, the strategy based on immunohistochemistry as a genetic test followed by BRAF mutation testing was considered to be highly cost-effective relative to no screening. Our probabilistic sensitivity analysis results also suggest that the strategy has a probability of 0.939 of being cost-effective relative to no screening based on the commonly used threshold of $50,000 to determine cost-effectiveness. To the best of our knowledge, this is the first cost-effectiveness analysis for evaluating different genetic testing

An economic cost analysis of emergency department key performance indicators in Ireland.

Science.gov (United States)

Gannon, Brenda; Jones, Cheryl; McCabe, Aileen; O'Sullivan, Ronan; Wakai, Abel

2017-06-01

High quality data is fundamental to using key performance indicators (KPIs) for performance monitoring. However, the resources required to collect high quality data are often significant and should usually be targeted at high priority areas. As part of a study of 11 emergency department (ED) KPIs in Ireland, the primary objective of this study was to estimate the relative cost of collecting the additional minimum data set (MDS) elements for those 11 KPIs. An economic cost analysis focused on 12 EDs in the Republic of Ireland. The resource use data were obtained using two separate focus group interviews. The number of available MDS elements was obtained from a sample of 100 patient records per KPI per participating ED. Unit costs for all resource use were taken at the midpoint of the relevant staff salary scales. An ED would need to spend an estimated additional &OV0556;3561 per month on average to capture all the MDS elements relevant to the 11 KPIs investigated. The additional cost ranges from 14.8 to 39.2%; this range is 13.9-32.3% for small EDs, whereas the range for medium EDs is 11.7-40%. Regional EDs have a higher additional estimated cost to capture all the relevant MDS elements (&OV0556;3907), compared with urban EDs (&OV0556;3353). The additional cost of data collection, contingent on that already collected, required to capture all the relevant MDS elements for the KPIs examined, ranges from 14.8 to 39.2% per KPI, with variation identified between regional and urban hospitals.

Low-Cost Bio-Based Carbon Fibers for High Temperature Processing

Energy Technology Data Exchange (ETDEWEB)

Paul, Ryan Michael [GrafTech International, Brooklyn Heights, OH (United States); Naskar, Amit [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2017-08-03

GrafTech International Holdings Inc. (GTI), under Award No. DE-EE0005779, worked with Oak Ridge National Laboratory (ORNL) under CRADA No. NFE-15-05807 to develop lignin-based carbon fiber (LBCF) technology and to demonstrate LBCF performance in high-temperature products and applications. This work was unique and different from other reported LBCF work in that this study was application-focused and scalability-focused. Accordingly, the executed work was based on meeting criteria based on technology development, cost, and application suitability. High-temperature carbon fiber based insulation is used in energy intensive industries, such as metal heat treating and ceramic and semiconductor material production. Insulation plays a critical role in achieving high thermal and process efficiency, which is directly related to energy usage, cost, and product competitiveness. Current high temperature insulation is made with petroleum based carbon fibers, and one goal of this protect was to develop and demonstrate an alternative lignin (biomass) based carbon fiber that would achieve lower cost, CO2 emissions, and energy consumption and result in insulation that met or exceeded the thermal efficiency of current commercial insulation. In addition, other products were targeted to be evaluated with LBCF. As the project was designed to proceed in stages, the initial focus of this work was to demonstrate lab-scale LBCF from at least 4 different lignin precursor feedstock sources that could meet the estimated production cost of $5.00/pound and have ash level of less than 500 ppm in the carbonized insulation-grade fiber. Accordingly, a preliminary cost model was developed based on publicly available information. The team demonstrated that 4 lignin samples met the cost criteria. In addition, the ash level for the 4 carbonized lignin samples was below 500 ppm. Processing as-received lignin to produce a high purity lignin fiber was a significant accomplishment in that most industrial

Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP.

Directory of Open Access Journals (Sweden)

Lora L Sabin

Full Text Available The Lufwanyama Neonatal Survival Project ("LUNESP" was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness.We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020. In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation.Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

Cost-effectiveness of Intensive Blood Pressure Management

DEFF Research Database (Denmark)

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

2016-01-01

Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age...... and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times...

Diagnostic staging laparoscopy in gastric cancer treatment: A cost-effectiveness analysis.

Science.gov (United States)

Li, Kevin; Cannon, John G D; Jiang, Sam Y; Sambare, Tanmaya D; Owens, Douglas K; Bendavid, Eran; Poultsides, George A

2018-05-01

Accurate preoperative staging helps avert morbidity, mortality, and cost associated with non-therapeutic laparotomy in gastric cancer (GC) patients. Diagnostic staging laparoscopy (DSL) can detect metastases with high sensitivity, but its cost-effectiveness has not been previously studied. We developed a decision analysis model to assess the cost-effectiveness of preoperative DSL in GC workup. Analysis was based on a hypothetical cohort of GC patients in the U.S. for whom initial imaging shows no metastases. The cost-effectiveness of DSL was measured as cost per quality-adjusted life-year (QALY) gained. Drivers of cost-effectiveness were assessed in sensitivity analysis. Preoperative DSL required an investment of $107 012 per QALY. In sensitivity analysis, DSL became cost-effective at a threshold of $100 000/QALY when the probability of occult metastases exceeded 31.5% or when test sensitivity for metastases exceeded 86.3%. The likelihood of cost-effectiveness increased from 46% to 93% when both parameters were set at maximum reported values. The cost-effectiveness of DSL for GC patients is highly dependent on patient and test characteristics, and is more likely when DSL is used selectively where procedure yield is high, such as for locally advanced disease or in detecting peritoneal and superficial versus deep liver lesions. © 2017 Wiley Periodicals, Inc.

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

Energy Technology Data Exchange (ETDEWEB)

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

2017-02-01

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

ASCR{trademark}: lower NOx removal costs without sacrificing performance

Energy Technology Data Exchange (ETDEWEB)

Bible, S.; Rummenhohl, V.; Siebeking, M.; Thomas, R.; Triece, C. [Fuel Tech (United States)

2011-05-15

With recent regulatory initiatives, the new Industrial Emissions Directive in Europe, and new rules being proposed by EPA in the USA, the question for power plants is now whether they will be required to reduce NOx emissions in the future to stay in operation, but when. What is needed is a low-capital-cost but high-performance NOx removal technology. 7 figs.

High performance APCS conceptual design and evaluation scoping study

International Nuclear Information System (INIS)

Soelberg, N.; Liekhus, K.; Chambers, A.; Anderson, G.

1998-02-01

This Air Pollution Control System (APCS) Conceptual Design and Evaluation study was conducted to evaluate a high-performance (APC) system for minimizing air emissions from mixed waste thermal treatment systems. Seven variations of high-performance APCS designs were conceptualized using several design objectives. One of the system designs was selected for detailed process simulation using ASPEN PLUS to determine material and energy balances and evaluate performance. Installed system capital costs were also estimated. Sensitivity studies were conducted to evaluate the incremental cost and benefit of added carbon adsorber beds for mercury control, specific catalytic reduction for NO x control, and offgas retention tanks for holding the offgas until sample analysis is conducted to verify that the offgas meets emission limits. Results show that the high-performance dry-wet APCS can easily meet all expected emission limits except for possibly mercury. The capability to achieve high levels of mercury control (potentially necessary for thermally treating some DOE mixed streams) could not be validated using current performance data for mercury control technologies. The engineering approach and ASPEN PLUS modeling tool developed and used in this study identified APC equipment and system performance, size, cost, and other issues that are not yet resolved. These issues need to be addressed in feasibility studies and conceptual designs for new facilities or for determining how to modify existing facilities to meet expected emission limits. The ASPEN PLUS process simulation with current and refined input assumptions and calculations can be used to provide system performance information for decision-making, identifying best options, estimating costs, reducing the potential for emission violations, providing information needed for waste flow analysis, incorporating new APCS technologies in existing designs, or performing facility design and permitting activities

Estimate of Cost-Effective Potential for Minimum Efficiency Performance Standards in 13 Major World Economies Energy Savings, Environmental and Financial Impacts

Energy Technology Data Exchange (ETDEWEB)

Letschert, Virginie E. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bojda, Nicholas [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Ke, Jing [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McNeil, Michael A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2012-07-01

This study analyzes the financial impacts on consumers of minimum efficiency performance standards (MEPS) for appliances that could be implemented in 13 major economies around the world. We use the Bottom-Up Energy Analysis System (BUENAS), developed at Lawrence Berkeley National Laboratory (LBNL), to analyze various appliance efficiency target levels to estimate the net present value (NPV) of policies designed to provide maximum energy savings while not penalizing consumers financially. These policies constitute what we call the “cost-effective potential” (CEP) scenario. The CEP scenario is designed to answer the question: How high can we raise the efficiency bar in mandatory programs while still saving consumers money?

The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan.

Science.gov (United States)

Trenouth, Lani; Colbourn, Timothy; Fenn, Bridget; Pietzsch, Silke; Myatt, Mark; Puett, Chloe

2018-07-01

Cash-based interventions (CBIs) increasingly are being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash transfers for preventing undernutrition in emergency contexts. The objectives of this study were to assess the costs, cost-efficiency and cost-effectiveness in achieving nutrition outcomes of three CBIs in southern Pakistan: a 'double cash' (DC) transfer, a 'standard cash' (SC) transfer and a 'fresh food voucher' (FFV) transfer. Cash and FFVs were provided to poor households with children aged 6-48 months for 6 months in 2015. The SC and FFV interventions provided $14 monthly and the DC provided $28 monthly. Cost data were collected via institutional accounting records, interviews, programme observation, document review and household survey. Cost-effectiveness was assessed as cost per case of wasting, stunting and disability-adjusted life year (DALY) averted. Beneficiary costs were higher for the cash groups than the voucher group. Net total cost transfer ratios (TCTRs) were estimated as 1.82 for DC, 2.82 for SC and 2.73 for FFV. Yet, despite the higher operational costs, the FFV TCTR was lower than the SC TCTR when incorporating the participation cost to households, demonstrating the relevance of including beneficiary costs in cost-efficiency estimations. The DC intervention achieved a reduction in wasting, at $4865 per case averted; neither the SC nor the FFV interventions reduced wasting. The cost per case of stunting averted was $1290 for DC, $882 for SC and $883 for FFV. The cost per DALY averted was $641 for DC, $434 for SC and $563 for FFV without discounting or age weighting. These interventions are highly cost-effective by international thresholds. While it is debatable whether these resource requirements represent a feasible or sustainable investment given low health expenditures in Pakistan, these findings may provide justification for continuing Pakistan's investment in national social safety

Micro-cost Analysis of ALK Rearrangement Testing by FISH to Determine Eligibility for Crizotinib Therapy in NSCLC: Implications for Cost Effectiveness of Testing and Treatment

Science.gov (United States)

Parker, David; Belaud-Rotureau, Marc-Antoine

2014-01-01

Break-apart fluorescence in situ hybridization (FISH) is the gold standard test for anaplastic lymphoma kinase (ALK) gene rearrangement. However, this methodology often is assumed to be expensive and potentially cost-prohibitive given the low prevalence of ALK-positive non-small cell lung cancer (NSCLC) cases. To more accurately estimate the cost of ALK testing by FISH, we developed a micro-cost model that accounts for all cost elements of the assay, including laboratory reagents, supplies, capital equipment, technical and pathologist labor, and the acquisition cost of the commercial test and associated reagent kits and controls. By applying a set of real-world base-case parameter values, we determined that the cost of a single ALK break-apart FISH test result is $278.01. Sensitivity analysis on the parameters of batch size, testing efficiency, and the cost of the commercial diagnostic testing products revealed that the cost per result is highly sensitive to batch size, but much less so to efficiency or product cost. This implies that ALK testing by FISH will be most cost effective when performed in high-volume centers. Our results indicate that testing cost may not be the primary determinant of crizotinib (Xalkori®) treatment cost effectiveness, and suggest that testing cost is an insufficient reason to limit the use of FISH testing for ALK rearrangement. PMID:25520569

Micro-cost Analysis of ALK Rearrangement Testing by FISH to Determine Eligibility for Crizotinib Therapy in NSCLC: Implications for Cost Effectiveness of Testing and Treatment.

Science.gov (United States)

Parker, David; Belaud-Rotureau, Marc-Antoine

2014-01-01

Break-apart fluorescence in situ hybridization (FISH) is the gold standard test for anaplastic lymphoma kinase (ALK) gene rearrangement. However, this methodology often is assumed to be expensive and potentially cost-prohibitive given the low prevalence of ALK-positive non-small cell lung cancer (NSCLC) cases. To more accurately estimate the cost of ALK testing by FISH, we developed a micro-cost model that accounts for all cost elements of the assay, including laboratory reagents, supplies, capital equipment, technical and pathologist labor, and the acquisition cost of the commercial test and associated reagent kits and controls. By applying a set of real-world base-case parameter values, we determined that the cost of a single ALK break-apart FISH test result is $278.01. Sensitivity analysis on the parameters of batch size, testing efficiency, and the cost of the commercial diagnostic testing products revealed that the cost per result is highly sensitive to batch size, but much less so to efficiency or product cost. This implies that ALK testing by FISH will be most cost effective when performed in high-volume centers. Our results indicate that testing cost may not be the primary determinant of crizotinib (Xalkori(®)) treatment cost effectiveness, and suggest that testing cost is an insufficient reason to limit the use of FISH testing for ALK rearrangement.

An Evaluation of Clinical Economics and Cases of Cost-effectiveness.

Science.gov (United States)

Takura, Tomoyuki

2018-05-01

In order to maintain and develop a universal health insurance system, it is crucial to utilize limited medical resources effectively. In this context, considerations are underway to introduce health technology assessments (HTAs), such as cost-effectiveness analyses (CEAs), into the medical treatment fee system. CEAs, which is the general term for these methods, are classified into four categories, such as cost-effectiveness analyses based on performance indicators, and in the comparison of health technologies, the incremental cost-effectiveness ratio (ICER) is also applied. When I comprehensively consider several Japanese studies based on these concepts, I find that, in the results of the analysis of the economic performance of healthcare systems, Japan shows the most promising trend in the world. In addition, there is research indicating the superior cost-effectiveness of Rituximab against refractory nephrotic syndrome, and it is expected that health economics will be actively applied to the valuation of technical innovations such as drug discovery.

High performance anode for advanced Li batteries

Energy Technology Data Exchange (ETDEWEB)

Lake, Carla [Applied Sciences, Inc., Cedarville, OH (United States)

2015-11-02

The overall objective of this Phase I SBIR effort was to advance the manufacturing technology for ASI’s Si-CNF high-performance anode by creating a framework for large volume production and utilization of low-cost Si-coated carbon nanofibers (Si-CNF) for the battery industry. This project explores the use of nano-structured silicon which is deposited on a nano-scale carbon filament to achieve the benefits of high cycle life and high charge capacity without the consequent fading of, or failure in the capacity resulting from stress-induced fracturing of the Si particles and de-coupling from the electrode. ASI’s patented coating process distinguishes itself from others, in that it is highly reproducible, readily scalable and results in a Si-CNF composite structure containing 25-30% silicon, with a compositionally graded interface at the Si-CNF interface that significantly improve cycling stability and enhances adhesion of silicon to the carbon fiber support. In Phase I, the team demonstrated the production of the Si-CNF anode material can successfully be transitioned from a static bench-scale reactor into a fluidized bed reactor. In addition, ASI made significant progress in the development of low cost, quick testing methods which can be performed on silicon coated CNFs as a means of quality control. To date, weight change, density, and cycling performance were the key metrics used to validate the high performance anode material. Under this effort, ASI made strides to establish a quality control protocol for the large volume production of Si-CNFs and has identified several key technical thrusts for future work. Using the results of this Phase I effort as a foundation, ASI has defined a path forward to commercialize and deliver high volume and low-cost production of SI-CNF material for anodes in Li-ion batteries.

Breadnut peel as a highly effective low-cost biosorbent for methylene blue: Equilibrium, thermodynamic and kinetic studies

Directory of Open Access Journals (Sweden)

Linda B.L. Lim

2017-05-01

Full Text Available This work reports the potential use of peel of breadnut, Artocarpus camansi, as an effective low-cost biosorbent for the removal of methylene blue (MB. Oven dried A. camansi peel (ACP, which had a point of zero charge at pH = 4.8, showed maximum biosorption capacity which was far superior to most literature reported fruit biomasses, including samples that have been activated. Isotherm studies on biosorption of MB onto ACP gave a maximum biosorption capacity of 409 mg g−1. The Langmuir model was found to give the best fit among various isotherm models investigated and error analyses performed. Kinetics studies were fast with 50% dye being removed in less than 8 min from a 50 mg L−1 dye solution and further, kinetics followed the pseudo second order. Thermodynamic studies indicated that the biosorption process was both spontaneous and exothermic. Fourier transform infrared (FT-IR of ACP before and after MB adsorption was investigated. It can be concluded that oven dried breadnut peel is a highly promising low-cost biosorbent with great potential for the removal of MB.

High-throughput determination of vancomycin in human plasma by a cost-effective system of two-dimensional liquid chromatography.

Science.gov (United States)

Sheng, Yanghao; Zhou, Boting

2017-05-26

Therapeutic drug monitoring (TDM) is one of the most important services of clinical laboratories. Two main techniques are commonly used: the immunoassay and chromatography method. We have developed a cost-effective system of two-dimensional liquid chromatography with ultraviolet detection (2D-LC-UV) for high-throughput determination of vancomycin in human plasma that combines the automation and low start-up costs of the immunoassay with the high selectivity and sensitivity of the liquid chromatography coupled with mass spectrometric detection without incurring their disadvantages, achieving high cost-effectiveness. This 2D-LC system offers a large volume injection to provide sufficient sensitivity and uses simulated gradient peak compression technology to control peak broadening and to improve peak shape. A middle column was added to reduce the analysis cycle time and make it suitable for high-throughput routine clinical assays. The analysis cycle time was 4min and the peak width was 0.8min. Compared with other chromatographic methods that have been developed, the analysis cycle time and peak width for vancomycin was reduced significantly. The lower limit of quantification was 0.20μg/mL for vancomycin, which is the same as certain LC-MS/MS methods that have been recently developed and validated. The method is rapid, automated, and low-cost and has high selectivity and sensitivity for the quantification of vancomycin in human plasma, thus making it well-suited for use in hospital clinical laboratories. Copyright © 2017 Elsevier B.V. All rights reserved.

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

NARCIS (Netherlands)

Kempers, J.; Ketting, E.; Lesco, G.

2014-01-01

BACKGROUND: Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of

Can Water-Injected Turbomachines Provide Cost-Effective Emissions and Maintenance Reductions?

Science.gov (United States)

Hendricks, Robert C.; Daggett, David L.; Shouse, Dale T.; Roquemore, William M.; Brankovic, Andreja; Ryder, Robert C., Jr.

2011-01-01

An investigation has been performed to evaluate the effect of water injection on the performance of the Air Force Research Laboratory (AFRL, Wright-Patterson Air Force Base (WPAFB)) experimental trapped vortex combustor (TVC) over a range of fuel-to-air and water-to-fuel ratios. Performance is characterized by combustor exit quantities: temperature and emissions measurements using rakes, and overall pressure drop, from upstream plenum to combustor exit. Combustor visualization is performed using gray-scale and color still photographs and high-frame-rate videos. A parallel investigation evaluated the performance of a computational fluid dynamics (CFD) tool for the prediction of the reacting flow in a liquid fueled combustor (e.g., TVC) that uses water injection for control of pollutant emissions and turbine inlet temperature. Generally, reasonable agreement is found between data and NO(x) computations. Based on a study assessing the feasibility and performance impact of using water injection on a Boeing 747-400 aircraft to reduce NO(x) emissions during takeoff, retrofitting does not appear to be cost effective; however, an operator of a newly designed engine and airframe might be able to save up to 1.0 percent in operating costs. Other challenges of water injection will be discussed.

Effect of high wind conditions on AHX performance for PFBR

International Nuclear Information System (INIS)

Goyal, P.; Datta, Anu; Verma, Vishnu; Singh, R.K.

2013-05-01

In case of normal shut down or station blackout condition the core decay heat is removed by Safety Grade Decay Heat Removal System (SGDHRS) in PFBR. The Prototype Fast Breeder Reactor (PFBR) is under construction at Kalpakkam. SGDHRS remove decay heat from the core and dissipate it into the environment with the help of Air Heat Exchanger (AHX). SGDHRS consists of four redundant numbers of totally independent circuits capable of removing decay heat from the hot pool through natural convection in the primary and intermediate sodium sides as well as in the air side. Each circuit consists of a sodium to sodium heat exchanger (DHX) and a sodium to AHX connected to intermediate sodium circuit, AHX is located at a higher elevation compared to DHX. AHX is serpentine type finned tube compact heat exchanger with sodium in the tube side and air flowing over finned tubes. A tall stack provides the driving force for the natural convection of air flow through the AHX, when the dampers are opened. The AHX is placed outside of Reactor Control Building (RCB), on the roof of Steam Generator Building. Due to the presence of nearby buildings around the stack, the AHX performance under high wind condition may be affected. A CFD simulation using CFD-ACE+ code has been carried in which effect of high wind condition and nearby building on AHX performance have been studied. For high wind condition various orientation of wind movement was considered for parametric studies. AHX performance for all the cases were compared with the results that obtained for the absence of nearby buildings. A comparative table was prepared to understand how the AHX performance is effected with the high wind condition for various direction and with the presence of nearby building. It was observed that AHX performance is influenced by high wind conditions in most of the cases for with and without presence of nearby building. Hence to ensure the optimal performance of the AHX under high wind conditions its

Deregulation and Nuclear Training: Cost Effective Alternatives

International Nuclear Information System (INIS)

Richard P. Coe; Patricia A. Lake

2000-01-01

Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies

Cost-effective treatment for the couple with infertility.

Science.gov (United States)

Van Voorhis, B J; Syrop, C H

2000-12-01

Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated.

The Opportunity for High-Performance Biomaterials from Methane.

Science.gov (United States)

Strong, Peter James; Laycock, Bronwyn; Mahamud, Syarifah Nuraqmar Syed; Jensen, Paul Douglas; Lant, Paul Andrew; Tyson, Gene; Pratt, Steven

2016-02-03

Polyhydroxyalkanoate (PHA) biopolymers are widely recognised as outstanding candidates to replace conventional petroleum-derived polymers. Their mechanical properties are good and can be tailored through copolymer composition, they are biodegradable, and unlike many alternatives, they do not rely on oil-based feedstocks. Further, they are the only commodity polymer that can be synthesised intracellularly, ensuring stereoregularity and high molecular weight. However, despite offering enormous potential for many years, they are still not making a significant impact. This is broadly because commercial uptake has been limited by variable performance (inconsistent polymer properties) and high production costs of the raw polymer. Additionally, the main type of PHA produced naturally is poly-3-hydroxybutyrate (PHB), which has limited scope due to its brittle nature and low thermal stability, as well as its tendency to embrittle over time. Production cost is strongly impacted by the type of the feedstock used. In this article we consider: the production of PHAs from methanotrophs using methane as a cost-effective substrate; the use of mixed cultures, as opposed to pure strains; and strategies to generate a poly(3-hydroxybutyrate-co-3-hydroxyvalerate) copolymer (PHBV), which has more desirable qualities such as toughness and elasticity.

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

Science.gov (United States)

Sinkey, Rachel G; Odibo, Anthony O

2016-06-01

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

High performance computing in Windows Azure cloud

OpenAIRE

Ambruš, Dejan

2013-01-01

High performance, security, availability, scalability, flexibility and lower costs of maintenance have essentially contributed to the growing popularity of cloud computing in all spheres of life, especially in business. In fact cloud computing offers even more than this. With usage of virtual computing clusters a runtime environment for high performance computing can be efficiently implemented also in a cloud. There are many advantages but also some disadvantages of cloud computing, some ...

The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

Science.gov (United States)

Barlow, Brian T; McLawhorn, Alexander S; Westrich, Geoffrey H

2017-05-03

Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty. Markov model analysis was conducted from the societal perspective with use of direct and indirect costs. Costs, expressed in 2013 U.S. dollars, were derived from the literature, the National Inpatient Sample, and the Centers for Medicare & Medicaid Services. Effectiveness was expressed in quality-adjusted life years (QALYs). The model was populated with health state utilities and state transition probabilities derived from previously published literature. The analysis was performed for a patient's lifetime, and costs and effectiveness were discounted at 3% annually. The principal outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to explore relevant uncertainty. In the base case, DM total hip arthroplasty showed absolute dominance over conventional total hip arthroplasty, with lower accrued costs ($39,008 versus $40,031 U.S. dollars) and higher accrued utility (13.18 versus 13.13 QALYs) indicating cost-savings. DM total hip arthroplasty ceased being cost-saving when its implant costs exceeded those of conventional total hip arthroplasty by $1,023, and the cost-effectiveness threshold for DM implants was $5,287 greater than that for conventional implants. DM was not cost-effective when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29%. The probability of intraprosthetic dislocation exerted the most influence on model results. This model

Political versus managerial use of cost and performance accounting

OpenAIRE

Flury, Reto; Schedler, Kuno

2006-01-01

This article explains why it is impossible to use cost and performance accounting in public administration purely as an instrument for internal management. The authors report on a survey in Switzerland which highlighted the different expectations that politicians and managers have for cost and performance accounting. The authors warn that politicians and managers need to be aware of the conflicts arising from their different information needs. New cost and performance accounting systems need ...

Health care resource use and costs associated with possible side effects of high oral corticosteroid use in asthma: a claims-based analysis.

Science.gov (United States)

Luskin, Allan T; Antonova, Evgeniya N; Broder, Michael S; Chang, Eunice Y; Omachi, Theodore A; Ledford, Dennis K

2016-01-01

The objective of this study was to estimate the prevalence of possible oral corticosteroid (OCS)-related side effects and health care resource use and costs in patients with asthma. This was a cross-sectional, matched-cohort, retrospective study using a commercial claims database. Adults with asthma diagnosis codes and evidence of asthma medication use were studied. Patients with high OCS use (≥30 days of OCS annually) were divided into those who did versus those who did not experience OCS-related possible side effects. Their health care resource use and costs were compared using linear regression or negative binomial regression models, adjusting for age, sex, geographic region, Charlson Comorbidity Index score, and chronic obstructive pulmonary disease status. After adjustment, high OCS users with possible side effects were more likely to have office visits (23.0 vs 19.6; P possible side effects. Emergency department visits were similar between the groups. High OCS users with possible side effects had higher adjusted total annual mean health care costs ($25,168) than those without such side effects ($21,882; P =0.009). Among high OCS users, patients with possible OCS-related side effects are more likely to use health care services than those without such side effects. Although OCS may help control asthma and manage exacerbations, OCS side effects may result in additional health care resource use and costs, highlighting the need for OCS-sparing asthma therapies.

Validity and cost-effectiveness of methods for screening of primary open angle glaucoma

Directory of Open Access Journals (Sweden)

Fröschl, Barbara

2007-02-01

Full Text Available Health political background: About 950,000 people are affected by glaucoma in Germany, about 50% of which are undiagnosed. The German Ophthalmological Society and the German Association of Ophthalmologists recommend a screening for glaucoma according to their guidelines. The Federal Joint Committee disapproved a glaucoma-screening program on expense of the compulsory health insurance in 2004. Scientific background: Primary open angle glaucoma is diagnosed by evaluation of the optic disc, the retinal fibre layer and the visual field. The main examinations are ophthalmoscopy, scanning laser polarimetry, confocal scanning laser ophthalmoscopy, retinal thickness analysis and optical coherence tomography. Scotomas are diagnosed by perimetry (standard automated perimetry, short wavelength automated perimetry and frequency doubling perimetry. The intraocular pressure is the most important treatable risk factor and is measured by (contact or non-contact tonometry. Research questions: The aim of this HTA-report is to investigate the diagnostic validity and cost effectiveness of diagnostic techniques or combinations of these methods with respect to the use in a screening setting in Germany. Methods: A systematic literature research was performed in 35 international databases and yielded 2602 articles. Overall 57 publications were included for assessment, according to predefined selection criteria. Results: The 55 medical articles deal mainly with frequency doubling perimetry, confocal scanning laser ophthalmoscopy and scanning laser polarimetry. Few articles cover short wavelength automated perimetry, tonometry and ophalmocopic evaluations by ophthalmologists. The quality of the papers is generally low, as far as the evidence in respect of screening is concerned. No single method exists with both, high sensitivity and high specificity for screening purpose. Data are also not sufficient to recommend combinations of methods. Only two economic models on cost

Cost-effectiveness of tiotropium versus salmeterol: the POET-COPD trial.

Science.gov (United States)

Hoogendoorn, Martine; Al, Maiwenn J; Beeh, Kai-Michael; Bowles, David; Graf von der Schulenburg, J Matthias; Lungershausen, Juliane; Monz, Brigitta U; Schmidt, Hendrik; Vogelmeier, Claus; Rutten-van Mölken, Maureen P M H

2013-03-01

The aim of this study was to perform a 1-yr trial-based cost-effectiveness analysis (CEA) of tiotropium versus salmeterol followed by a 5-yr model-based CEA. The within-trial CEA, including 7,250 patients with moderate to very severe chronic obstructive pulmonary disease (COPD), was performed alongside the 1-yr international randomised controlled Prevention of Exacerbations with Tiotropium (POET)-COPD trial comparing tiotropium with salmeterol regarding the effect on exacerbations. Main end-points of the trial-based analysis were costs, number of exacerbations and exacerbation days. The model-based analysis was conducted to extrapolate results to 5 yrs and to calculate quality-adjusted life years (QALYs). 1-yr costs per patient from the German statutory health insurance (SHI) perspective and the societal perspective were €126 (95% uncertainty interval (UI) €55-195) and €170 (95% UI €77-260) higher for tiotropium, respectively. The annual number of exacerbations was 0.064 (95% UI 0.010-0.118) lower for tiotropium, leading to a reduction in exacerbation-related costs of €87 (95% UI €19-157). The incremental cost-effectiveness ratio was €1,961 per exacerbation avoided from the SHI perspective and €2,647 from the societal perspective. In the model-based analyses, the 5-yr costs per QALY were €3,488 from the SHI perspective and €8,141 from the societal perspective. Tiotropium reduced exacerbations and exacerbation-related costs, but increased total costs. Tiotropium can be considered cost-effective as the resulting cost-effectiveness ratios were below commonly accepted willingness-to-pay thresholds.

Effectively Managing Nuclear Risk Through Human Performance Improvement

International Nuclear Information System (INIS)

Coe, Richard; Lake, Patricia

2003-01-01

The U.S. commercial nuclear industry has just completed an outstanding decade of plant performance. Safety levels and electric production are at unprecedented high levels and continue to exceed even high industry goals. Nuclear energy continues to keep the highest priority on performance improvement programs and highly trained and qualified people that maintain its record setting safety and reliability of operations. While the industry has maintained a high level of performance, the advent of deregulation and the consolidation of nuclear power plant ownership, as well as the current climate for concern about both rising energy costs and the availability of power, have raised the standard for nuclear energy's level of competitiveness in today's market place. The resulting challenge is how to more effectively manage risk and to improve performance even further in a generally high-performing industry. One of the most effective ways to develop this culture is to apply the principles of Hum an Performance Technology, or HPT. HPT is a relatively new field. Its principles are derived from the research and practice of behavioral and cognitive psychologists, instructional technologists, training designers, organizational developers, and various human resource specialists. Using the principles of HPT can help the nuclear industry successfully meet ever-changing environmental and business demands

Electrostatic direct energy converter performance and cost scaling laws

International Nuclear Information System (INIS)

Hoffman, M.A.

1977-08-01

This study is concerned with electrostatic type direct energy converters for direct recovery of a large fraction of the plasma ion energy from fusion reactors. Simplified equations are presented for each of the important loss mechanisms in both single-stage direct converters and multistage ''Venetian Blind'' type direct converters. These equations can be used to estimate the efficiency and electric power output of the direct converter subsystem. Scaling relations for the cost of each major component in the direct converter subsystem are also given; these include the vacuum tank, direct converter modules, the DC power conditioning equipment, cryogenic vacuum pumping system and the thermal bottoming plant. The performance and cost scaling laws have been developed primarily for use in overall fusion power plant systems codes. However, to illustrate their utility, cost-effectiveness studies of two specific reference direct converter designs are presented in terms of the specific capital costs (i.e., the capital cost per unit electric power produced) for the Direct Converter Subsystem alone. Some examples of design improvements which can significantly reduce the specific capital costs of the Direct Converter Subsystem are also given

A Linux Workstation for High Performance Graphics

Science.gov (United States)

Geist, Robert; Westall, James

2000-01-01

The primary goal of this effort was to provide a low-cost method of obtaining high-performance 3-D graphics using an industry standard library (OpenGL) on PC class computers. Previously, users interested in doing substantial visualization or graphical manipulation were constrained to using specialized, custom hardware most often found in computers from Silicon Graphics (SGI). We provided an alternative to expensive SGI hardware by taking advantage of third-party, 3-D graphics accelerators that have now become available at very affordable prices. To make use of this hardware our goal was to provide a free, redistributable, and fully-compatible OpenGL work-alike library so that existing bodies of code could simply be recompiled. for PC class machines running a free version of Unix. This should allow substantial cost savings while greatly expanding the population of people with access to a serious graphics development and viewing environment. This should offer a means for NASA to provide a spectrum of graphics performance to its scientists, supplying high-end specialized SGI hardware for high-performance visualization while fulfilling the requirements of medium and lower performance applications with generic, off-the-shelf components and still maintaining compatibility between the two.

Is Myomectomy Prior to Assisted Reproductive Technology Cost Effective in Women with Intramural Fibroids?

Science.gov (United States)

Ojo-Carons, Mary; Mumford, Sunni L; Armstrong, Alicia Y; DeCherney, Alan H; Devine, Kate

2016-01-01

To evaluate the cost effectiveness of surgery to remove intramural (IM) fibroids prior to assisted reproductive technology (ART). The decision tree mathematical model along with sensitivity analysis was performed to analyze cost effectiveness of: (1) myomectomy followed by ART or (2) ART with IM myoma(s) in situ. At the median ongoing pregnancy (OP) rate (OPR) reported in the literature for a fresh, autologous ART cycle with IM fibroids in situ vs. post-IM myomectomy, average cost per OP was $72,355 vs. 66,075, indicating a cost savings with myomectomy. Sensitivity analysis over the range of reported OPRs demonstrated that pre-ART IM myomectomy was always cost effective when OPR among women with in situ myomas was ART IM myomectomy was only cost effective if it increased OPR by at least 9.6%. At the high end of OPRs reported for patients with IM myomas in situ (31.4%), a 19.5% improvement in OPR was needed to justify IM myomectomy from a cost perspective. Myomectomy should be used sparingly in cases where the goal of surgery is to achieve improvement in the outcomes of ART. © 2016 S. Karger AG, Basel.

Photovoltaic technology, performance, manufacturing cost and markets

International Nuclear Information System (INIS)

Maycock, P.D.

1999-01-01

A comprehensive discussion of key aspects of photovoltaic energy conversion systems will provide the basis for forecasting PV module shipments from 1999 to 2010. Principal areas covered include: (1) Technology and Performance Status: The module efficiency and performance are described for commercial cell technologies including single crystal silicon, polycrystal silicon, ribbon silicon, film silicon on low cost substrate, amorphous silicon, copper indium diselenide, and cadmium telluride; (2) Manufacturing cost: 1999 costs for PV technologies in production (single crystal silicon, polycrystal silicon, and amorphous silicon) are developed. Manufacturing costs for 10--25 MW plants and 100 MW plants will be estimated; (3) The world PV market is summarized by region, top ten companies, and technology; and (4) Forecast of the World Market (seven market sectors) to 2010 will be presented. Key assumptions, price of modules, incentive programs, price of competing electricity generation will be detailed

Energetic costs of performance in trained and untrained Anolis carolinensis lizards.

Science.gov (United States)

Lailvaux, Simon P; Wang, Andrew Z; Husak, Jerry F

2018-03-12

The energetic costs of performance constitute a non-trivial component of animals' daily energetic budgets. However, we currently lack an understanding of how those costs are partitioned among the various stages of performance development, maintenance, and production. We manipulated individual investment in performance by training Anolis carolinensis lizards for endurance or sprinting ability. We then measured energetic expenditure both at rest and immediately following exercise to test whether such training alters the maintenance and production costs of performance. Trained lizards had lower resting metabolic rates than controls, suggestive of a maintenance saving associated with enhanced performance as opposed to a cost. Production costs also differed, with sprint-trained lizards incurring the largest energetic performance cost and experiencing the longest recovery times compared to endurance trained and control animals. Although performance training modifies metabolism, production costs are probably the key drivers of trade-offs between performance and other life-history traits in this species. © 2018. Published by The Company of Biologists Ltd.

Costs and Cost-Effectiveness of Plasmodium vivax Control.

Science.gov (United States)

White, Michael T; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard

2016-12-28

The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum-specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. © The American Society of Tropical Medicine and Hygiene.

Stretchable and High-Performance Supercapacitors with Crumpled Graphene Papers

OpenAIRE

Zang, Jianfeng; Cao, Changyong; Feng, Yaying; Liu, Jie; Zhao, Xuanhe

2014-01-01

Fabrication of unconventional energy storage devices with high stretchability and performance is challenging, but critical to practical operations of fully power-independent stretchable electronics. While supercapacitors represent a promising candidate for unconventional energy-storage devices, existing stretchable supercapacitors are limited by their low stretchability, complicated fabrication process, and high cost. Here, we report a simple and low-cost method to fabricate extremely stretch...

Flexible embedded circuitry : a novel process for high density, cost effective electronics

NARCIS (Netherlands)

Brand, van den J.; Kusters, R.; Barink, M.; Dietzel, A.H.

2010-01-01

Flexible electronics are starting to emerge with all-printed but also hybrid cost effective, smart electronic products that will find a wide range of applications in large quantities in our society. Such products have to be built on low cost substrate materials like PEN or PET foils. Because of the

Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

Science.gov (United States)

Bertoldi, Eduardo G; Stella, Steffen F; Rohde, Luis Eduardo P; Polanczyk, Carisi A

2017-05-04

The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation's public healthcare system. Hypothetical cohort of patients with pretest probability of CAD between 20% and 70%. The primary outcome is cost per correct diagnosis of CAD. Proportion of false-positive or false-negative tests and number of unnecessary tests performed were also evaluated. Strategies using Ex-ECG as initial test were the least costly alternatives but generated more frequent false-positive initial tests and false-negative final diagnosis. Strategies based on CTA or ECHO as initial test were the most attractive and resulted in similar cost-effectiveness ratios (I$ 286 and I$ 305 per correct diagnosis, respectively). A strategy based on C-MRI was highly effective for diagnosing stable CAD, but its high cost resulted in unfavourable incremental cost-effectiveness (ICER) in moderate-risk and high-risk scenarios. Non-invasive strategies based on SPECT have been dominated. An anatomical diagnostic strategy based on CTA is a cost-effective option for CAD diagnosis. Functional strategies performed equally well when based on ECHO. C-MRI yielded acceptable ICER only at low pretest probability, and SPECT was not cost-effective in our analysis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Application of Activity-Based Costing Management System by Key Success Paths to Promote the Competitive Advantages and Operation Performance

OpenAIRE

Mei-Fang Wu; Shu-Li Wang; Feng-Tsung Cheng

2015-01-01

Highly developed technology and highly competitive global market highlight the important role of competitive advantages and operation performances in sustainable company operation. Activity-Based Costing (ABC) provides accurate operation cost and operation performance information. Rich literatures provide relevant research with cases study on Activity-Based Costing application, but the research on cause relationship between key success factors and its specific outcome, su...

Is individualized medicine more cost-effective? A systematic review.

Science.gov (United States)

Hatz, Maximilian H M; Schremser, Katharina; Rogowski, Wolf H

2014-05-01

Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was

The effectiveness and cost-effectiveness of screening for latent tuberculosis among migrants in the EU/EEA

DEFF Research Database (Denmark)

Greenaway, Christina; Pareek, Manish; Chakra, Claire Nour Abou

2018-01-01

Background: Migrants account for a large and growing proportion of tuberculosis (TB) cases in lowincidence countries in the European Union/European Economic Area (EU/EEA) which are primarily due to reactivation of latent TB infection (LTBI). Addressing LTBI among migrants will be critical to achi...... by the large pool of migrants with LTBI, poorly predictive tests, long treatments and a weak care cascade. Targeted LTBI programmes that ensure high screening uptake and treatment completion will have greatest individual and public health benefit....... to achieve TB elimination. Methods: We conducted a systematic review to determine effectiveness (performance of diagnostic tests, efficacy of treatment, uptake and completion of screening and treatment) and a second systematic review on cost-effectiveness of LTBI screening programmes for migrants living...... eligible for screening completed treatment because of losses along all steps of the LTBI care cascade. Limited economic analyses suggest that the most cost-effective approach may be targeting young migrants from high TB incidence countries. Discussion: The effectiveness of LTBI programmes is limited...

Cost-effectiveness of treatment strategies for BRAF-mutated metastatic melanoma.

Directory of Open Access Journals (Sweden)

Patti Curl

Full Text Available Genetically-targeted therapies are both promising and costly advances in the field of oncology. Several treatments for metastatic melanoma with a mutation in the BRAF gene have been approved. They extend life but are more expensive than the previous standard of care (dacarbazine. Vemurafenib, the first drug in this class, costs $13,000 per month ($207,000 for a patient with median survival. Patients failing vemurafenib are often given ipilimumab, an immunomodulator, at $150,000 per course. Assessment of cost-effectiveness is a valuable tool to help navigate the transition toward targeted cancer therapy.We performed a cost-utility analysis to compare three strategies for patients with BRAF+ metastatic melanoma using a deterministic expected-value decision tree model to calculate the present value of lifetime costs and quality-adjusted life years (QALYs for each strategy. We performed sensitivity analyses on all variables.In the base case, the incremental cost-effectiveness ratio (ICER for vemurafenib compared with dacarbazine was $353,993 per QALY gained (0.42 QALYs added, $156,831 added. The ICER for vemurafenib followed by ipilimumab compared with vemurafenib alone was $158,139. In sensitivity analysis, treatment cost had the largest influence on results: the ICER for vemurafenib versus dacarbazine dropped to $100,000 per QALY gained with a treatment cost of $3600 per month.The cost per QALY gained for treatment of BRAF+ metastatic melanoma with vemurafenib alone or in combination exceeds widely-cited thresholds for cost-effectiveness. These strategies may become cost-effective with lower drug prices or confirmation of a durable response without continued treatment.

Perspectives on Performance Indicators: GCE Advanced Level and Differences Between Institution Types in Cost Effectiveness.

Science.gov (United States)

Fielding, A.

1998-01-01

Applies multilevel models of cost-effectiveness to numerous types of (British) institutions providing courses of instruction in the General Certificate of Education at Advanced Level. Different impressions may be gained about an institution's relative effectiveness when cost considerations are combined with outcome measures. Data evaluation needs…

An Assessment Of The Effectiveness Of Collaborative Cost ...

African Journals Online (AJOL)

This paper presents the effects of Collaborative Cost Reduction Model (CCRM) as a control Approach to reduce the high cost implication that causes the slow pace of migration process from IPV4 to IPV6 in Nigeria. This study reveals that CCRM can be applied to achieve Cost Reduction in collocation efforts in ...

Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

Science.gov (United States)

Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

2013-10-01

To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

Scalable Light Module for Low-Cost, High-Efficiency Light- Emitting Diode Luminaires

Energy Technology Data Exchange (ETDEWEB)

Tarsa, Eric [Cree, Inc., Goleta, CA (United States)

2015-08-31

During this two-year program Cree developed a scalable, modular optical architecture for low-cost, high-efficacy light emitting diode (LED) luminaires. Stated simply, the goal of this architecture was to efficiently and cost-effectively convey light from LEDs (point sources) to broad luminaire surfaces (area sources). By simultaneously developing warm-white LED components and low-cost, scalable optical elements, a high system optical efficiency resulted. To meet program goals, Cree evaluated novel approaches to improve LED component efficacy at high color quality while not sacrificing LED optical efficiency relative to conventional packages. Meanwhile, efficiently coupling light from LEDs into modular optical elements, followed by optimally distributing and extracting this light, were challenges that were addressed via novel optical design coupled with frequent experimental evaluations. Minimizing luminaire bill of materials and assembly costs were two guiding principles for all design work, in the effort to achieve luminaires with significantly lower normalized cost ($/klm) than existing LED fixtures. Chief project accomplishments included the achievement of >150 lm/W warm-white LEDs having primary optics compatible with low-cost modular optical elements. In addition, a prototype Light Module optical efficiency of over 90% was measured, demonstrating the potential of this scalable architecture for ultra-high-efficacy LED luminaires. Since the project ended, Cree has continued to evaluate optical element fabrication and assembly methods in an effort to rapidly transfer this scalable, cost-effective technology to Cree production development groups. The Light Module concept is likely to make a strong contribution to the development of new cost-effective, high-efficacy luminaries, thereby accelerating widespread adoption of energy-saving SSL in the U.S.

The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection; a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI.

Science.gov (United States)

Eljamel, M Sam; Mahboob, Syed Osama

2016-12-01

Surgical resection of high-grade gliomas (HGG) is standard therapy because it imparts significant progression free (PFS) and overall survival (OS). However, HGG-tumor margins are indistinguishable from normal brain during surgery. Hence intraoperative technology such as fluorescence (ALA, fluorescein) and intraoperative ultrasound (IoUS) and MRI (IoMRI) has been deployed. This study compares the effectiveness and cost-effectiveness of these technologies. Critical literature review and meta-analyses, using MEDLINE/PubMed service. The list of references in each article was double-checked for any missing references. We included all studies that reported the use of ALA, fluorescein (FLCN), IoUS or IoMRI to guide HGG-surgery. The meta-analyses were conducted according to statistical heterogeneity between studies. If there was no heterogeneity, fixed effects model was used; otherwise, a random effects model was used. Statistical heterogeneity was explored by χ 2 and inconsistency (I 2 ) statistics. To assess cost-effectiveness, we calculated the incremental cost per quality-adjusted life-year (QALY). Gross total resection (GTR) after ALA, FLCN, IoUS and IoMRI was 69.1%, 84.4%, 73.4% and 70% respectively. The differences were not statistically significant. All four techniques led to significant prolongation of PFS and tended to prolong OS. However none of these technologies led to significant prolongation of OS compared to controls. The cost/QALY was $16,218, $3181, $6049 and $32,954 for ALA, FLCN, IoUS and IoMRI respectively. ALA, FLCN, IoUS and IoMRI significantly improve GTR and PFS of HGG. Their incremental cost was below the threshold for cost-effectiveness of HGG-therapy, denoting that each intraoperative technology was cost-effective on its own. Copyright © 2016 Elsevier B.V. All rights reserved.

Cost-effective mammography screening in Korea. High incidence of breast cancer in young women

International Nuclear Information System (INIS)

Lee, Soon-Young; Jeong, Seong-Hwa; Kim, Youn-Nam; Kim, Jinheum; Kang, Dae-Ryong; Kim, Hyeon-Chang; Nam, Chung-Mo

2009-01-01

The epidemiological characteristics of breast cancer in Korean women are different from the characteristics reported in Western women. The highest incidence rate occurs in Korean women in their 40s. The purpose of this study was to determine the most cost-effective screening interval and target age range for Korean women from the perspective of the national healthcare system. A stochastic model was used to simulate breast cancer screenings by varying both the screening intervals and the age ranges. The effectiveness of mammography screening was defined as the probability of detecting breast cancer in the preclinical state and the cost was based on the direct cost of mammography screening and the confirmative tests. The age-specific mean sojourn times and the sensitivity of the mammography were applied in the stochastic model. An optimal cost-effectiveness was determined by the incremental cost-effectiveness ratio and lifetime schedule sensitivity. Sensitivity analyses were undertaken to assess parameter uncertainty. The selected cost-effective strategies were: the current biennial mammography screenings for women who are at least 40 years old; biennial screening for women between the ages of 35 and 75 years; and a combination strategy consisting of biennial screening for women aged between 45 and 54 years, and 3-year interval screening for women aged between 40 and 44 years and 55 and 65 years. Further studies should follow to investigate the effectiveness of mammography screening in women younger than 40 years in Asia as well as in Korea. (author)

An Evaluation of Cost-Effectiveness of Micro Computerized ...

African Journals Online (AJOL)

/Integrated Set of Information System (CDS/ISIS) application software in the library and its effectiveness in performance operations was evaluated to determine the cost – effectiveness. The study population was made up of all the staff involved ...

Monitoring worksite clinic performance using a cost-benefit tool.

Science.gov (United States)

Tao, Xuguang; Chenoweth, David; Alfriend, Amy S; Baron, David M; Kirkland, Tracie W; Scherb, Jill; Bernacki, Edward J

2009-10-01

The purpose of this study was to explore the usefulness of continuously assessing the return on investment (ROI) of worksite medical clinics as a means of evaluating clinic performance. Visit data from January 1, 2007, to December 31, 2008, were collected from all the on-site clinics operated for the Pepsi Bottling Group. An average system-wide ROI was calculated from the time of each clinic's opening and throughout the study period. A multivariate linear regression model was used to determine the association of average ROI with penetration/utilization rate and plant size. A total of 26 on-site clinics were actively running as of December 2008. The average ROI at the time of start up was 0.4, which increased to 1.2 at approximately 4 months and 1.6 at the end of the first year of operation. Overall, it seems that the cost of operating a clinic becomes equal to the cost of similar care purchased in the community (ROI = 1) at approximately 3 months after a clinic's opening and flattens out at the end of the first year. The magnitude of the ROI was closely related to the number of visits (a function of the penetration/utilization rate) and the size of the plant population served. Serial monitoring of ROIs is a useful metric in assessing on-site clinic performance and quantifying the effect of new initiatives aimed at increasing a clinic's cost effectiveness.

Older Adults Pay an Additional Cost When Texting and Walking: Effects of Age, Environment, and Use of Mixed Reality on Dual-Task Performance.

Science.gov (United States)

Krasovsky, Tal; Weiss, Patrice L; Kizony, Rachel

2018-04-06

Texting while walking (TeWW) has become common among people of all ages, and mobile phone use during gait is increasingly associated with pedestrian injury. Although dual-task walking performance is known to decline with age, data regarding the effect of age on dual-task performance in ecological settings are limited. The objective of this study was to evaluate the effect of age, environment (indoors/outdoors), and mixed reality (merging of real and virtual environments) on TeWW performance. A cross-sectional design was used. Young (N = 30; 27.8 ± 4.4 years) and older (N = 20; 68.9 ± 3.9 years) adults performed single and dual-task texting and walking indoors and outdoors, with and without a mixed reality display. Participants also completed evaluations of visual scanning and cognitive flexibility (Trail Making Test) and functional mobility (Timed Up and Go). Indoors, similar interference to walking and texting occurred for both groups, but only older adults' gait variability increased under dual task conditions. Outdoors, TeWW was associated with larger age-related differences in gait variability, texting accuracy, and gait dual-task costs. Young adults with better visual scanning and cognitive flexibility performed TeWW with lower gait costs (r = 0.52 to r = 0.65). The mixed reality display was unhelpful and did not modify walking or texting. Older adults tested in this study were relatively high-functioning. Gaze of participants was not directly monitored. Although young and older adults possess the resources necessary for TeWW, older adults pay an additional "price" when dual-tasking, especially outdoors. TeWW may have potential as an ecologically-valid assessment and/or an intervention paradigm for dual task performance among older adults as well as for clinical populations.

High-performance flat-panel solar thermoelectric generators with high thermal concentration

Science.gov (United States)

Kraemer, Daniel; Poudel, Bed; Feng, Hsien-Ping; Caylor, J. Christopher; Yu, Bo; Yan, Xiao; Ma, Yi; Wang, Xiaowei; Wang, Dezhi; Muto, Andrew; McEnaney, Kenneth; Chiesa, Matteo; Ren, Zhifeng; Chen, Gang

2011-07-01

The conversion of sunlight into electricity has been dominated by photovoltaic and solar thermal power generation. Photovoltaic cells are deployed widely, mostly as flat panels, whereas solar thermal electricity generation relying on optical concentrators and mechanical heat engines is only seen in large-scale power plants. Here we demonstrate a promising flat-panel solar thermal to electric power conversion technology based on the Seebeck effect and high thermal concentration, thus enabling wider applications. The developed solar thermoelectric generators (STEGs) achieved a peak efficiency of 4.6% under AM1.5G (1 kW m-2) conditions. The efficiency is 7-8 times higher than the previously reported best value for a flat-panel STEG, and is enabled by the use of high-performance nanostructured thermoelectric materials and spectrally-selective solar absorbers in an innovative design that exploits high thermal concentration in an evacuated environment. Our work opens up a promising new approach which has the potential to achieve cost-effective conversion of solar energy into electricity.

High-performance flat-panel solar thermoelectric generators with high thermal concentration.

Science.gov (United States)

Kraemer, Daniel; Poudel, Bed; Feng, Hsien-Ping; Caylor, J Christopher; Yu, Bo; Yan, Xiao; Ma, Yi; Wang, Xiaowei; Wang, Dezhi; Muto, Andrew; McEnaney, Kenneth; Chiesa, Matteo; Ren, Zhifeng; Chen, Gang

2011-05-01

The conversion of sunlight into electricity has been dominated by photovoltaic and solar thermal power generation. Photovoltaic cells are deployed widely, mostly as flat panels, whereas solar thermal electricity generation relying on optical concentrators and mechanical heat engines is only seen in large-scale power plants. Here we demonstrate a promising flat-panel solar thermal to electric power conversion technology based on the Seebeck effect and high thermal concentration, thus enabling wider applications. The developed solar thermoelectric generators (STEGs) achieved a peak efficiency of 4.6% under AM1.5G (1 kW m(-2)) conditions. The efficiency is 7-8 times higher than the previously reported best value for a flat-panel STEG, and is enabled by the use of high-performance nanostructured thermoelectric materials and spectrally-selective solar absorbers in an innovative design that exploits high thermal concentration in an evacuated environment. Our work opens up a promising new approach which has the potential to achieve cost-effective conversion of solar energy into electricity. © 2011 Macmillan Publishers Limited. All rights reserved

Cost optimal building performance requirements. Calculation methodology for reporting on national energy performance requirements on the basis of cost optimality within the framework of the EPBD

Energy Technology Data Exchange (ETDEWEB)

Boermans, T.; Bettgenhaeuser, K.; Hermelink, A.; Schimschar, S. [Ecofys, Utrecht (Netherlands)

2011-05-15

effects. The methodology described in this report is consistent with the description of the process as presented in the study 'Cost Optimality - Discussing methodology and challenges within the recast Energy Performance of Buildings Directive' published in September 2010 by the Buildings Performance Institute Europe (BPIE). The present document provides additional insights and details.

Cost-effectiveness of hysteroscopy screening for infertile women.

Science.gov (United States)

Kasius, Jenneke C; Eijkemans, René J C; Mol, Ben W J; Fauser, Bart C J M; Fatemi, Human M; Broekmans, Frank J M

2013-06-01

This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

High performance platinum single atom electrocatalyst for oxygen reduction reaction

Science.gov (United States)

Liu, Jing; Jiao, Menggai; Lu, Lanlu; Barkholtz, Heather M.; Li, Yuping; Wang, Ying; Jiang, Luhua; Wu, Zhijian; Liu, Di-Jia; Zhuang, Lin; Ma, Chao; Zeng, Jie; Zhang, Bingsen; Su, Dangsheng; Song, Ping; Xing, Wei; Xu, Weilin; Wang, Ying; Jiang, Zheng; Sun, Gongquan

2017-07-01

For the large-scale sustainable implementation of polymer electrolyte membrane fuel cells in vehicles, high-performance electrocatalysts with low platinum consumption are desirable for use as cathode material during the oxygen reduction reaction in fuel cells. Here we report a carbon black-supported cost-effective, efficient and durable platinum single-atom electrocatalyst with carbon monoxide/methanol tolerance for the cathodic oxygen reduction reaction. The acidic single-cell with such a catalyst as cathode delivers high performance, with power density up to 680 mW cm-2 at 80 °C with a low platinum loading of 0.09 mgPt cm-2, corresponding to a platinum utilization of 0.13 gPt kW-1 in the fuel cell. Good fuel cell durability is also observed. Theoretical calculations reveal that the main effective sites on such platinum single-atom electrocatalysts are single-pyridinic-nitrogen-atom-anchored single-platinum-atom centres, which are tolerant to carbon monoxide/methanol, but highly active for the oxygen reduction reaction.

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.

Science.gov (United States)

El Alaoui, Samir; Lindefors, Nils

2016-01-01

A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT). Data was collected from 568 adult patients treated with ICBT for depression during 2013-2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Taking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 cost-effectiveness plane at both post-treatment and at follow-up, indicating that the ICBT treatment was less costly and equally effective after staff reallocation. Treating patients to the target

The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model

Science.gov (United States)

Kahn, James G.; Jiwani, Aliya; Gomez, Gabriela B.; Hawkes, Sarah J.; Chesson, Harrell W.; Broutet, Nathalie; Kamb, Mary L.; Newman, Lori M.

2014-01-01

Background Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million disability-adjusted life years (DALYs) and $309 million in medical costs. Syphilis screening and treatment is simple, effective, and affordable, yet, worldwide, most pregnant women do not receive these services. We assessed cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in various programmatic, epidemiologic, and economic contexts. Methods and Findings We modeled the cost, health impact, and cost-effectiveness of expanded syphilis screening and treatment in ANC, compared to current services, for 1,000,000 pregnancies per year over four years. We defined eight generic country scenarios by systematically varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare. We calculated program and net costs, DALYs averted, and net costs per DALY averted over four years in each scenario. Program costs are estimated at $4,142,287 – $8,235,796 per million pregnant women (2010 USD). Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program averts an estimated 5,754 – 93,484 DALYs, yielding net savings in four scenarios, and a cost per DALY averted of $24 – $111 in the four scenarios with net costs. Results were robust in sensitivity analyses. Conclusions Eliminating MTCT of syphilis through expanded screening and treatment in ANC is likely to be highly cost-effective by WHO-defined thresholds in a wide range of settings. Countries with high prevalence, low current service coverage, and high healthcare cost would benefit most. Future analyses can be

The anticipated costs analysis and benefit items survey against performing the maintenance rule

International Nuclear Information System (INIS)

Hwang, M. J.; Kim, K. Y.; Yang, Z. A.

2002-01-01

In this paper, we surveyed the cost and benefit items and evaluated the costs against performing the Maintenance Rule. In the past, only one electric power company had provided the electricity without free competition in Korea. In these days, however, the electric power company was divided into two parts by the sources: atomic and hydraulic generation and thermal-power generation. Therefore, the generation sources that done have competitiveness at the price will be weeded out in the electric power market. Although the preferential goal is on the safe operation at the Nuclear power Plants (NPPs), if too much money is required to maintain or improve the safety of the NPP, the licensee could hesitate to adopt the program related to the safety even though it is a good one. Since the Risk-Informed Applications (RIA) have been using for a plant operation in recent, the condition of a plant might be changed. Therefore, considering the affects of the RIA, a method to keep the capability through the monitoring the maintenance effectiveness has been proposed. However, to perform this, a number of works, continuous collecting data and monitoring the maintenance effectiveness and understanding the reason of degrading capability, should be preceded. Therefore, a lot of man-hour is needed to develop and to manage the application method, and the licensee should pay the costs. Therefore, in the domestic circumstance, it is necessary to evaluate the cost to monitor the maintenance effectiveness. Hence, we are going to examine the cost to perform the MR and its anticipated benefit lists

Progress on high-performance rapid prototype aluminum mirrors

Science.gov (United States)

Woodard, Kenneth S.; Myrick, Bruce H.

2017-05-01

Near net shape parts can be produced using some very old processes (investment casting) and the relatively new direct metal laser sintering (DMLS) process. These processes have significant advantages for complex blank lightweighting and costs but are not inherently suited for producing high performance mirrors. The DMLS process can provide extremely complex lightweight structures but the high residual stresses left in the material results in unstable mirror figure retention. Although not to the extreme intricacy of DMLS, investment casting can also provide complex lightweight structures at considerably lower costs than DMLS and even conventional wrought mirror blanks but the less than 100% density for casting (and also DMLS) limits finishing quality. This paper will cover the progress that has been made to make both the DMLS and investment casting processes into viable near net shape blank options for high performance aluminum mirrors. Finish and figure results will be presented to show performance commensurate with existing conventional processes.

High-precision and low-cost vibration generator for low-frequency calibration system

Science.gov (United States)

Li, Rui-Jun; Lei, Ying-Jun; Zhang, Lian-Sheng; Chang, Zhen-Xin; Fan, Kuang-Chao; Cheng, Zhen-Ying; Hu, Peng-Hao

2018-03-01

Low-frequency vibration is one of the harmful factors that affect the accuracy of micro-/nano-measuring machines because its amplitude is significantly small and it is very difficult to avoid. In this paper, a low-cost and high-precision vibration generator was developed to calibrate an optical accelerometer, which is self-designed to detect low-frequency vibration. A piezoelectric actuator is used as vibration exciter, a leaf spring made of beryllium copper is used as an elastic component, and a high-resolution, low-thermal-drift eddy current sensor is applied to investigate the vibrator’s performance. Experimental results demonstrate that the vibration generator can achieve steady output displacement with frequency range from 0.6 Hz to 50 Hz, an analytical displacement resolution of 3.1 nm and an acceleration range from 3.72 mm s-2 to 1935.41 mm s-2 with a relative standard deviation less than 1.79%. The effectiveness of the high-precision and low-cost vibration generator was verified by calibrating our optical accelerometer.

Cost-effectiveness analysis of lifestyle intervention in obese infertile women.

Science.gov (United States)

van Oers, A M; Mutsaerts, M A Q; Burggraaff, J M; Kuchenbecker, W K H; Perquin, D A M; Koks, C A M; van Golde, R; Kaaijk, E M; Schierbeek, J M; Klijn, N F; van Kasteren, Y M; Land, J A; Mol, B W J; Hoek, A; Groen, H

2017-07-01

What is the cost-effectiveness of lifestyle intervention preceding infertility treatment in obese infertile women? Lifestyle intervention preceding infertility treatment as compared to prompt infertility treatment in obese infertile women is not a cost-effective strategy in terms of healthy live birth rate within 24 months after randomization, but is more likely to be cost-effective using a longer follow-up period and live birth rate as endpoint. In infertile couples, obesity decreases conception chances. We previously showed that lifestyle intervention prior to infertility treatment in obese infertile women did not increase the healthy singleton vaginal live birth rate at term, but increased natural conceptions, especially in anovulatory women. Cost-effectiveness analyses could provide relevant additional information to guide decisions regarding offering a lifestyle intervention to obese infertile women. The cost-effectiveness of lifestyle intervention preceding infertility treatment compared to prompt infertility treatment was evaluated based on data of a previous RCT, the LIFEstyle study. The primary outcome for effectiveness was the vaginal birth of a healthy singleton at term within 24 months after randomization (the healthy live birth rate). The economic evaluation was performed from a hospital perspective and included direct medical costs of the lifestyle intervention, infertility treatments, medication and pregnancy in the intervention and control group. In addition, we performed exploratory cost-effectiveness analyses of scenarios with additional effectiveness outcomes (overall live birth within 24 months and overall live birth conceived within 24 months) and of subgroups, i.e. of ovulatory and anovulatory women, women birth rates were 27 and 35% in the intervention group and the control group, respectively (effect difference of -8.1%, P birth rate. Mean costs per healthy live birth event were €15 932 in the intervention group and €15 912 in the

Performance and cost benefits analysis of double-pass solar collector with and without fins

International Nuclear Information System (INIS)

Fudholi, Ahmad; Sopian, Kamaruzzaman; Ruslan, Mohd Hafidz; Othman, Mohd Yusof

2013-01-01

Highlights: • The thermal performances and cost analysis of the double-pass solar collector with and without fins absorber were discussed. • The theoretical and experimental study on the double-pass solar air collector with and without fins absorber was conducted. • The ratio of AC/AEG or the cost benefit ratio was presented. • The double-pass solar collector with fins absorber is more cost-effective compared to without fins absorber. - Abstract: The performance and cost benefit analysis of double-pass solar collector with and without fins have been conducted. The theoretical model using steady state analysis has been developed and compared with the experimental results. The performance curves of the double-pass solar collector with and without fins, which included the effects of mass flow rate and solar intensity on the thermal efficiency of the solar collector, were obtained. Results indicated that the thermal efficiency is proportional to the solar intensity at a specific mass flow rate. The thermal efficiency increased by 9% at a solar intensity of 425–790 W/m 2 and mass flow rate of 0.09 kg/s. The theoretical and experimental analysis showed a similar trend as well as close agreement. Moreover, a cost-effectiveness model has been developed examine the cost benefit ratio of double-pass solar collector with and without fins. Evaluation of the annual cost (AC) and the annual energy gain (AEG) of the collector were also performed. The results show that the double-pass solar collector with fins is more cost-effective compared to the double-pass solar collector without fins for mass flow rate of 0.01–0.07 kg/s. Also, simulations were obtained for the double-pass solar collector with fins at Nusselt number of 5.42–36.21. The energy efficiency of collector increases with the increase of Nusselt number. The results show that by increasing the Nusselt number simultaneously would drop the outlet temperature at any solar intensity. Increase in Nusselt number

Expected cost effectiveness of high-dose trivalent influenza vaccine in US seniors.

Science.gov (United States)

Chit, Ayman; Roiz, Julie; Briquet, Benjamin; Greenberg, David P

2015-01-29

Seniors are particularly vulnerable to complications resulting from influenza infection. Numerous influenza vaccines are available to immunize US seniors, and practitioners must decide which product to use. Options include trivalent and quadrivalent standard-dose inactivated influenza vaccines (IIV3 and IIV4 respectively), as well as a high-dose IIV3 (HD). Our research examines the public health impact, budget impact, and cost-utility of HD versus IIV3 and IIV4 for immunization of US seniors 65 years of age and older. Our model was based on US influenza-related health outcome data. Health care costs and vaccine prices were obtained from the Centers for Medicare and Medicaid Services. Efficacies of IIV3 and IIV4 were estimated from various meta-analyses of IIV3 efficacy. The results of a head-to-head randomized controlled trial of HD vs. IIV3 were used to estimate relative efficacy of HD. Conservatively, herd protection was not considered. Compared to IIV3, HD would avert 195,958 cases of influenza, 22,567 influenza-related hospitalizations, and 5423 influenza-related deaths among US seniors. HD generates 29,023 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $154 million. The Incremental Cost Effectiveness Ratio (ICER) for this comparison is $5299/QALY. 71% of the probabilistic sensitivity analysis (PSA) simulations were seniors. Our conclusions were robust in the face of sensitivity analyses. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Cost-optimal levels for energy performance requirements

DEFF Research Database (Denmark)

Thomsen, Kirsten Engelund; Aggerholm, Søren; Kluttig-Erhorn, Heike

2011-01-01

The CA conducted a study on experiences and challenges for setting cost optimal levels for energy performance requirements. The results were used as input by the EU Commission in their work of establishing the Regulation on a comparative methodology framework for calculating cost optimal levels...... of minimum energy performance requirements. In addition to the summary report released in August 2011, the full detailed report on this study is now also made available, just as the EC is about to publish its proposed Regulation for MS to apply in their process to update national building requirements....

Simulating Effects of High Angle of Attack on Turbofan Engine Performance

Science.gov (United States)

Liu, Yuan; Claus, Russell W.; Litt, Jonathan S.; Guo, Ten-Huei

2013-01-01

A method of investigating the effects of high angle of attack (AOA) flight on turbofan engine performance is presented. The methodology involves combining a suite of diverse simulation tools. Three-dimensional, steady-state computational fluid dynamics (CFD) software is used to model the change in performance of a commercial aircraft-type inlet and fan geometry due to various levels of AOA. Parallel compressor theory is then applied to assimilate the CFD data with a zero-dimensional, nonlinear, dynamic turbofan engine model. The combined model shows that high AOA operation degrades fan performance and, thus, negatively impacts compressor stability margins and engine thrust. In addition, the engine response to high AOA conditions is shown to be highly dependent upon the type of control system employed.

Cost savings from performance-based maintenance contracting

NARCIS (Netherlands)

Straub, A.

2009-01-01

New procurement approaches combined with performance-based building approaches should reduce costs, but empirical qualitative and quantitative studies are lacking. Performance-based maintenance contracts give maintenance suppliers incentives to improve their way of working. Innovative,

Health care resource use and costs associated with possible side effects of high oral corticosteroid use in asthma: a claims-based analysis

Directory of Open Access Journals (Sweden)

Luskin AT

2016-10-01

Full Text Available Allan T Luskin,1 Evgeniya N Antonova,2 Michael S Broder,3 Eunice Y Chang,3 Theodore A Omachi,2 Dennis K Ledford4 1HealthyAirways, Madison, WI, 2Genentech, Inc., South San Francisco, 3Partnership for Health Analytic Research, LLC, Beverly Hills, CA, 4Division of Allergy and Immunology, Department of Medicine, James A. Haley Veterans’ Hospital, Morsani College of Medicine, University of South Florida, Tampa, FL, USA Background: The objective of this study was to estimate the prevalence of possible oral corticosteroid (OCS-related side effects and health care resource use and costs in patients with asthma.Methods: This was a cross-sectional, matched-cohort, retrospective study using a commercial claims database. Adults with asthma diagnosis codes and evidence of asthma medication use were studied. Patients with high OCS use (≥30 days of OCS annually were divided into those who did versus those who did not experience OCS-related possible side effects. Their health care resource use and costs were compared using linear regression or negative binomial regression models, adjusting for age, sex, geographic region, Charlson Comorbidity Index score, and chronic obstructive pulmonary disease status.Results: After adjustment, high OCS users with possible side effects were more likely to have office visits (23.0 vs 19.6; P<0.001 and hospitalizations (0.44 vs 0.22; P<0.001 than those without possible side effects. Emergency department visits were similar between the groups. High OCS users with possible side effects had higher adjusted total annual mean health care costs ($25,168 than those without such side effects ($21,882; P=0.009.Conclusion: Among high OCS users, patients with possible OCS-related side effects are more likely to use health care services than those without such side effects. Although OCS may help control asthma and manage exacerbations, OCS side effects may result in additional health care resource use and costs, highlighting the need

The Opportunity for High-Performance Biomaterials from Methane

Directory of Open Access Journals (Sweden)

Peter James Strong

2016-02-01

Full Text Available Polyhydroxyalkanoate (PHA biopolymers are widely recognised as outstanding candidates to replace conventional petroleum-derived polymers. Their mechanical properties are good and can be tailored through copolymer composition, they are biodegradable, and unlike many alternatives, they do not rely on oil-based feedstocks. Further, they are the only commodity polymer that can be synthesised intracellularly, ensuring stereoregularity and high molecular weight. However, despite offering enormous potential for many years, they are still not making a significant impact. This is broadly because commercial uptake has been limited by variable performance (inconsistent polymer properties and high production costs of the raw polymer. Additionally, the main type of PHA produced naturally is poly-3-hydroxybutyrate (PHB, which has limited scope due to its brittle nature and low thermal stability, as well as its tendency to embrittle over time. Production cost is strongly impacted by the type of the feedstock used. In this article we consider: the production of PHAs from methanotrophs using methane as a cost-effective substrate; the use of mixed cultures, as opposed to pure strains; and strategies to generate a poly(3-hydroxybutyrate-co-3-hydroxyvalerate copolymer (PHBV, which has more desirable qualities such as toughness and elasticity.

Performance and cost benefits associated with nonimaging secondary concentrators used in point-focus dish solar thermal applications

Science.gov (United States)

Ogallagher, J.; Winston, R.

1987-09-01

Using nonimaging secondary concentrators in point-focus applications may permit the development of more cost-effective concentrator systems by either improving performance or reducing costs. Secondaries may also increase design flexibility. The major objective of this study was to develop as complete an understanding as possible of the quantitative performance and cost effects associated with deploying nonimaging secondary concentrators at the focal zone of point-focus solar thermal concentrators. A performance model was developed that uses a Monte Carlo ray-trace procedure to determine the focal plane distribution of a paraboloidal primary as a function of optical parameters. It then calculates the corresponding optimized concentration and thermal efficiency as a function of temperature with and without the secondary. To examine the potential cost benefits associated with secondaries, a preliminary model for the rational optimization of performance versus cost trade-offs was developed. This model suggests a possible 10 to 20 percent reduction in the cost of delivered energy when secondaries are used. This is a lower limit, and the benefits may even be greater if using a secondary permits the development of inexpensive primary technologies for which the performance would not otherwise be viable.

Cost-effectiveness Analysis of Antipsychotic Combination Therapy in Schizophrenia Inpatients

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Rizky Abdulah

2017-03-01

Full Text Available Schizophrenia is one of mental disorders with high cost and lifetime morbidity risk. Hence, it is necessary to analyze the cost-effectiveness of various combinations of antipsychotics. The aim of this study was to analyze the most cost-effective group of antipsychotic combinations in schizophrenia inpatients in West Java Psychiatric Hospital during 2012–2013. Data were collected retrospectively from medical record of patients who used antipsychotics clozapine-haloperidol or clozapine-risperidone therapy. Direct medical costs were obtained from antipsychotics costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The results showed that the average cost-effectiveness ratio of antipsychotic clozapine-haloperidol was Rp126.898/day and Rp132.781/day for the combination of clozapine-haloperidol and clozapine-risperidone, respectively. Considering length of stay as the therapy effectiveness, it can be concluded that the combination of clozapine-haloperidol is more cost-effective than clozapine-risperidone.

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model

Science.gov (United States)

Laramée, Philippe; Brodtkorb, Thor-Henrik; Rahhali, Nora; Knight, Chris; Barbosa, Carolina; François, Clément; Toumi, Mondher; Daeppen, Jean-Bernard; Rehm, Jürgen

2014-01-01

Objectives To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Design Decision modelling using Markov chains compared costs and effects over 5 years. Setting The analysis was from the perspective of the National Health Service (NHS) in England and Wales. Participants The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. Data sources We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. Main outcome measures We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Results Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20 000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to psychosocial support alone over the course of 5 years. Conclusions

The Science of Cost-Effective Materials Design - A Study in the Development of a High Strength, Impact Resistant Steel

Science.gov (United States)

Abrahams, Rachel

2017-06-01

Intermediate alloy steels are widely used in applications where both high strength and toughness are required for extreme/dynamic loading environments. Steels containing greater than 10% Ni-Co-Mo are amongst the highest strength martensitic steels, due to their high levels of solution strengthening, and preservation of toughness through nano-scaled secondary hardening, semi-coherent hcp-M2 C carbides. While these steels have high yield strengths (σy 0.2 % >1200 MPa) with high impact toughness values (CVN@-40 >30J), they are often cost-prohibitive due to the material and processing cost of nickel and cobalt. Early stage-I steels such as ES-1 (Eglin Steel) were developed in response to the high cost of nickel-cobalt steels and performed well in extreme shock environments due to the presence of analogous nano-scaled hcp-Fe2.4 C epsilon carbides. Unfortunately, the persistence of W-bearing carbides limited the use of ES-1 to relatively thin sections. In this study, we discuss the background and accelerated development cycle of AF96, an alternative Cr-Mo-Ni-Si stage-I temper steel using low-cost heuristic and Integrated Computational Materials Engineering (ICME)-assisted methods. The microstructure of AF96 was tailored to mimic that of ES-1, while reducing stability of detrimental phases and improving ease of processing in industrial environments. AF96 is amenable to casting and forging, deeply hardenable, and scalable to 100,000 kg melt quantities. When produced at the industrial scale, it was found that AF96 exhibits near-statistically identical mechanical properties to ES-1 at 50% of the cost.

Cost-effectiveness of maternal GBS immunization in low-income sub-Saharan Africa.

Science.gov (United States)

Russell, Louise B; Kim, Sun-Young; Cosgriff, Ben; Pentakota, Sri Ram; Schrag, Stephanie J; Sobanjo-Ter Meulen, Ajoke; Verani, Jennifer R; Sinha, Anushua

2017-12-14

A maternal group B streptococcal (GBS) vaccine could prevent neonatal sepsis and meningitis. Its cost-effectiveness in low-income sub-Saharan Africa, a high burden region, is unknown. We used a decision tree model, with Markov nodes to project infants' lifetimes, to compare maternal immunization delivered through routine antenatal care with no immunization. 37 countries were clustered on the basis of economic and health resources and past public health performance. Vaccine efficacy for covered serotypes was ranged from 50% to 90%. The model projected EOGBS (early-onset) and LOGBS (late-onset) cases and deaths, disability-adjusted life years (DALYs), healthcare costs (2014 US$), and cost-effectiveness for a representative country in each of the four clusters: Guinea-Bissau, Uganda, Nigeria, and Ghana. Maximum vaccination costs/dose were estimated to meet two cost-effectiveness benchmarks, 0.5 GDP and GDP per capita/DALY, for ranges of disease incidence (reported and adjusted for under-reporting) and vaccine efficacy. At coverage equal to the proportion of pregnant women with≥4 antenatal visits (ANC4) and serotype-specific vaccine efficacy of 70%, maternal GBS immunization would prevent one-third of GBS cases and deaths in Uganda and Nigeria, where ANC4 is 50%, 42-43% in Guinea-Bissau (ANC4=65%), and 55-57% in Ghana (ANC4=87%). At a vaccination cost of $7/dose, maternal immunization would cost $320-$350/DALY averted in Guinea-Bissau, Nigeria, and Ghana, less than half these countries' GDP per capita. In Uganda, which has the lowest case fatality ratios, the cost would be $573/DALY. If the vaccine prevents a small proportion of stillbirths, it would be even more cost-effective. Vaccination cost/dose, disease incidence, and case fatality were key drivers of cost/DALY in sensitivity analyses. Maternal GBS immunization could be a cost-effective intervention in low-income sub-Saharan Africa, with cost-effectiveness ratios similar to other recently introduced vaccines

A cost-effect analysis of an intervention against radon in homes

Directory of Open Access Journals (Sweden)

Hein Stigum

2009-10-01

Full Text Available Background  Key words  : Radon exposure, lung cancer, cost-effect analysis, attributable risk, models-mathematical: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m-3 and improving these, and of protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. Methods: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean=74.5 Bq/m3, and 7.6% above 200 Bq/m3. Results: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%. In cumulative present values the intervention would cost $238 (145, 310 million and save 892 (133, 1981 lives, each life saved costs $0.27 (0.09, 0.9 million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. Conclusions: Reducing the radon concentration in present and future homes to below 200 Bq/m3 will cost $0.27 (0.09, 0.9 million per life saved. The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. We therefore conclude that the intervention against radon in homes is justifiable. The willingness to pay is also larger that the upper uncertainty limit of the cost per life. Our conclusion is therefore robust against the uncertainties in the parameters.

Cost-effectiveness analysis and innovation.

Science.gov (United States)

Jena, Anupam B; Philipson, Tomas J

2008-09-01

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

Final Report - High Performance, Durable, Low Cost Membrane Electrode Assemblies for Transportation Applications

Energy Technology Data Exchange (ETDEWEB)

Steinbach, Andrew [3M Company, Maplewood, MN (United States)

2017-05-31

The primary project objective was development of improved polymer electrolyte membrane fuel cell (PEMFC) membrane electrode assemblies (MEAs) which address the key DOE barriers of performance, durability and cost. Additional project objectives were to address commercialization barriers specific to MEAs comprising 3M nanostructured thin film (NSTF) electrodes, including a larger-than-acceptable sensitivity to operating conditions, an unexplained loss of rated power capability with operating time, and slow break-in conditioning. Significant progress was made against each of these barriers, and most DOE 2020 targets were met or substantially approached.

Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

International Nuclear Information System (INIS)

Ribeiro, Rodrigo Antonini; Duncan, Bruce Bartholow; Ziegelmann, Patricia Klarmann; Stella, Steffan Frosi; Vieira, Jose Luiz da Costa; Restelatto, Luciane Maria Fabian; Polanczyk, Carisi Anne

2015-01-01

Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil

Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

Energy Technology Data Exchange (ETDEWEB)

Ribeiro, Rodrigo Antonini, E-mail: rodrigo.ribeiro@htanalyze.com [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Duncan, Bruce Bartholow [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Ziegelmann, Patricia Klarmann [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Departamento de Estatística da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Stella, Steffan Frosi [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Vieira, Jose Luiz da Costa [Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil); Restelatto, Luciane Maria Fabian [Serviço de Medicina Interna do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS (Brazil); Polanczyk, Carisi Anne [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil)

2015-01-15

Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

Cost-effectiveness analysis of rotavirus vaccination in Argentina.

Science.gov (United States)

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

2015-05-07

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

Simulation of the cost-effectiveness of malaria vaccines

Directory of Open Access Journals (Sweden)

Tediosi Fabrizio

2009-06-01

Full Text Available Abstract Background A wide range of possible malaria vaccines is being considered and there is a need to identify which vaccines should be prioritized for clinical development. An important element of the information needed for this prioritization is a prediction of the cost-effectiveness of potential vaccines in the transmission settings in which they are likely to be deployed. This analysis needs to consider a range of delivery modalities to ensure that clinical development plans can be aligned with the most appropriate deployment strategies. Methods The simulations are based on a previously published individual-based stochastic model for the natural history and epidemiology of Plasmodium falciparum malaria. Three different vaccine types: pre-erythrocytic vaccines (PEV, blood stage vaccines (BSV, mosquito-stage transmission-blocking vaccines (MSTBV, and combinations of these, are considered each delivered via a range of delivery modalities (Expanded Programme of Immunization – EPI-, EPI with booster, and mass vaccination combined with EPI. The cost-effectiveness ratios presented are calculated for four health outcomes, for assumed vaccine prices of US$ 2 or US$ 10 per dose, projected over a 10-year period. Results The simulations suggest that PEV will be more cost-effective in low transmission settings, while BSV at higher transmission settings. Combinations of BSV and PEV are more efficient than PEV, especially in moderate to high transmission settings, while compared to BSV they are more cost-effective in moderate to low transmission settings. Combinations of MSTBV and PEV or PEV and BSV improve the effectiveness and the cost-effectiveness compared to PEV and BSV alone only when applied with EPI and mass vaccinations. Adding booster doses to the EPI is unlikely to be a cost-effective alternative to delivering vaccines via the EPI for any vaccine, while mass vaccination improves effectiveness, especially in low transmission settings, and is

Cost-effectiveness of methadone maintenance therapy as HIV prevention in an Indonesian high-prevalence setting: a mathematical modeling study.

Science.gov (United States)

Wammes, Joost J G; Siregar, Adiatma Y; Hidayat, Teddy; Raya, Reynie P; van Crevel, Reinout; van der Ven, André J; Baltussen, Rob

2012-09-01

Indonesia faces an HIV epidemic that is in rapid transition. Injecting drug users (IDUs) are among the most heavily affected risk populations, with estimated prevalence of HIV reaching 50% or more in most parts of the country. Although Indonesia started opening methadone clinics in 2003, coverage remains low. We used the Asian Epidemic Model and Resource Needs Model to evaluate the long-term population-level preventive impact of expanding Methadone Maintenance Therapy (MMT) in West Java (43 million people). We compared intervention costs and the number of incident HIV cases in the intervention scenario with current practice to establish the cost per infection averted by expanding MMT. An extensive sensitivity analysis was performed on costs and epidemiological input, as well as on the cost-effectiveness calculation itself. Our analysis shows that expanding MMT from 5% coverage now to 40% coverage in 2019 would avert approximately 2400 HIV infections, at a cost of approximately US$7000 per HIV infection averted. Sensitivity analyses demonstrate that the use of alternative assumptions does not change the study conclusions. Our analyses suggest that expanding MMT is cost-effective, and support government policies to make MMT widely available as an integrated component of HIV/AIDS control in West Java. Copyright © 2012 Elsevier B.V. All rights reserved.

Final Technical Report - Recovery Act: Organic Coatings as Encapsulants for Low Cost, High Performance PV Modules

Energy Technology Data Exchange (ETDEWEB)

Stuart Hellring; Jiping Shao; James Poole

2011-12-05

The objective of this project was to evaluate the feasibility of utilizing PPG's commercial organic coatings systems as efficient, modernized encapsulants for low cost, high performance, thin film photovoltaic modules. Our hypothesis was that the combination of an anticorrosive coating with a more traditional barrier topcoat would mitigate many electrochemical processes that are now responsible for the significant portion of photovoltaic (PV) failures, thereby nullifying the extremely high moisture barrier requirements of currently used encapsulation technology. Nine commercially available metal primer coatings and six commercially available top coatings were selected for screening. Twenty-one different primer/top coat combinations were evaluated. The primer coatings were shown to be the major contributor to corrosion inhibition, adhesion, and barrier properties. Two primer coatings and one top coating were downselected for testing on specially-fabricated test modules. The coated test modules passed initial current leakage and insulation testing. Damp Heat testing of control modules showed visible corrosion to the bus bar metal, whereas the coated modules showed none. One of the primer/top coat combinations retained solar power performance after Damp Heat testing despite showing some delamination at the EVA/solar cell interface. Thermal Cycling and Humidity Freeze testing resulted in only one test module retaining its power performance. Failure modes depended on the particular primer/top coating combination used. Overall, this study demonstrated that a relatively thin primer/top coating has the potential to replace the potting film and backsheet in crystalline silicon-based photovoltaic modules. Positive signals were received from commercially available coatings developed for applications having performance requirements different from those required for photovoltaic modules. It is likely that future work to redesign and customize these coatings would result in

CALiPER Report 21.3. Cost Effectiveness of Linear (T8) LED Lamps

Energy Technology Data Exchange (ETDEWEB)

None

2014-05-01

Meeting performance expectations is important for driving adoption of linear LED lamps, but cost-effectiveness may be an overriding factor in many cases. Linear LED lamps cost more initially than fluorescent lamps, but energy and maintenance savings may mean that the life-cycle cost is lower. This report details a series of life-cycle cost simulations that compared a two-lamp troffer using LED lamps (38 W total power draw) or fluorescent lamps (51 W total power draw) over a 10-year study period. Variables included LED system cost ($40, $80, or $120), annual operating hours (2,000 hours or 4,000 hours), LED installation time (15 minutes or 30 minutes), and melded electricity rate ($0.06/kWh, $0.12/kWh, $0.18/kWh, or $0.24/kWh). A full factorial of simulations allows users to interpolate between these values to aid in making rough estimates of economic feasibility for their own projects. In general, while their initial cost premium remains high, linear LED lamps are more likely to be cost-effective when electric utility rates are higher than average and hours of operation are long, and if their installation time is shorter.

CALiPER Report 21.3: Cost-Effectiveness of Linear (T8) LED Lamps

Energy Technology Data Exchange (ETDEWEB)

Miller, Naomi J.; Perrin, Tess E.; Royer, Michael P.

2014-05-27

Meeting performance expectations is important for driving adoption of linear LED lamps, but cost-effectiveness may be an overriding factor in many cases. Linear LED lamps cost more initially than fluorescent lamps, but energy and maintenance savings may mean that the life-cycle cost is lower. This report details a series of life-cycle cost simulations that compared a two-lamp troffer using LED lamps (38 W total power draw) or fluorescent lamps (51 W total power draw) over a 10-year study period. Variables included LED system cost ($40, $80, or $120), annual operating hours (2,000 hours or 4,000 hours), LED installation time (15 minutes or 30 minutes), and melded electricity rate ($0.06/kWh, $0.12/kWh, $0.18/kWh, or $0.24/kWh). A full factorial of simulations allows users to interpolate between these values to aid in making rough estimates of economic feasibility for their own projects. In general, while their initial cost premium remains high, linear LED lamps are more likely to be cost-effective when electric utility rates are higher than average and hours of operation are long, and if their installation time is shorter.

Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

Science.gov (United States)

Baltzer, H; Binhammer, P A

2013-08-01

In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

Cost-effectiveness of ergonomic interventions in production

NARCIS (Netherlands)

Looze, M.P. de; Koningsveld, E.P.A.; Fritzsche, L.; O'Sullivan, L.; Levizzari, A.

2008-01-01

Ergonomic measures to reduce or eliminate the risks for developing musculoskeletal disorders, usually affects the performance at work as well, e.g. productivity or quality. The costs and benefits that can be associated with ergonomic measures are highly diverse in nature. Prior to investing in any

Cost-effectiveness of private umbilical cord blood banking.

Science.gov (United States)

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

2009-10-01

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

Effects of cost metric on cost-effectiveness of protected-area network design in urban landscapes.

Science.gov (United States)

Burkhalter, J C; Lockwood, J L; Maslo, B; Fenn, K H; Leu, K

2016-04-01

A common goal in conservation planning is to acquire areas that are critical to realizing biodiversity goals in the most cost-effective manner. The way monetary acquisition costs are represented in such planning is an understudied but vital component to realizing cost efficiencies. We sought to design a protected-area network within a forested urban region that would protect 17 birds of conservation concern. We compared the total costs and spatial structure of the optimal protected-area networks produced using three acquisition-cost surrogates (area, agricultural land value, and tax-assessed land value). Using the tax-assessed land values there was a 73% and 78% cost savings relative to networks derived using area or agricultural land value, respectively. This cost reduction was due to the considerable heterogeneity in acquisition costs revealed in tax-assessed land values, especially for small land parcels, and the corresponding ability of the optimization algorithm to identify lower-cost parcels for inclusion that had equal value to our target species. Tax-assessed land values also reflected the strong spatial differences in acquisition costs (US$0.33/m(2)-$55/m(2)) and thus allowed the algorithm to avoid inclusion of high-cost parcels when possible. Our results add to a nascent but growing literature that suggests conservation planners must consider the cost surrogate they use when designing protected-area networks. We suggest that choosing cost surrogates that capture spatial- and size-dependent heterogeneity in acquisition costs may be relevant to establishing protected areas in urbanizing ecosystems. © 2015 Society for Conservation Biology.

Cost-Effectiveness of the Freeze-All Policy.

Science.gov (United States)

Roque, Matheus; Valle, Marcello; Guimarães, Fernando; Sampaio, Marcos; Geber, Selmo

2015-08-01

To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer. This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles - 351 fresh embryo transfers and 179 freeze-all cycles - with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers. The pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In scenario 1, we included those costs associated with the ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen- thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in treatment costs per ongoing pregnancy. The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.

Is computer aided detection (CAD) cost effective in screening mammography? A model based on the CADET II study

Science.gov (United States)

2011-01-01

Background Single reading with computer aided detection (CAD) is an alternative to double reading for detecting cancer in screening mammograms. The aim of this study is to investigate whether the use of a single reader with CAD is more cost-effective than double reading. Methods Based on data from the CADET II study, the cost-effectiveness of single reading with CAD versus double reading was measured in terms of cost per cancer detected. Cost (Pound (£), year 2007/08) of single reading with CAD versus double reading was estimated assuming a health and social service perspective and a 7 year time horizon. As the equipment cost varies according to the unit size a separate analysis was conducted for high, average and low volume screening units. One-way sensitivity analyses were performed by varying the reading time, equipment and assessment cost, recall rate and reader qualification. Results CAD is cost increasing for all sizes of screening unit. The introduction of CAD is cost-increasing compared to double reading because the cost of CAD equipment, staff training and the higher assessment cost associated with CAD are greater than the saving in reading costs. The introduction of single reading with CAD, in place of double reading, would produce an additional cost of £227 and £253 per 1,000 women screened in high and average volume units respectively. In low volume screening units, the high cost of purchasing the equipment will results in an additional cost of £590 per 1,000 women screened. One-way sensitivity analysis showed that the factors having the greatest effect on the cost-effectiveness of CAD with single reading compared with double reading were the reading time and the reader's professional qualification (radiologist versus advanced practitioner). Conclusions Without improvements in CAD effectiveness (e.g. a decrease in the recall rate) CAD is unlikely to be a cost effective alternative to double reading for mammography screening in UK. This study

Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage.

Science.gov (United States)

Võrno, Triin; Lutsar, Katrin; Uusküla, Anneli; Padrik, Lee; Raud, Terje; Reile, Rainer; Nahkur, Oliver; Kiivet, Raul-Allan

2017-11-01

Estonia has high cervical cancer incidence and low screening coverage. We modelled the impact of population-based bivalent, quadrivalent or nonavalent HPV vaccination alongside cervical cancer screening. A Markov cohort model of the natural history of HPV infection was used to assess the cost-effectiveness of vaccinating a cohort of 12-year-old girls with bivalent, quadrivalent or nonavalent vaccine in two doses in a national, school-based vaccination programme. The model followed the natural progression of HPV infection into subsequent genital warts (GW); premalignant lesions (CIN1-3); cervical, oropharyngeal, vulvar, vaginal and anal cancer. Vaccine coverage was assumed to be 70%. A time horizon of 88years (up to 100years of age) was used to capture all lifetime vaccination costs and benefits. Costs and utilities were discounted using an annual discount rate of 5%. Vaccination of 12-year-old girls alongside screening compared to screening alone had an incremental cost-effectiveness ratio (ICER) of €14,007 (bivalent), €14,067 (quadrivalent) and €11,633 (nonavalent) per quality-adjusted life-year (QALY) in the base-case scenario and ranged between €5367-21,711, €5142-21,800 and €4563-18,142, respectively, in sensitivity analysis. The results were most sensitive to changes in discount rate, vaccination regimen, vaccine prices and cervical cancer screening coverage. Vaccination of 12-year-old girls alongside current cervical cancer screening can be considered a cost-effective intervention in Estonia. Adding HPV vaccination to the national immunisation schedule is expected to prevent a considerable number of HPV infections, genital warts, premalignant lesions, HPV related cancers and deaths. Although in our model ICERs varied slightly depending on the vaccine used, they generally fell within the same range. Cost-effectiveness of HPV vaccination was found to be most dependent on vaccine cost and duration of vaccine immunity, but not on the type of vaccine

High-performance composite chocolate

Science.gov (United States)

Dean, Julian; Thomson, Katrin; Hollands, Lisa; Bates, Joanna; Carter, Melvyn; Freeman, Colin; Kapranos, Plato; Goodall, Russell

2013-07-01

The performance of any engineering component depends on and is limited by the properties of the material from which it is fabricated. It is crucial for engineering students to understand these material properties, interpret them and select the right material for the right application. In this paper we present a new method to engage students with the material selection process. In a competition-based practical, first-year undergraduate students design, cost and cast composite chocolate samples to maximize a particular performance criterion. The same activity could be adapted for any level of education to introduce the subject of materials properties and their effects on the material chosen for specific applications.

Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

Science.gov (United States)

Derdeyn, C P; Powers, W J

1996-11-01

The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

Stretchable and High-Performance Supercapacitors with Crumpled Graphene Papers

Science.gov (United States)

Zang, Jianfeng; Cao, Changyong; Feng, Yaying; Liu, Jie; Zhao, Xuanhe

2014-01-01

Fabrication of unconventional energy storage devices with high stretchability and performance is challenging, but critical to practical operations of fully power-independent stretchable electronics. While supercapacitors represent a promising candidate for unconventional energy-storage devices, existing stretchable supercapacitors are limited by their low stretchability, complicated fabrication process, and high cost. Here, we report a simple and low-cost method to fabricate extremely stretchable and high-performance electrodes for supercapacitors based on new crumpled-graphene papers. Electrolyte-mediated-graphene paper bonded on a compliant substrate can be crumpled into self-organized patterns by harnessing mechanical instabilities in the graphene paper. As the substrate is stretched, the crumpled patterns unfold, maintaining high reliability of the graphene paper under multiple cycles of large deformation. Supercapacitor electrodes based on the crumpled graphene papers exhibit a unique combination of high stretchability (e.g., linear strain ~300%, areal strain ~800%), high electrochemical performance (e.g., specific capacitance ~196 F g−1), and high reliability (e.g., over 1000 stretch/relax cycles). An all-solid-state supercapacitor capable of large deformation is further fabricated to demonstrate practical applications of the crumpled-graphene-paper electrodes. Our method and design open a wide range of opportunities for manufacturing future energy-storage devices with desired deformability together with high performance. PMID:25270673

Stretchable and High-Performance Supercapacitors with Crumpled Graphene Papers

Science.gov (United States)

Zang, Jianfeng; Cao, Changyong; Feng, Yaying; Liu, Jie; Zhao, Xuanhe

2014-10-01

Fabrication of unconventional energy storage devices with high stretchability and performance is challenging, but critical to practical operations of fully power-independent stretchable electronics. While supercapacitors represent a promising candidate for unconventional energy-storage devices, existing stretchable supercapacitors are limited by their low stretchability, complicated fabrication process, and high cost. Here, we report a simple and low-cost method to fabricate extremely stretchable and high-performance electrodes for supercapacitors based on new crumpled-graphene papers. Electrolyte-mediated-graphene paper bonded on a compliant substrate can be crumpled into self-organized patterns by harnessing mechanical instabilities in the graphene paper. As the substrate is stretched, the crumpled patterns unfold, maintaining high reliability of the graphene paper under multiple cycles of large deformation. Supercapacitor electrodes based on the crumpled graphene papers exhibit a unique combination of high stretchability (e.g., linear strain ~300%, areal strain ~800%), high electrochemical performance (e.g., specific capacitance ~196 F g-1), and high reliability (e.g., over 1000 stretch/relax cycles). An all-solid-state supercapacitor capable of large deformation is further fabricated to demonstrate practical applications of the crumpled-graphene-paper electrodes. Our method and design open a wide range of opportunities for manufacturing future energy-storage devices with desired deformability together with high performance.