WorldWideScience

Sample records for rapid cost improvement

  1. Improved rapid magnitude estimation for a community-based, low-cost MEMS accelerometer network

    Science.gov (United States)

    Chung, Angela I.; Cochran, Elizabeth S.; Kaiser, Anna E.; Christensen, Carl M.; Yildirim, Battalgazi; Lawrence, Jesse F.

    2015-01-01

    Immediately following the Mw 7.2 Darfield, New Zealand, earthquake, over 180 Quake‐Catcher Network (QCN) low‐cost micro‐electro‐mechanical systems accelerometers were deployed in the Canterbury region. Using data recorded by this dense network from 2010 to 2013, we significantly improved the QCN rapid magnitude estimation relationship. The previous scaling relationship (Lawrence et al., 2014) did not accurately estimate the magnitudes of nearby (estimates earthquake magnitudes within 1 magnitude unit of the GNS Science GeoNet earthquake catalog magnitudes for 99% of the events tested, within 0.5 magnitude units for 90% of the events, and within 0.25 magnitude units for 57% of the events. These magnitudes are reliably estimated within 3 s of the initial trigger recorded on at least seven stations. In this report, we present the methods used to calculate a new scaling relationship and demonstrate the accuracy of the revised magnitude estimates using a program that is able to retrospectively estimate event magnitudes using archived data.

  2. Reduction of mesqa improvement costs

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed Saad ElFetyany

    2017-10-01

    Results show that using the revised approach brings down the cost of mesqa improvement from nearly 10,000LE/fed at present to about 6000LE/fed. These reductions based on the analyses of different mesqa modelling through the adoption of certain parameters such as feasibility of the revised design, effective application of continuous flow for water distribution, and downsizing of the capacity of improved mesqas.

  3. Rapid, cost-effective liquid chromatograghic method for the ...

    African Journals Online (AJOL)

    GRACE

    2006-07-03

    Jul 3, 2006 ... 1Department of Medicinal Chemistry and Quality Control, National Institute for Pharmaceutical Research and Development, Abuja,. Nigeria. ... A rapid and cost effective method for the analysis of metronidazole in biological samples was ... effective HPLC method of assaying metronidazole both in.

  4. Systematic Review of the Cost and Cost-Effectiveness of Rapid Endovascular Therapy for Acute Ischemic Stroke.

    Science.gov (United States)

    Sevick, Laura K; Ghali, Sarah; Hill, Michael D; Danthurebandara, Vishva; Lorenzetti, Diane L; Noseworthy, Tom; Spackman, Eldon; Clement, Fiona

    2017-09-01

    Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of EVT for ischemic stroke patients and to synthesize all the publicly available economic literature. A systematic review of the published literature was conducted to identify economic evaluations and cost analyses of EVT for acute ischemic stroke patients. Systematic review best practices were followed, and study quality was assessed. Four-hundred sixty-three articles were identified from electronic databases. After deduplication, abstract review, and full-text review, 17 studies were included. Seven of the studies were cost analyses, and 10 were cost-effectiveness studies. Generally, the cost analyses reported on the cost of the approach/procedure or the hospitalization costs associated with EVT. All of the cost-effectiveness studies reported a cost per quality-adjusted life year as the primary outcomes. Studies varied in regards to the costs considered, the perspective adopted, and the time horizon used. All the studies reported a cost per quality-adjusted life year of cost and cost-effectiveness of EVT. The cost analyses suggested that although EVT was associated with higher costs, it also resulted in improved patient outcomes. From the cost-effectiveness studies, EVT seems to be good value for money when a threshold of $50 000 per quality-adjusted life year gained is adopted. © 2017 American Heart Association, Inc.

  5. Benchmarking for Cost Improvement. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-01

    The US Department of Energy`s (DOE) Office of Environmental Restoration and Waste Management (EM) conducted the Benchmarking for Cost Improvement initiative with three objectives: Pilot test benchmarking as an EM cost improvement tool; identify areas for cost improvement and recommend actions to address these areas; provide a framework for future cost improvement. The benchmarking initiative featured the use of four principal methods (program classification, nationwide cost improvement survey, paired cost comparison and component benchmarking). Interested parties contributed during both the design and execution phases. The benchmarking initiative was conducted on an accelerated basis. Of necessity, it considered only a limited set of data that may not be fully representative of the diverse and complex conditions found at the many DOE installations. The initiative generated preliminary data about cost differences and it found a high degree of convergence on several issues. Based on this convergence, the report recommends cost improvement strategies and actions. This report describes the steps taken as part of the benchmarking initiative and discusses the findings and recommended actions for achieving cost improvement. The results and summary recommendations, reported below, are organized by the study objectives.

  6. Cost-effectiveness of rapid susceptibility testing against second-line drugs for tuberculosis

    NARCIS (Netherlands)

    Dowdy, D. W.; van't Hoog, A.; Shah, M.; Cobelens, F.

    2014-01-01

    Drug susceptibility testing (DST) against second-line tuberculosis drugs (SLDs) is essential for improving outcomes among multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) cases. To evaluate the potential cost-effectiveness of rapid DST for SLDs. We constructed a

  7. Applying Lean principles and Kaizen rapid improvement events in public health practice.

    Science.gov (United States)

    Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D

    2012-01-01

    This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

  8. Rapid Cost Assessment of Space Mission Concepts Through Application of Complexity-Based Cost Indices

    Science.gov (United States)

    Peterson, Craig E.; Cutts, James; Balint, Tibor; Hall, James B.

    2008-01-01

    This slide presentation reviews the development of a rapid cost assessment models for evaluation of exploration missions through the application of complexity based cost indices. In Fall of 2004, NASA began developing 13 documents, known as "strategic roadmaps," intended to outline a strategy for space exploration over the next 30 years. The Third Strategic Roadmap, The Strategic Roadmap for Solar System Exploration, focused on strategy for robotic exploration of the Solar System. Development of the Strategic Roadmap for Solar System Exploration led to the investigation of a large variety of missions. However, the necessity of planning around scientific inquiry and budgetary constraints made it necessary for the roadmap development team to evaluate potential missions not only for scientific return but also cost. Performing detailed cost studies for each of the large number of missions was impractical given the time constraints involved and lack of detailed mission studies; so a method of rapid cost assessment was developed by us to allow preliminary analysis. It has been noted that there is a strong correlation between complexity and cost and schedule of planetary missions. While these correlations were made after missions had been built and flown (successfully or otherwise), it seemed likely that a similar approach could provide at least some relative cost ranking. Cost estimation relationships (CERs) have been developed based on subsystem design choices. These CERs required more detailed information than available, forcing the team to adopt a more high level approach. Costing by analogy has been developed for small satellites, however, planetary exploration missions provide such varying spacecraft requirements that there is a lack of adequately comparable missions that can be used for analogy.

  9. The value journey: improving cost structure through performance improvement.

    Science.gov (United States)

    DeMarco, Victor G; Richards, Barton S; Volkmar, Larry; Gorski, Lauren C

    2016-06-01

    A performance improvement project helped Bronx-Lebanon Hospital Center in New York, which serves a highly indigent population, to increase efficiencies and cost savings as it moved toward value-based health care. Specific initiatives included in-depth analyses of provider and employee productivity, performed by focus teams led by executive sponsors and the department directors or managers. Through two broad phases, focusing on nonlabor and labor areas, the organization was able to realize savings amounting to more than $20 million.

  10. Rapidly falling costs of battery packs for electric vehicles

    Science.gov (United States)

    Nykvist, Björn; Nilsson, Måns

    2015-04-01

    To properly evaluate the prospects for commercially competitive battery electric vehicles (BEV) one must have accurate information on current and predicted cost of battery packs. The literature reveals that costs are coming down, but with large uncertainties on past, current and future costs of the dominating Li-ion technology. This paper presents an original systematic review, analysing over 80 different estimates reported 2007-2014 to systematically trace the costs of Li-ion battery packs for BEV manufacturers. We show that industry-wide cost estimates declined by approximately 14% annually between 2007 and 2014, from above US$1,000 per kWh to around US$410 per kWh, and that the cost of battery packs used by market-leading BEV manufacturers are even lower, at US$300 per kWh, and has declined by 8% annually. Learning rate, the cost reduction following a cumulative doubling of production, is found to be between 6 and 9%, in line with earlier studies on vehicle battery technology. We reveal that the costs of Li-ion battery packs continue to decline and that the costs among market leaders are much lower than previously reported. This has significant implications for the assumptions used when modelling future energy and transport systems and permits an optimistic outlook for BEVs contributing to low-carbon transport.

  11. Low Cost Rapid Response Spacecraft, (LCRRS): A Research Project in Low Cost Spacecraft Design and Fabrication in a Rapid Prototyping Environment

    Science.gov (United States)

    Spremo, Stevan; Bregman, Jesse; Dallara, Christopher D.; Ghassemieh, Shakib M.; Hanratty, James; Jackson, Evan; Kitts, Christopher; Klupar, Pete; Lindsay, Michael; Ignacio, Mas; hide

    2009-01-01

    The Low Cost Rapid Response Spacecraft (LCRRS) is an ongoing research development project at NASA Ames Research Center (ARC), Moffett Field, California. The prototype spacecraft, called Cost Optimized Test for Spacecraft Avionics and Technologies (COTSAT) is the first of what could potentially be a series of rapidly produced low-cost satellites. COTSAT has a target launch date of March 2009 on a SpaceX Falcon 9 launch vehicle. The LCRRS research system design incorporates use of COTS (Commercial Off The Shelf), MOTS (Modified Off The Shelf), and GOTS (Government Off The Shelf) hardware for a remote sensing satellite. The design concept was baselined to support a 0.5 meter Ritchey-Chretien telescope payload. This telescope and camera system is expected to achieve 1.5 meter/pixel resolution. The COTSAT team is investigating the possibility of building a fully functional spacecraft for $500,000 parts and $2,000,000 labor. Cost is dramatically reduced by using a sealed container, housing the bus and payload subsystems. Some electrical and RF designs were improved/upgraded from GeneSat-1 heritage systems. The project began in January 2007 and has yielded two functional test platforms. It is expected that a flight-qualified unit will be finished in December 2008. Flight quality controls are in place on the parts and materials used in this development with the aim of using them to finish a proto-flight satellite. For LEO missions the team is targeting a mission class requiring a minimum of six months lifetime or more. The system architecture incorporates several design features required by high reliability missions. This allows for a true skunk works environment to rapidly progress toward a flight design. Engineering and fabrication is primarily done in-house at NASA Ames with flight certifications on materials. The team currently employs seven Full Time Equivalent employees. The success of COTSATs small team in this effort can be attributed to highly cross trained

  12. Composite Dry Structure Cost Improvement Approach

    Science.gov (United States)

    Nettles, Alan; Nettles, Mindy

    2015-01-01

    This effort demonstrates that by focusing only on properties of relevance, composite interstage and shroud structures can be placed on the Space Launch System vehicle that simultaneously reduces cost, improves reliability, and maximizes performance, thus providing the Advanced Development Group with a new methodology of how to utilize composites to reduce weight for composite structures on launch vehicles. Interstage and shroud structures were chosen since both of these structures are simple in configuration and do not experience extreme environments (such as cryogenic or hot gas temperatures) and should represent a good starting point for flying composites on a 'man-rated' vehicle. They are used as an example only. The project involves using polymer matrix composites for launch vehicle structures, and the logic and rationale behind the proposed new methodology.

  13. Rapid-fire improvement with short-cycle kaizen.

    Science.gov (United States)

    Heard, E

    1999-05-01

    Continuous improvement is an attractive idea, but it is typically more myth than reality. SCK is no myth. It delivers dramatic improvements in traditional measures quickly. SCK accomplishes this via kaizens: rapid, repeated, time-compressed changes for the better in bite-sized chunks of the business.

  14. Improving the Acute Myocardial Infarction Rapid Rule Out process.

    Science.gov (United States)

    Hyden, Rachel; Fields, Willa

    2010-01-01

    Bedside staff nurses are in a unique position to identify implementation problems and ways to improve compliance with evidence-based practice guidelines. The goal of this performance improvement project was to improve compliance with an evidence-based Acute Myocardial Infarction Rapid Rule Out pathway. The purpose of the article is to demonstrate how a bedside staff nurse was able to decrease wait times and length of stay for patients with low-risk chest pain while applying evidence-based practice.

  15. Rapid economic analysis of northern hardwood stand improvement options

    Science.gov (United States)

    William B. Leak

    1980-01-01

    Data and methodology are provided for projecting basal area, diameter, volumes, and values by product for northern hardwood stands, and for determining the rate of return on stand improvement investments. The method is rapid, requires a minimum amount of information, and should prove useful for on-the-ground economic analyses.

  16. A low cost rapid prototype platform for a three phase PFC rectifier application

    DEFF Research Database (Denmark)

    Haase, Frerk; Kouchaki, Alireza; Nymand, Morten

    2015-01-01

    In this paper the design and development of a low cost rapid prototype platform for a Three Phase PFC rectifier application is presented. The active rectifier consists of a SiC-MOSFET based PWM converter and a low cost rapid prototype platform for simulating and implementing the digital control...... is then performed using automatic code generation for embedded targets, which provided a close link between simulation and implementation of the PFC controller. The paper shows how this rapid prototype platform developed and how it was used for the design and implementation of the controller for a high efficient Si...

  17. Low-Cost Inkjet Printing Technology for the Rapid Prototyping of Transducers

    Science.gov (United States)

    Andò, Bruno; Baglio, Salvatore; Bulsara, Adi R.; Emery, Teresa; Marletta, Vincenzo; Pistorio, Antonio

    2017-01-01

    Recently, there has been an upsurge in efforts dedicated to developing low-cost flexible electronics by exploiting innovative materials and direct printing technologies. This interest is motivated by the need for low-cost mass-production, shapeable, and disposable devices, and the rapid prototyping of electronics and sensors. This review, following a short overview of main printing processes, reports examples of the development of flexible transducers through low-cost inkjet printing technology. PMID:28368318

  18. Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?

    OpenAIRE

    Rolland, E; Checchi, F; Pinoges, L.; Balkan, S; Guthmann, J P; Guerin, P. J.

    2006-01-01

    OBJECTIVE: To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). METHODS: We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effect...

  19. Low-Cost Inkjet Printing Technology for the Rapid Prototyping of Transducers.

    Science.gov (United States)

    Andò, Bruno; Baglio, Salvatore; Bulsara, Adi R; Emery, Teresa; Marletta, Vincenzo; Pistorio, Antonio

    2017-04-01

    Recently, there has been an upsurge in efforts dedicated to developing low-cost flexible electronics by exploiting innovative materials and direct printing technologies. This interest is motivated by the need for low-cost mass-production, shapeable, and disposable devices, and the rapid prototyping of electronics and sensors. This review, following a short overview of main printing processes, reports examples of the development of flexible transducers through low-cost inkjet printing technology.

  20. A Rapid and Low-Cost PCR Thermal Cycler for Infectious Disease Diagnostics.

    Science.gov (United States)

    Chan, Kamfai; Wong, Pui-Yan; Yu, Peter; Hardick, Justin; Wong, Kah-Yat; Wilson, Scott A; Wu, Tiffany; Hui, Zoe; Gaydos, Charlotte; Wong, Season S

    2016-01-01

    The ability to make rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a great step forward in global health. Many molecular diagnostic assays are developed based on using thermal cyclers to carry out polymerase chain reaction (PCR) and reverse-transcription PCR for DNA and RNA amplification and detection, respectively. Unfortunately, most commercial thermal cyclers are expensive and need continuous electrical power supply, so they are not suitable for uses in low-resource settings. We have previously reported a low-cost and simple approach to amplify DNA using vacuum insulated stainless steel thermoses food cans, which we have named it thermos thermal cycler or TTC. Here, we describe the use of an improved set up to enable the detection of viral RNA targets by reverse-transcription PCR (RT-PCR), thus expanding the TTC's ability to identify highly infectious, RNA virus-based diseases in low resource settings. The TTC was successful in demonstrating high-speed and sensitive detection of DNA or RNA targets of sexually transmitted diseases, HIV/AIDS, Ebola hemorrhagic fever, and dengue fever. Our innovative TTC costs less than $200 to build and has a capacity of at least eight tubes. In terms of speed, the TTC's performance exceeded that of commercial thermal cyclers tested. When coupled with low-cost endpoint detection technologies such as nucleic acid lateral-flow assay or a cell-phone-based fluorescence detector, the TTC will increase the availability of on-site molecular diagnostics in low-resource settings.

  1. A Rapid and Low-Cost PCR Thermal Cycler for Infectious Disease Diagnostics.

    Directory of Open Access Journals (Sweden)

    Kamfai Chan

    Full Text Available The ability to make rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a great step forward in global health. Many molecular diagnostic assays are developed based on using thermal cyclers to carry out polymerase chain reaction (PCR and reverse-transcription PCR for DNA and RNA amplification and detection, respectively. Unfortunately, most commercial thermal cyclers are expensive and need continuous electrical power supply, so they are not suitable for uses in low-resource settings. We have previously reported a low-cost and simple approach to amplify DNA using vacuum insulated stainless steel thermoses food cans, which we have named it thermos thermal cycler or TTC. Here, we describe the use of an improved set up to enable the detection of viral RNA targets by reverse-transcription PCR (RT-PCR, thus expanding the TTC's ability to identify highly infectious, RNA virus-based diseases in low resource settings. The TTC was successful in demonstrating high-speed and sensitive detection of DNA or RNA targets of sexually transmitted diseases, HIV/AIDS, Ebola hemorrhagic fever, and dengue fever. Our innovative TTC costs less than $200 to build and has a capacity of at least eight tubes. In terms of speed, the TTC's performance exceeded that of commercial thermal cyclers tested. When coupled with low-cost endpoint detection technologies such as nucleic acid lateral-flow assay or a cell-phone-based fluorescence detector, the TTC will increase the availability of on-site molecular diagnostics in low-resource settings.

  2. NATO Initiatives to Improve Life Cycle Costing

    NARCIS (Netherlands)

    Smit, M.C.

    2009-01-01

    There is a long and documented history of both cost growth and estimating optimism within military programmes. This is particularly the case for multi-national programmes. The NATO ALP-10 –Guidance on Integrated Logistics Support for multi-national equipment projects (ILS) dated June 1990 (Reference

  3. Process-Improvement Cost Model for the Emergency Department.

    Science.gov (United States)

    Dyas, Sheila R; Greenfield, Eric; Messimer, Sherri; Thotakura, Swati; Gholston, Sampson; Doughty, Tracy; Hays, Mary; Ivey, Richard; Spalding, Joseph; Phillips, Robin

    2015-01-01

    The objective of this report is to present a simplified, activity-based costing approach for hospital emergency departments (EDs) to use with Lean Six Sigma cost-benefit analyses. The cost model complexity is reduced by removing diagnostic and condition-specific costs, thereby revealing the underlying process activities' cost inefficiencies. Examples are provided for evaluating the cost savings from reducing discharge delays and the cost impact of keeping patients in the ED (boarding) after the decision to admit has been made. The process-improvement cost model provides a needed tool in selecting, prioritizing, and validating Lean process-improvement projects in the ED and other areas of patient care that involve multiple dissimilar diagnoses.

  4. Costs and Benefits of Software Process Improvement

    Science.gov (United States)

    1997-12-01

    in production. In contrast, the cost of computer hardware components that are integral to weapon systems and other critical military and...SCRs requirements management tracking time spent reporting unit and/or component test managing the source code itself periodic reviews It is...on guava 30-APR-1997 Wanda Lam SCR #1011 sn-submit does not return to command line prompt after completion 30-APR-1997 Matt Kussow SCR #1125

  5. The Costs of Participating in a Diabetes Quality Improvement Collaborative: Variation Among Five Clinics.

    Science.gov (United States)

    Sathe, Neha A; Nocon, Robert S; Hughes, Brenna; Peek, Monica E; Chin, Marshall H; Huang, Elbert S

    2016-01-01

    Quality improvement collaboratives (QICs) support rapid testing and implementation of interventions through the collective experience of participating organizations to improve care quality and reduce costs. Although QICs have been societally cost-effective in improving the care of chronic diseases, they may not be adopted by outpatient clinics if their costs are high. Diabetes QICs warrant reexamination as secular trends in the quality of diabetes care, new care guidelines for diabetes, and evolving strategies for quality improvement may have altered implementation costs. The costs over the first four years-from June 2009 through May 2013-of an ongoing diabetes QIC were characterized by activities and over time. The QIC, linking six clinics on Chicago's South Side, tailored interventions to minority populations and built community partnerships. Costs were calculated from clinic surveys regarding activities, labor, and purchases. Data were obtained from five of the six participating clinics. Cost/diabetic patient/year ranged across clinic sites from $6 (largest clinic) to $68 (smallest clinic). Clinics spent 62%-88% of their total QIC costs on labor. The cost/diabetic patient/year changed over time from Year 1 (range across clinics, $5-$51), Year 2 ($11-$84), Year 3 ($4-$57), to Year 4 ($4-$80), with costs peaking at Year 2 for all clinics except Clinic 4, where costs peaked at Year 4. Cost experiences of QICs in clinics were di- verse over time and setting. High per-patient costs may stem from small clinic size, a sicker patient population, and variation in personnel type used. Cost decreases over time may represent increasing organizational learning and efficiency. Sharing resources may have achieved additional cost savings. This practical information can help administrators and policy makers predict, manage, and support costs of QICs as payers increasingly seek high-value health care.

  6. Implementation of Rapid Prototyping Tools for Power Loss and Cost Minimization of DC-DC Converters

    Directory of Open Access Journals (Sweden)

    Amruta V. Kulkarni

    2016-07-01

    Full Text Available In this paper, power loss and cost models of power electronic converters based on converter ratings and datasheet information are presented. These models aid in creating rapid prototypes which facilitate the component selection process. Through rapid prototyping, users can estimate power loss and cost which are essential in design decisions. The proposed approach treats main power electronic components of a converter as building blocks that can be arranged to obtain multiple topologies to facilitate rapid prototyping. In order to get system-level power loss and cost models, two processes are implemented. The first process automatically provides minimum power loss or cost estimates and identifies components for specific applications and ratings; the second process estimates power losses and costs of each component of interest as well as the whole system. Two examples are used to illustrate the proposed approaches—boost and buck converters in continuous conduction mode. Achieved cost and loss estimates are over 93% accurate when compared to measured losses and real cost data. This research presents derivations of the proposed models, experimental validation of the models and demonstration of a user friendly interface that integrates all the models. Tools presented in this paper are expected to be very useful for practicing engineers, designers, and researchers, and are flexible and adaptable with changing or new technologies and varying component prices.

  7. Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti.

    Directory of Open Access Journals (Sweden)

    Bruce R Schackman

    2007-05-01

    Full Text Available New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled-up prenatal testing to prevent mother-to-child HIV transmission in Haiti.A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance (rural standard of care, rapid plasma reagin test with results and treatment at 1-wk follow-up (urban standard of care, and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization-Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years (DALYs of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost-effectiveness ratios are in US dollars/DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost-effectiveness ratio of $6.83/DALY in rural settings and $9.95/DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow-up visits. Integrating rapid syphilis testing into a scaled-up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $525,000.In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost-effective. A similar approach may be beneficial in other resource

  8. Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti.

    Science.gov (United States)

    Schackman, Bruce R; Neukermans, Christopher P; Fontain, Sandy N Nerette; Nolte, Claudine; Joseph, Patrice; Pape, Jean W; Fitzgerald, Daniel W

    2007-05-01

    New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled-up prenatal testing to prevent mother-to-child HIV transmission in Haiti. A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance (rural standard of care), rapid plasma reagin test with results and treatment at 1-wk follow-up (urban standard of care), and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization-Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years (DALYs) of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost-effectiveness ratios are in US dollars/DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost-effectiveness ratio of $6.83/DALY in rural settings and $9.95/DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow-up visits. Integrating rapid syphilis testing into a scaled-up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $525,000. In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost-effective. A similar approach may be beneficial in other resource-poor countries

  9. Rapid, low-cost prototyping of centrifugal microfluidic devices for effective implementation of various microfluidic components

    Directory of Open Access Journals (Sweden)

    Smith, Suzanne

    2015-05-01

    Full Text Available A centrifugal microfluidic platform to develop various microfluidic operations – the first of its kind in South Africa – is presented. Rapid and low-cost prototyping of centrifugal microfluidic disc devices, as well as a set-up to test the devices using centrifugal forces, is described. Preliminary results show that various microfluidic operations such as fluidic valving, transportation, and microfluidic droplet generation can be achieved. This work provides a complete centrifugal microfluidic platform and the building blocks on which to develop a variety of microfluidic applications and potential products rapidly and at a low cost.

  10. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts...... packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider...

  11. Low-Cost Rapid Prototyping of Whole-Glass Microfluidic Devices

    Science.gov (United States)

    Yuen, Po Ki; Goral, Vasiliy N.

    2012-01-01

    A low-cost, straightforward, rapid prototyping of whole-glass microfluidic devices is presented using glass-etching cream that can be easily purchased in local stores. A self-adhered vinyl stencil cut out by a desktop digital craft cutter was used as an etching mask for patterning microstructures in glass using the glass-etching cream. A specific…

  12. Rapid core measure improvement through a "business case for quality".

    Science.gov (United States)

    Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

    2014-01-01

    Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

  13. Improving The Discipline of Cost Estimation and Analysis

    Science.gov (United States)

    Piland, William M.; Pine, David J.; Wilson, Delano M.

    2000-01-01

    The need to improve the quality and accuracy of cost estimates of proposed new aerospace systems has been widely recognized. The industry has done the best job of maintaining related capability with improvements in estimation methods and giving appropriate priority to the hiring and training of qualified analysts. Some parts of Government, and National Aeronautics and Space Administration (NASA) in particular, continue to need major improvements in this area. Recently, NASA recognized that its cost estimation and analysis capabilities had eroded to the point that the ability to provide timely, reliable estimates was impacting the confidence in planning many program activities. As a result, this year the Agency established a lead role for cost estimation and analysis. The Independent Program Assessment Office located at the Langley Research Center was given this responsibility. This paper presents the plans for the newly established role. Described is how the Independent Program Assessment Office, working with all NASA Centers, NASA Headquarters, other Government agencies, and industry, is focused on creating cost estimation and analysis as a professional discipline that will be recognized equally with the technical disciplines needed to design new space and aeronautics activities. Investments in selected, new analysis tools, creating advanced training opportunities for analysts, and developing career paths for future analysts engaged in the discipline are all elements of the plan. Plans also include increasing the human resources available to conduct independent cost analysis of Agency programs during their formulation, to improve near-term capability to conduct economic cost-benefit assessments, to support NASA management's decision process, and to provide cost analysis results emphasizing "full-cost" and "full-life cycle" considerations. The Agency cost analysis improvement plan has been approved for implementation starting this calendar year. Adequate financial

  14. Improved sensitivity over time with rapid prescreening in gynecologic cytology.

    Science.gov (United States)

    Dudding, Nick; Renshaw, Andrew A; Ellis, Kay

    2011-06-01

    Rapid prescreening (RPS) is a powerful tool to measure and improve performance in the cytology laboratory. Long-term use of RPS has been shown to result in improved sensitivity and precision in routine screening. The effect of long-term RPS on RPS itself is not known. We compared the sensitivity of 100% RPS of Surepath™ liquid-based cytology over a 4-year period in a laboratory of 11 cytotechnologists (CTs). In comparison with the first 2 years, RPS for the laboratory showed a significant increase in sensitivity for all abnormalities (72.2% vs. 67.3%, P < 0.001) and ASCUS + LSIL (68.5% vs. 62.1%, P < 0.001). For individual CTs s, the lowest sensitivity for all abnormalities increased from 59.0 to 63.2%, whereas, for HSIL, it increased from 71.4% to 75.0%. We conclude that long-term use of RPS leads to significant increase in the sensitivity of RPS. Copyright © 2010 Wiley-Liss, Inc.

  15. Rapidly improving stroke symptoms: a pilot, prospective study.

    Science.gov (United States)

    Balucani, Clotilde; Bianchi, Riccardo; Ramkishun, Charles; Weedon, Jeremy; Law, Susan; Szarek, Michael; Rojas-Soto, Diana; Tariq, Sara; Levine, Steven R

    2015-06-01

    Rapidly improving stroke symptoms (RISSs) are a controversial exclusion for intravenous recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS). We estimated the frequency of 4 prespecified RISS definitions and explored their relationship to clinical outcome. Pilot, prospective study of AIS patients admitted within 4.5 hours of symptom onset. Serial assessments using National Institute of Health Stroke Scale (NIHSS) were performed every 20 ± 5 minutes until a rt-PA treatment decision was made, independent of the study. Improvement was calculated as the difference between baseline NIHSS and treatment decision NIHSS. RISS was defined as a 4-point or greater improvement, 25% or greater, 50% or greater, and according to the previously reported TREAT (The Re-examining Acute Eligibility for Thrombolysis) criteria. Unfavorable outcome was defined as modified Rankin Scale score more than 1 at 90 days after stroke. Logistic regression determined if RISS definition(s) related to the outcome. Fifty patients with AIS were enrolled: mean age 65 years; median baseline NIHSS score 5 (interquartile range, 2-11). RISS frequencies were 10%-22% based on definition. Median treatment decision NIHSS score is 5 (interquartile range, 2-9). Twenty-three (46%) patients received rt-PA. None of the 3 non-TREAT RISS definitions was independently associated with the outcome. Five of fifty (10%) were RISS according to the TREAT criteria, all 5 had good outcome without rt-PA. A Serial NIHSS assessment before treatment decision is feasible and may help determine the frequency and magnitude of RISS. This is the first prospective estimate of RISS frequency and outcome according to various prespecified definitions. The TREAT RISS frequency as a more restrictive definition may better predict good outcome of RISS in future, larger studies. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda.

    Science.gov (United States)

    Hansen, Kristian S; Ndyomugyenyi, Richard; Magnussen, Pascal; Lal, Sham; Clarke, Siân E

    2017-06-01

    In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision, allowances for CHWs and provision of mRDTs and ACTs. The opportunity costs of time utilised by CHWs were estimated based on self-reporting. Household costs of subsequent treatment-seeking at public health centres and private health providers were captured in a sample of households. mRDTs performed by CHWs was associated with large improvements in appropriate treatment of malaria in both transmission settings. This resulted in low incremental costs for the health sector at US$3.0 per appropriately treated child in the moderate-to-high transmission area. Higher incremental costs at US$13.3 were found in the low transmission area due to lower utilisation of CHW services and higher programme costs. Incremental costs from a societal perspective were marginally higher. The use of mRDTs by CHWs improved the targeting of ACTs to children with malaria and was likely to be considered a cost-effective intervention compared to a presumptive diagnosis in the moderate-to-high transmission area. In contrast to this, in the low transmission area with low attendance, RDT use by CHWs was

  17. INTEGRATED COST MODEL FOR IMPROVING THE PRODUCTION IN COMPANIES

    Directory of Open Access Journals (Sweden)

    Zuzana Hajduova

    2014-12-01

    Full Text Available Purpose: All processes in the company play important role in ensuring functional integrated management system. We point out the importance of need for a systematic approach to the use of quantitative, but especially statistical methods for modelling the cost of the improvement activities that are part of an integrated management system. Development of integrated management systems worldwide leads towards building of systematic procedures of implementation maintenance and improvement of all systems according to the requirements of all the sides involved.Methodology: Statistical evaluation of the economic indicators of improvement costs and the need for a systematic approach to their management in terms of integrated management systems have become a key role also in the management of processes in the company Cu Drôt, a.s. The aim of this publication is to highlight the importance of proper implementation of statistical methods in the process of improvement costs management in the integrated management system of current market conditions and document the legitimacy of a systematic approach in the area of monitoring and analysing indicators of improvement with the aim of the efficient process management of company. We provide specific example of the implementation of appropriate statistical methods in the production of copper wire in a company Cu Drôt, a.s. This publication also aims to create a model for the estimation of integrated improvement costs, which through the use of statistical methods in the company Cu Drôt, a.s. is used to support decision-making on improving efficiency.Findings: In the present publication, a method for modelling the improvement process, by an integrated manner, is proposed. It is a method in which the basic attributes of the improvement in quality, safety and environment are considered and synergistically combined in the same improvement project. The work examines the use of sophisticated quantitative, especially

  18. Improved rapid prototyping methodology for MPEG-4 IC development

    Science.gov (United States)

    Tang, Clive K. K.; Moseler, Kathy; Levi, Sami

    1998-12-01

    One important factor in deciding the success of a new consumer product or integrated circuit is minimized time-to- market. A rapid prototyping methodology that encompasses algorithm development in the hardware design phase will have great impact on reducing time-to-market. In this paper, a proven hardware design methodology and a novel top-down design methodology based on Frontier Design's DSP Station tool are described. The proven methodology was used during development of the MC149570 H.261/H.263 video codec manufactured by Motorola. This paper discusses an improvement to this method to create an integrated environment for both system and hardware development, thereby further reducing the time-to-market. The software tool chosen is DSP Station tool by Frontier Design. The rich features of DSP Station tool will be described and then it will be shown how these features may be useful in designing from algorithm to silicon. How this methodology may be used in the development of a new MPEG4 Video Communication ASIC will be outlined. A brief comparison with a popular tool, Signal Processing WorkSystem tool by Cadence, will also be given.

  19. Improving the Discipline of Cost Estimation and Analysis

    Science.gov (United States)

    Piland, William M.; Pine, David J.; Wilson, Delano M.

    2000-01-01

    The need to improve the quality and accuracy of cost estimates of proposed new aerospace systems has been widely recognized. The industry has done the best job of maintaining related capability with improvements in estimation methods and giving appropriate priority to the hiring and training of qualified analysts. Some parts of Government, and National Aeronautics and Space Administration (NASA) in particular, continue to need major improvements in this area. Recently, NASA recognized that its cost estimation and analysis capabilities had eroded to the point that the ability to provide timely, reliable estimates was impacting the confidence in planning man), program activities. As a result, this year the Agency established a lead role for cost estimation and analysis. The Independent Program Assessment Office located at the Langley Research Center was given this responsibility.

  20. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill

    2005-03-01

    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  1. Rapid Cost Assessment of Space Mission Concepts through Application of Complexity Indices

    Science.gov (United States)

    Peterson, Craig; Cutts, James; Balint, Tibor; Hall, James B.

    2008-01-01

    In 2005, the Solar System Exploration Strategic Roadmap Conmrittee (chartered by NASA to develop the roadmap for Solar System Exploration Missions for the coming decades) found itself posed with the difficult problem of sorting through several mission concepts and determining their relative costs. While detailed mission studies are the normal approach to costing, neither the budget nor schedule allotted to the conmrittee could support such studies. Members of the Jet Propulsion Laboratory (JPL) supporting the conmrittee were given the challenge of developing a semi-quantitative approach that could provide the relative costs of these missions, without requiring an in depth study of the missions. In response to this challenge, a rapid cost assessment methodology based on a set of mission cost/complexity indexes was developed. This methodology also underwent two separate validations, one comparing its results when applied to historical missions, and another comparing its estimates against those of veteran space mission managers. Remarkably good agreement was achieved, suggesting that this approach provides an effective early indication of space mission costs.

  2. Improving cost efficiency on a vascular surgery service.

    Science.gov (United States)

    Skillman, J J; Paras, C; Rosen, M; Davis, R B; Kim, D; Kent, K C

    2000-03-01

    A vascular task force (VTF) consisting of two vascular surgeons and other key personnel was established to reduce costs and improve efficiency in the management of patients on a vascular surgery service. The VTF met monthly beginning in 1994 to study and implement changes in the management of patients with (1) abdominal vascular, (2), carotid endarterectomy (3) distal bypass, and (4) other vascular procedures, including amputations. Length of stay, and fixed and variable costs were assessed for change over time using Pearson correlation coefficients. Improvements in efficiency (length of stay) and decreases in costs (fixed and variable costs) from fiscal year 1993 to fiscal year 1996 were significant for the total group of vascular patients (P Management of distal bypass and other vascular surgery patients showed less striking improvement. Vascular surgeons in collaboration with other dedicated personnel involved in the care of vascular patients can improve efficiency and reduce costs. Advances were greatest in patients who required operations for carotid and abdominal vascular disorders and least for patients who required distal bypasses and other vascular procedures.

  3. Cost-effectiveness analysis of malaria rapid diagnostic tests for appropriate treatment of malaria at the community level in Uganda

    DEFF Research Database (Denmark)

    Hansen, Kristian S; Ndyomugyenyi, Richard; Magnussen, Pascal

    2017-01-01

    In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study...... was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT......) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision...

  4. TWT efficiency improvement by a low-cost technique for deposition of carbon on MDC electrodes

    Science.gov (United States)

    Ebihara, Ben T.; Ramins, Peter; Peet, Shelly

    1987-01-01

    A simple method of improving the TWT and multistage depressed collector (MDC) efficiency has been demonstrated. The efficiency improvement was produced by the application of a thin layer of carbon to the copper electrodes of the MDC by means of a rapid low-cost technique involving the pyrolysis of hydrocarbon oil in electric arc discharges. Experimental results with a representative TWT and MDC showed an 11 percent improvement in both the TWT and MDC efficiencies as compared to those of the same TWT and MDC with machined copper electrode surfaces. An extended test with a 550-W CW TWT indicated good durability of the carbon-coated electrode surfaces.

  5. Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?

    Science.gov (United States)

    Rolland, Estelle; Checchi, Francesco; Pinoges, Loretxu; Balkan, Suna; Guthmann, Jean-Paul; Guerin, Philippe J

    2006-04-01

    To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if

  6. Improving Life-Cycle Cost Management of Spacecraft Missions

    Science.gov (United States)

    Clardy, Dennon

    2010-01-01

    This presentation will explore the results of a recent NASA Life-Cycle Cost study and how project managers can use the findings and recommendations to improve planning and coordination early in the formulation cycle and avoid common pitfalls resulting in cost overruns. The typical NASA space science mission will exceed both the initial estimated and the confirmed life-cycle costs by the end of the mission. In a fixed-budget environment, these overruns translate to delays in starting or launching future missions, or in the worst case can lead to cancelled missions. Some of these overruns are due to issues outside the control of the project; others are due to the unpredictable problems (unknown unknowns) that can affect any development project. However, a recent study of life-cycle cost growth by the Discovery and New Frontiers Program Office identified a number of areas that are within the scope of project management to address. The study also found that the majority of the underlying causes for cost overruns are embedded in the project approach during the formulation and early design phases, but the actual impacts typically are not experienced until late in the project life cycle. Thus, project management focus in key areas such as integrated schedule development, management structure and contractor communications processes, heritage and technology assumptions, and operations planning, can be used to validate initial cost assumptions and set in place management processes to avoid the common pitfalls resulting in cost overruns.

  7. IMPROVEMENT OF NORMATIVE METHOD OF ACCOUNTING AND MONITORING COSTS

    Directory of Open Access Journals (Sweden)

    Solomennikova E. A.

    2017-06-01

    Full Text Available The normative method for accounting of costs and calculating has been known for a long time and is widely used by foreign companies. While in the practice of Russian enterprises it is used quite rarely because of difficulties of its use. The article suggests ways to improve the normative method of accounting and control of costs: for the normalization, divide the indirect costs for guild, general factory and commercial expenses according to the elements of the cost estimate and places from the occurrence; for a detailed analysis of deviations, form a matrix whose columns show the division, and the rows cost element, and the value in the cells shows the amount of the deviation, which will allow the management to identify more objectively the perpetrators of the occurrence of adverse deviations and apply adequate penalties to them. It is proposed to create a single center for the development of norms and standards that will allow the organization of end-to-end management of a newly identified management entity, in which the specific cost norms for types of products and deviations for them in the production and sale of products. Such centers should be built into organizational structures of Russian industrial enterprises operating in the enterprise, which will allow enterprise managers to choose the option of a comprehensive use of the standard method of accounting and control of costs.

  8. Organizational Perspectives on Rapid Response Team Structure, Function, and Cost: A Qualitative Study.

    Science.gov (United States)

    Smith, Patricia L; McSweeney, Jean

    Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs. The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs. Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics. The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost. It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits.

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

    African Journals Online (AJOL)

    improving cost-effectiveness of hypertension care in primary care in South Africa and the potential for research in this setting. s AIr Med J 1998; 88: 549-554. The National Health Plan for South Africa announced that. 'the primary health care approach is the underlying philosophy for the lestructuring of the health system' and.

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

    African Journals Online (AJOL)

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

  11. Orlistat for the treatment of obesity: rapid review and cost-effectiveness model.

    Science.gov (United States)

    Foxcroft, D R; Milne, R

    2000-10-01

    The aim of this study is to clarify the potential benefits, disbenefits and costs of Orlistat for the treatment of obesity. The method was a search for relevant systematic reviews and randomized controlled trials, in Medline, Pre-Medline, Embase and the Cochrane Library, using Orlistat and its synonyms. Identified trials were appraised using a standard appraisal checklist and trial data were extracted for use in cost-effectiveness modelling. Three large multicentre, randomized placebo controlled trials were included in the rapid review. On average, Orlistat results in obese people losing an additional 3-4% of their initial body weight over diet alone during a 2 year period. There was no strong evidence that this short-term weight loss would have a longer-term impact on morbidity and mortality. The cost utility of Orlistat treatment was estimated at around 46,000 Pounds per Quality Adjusted Life Year gained (extreme values sensitivity analysis 14,000 Pounds to 132,000 Pounds). This rapid review raises some important questions about the potential value of Orlistat in the treatment of obesity. Further research is needed, not only to clarify the longer-term impact of Orlistat treatment, but also to uncover the longer-term impact on mortality and morbidity from short-term weight loss.

  12. Rapid prototyping prosthetic hand acting by a low-cost shape-memory-alloy actuator.

    Science.gov (United States)

    Soriano-Heras, Enrique; Blaya-Haro, Fernando; Molino, Carlos; de Agustín Del Burgo, José María

    2018-01-08

    The purpose of this article is to develop a new concept of modular and operative prosthetic hand based on rapid prototyping and a novel shape-memory-alloy (SMA) actuator, thus minimizing the manufacturing costs. An underactuated mechanism was needed for the design of the prosthesis to use only one input source. Taking into account the state of the art, an underactuated mechanism prosthetic hand was chosen so as to implement the modifications required for including the external SMA actuator. A modular design of a new prosthesis was developed which incorporated a novel SMA actuator for the index finger movement. The primary objective of the prosthesis is achieved, obtaining a modular and functional low-cost prosthesis based on additive manufacturing executed by a novel SMA actuator. The external SMA actuator provides a modular system which allows implementing it in different systems. This paper combines rapid prototyping and a novel SMA actuator to develop a new concept of modular and operative low-cost prosthetic hand.

  13. Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

    Science.gov (United States)

    Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

    2011-04-01

    The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The

  14. Medication nonadherence in diabetes: longitudinal effects on costs and potential cost savings from improvement.

    Science.gov (United States)

    Egede, Leonard E; Gebregziabher, Mulugeta; Dismuke, Clara E; Lynch, Cheryl P; Axon, R Neal; Zhao, Yumin; Mauldin, Patrick D

    2012-12-01

    To examine the longitudinal effects of medication nonadherence (MNA) on key costs and estimate potential savings from increased adherence using a novel methodology that accounts for shared correlation among cost categories. Veterans with type 2 diabetes (740,195) were followed from January 2002 until death, loss to follow-up, or December 2006. A novel multivariate, generalized, linear, mixed modeling approach was used to assess the differential effect of MNA, defined as medication possession ratio (MPR) ≥0.8 on healthcare costs. A sensitivity analysis was performed to assess potential cost savings at different MNA levels using the Consumer Price Index to adjust estimates to 2012 dollar value. Mean MPR for the full sample over 5 years was 0.78, with a mean of 0.93 for the adherent group and 0.58 for the MNA group. In fully adjusted models, all annual cost categories increased ∼3% per year (P = 0.001) during the 5-year study time period. MNA was associated with a 37% lower pharmacy cost, 7% lower outpatient cost, and 41% higher inpatient cost. Based on sensitivity analyses, improving adherence in the MNA group would result in annual estimated cost savings ranging from ∼$661 million (MPR <0.6 vs. ≥0.6) to ∼$1.16 billion (MPR <1 vs. 1). Maximal incremental annual savings would occur by raising MPR from <0.8 to ≥0.8 ($204,530,778) among MNA subjects. Aggressive strategies and policies are needed to achieve optimal medication adherence in diabetes. Such approaches may further the so-called "triple aim" of achieving better health, better quality care, and lower cost.

  15. Costs and benefits of energy efficiency improvements in ceiling fans

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Nihar; Sathaye, Nakul; Phadke, Amol; Letschert, Virginie [Lawrence Berkeley National Lab., CA (United States). Environmental Energy Technology Division

    2013-10-15

    Ceiling fans contribute significantly to residential electricity consumption, especially in developing countries with warm climates. The paper provides analysis of costs and benefits of several options to improve the efficiency of ceiling fans to assess the global potential for electricity savings and green house gas (GHG) emission reductions. Ceiling fan efficiency can be cost-effectively improved by at least 50% using commercially available technology. If these efficiency improvements are implemented in all ceiling fans sold by 2020, 70 terawatt hours per year could be saved and 25 million metric tons of carbon dioxide equivalent (CO2-e) emissions per year could be avoided, globally. We assess how policies and programs such as standards, labels, and financial incentives can be used to accelerate the adoption of efficient ceiling fans in order to realize potential savings.

  16. Evidence of Dietary Improvement and Preventable Costs of Cardiovascular Disease.

    Science.gov (United States)

    Zhang, Donglan; Cogswell, Mary E; Wang, Guijing; Bowman, Barbara A

    2017-11-01

    We conducted a review to summarize preventable medical costs of cardiovascular disease (CVD) associated with improved diet, as defined by the 2020 Strategic Impact Goal of the American Heart Association. We searched databases of PubMed, Embase, CINAHL and ABI/INFORM to identify population-based studies published from January 1995 to December 2015 on CVD medical costs related to excess intake of salt/sodium or sugar-sweetened beverages, and inadequate intake of fruits and vegetables, fish/fish oils/omega-3 fatty acids, or whole grains/fiber/dietary fiber. Based on the American Heart Association's secondary dietary metrics, we also searched the literature on inadequate intake of nuts and excess intake of processed meat and saturated fat. For each component, we evaluated the CVD cost savings if consumption levels were changed. The cost savings were adjusted into 2013 US dollars. Among 330 studies focusing on diet and economic consequences, 16 studies evaluated CVD costs associated with 1 or more dietary components: salt/sodium (n = 13), fruits and vegetables (n = 1), meat (n = 1), and saturated fat (n = 3). In the United States, reducing individual sodium intake to 2,300 mg/day from the current level could potentially save $1,990.9/person per year for hypertension treatment, based on a simulation study. Increasing consumption of fruits and vegetables from 1.5 cups/day could save $1,568.0/person per year in treatment costs for CVD, based on a cohort study. Potential CVD cost savings associated with diet improvement are substantial. Interventions for reducing sodium intake and increasing fruit and vegetable consumption could be viable means to alleviate the increasing national medical expenditures. Published by Elsevier Inc.

  17. A RAPID ASSESSMENT MODEL FOR UNDERSTANDING THE SOCIAL COST OF CARBON

    OpenAIRE

    STEPHEN C. NEWBOLD; CHARLES GRIFFITHS; CHRIS MOORE; ANN WOLVERTON; ELIZABETH KOPITS

    2013-01-01

    The "social cost of carbon" (SCC) is the present value of the stream of future damages from one additional unit of carbon emissions in a particular year. This paper develops a rapid assessment model for the SCC. The model includes the essential ingredients for calculating the SCC at the global scale and is designed to be transparent and easy to use and modify. Our goal is to provide a tool to help analysts and decision-makers quickly explore the implications of various modeling assumptions fo...

  18. The Rapid Transit System That Achieves Higher Performance with Lower Life-Cycle Costs

    Science.gov (United States)

    Sone, Satoru; Takagi, Ryo

    In the age of traction system made of inverter and ac traction motors, distributed traction system with pure electric brake of regenerative mode has been recognised very advantageous. This paper proposes a new system as the lowest life-cycle cost system for high performance rapid transit, a new architecture and optimum parameters of power feeding system, and a new running method of trains. In Japan, these components of this proposal, i.e. pure electric brake and various countermeasures of reducing loss of regeneration have been already popular but not as yet the new running method for better utilisation of the equipment and for lower life-cycle cost. One example of what are proposed in this paper will be made as Tsukuba Express, which is under construction as the most modern commuter railway in Greater Tokyo area.

  19. High-throughput rapid-prototyping of low-cost paper-based microfluidics.

    Science.gov (United States)

    Ghaderinezhad, Fariba; Amin, Reza; Temirel, Mikail; Yenilmez, Bekir; Wentworth, Adam; Tasoglu, Savas

    2017-06-15

    Paper-based micro analytical devices offer significant advantages compared to the conventional microfluidic chips including cost-effectiveness, ease of fabrication, and ease of use while preserving critical features including strong capillary action and biological compatibility. In this work, we demonstrate an inexpensive, rapid method for high-throughput fabrication of paper-based microfluidics by patterning hydrophobic barriers using a desktop pen plotter integrated with a custom-made, low-cost paper feeder. We tested various types of commercial permanent markers and compared their water-resistant capabilities for creating hydrophobic barriers. Additionally, we studied the performance of markers with different types of paper, plotting speeds, and pattern dimensions. To verify the effectiveness of the presented fabrication method, colorimetric analysis was performed on the results of a glucose assay.

  20. Cost and Impact on Patient Length of Stay of Rapid Molecular Testing for Clostridium difficile.

    Science.gov (United States)

    Sewell, Bernadette; Rees, Eugene; Thomas, Ian; Ch'ng, Chin Lye; Isaac, Mike; Berry, Nidhika

    2014-12-01

    A study was performed to assess the cost of a rapid molecular assay (PCR) for diagnosis of Clostridium difficile infection (CDI) and the impact of its routine use on patient length of stay (LOS) in comparison with cell culture cytotoxin neutralization assay (CCNA). From March 2011 to September 2011, Xpert(®) C. difficile (Cepheid, Sunnyvale, CA, USA) PCR was used on patients with suspicion of CDI in two acute care hospitals in Abertawe Bro Morgannwg University Health Board, Swansea, Wales, UK. Test results were used for patient management. LOS and time to reportable result were compared for negative and positive prospective patients tested by PCR and historic control patients tested by CCNA during March 2010 to September 2010. Tests were priced using micro-costing and a cost comparison analysis was undertaken. In total, 506 patients were included. Time to reportable result for PCR samples was 1.53 h compared to 46.54 h for CCNA negatives and 22.45 h for CCNA positives. Patients tested by CCNA stayed 4.88 days longer in hospital compared to PCR patients if they tested positive and 7.03 days if tests were negative. The mean reduction in LOS observed in our study has the potential to generate cost savings of up to £2,292.62 for every patient with suspected CDI, if samples were to be tested routinely with PCR instead of CCNA. A rapid molecular test for C. difficile in an acute hospital setting produced quick results that led to a decrease in LOS compared to historic CCNA control patients. This could result in considerable savings through reduced excess inpatient days.

  1. Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting.

    Science.gov (United States)

    Wolfe, Marlene K; Dentz, Holly N; Achando, Beryl; Mureithi, MaryAnne; Wolfe, Tim; Null, Clair; Pickering, Amy J

    2017-02-08

    Diarrhea is a leading cause of death among children under 5 years of age worldwide. Flies are important vectors of diarrheal pathogens in settings lacking networked sanitation services. There is no standardized method for measuring fly density in households; many methods are cumbersome and unvalidated. We adapted a rapid, low-cost fly enumeration technique previously developed for industrial settings, the Scudder fly grill, for field use in household settings. We evaluated its performance in comparison to a sticky tape fly trapping method at latrine and food preparation areas among households in rural Kenya. The grill method was more sensitive; it detected the presence of any flies at 80% (433/543) of sampling locations versus 64% (348/543) of locations by the sticky tape. We found poor concordance between the two methods, suggesting that standardizing protocols is important for comparison of fly densities between studies. Fly species identification was feasible with both methods; however, the sticky tape trap allowed for more nuanced identification. Both methods detected a greater presence of bottle flies near latrines compared with food preparation areas (P < 0.01). The grill method detected more flies at the food preparation area compared with near the latrine (P = 0.014) while the sticky tape method detected no difference. We recommend the Scudder grill as a sensitive fly enumeration tool that is rapid and low cost to implement. © The American Society of Tropical Medicine and Hygiene.

  2. Rapid Bioassessment and In Situ Bioassay: Cost Effective Tools for Environmental Impact Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Wike, L.D.

    2002-08-23

    Environmental impact can be difficult to assess, especially at the ecosystem level. Any impact assessment methodology that can give cost effective and timely results is highly desirable. Rapid bioassessment (RBA) is cost effective and produces timely results. Several types of RBA have been used at the Savannah River Site (SRS) to assess stream conditions, including the Index of Biotic Integrity (IBI) based on fish community characteristics, and various techniques using aquatic macroinvertebrate species diversity and abundance. In an attempt to broaden the applicability of the RBA concept, we have also begun to develop RBA techniques for seep-fed wetlands and terrestrial habitats. These techniques will focus on vertebrate and macroinvertebrate assemblages for seep-fed wetlands and arthropod assemblages for terrestrial habitats. In situ bioassay is another technique that could be used for rapid and economical assessment of the effects of anthropogenic disturbance. We propose the development of two methods of in situ bioassay that can address bioavailability of constituents of concern. The use of caged bioassay organisms can be applied to terrestrial systems such as capped or existing waste sites using the common house cricket. Another proposed bioassay could use a resident species, such as the imported red fire ant, which is found in disturbed habitats and open areas such as waste sites. Combining in situ techniques with RBA methodologies has the potential to provide a comprehensive assessment of chemical and physical impacts to a wide range of ecosystem types.

  3. VAPI: low-cost, rapid automated visual inspection system for Petri plate analysis

    Science.gov (United States)

    Chatburn, L. T.; Kirkup, B. C.; Polz, M. F.

    2007-09-01

    Most culture-based microbiology tasks utilize a petri plate during processing, but rarely do the scientists capture the full information available from the plate. In particular, visual analysis of plates is an under-developed rich source of data that can be rapid and non-invasive. However, collecting this data has been limited by the difficulties of standardizing and quantifying human observations, by the limits of a scientists' fatigue, and by the cost of automating the process. The availability of specialized counting equipment and intelligent camera systems has not changed this - they are prohibitively expensive for many laboratories, only process a limited number of plate types, are often destructive to the sample, and have limited accuracy. This paper describes an automated visual inspection solution, VAPI, that employs inexpensive consumer computing hardware and digital cameras along with custom cross-platform open-source software written in C++, combining Trolltech's Qt GUI toolkit with Intel's OpenCV computer vision library. The system is more accurate than common commercial systems costing many times as much, while being flexible in use and offering comparable responsiveness. VAPI not only counts colonies but also sorts and enumerates colonies by morphology, tracks colony growth by time series analysis, and provides other analytical resources. Output to XML files or directly to a database provides data that can be easily maintained and manipulated by the end user, offering ready access for system enhancement, interaction with other software systems, and rapid development of advanced analysis applications.

  4. Ion Torren Semiconductor Sequencing Allows Rapid, Low Cost Sequencing of the Human Exome ( 7th Annual SFAF Meeting, 2012)

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, David [EdgeBio

    2012-06-01

    David Jenkins on "Ion Torrent semiconductor sequencing allows rapid, low-cost sequencing of the human exome" at the 2012 Sequencing, Finishing, Analysis in the Future Meeting held June 5-7, 2012 in Santa Fe, New Mexico.

  5. Is your client's back pain "rapidly reversible"? Improving low back care at its foundation.

    Science.gov (United States)

    Donelson, Ronald

    2008-01-01

    To convey a valuable and greatly misunderstood paradigm for evaluating and treating low back pain (LBP) and its extensive scientific evidence. Low back pain is a highly prevalent and very expensive health dilemma. But by using a paradigm called Mechanical Diagnosis and Therapy (a.k.a. McKenzie methods), it is now possible to identify a very large LBP subgroup whose pain is rapidly reversible, meaning that it can often be eliminated quickly, with return to full function using a single, patient-specific direction of simple, yet precise, end-range low back exercises and some posture modifications. This interesting subgroup includes patients with both acute and chronic LBP as well as both LBP-only and sciatica with neural deficits. This special form of clinical assessment can detect which patients are in this large, rapidly reversible subgroup and which ones are not. Of the numerous studies targeting Mechanical Diagnosis and Therapy (MDT), three have focused on patients whose persisting pain had led to recommendations of disc surgery where 50% were then found to still have a rapidly reversible disc problem with high rates of nonsurgical rapid recovery. If patients are never assessed in this way, this reversibility remains undiscovered and these patients commonly undergo potentially unnecessary surgery. Armed with knowledge of this subgroup, how to identify it, the considerable supportive scientific evidence and strongly beneficial implications of utilizing this MDT paradigm, case managers are positioned to have an immensely positive impact on the care of LBP. Tremendous cost savings and greatly improved clinical outcomes are available by utilizing this form of evidence-based MDT care.

  6. Assessing the Potential of Low-Cost 3D Cameras for the Rapid Measurement of Plant Woody Structure

    Directory of Open Access Journals (Sweden)

    Charles Nock

    2013-11-01

    Full Text Available Detailed 3D plant architectural data have numerous applications in plant science, but many existing approaches for 3D data collection are time-consuming and/or require costly equipment. Recently, there has been rapid growth in the availability of low-cost, 3D cameras and related open source software applications. 3D cameras may provide measurements of key components of plant architecture such as stem diameters and lengths, however, few tests of 3D cameras for the measurement of plant architecture have been conducted. Here, we measured Salix branch segments ranging from 2–13 mm in diameter with an Asus Xtion camera to quantify the limits and accuracy of branch diameter measurement with a 3D camera. By scanning at a variety of distances we also quantified the effect of scanning distance. In addition, we also test the sensitivity of the program KinFu for continuous 3D object scanning and modeling as well as other similar software to accurately record stem diameters and capture plant form (<3 m in height. Given its ability to accurately capture the diameter of branches >6 mm, Asus Xtion may provide a novel method for the collection of 3D data on the branching architecture of woody plants. Improvements in camera measurement accuracy and available software are likely to further improve the utility of 3D cameras for plant sciences in the future.

  7. A Rapid and Low-Cost PCR Thermal Cycler for Low Resource Settings.

    Directory of Open Access Journals (Sweden)

    Grace Wong

    Full Text Available Many modern molecular diagnostic assays targeting nucleic acids are typically confined to developed countries or to the national reference laboratories of developing-world countries. The ability to make technologies for the rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a revolutionary step forward in global health. Many molecular assays are also developed based on polymerase chain reactions (PCR, which require thermal cyclers that are relatively heavy (>20 pounds and need continuous electrical power. The temperature ramping speed of most economical thermal cyclers are relatively slow (2 to 3 °C/s so a polymerase chain reaction can take 1 to 2 hours. Most of all, these thermal cyclers are still too expensive ($2k to $4k for low-resource setting uses.In this article, we demonstrate the development of a low-cost and rapid water bath based thermal cycler that does not require active temperature control or continuous power supply during PCR. This unit costs $130 to build using commercial off-the-shelf items. The use of two or three vacuum-insulated stainless-steel Thermos food jars containing heated water (for denaturation and annealing/extension steps and a layer of oil on top of the water allow for significantly stabilized temperatures for PCR to take place. Using an Arduino-based microcontroller, we automate the "archaic" method of hand-transferring PCR tubes between water baths.We demonstrate that this innovative unit can deliver high speed PCR (17 s per PCR cycle with the potential to go beyond the 1,522 bp long amplicons tested in this study and can amplify from templates down to at least 20 copies per reaction. The unit also accepts regular PCR tubes and glass capillary tubes. The PCR efficiency of our thermal cycler is not different from other commercial thermal cyclers. When combined with a rapid nucleic acid detection approach, the thermos thermal cycler (TTC can enable on-site molecular

  8. Cost-effective and rapid blood analysis on a cell-phone.

    Science.gov (United States)

    Zhu, Hongying; Sencan, Ikbal; Wong, Justin; Dimitrov, Stoyan; Tseng, Derek; Nagashima, Keita; Ozcan, Aydogan

    2013-04-07

    We demonstrate a compact and cost-effective imaging cytometry platform installed on a cell-phone for the measurement of the density of red and white blood cells as well as hemoglobin concentration in human blood samples. Fluorescent and bright-field images of blood samples are captured using separate optical attachments to the cell-phone and are rapidly processed through a custom-developed smart application running on the phone for counting of blood cells and determining hemoglobin density. We evaluated the performance of this cell-phone based blood analysis platform using anonymous human blood samples and achieved comparable results to a standard bench-top hematology analyser. Test results can either be stored on the cell-phone memory or be transmitted to a central server, providing remote diagnosis opportunities even in field settings.

  9. Energy efficiency improvement and cost saving opportunities forpetroleum refineries

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Galitsky, Christina

    2005-02-15

    The petroleum refining industry in the United States is the largest in the world, providing inputs to virtually any economic sector,including the transport sector and the chemical industry. The industry operates 146 refineries (as of January 2004) around the country,employing over 65,000 employees. The refining industry produces a mix of products with a total value exceeding $151 billion. Refineries spend typically 50 percent of cash operating costs (i.e., excluding capital costs and depreciation) on energy, making energy a major cost factor and also an important opportunity for cost reduction. Energy use is also a major source of emissions in the refinery industry making energy efficiency improvement an attractive opportunity to reduce emissions and operating costs. Voluntary government programs aim to assist industry to improve competitiveness through increased energy efficiency and reduced environmental impact. ENERGY STAR (R), a voluntary program managed by the U.S. Environmental Protection Agency, stresses the need for strong and strategic corporate energy management programs. ENERGY STAR provides energy management tools and strategies for successful corporate energy management programs. This Energy Guide describes research conducted to support ENERGY STAR and its work with the petroleum refining industry.This research provides information on potential energy efficiency opportunities for petroleum refineries. This Energy Guide introduces energy efficiency opportunities available for petroleum refineries. It begins with descriptions of the trends, structure, and production of the refining industry and the energy used in the refining and conversion processes. Specific energy savings for each energy efficiency measure based on case studies of plants and references to technical literature are provided. If available, typical payback periods are also listed. The Energy Guide draws upon the experiences with energy efficiency measures of petroleum refineries worldwide

  10. Optofluidic refractive-index sensors employing bent waveguide structures for low-cost, rapid chemical and biomedical sensing.

    Science.gov (United States)

    Liu, I-Chen; Chen, Pin-Chuan; Chau, Lai-Kwan; Chang, Guo-En

    2018-01-08

    We propose and develop an intensity-detection-based refractive-index (RI) sensor for low-cost, rapid RI sensing. The sensor is composed of a polymer bent ridge waveguide (BRWG) structure on a low-cost glass substrate and is integrated with a microfluidic channel. Different-RI solutions flowing through the BRWG sensing region induce output optical power variations caused by optical bend losses, enabling simple and real-time RI detection. Additionally, the sensors are fabricated using rapid and cost-effective vacuum-less processes, attaining the low cost and high throughput required for mass production. A good RI solution of 5.31 10-4 × RIU-1 is achieved from the RI experiments. This study demonstrates mass-producible and compact RI sensors for rapid and sensitive chemical analysis and biomedical sensing.

  11. Manufacturing of Low Cost, Durable Membrane Electrode Assemblies Engineered for Rapid Conditioning

    Energy Technology Data Exchange (ETDEWEB)

    Busby, Colin [W. L. Gore & Associates Inc., Newark, DE (United States)

    2017-05-23

    Over the past 20 years significant progress in membrane-electrode assembly (MEA) technology development for polymer electrolyte fuel cells (PEMFCs) has resulted in the PEMFC technology approaching a commercial reality for transportation applications. However, there remain two primary technical challenges to be addressed in the MEA. First and foremost is meeting the automotive cost targets: Producing a fuel cell stack cost competitive with today’s internal combustion engine. In addition to the material cost, MEA (and other components) and stack assembly production methods must be amenable for use in low cost, high speed, automotive assembly line. One impediment to this latter goal is that stack components must currently go through a long and tedious conditioning procedure before they produce optimal power. This so-called “break-in” can take many hours, and can involve quite complex voltage, temperature and/or pressure steps. These break-in procedures must be simplified and the time required reduced if fuel cells are to become a viable automotive engine. The second challenge is to achieve the durability targets in real-world automotive duty cycle operations. Significant improvements in cost, break-in time, and durability for the key component of fuel cell stacks, MEAs were achieved in this project. Advanced modeling was used to guide design of the new MEA to maximize performance and durability. A new, innovative process and manufacturing approach utilizing direct in-line coating using scalable, cost-competitive, continuous high volume 3-layer rolled-good manufacturing processes was developed and validated by single cell and short stack testing. In addition, the direct coating methods employed were shown to reduce the cost for sacrificial films. Furthermore, Gore has demonstrated a 10 µm reinforced membrane that is used in the new low-cost process and can meet automotive power density and durability targets. Across a wide range of operating conditions, the

  12. Improved and lower cost sealing of aerospace structure

    Science.gov (United States)

    Angeloni, D. J.; Thomas, J. H.; Lauer, H. K.

    1979-01-01

    An improved sealing method has been developed for the exposed metal fastener surfaces of the Solid Rocket Booster vehicle for the Space Shuttle launch system. The method employs properly sized flexible plastic caps filled with catalyzed polysulfide sealant, frozen and stored. At the time of use, the caps and sealant are thawed and positioned on the fasteners. The sealant covers the exposed portion of the fastener and prevents salt water damage. The method is one of high reliability with low installation and inspection costs.

  13. A Rapid and Low-Cost Nonlithographic Method to Fabricate Biomedical Microdevices for Blood Flow Analysis

    Directory of Open Access Journals (Sweden)

    Elmano Pinto

    2014-12-01

    Full Text Available Microfluidic devices are electrical/mechanical systems that offer the ability to work with minimal sample volumes, short reactions times, and have the possibility to perform massive parallel operations. An important application of microfluidics is blood rheology in microdevices, which has played a key role in recent developments of lab-on-chip devices for blood sampling and analysis. The most popular and traditional method to fabricate these types of devices is the polydimethylsiloxane (PDMS soft lithography technique, which requires molds, usually produced by photolithography. Although the research results are extremely encouraging, the high costs and time involved in the production of molds by photolithography is currently slowing down the development cycle of these types of devices. Here we present a simple, rapid, and low-cost nonlithographic technique to create microfluidic systems for biomedical applications. The results demonstrate the ability of the proposed method to perform cell free layer (CFL measurements and the formation of microbubbles in continuous blood flow.

  14. Low-Cost Rotating Experimentation in Compressor Aerodynamics Using Rapid Prototyping

    Directory of Open Access Journals (Sweden)

    Mathias Michaud

    2016-01-01

    Full Text Available With the rapid evolution of additive manufacturing, 3D printed parts are no longer limited to display purposes but can also be used in structural applications. The objective of this paper is to show that 3D prototyping can be used to produce low-cost rotating turbomachinery rigs capable of carrying out detailed flow measurements that can be used, among other things, for computational fluid dynamics (CFD code validation. A fully instrumented polymer two-stage axial-mixed flow compressor test rig was designed and fabricated with stereolithography (SLA technology by a team of undergraduate students as part of a senior-year design course. Experiments were subsequently performed on this rig to obtain both the overall pressure rise characteristics of the compressor and the stagnation pressure distributions downstream of the blade rows for comparison with CFD simulations. In doing so, this work provides a first-of-a-kind assessment of the use of polymer additive technology for low-cost rotating turbomachinery experimentation with detailed measurements.

  15. Improved Savitzky-Golay-method-based fluorescence subtraction algorithm for rapid recovery of Raman spectra.

    Science.gov (United States)

    Chen, Kun; Zhang, Hongyuan; Wei, Haoyun; Li, Yan

    2014-08-20

    In this paper, we propose an improved subtraction algorithm for rapid recovery of Raman spectra that can substantially reduce the computation time. This algorithm is based on an improved Savitzky-Golay (SG) iterative smoothing method, which involves two key novel approaches: (a) the use of the Gauss-Seidel method and (b) the introduction of a relaxation factor into the iterative procedure. By applying a novel successive relaxation (SG-SR) iterative method to the relaxation factor, additional improvement in the convergence speed over the standard Savitzky-Golay procedure is realized. The proposed improved algorithm (the RIA-SG-SR algorithm), which uses SG-SR-based iteration instead of Savitzky-Golay iteration, has been optimized and validated with a mathematically simulated Raman spectrum, as well as experimentally measured Raman spectra from non-biological and biological samples. The method results in a significant reduction in computing cost while yielding consistent rejection of fluorescence and noise for spectra with low signal-to-fluorescence ratios and varied baselines. In the simulation, RIA-SG-SR achieved 1 order of magnitude improvement in iteration number and 2 orders of magnitude improvement in computation time compared with the range-independent background-subtraction algorithm (RIA). Furthermore the computation time of the experimentally measured raw Raman spectrum processing from skin tissue decreased from 6.72 to 0.094 s. In general, the processing of the SG-SR method can be conducted within dozens of milliseconds, which can provide a real-time procedure in practical situations.

  16. Cost estimation for slope stability improvement in Muara Enim

    Science.gov (United States)

    Juliantina, Ika; Sutejo, Yulindasari; Adhitya, Bimo Brata; Sari, Nurul Permata; Kurniawan, Reffanda

    2017-11-01

    Case study area of SP. Sugihwaras-Baturaja is typologically specified in the C-zone type because the area is included in the foot of the mountain with a slope of 0 % to 20 %. Generally, the factors that cause landslide in Muara Enim Regency due to the influence of soil/rock, water factor, geological factors, and human activities. Slope improvement on KM.273 + 642-KM.273 + 774 along 132 m using soil nailing with 19 mm diameter tendon iron and an angle of 20o and a 75 mm shotcrete thickness, a K-250 concrete grouting material. Cost modeling (y) soil nailing based on 4 variables are X1 = length, X2 = horizontal distance, X3 = safety factor (SF), and X4 = time. Nine variations were used as multiple linear regression equations and analyzed with SPSS.16.0 program. Based on the SPSS output, then attempt the classical assumption and feasibility test model which produced the model that is Cost = (1,512,062 + 194,354 length-1,649,135 distance + 187,831 SF + 54,864 time) million Rupiah. The budget plan includes preparatory work, drainage system, soil nailing, and shotcrete. An efficient cost estimate of 8 m length nail, 1.5 m installation distance, safety factor (SF) = 1.742 and a 30 day processing time resulted in a fee of Rp. 2,566,313,000.00 (Two billion five hundred sixty six million three hundred thirteen thousand rupiah).

  17. Electrochromic Windows: Process and Fabrication Improvements for Lower Total Costs

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burdis; Neil Sbar

    2007-03-31

    The overall goal with respect to the U.S. Department of Energy (DOE) is to achieve significant national energy savings through maximized penetration of EC windows into existing markets so that the largest cumulative energy reduction can be realized. The speed with which EC windows can be introduced and replace current IGU's (and current glazings) is clearly a strong function of cost. Therefore, the aim of this project was to investigate possible improvements to the SageGlass{reg_sign} EC glazing products to facilitate both process and fabrication improvements resulting in lower overall costs. The project was split into four major areas dealing with improvements to the electrochromic layer, the capping layer, defect elimination and general product improvements. Significant advancements have been made in each of the four areas. These can be summarized as follows: (1) Plasma assisted deposition for the electrochromic layer was pursued, and several improvements made to the technology for producing a plasma beam were made. Functional EC devices were produced using the new technology, but there are still questions to be answered regarding the intrinsic properties of the electrochromic films produced by this method. (2) The capping layer work was successfully implemented into the existing SageGlass{reg_sign} product, thereby providing a higher level of transparency and somewhat lower reflectivity than the 'standard' product. (3) Defect elimination is an ongoing effort, but this project spurred some major defect reduction programs, which led to significant improvements in yield, with all the implicit benefits afforded. In particular, major advances were made in the development of a new bus bar application process aimed at reducing the numbers of 'shorts' developed in the finished product, as well as making dramatic improvements in the methods used for tempering the glass, which had previously been seen to produce a defect which appeared as a

  18. The cost-effectiveness of rapid HIV testing in substance abuse treatment: results of a randomized trial.

    Science.gov (United States)

    Schackman, Bruce R; Metsch, Lisa R; Colfax, Grant N; Leff, Jared A; Wong, Angela; Scott, Callie A; Feaster, Daniel J; Gooden, Lauren; Matheson, Tim; Haynes, Louise F; Paltiel, A David; Walensky, Rochelle P

    2013-02-01

    The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit. A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Rapid start-up and improvement of granulation in SBR.

    Science.gov (United States)

    Jalali, Sajjad; Shayegan, Jalal; Rezasoltani, Samira

    2015-01-01

    The aim of this study is to accelerate and improve aerobic granulation within a Sequencing Batch Reactor (SBR) by cationic polymer addition. To identify whether the polymer additive is capable of enhancing granule formation, two SBRs (R1 and R2, each 0.15 m in diameter and 2 m in height) are used by feeding synthetic wastewater. The cationic polymer with concentration of 30 to 2 ppm is added to R2, while no cationic polymer is added to R1. Results show that the cationic polymer addition causes faster granule formation and consequently shorter reactor start-up period. The polymer-amended reactor contains higher concentration of biomass with better settling ability (23% reduction in SVI15) and larger and denser granules (112% increase of granular diameter). In addition, the results demonstrate that the cationic polymer improve the sludge granulation process by 31% increase in Extracellular Polymer Substance(EPS) concentration, 7% increase in Specific Oxygen Uptake Rate(SOUR), 18% increase in hydrophobicity, and 17% reduction in effluent Mixed Liquor Suspended Solid(MLSS) concentration. Concludingly, it is found that using the cationic polymer to an aerobic granular system has the potential to enhance the sludge granulation process.

  20. Changes in Sensory Evoked Responses Coincide with Rapid Improvement in Speech Identification Performance

    Science.gov (United States)

    Alain, Claude; Campeanu, Sandra; Tremblay, Kelly

    2010-01-01

    Perceptual learning is sometimes characterized by rapid improvements in performance within the first hour of training (fast perceptual learning), which may be accompanied by changes in sensory and/or response pathways. Here, we report rapid physiological changes in the human auditory system that coincide with learning during a 1-hour test session…

  1. Rapid, simple, and cost-effective treatments to achieve long-term hydrophilic PDMS surfaces

    Science.gov (United States)

    Hemmilä, Samu; Cauich-Rodríguez, Juan V.; Kreutzer, Joose; Kallio, Pasi

    2012-10-01

    This paper describes rapid, simple, and cost-effective treatments for producing biocompatible and long-term hydrophilic polydimethylsiloxane (PDMS) surfaces identified in an experimental study investigating 39 treatments in all. The wetting of the surfaces was monitored during six months. Changes in surface morphology and chemical composition were also analyzed. Some of the treatments are presented here for the first time, while for earlier presented treatments the selection of investigated parameters was wider and the observation period for the surface wetting longer. The PDMS surfaces were modified by surface activation, physisorption, and synthesis of both “grafting to” and “grafting from” polymer brushes. In surface activation, the PDMS sample was exposed to oxygen plasma, with several combinations of exposure time and RF power. In the physisorption and synthesis of polymer brushes, three commercially available and biocompatible chemicals were used: 2-hydroxyethyl methacrylate (HEMA), polyethylene glycol (PEG), and polyvinylpyrrolidone (PVP). Thirty-three of the 39 treatments rendered the PDMS hydrophilic, and in 12 cases the hydrophilicity lasted at least six months. Seven of these long-term hydrophilic coatings supported a contact angle of 30° or less. Three of the long-lasting hydrophilic coatings required only minutes to prepare.

  2. New MEA Materials for Improved DMFC Performance, Durability and Cost

    Energy Technology Data Exchange (ETDEWEB)

    Fletcher, James H. [University of North Florida; Campbell, Joseph L. [University of North Florida; Cox, Philip [University of North Florida; Harrington, William J. [University of North Florida

    2013-09-16

    Abstract Project Title: New MEA Materials for Improved DMFC Performance, Durability and Cost The University of North Florida (UNF)--with project partners the University of Florida, Northeastern University, and Johnson Matthey--has recently completed the Department of Energy (DOE) project entitled “New MEA Materials for Improved DMFC Performance, Durability and Cost”. The primary objective of the project was to advance portable fuel cell MEA technology towards the commercial targets as laid out in the DOE R&D roadmap by developing a passive water recovery MEA (membrane electrode assembly). Developers at the University of North Florida identified water management components as an insurmountable barrier to achieving the required system size and weight necessary to achieve the energy density requirements of small portable power applications. UNF developed an innovative “passive water recovery” MEA for direct methanol fuel cells (DMFC) which provides a path to system simplification and optimization. The passive water recovery MEA incorporates a hydrophobic, porous, barrier layer within the cathode electrode, so that capillary pressure forces the water produced at the cathode through holes in the membrane and back to the anode. By directly transferring the water from the cathode to the anode, the balance of plant is very much simplified and the need for heavy, bulky water recovery components is eliminated. At the heart of the passive water recovery MEA is the UNF DM-1 membrane that utilizes a hydrocarbon structure to optimize performance in a DMFC system. The membrane has inherent performance advantages, such as a low methanol crossover (high overall efficiency), while maintaining a high proton conductivity (good electrochemical efficiency) when compared to perfluorinated sulfonic acid membranes such as Nafion. Critically, the membrane provides an extremely low electro-osmotic drag coefficient of approximately one water molecule per proton (versus the 2-3 for

  3. Improved Recharge Estimation from Portable, Low-Cost Weather Stations.

    Science.gov (United States)

    Holländer, Hartmut M; Wang, Zijian; Assefa, Kibreab A; Woodbury, Allan D

    2016-03-01

    Groundwater recharge estimation is a critical quantity for sustainable groundwater management. The feasibility and robustness of recharge estimation was evaluated using physical-based modeling procedures, and data from a low-cost weather station with remote sensor techniques in Southern Abbotsford, British Columbia, Canada. Recharge was determined using the Richards-based vadose zone hydrological model, HYDRUS-1D. The required meteorological data were recorded with a HOBO(TM) weather station for a short observation period (about 1 year) and an existing weather station (Abbotsford A) for long-term study purpose (27 years). Undisturbed soil cores were taken at two locations in the vicinity of the HOBO(TM) weather station. The derived soil hydraulic parameters were used to characterize the soil in the numerical model. Model performance was evaluated using observed soil moisture and soil temperature data obtained from subsurface remote sensors. A rigorous sensitivity analysis was used to test the robustness of the model. Recharge during the short observation period was estimated at 863 and 816 mm. The mean annual recharge was estimated at 848 and 859 mm/year based on a time series of 27 years. The relative ratio of annual recharge-precipitation varied from 43% to 69%. From a monthly recharge perspective, the majority (80%) of recharge due to precipitation occurred during the hydrologic winter period. The comparison of the recharge estimates with other studies indicates a good agreement. Furthermore, this method is able to predict transient recharge estimates, and can provide a reasonable tool for estimates on nutrient leaching that is often controlled by strong precipitation events and rapid infiltration of water and nitrate into the soil. © 2015, National Ground Water Association.

  4. The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement.

    Science.gov (United States)

    Thompson, Carl; Pulleyblank, Ryan; Parrott, Steve; Essex, Holly

    2016-02-01

    In resource constrained systems, decision makers should be concerned with the efficiency of implementing improvement techniques and technologies. Accordingly, they should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. An approach to doing this effectively is encapsulated in the 'policy cost-effectiveness' approach. This paper outlines some of the theoretical and practical challenges to assessing policy cost-effectiveness (the cost-effectiveness of implementation projects). A checklist and associated (freely available) online application are also presented to help services develop more cost-effective implementation strategies. © 2015 John Wiley & Sons, Ltd.

  5. An improved COCOMO software cost estimation model | Duke ...

    African Journals Online (AJOL)

    In this paper, we discuss the methodologies adopted previously in software cost estimation using the COnstructive COst MOdels (COCOMOs). From our analysis, COCOMOs produce very high software development efforts, which eventually produce high software development costs. Consequently, we propose its extension, ...

  6. Elevated guideway cost-ride quality studies for group rapid transit systems

    Science.gov (United States)

    1977-10-01

    A methodology is developed for relating cost to ride quality in elevated guideway : system design, based upon directly relating guideway structural properties and : construction tolerances to both cost and ride quality. It is illustrated in detail : ...

  7. A Model of Cost Reduction and Standardization: Improved Cost Savings While Maintaining the Quality of Care.

    Science.gov (United States)

    Guzman, Michael J; Gitelis, Matthew E; Linn, John G; Ujiki, Michael B; Waskerwitz, Matthew; Umanskiy, Konstantin; Muldoon, Joseph P

    2015-11-01

    Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending. We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction. We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques. This study was conducted in a university-affiliated hospital system. Patients included those undergoing a laparoscopic appendectomy within the hospital system. Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared. During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p costs are based on our institution contracts and vary compared with other institutions. In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.

  8. Lean Six Sigma for Reduced Cycle Costs and Improved Readiness

    National Research Council Canada - National Science Library

    Apte, Uday; Kang, Keebom

    2006-01-01

    ... it. Hence, efficient logistics systems, including transportation, inventory management, modifications and maintenance activities, are critically important for containing the lifecycle costs of weapon...

  9. Rapid and low-cost prototyping of medical devices using 3D printed molds for liquid injection molding.

    Science.gov (United States)

    Chung, Philip; Heller, J Alex; Etemadi, Mozziyar; Ottoson, Paige E; Liu, Jonathan A; Rand, Larry; Roy, Shuvo

    2014-06-27

    Biologically inert elastomers such as silicone are favorable materials for medical device fabrication, but forming and curing these elastomers using traditional liquid injection molding processes can be an expensive process due to tooling and equipment costs. As a result, it has traditionally been impractical to use liquid injection molding for low-cost, rapid prototyping applications. We have devised a method for rapid and low-cost production of liquid elastomer injection molded devices that utilizes fused deposition modeling 3D printers for mold design and a modified desiccator as an injection system. Low costs and rapid turnaround time in this technique lower the barrier to iteratively designing and prototyping complex elastomer devices. Furthermore, CAD models developed in this process can be later adapted for metal mold tooling design, enabling an easy transition to a traditional injection molding process. We have used this technique to manufacture intravaginal probes involving complex geometries, as well as overmolding over metal parts, using tools commonly available within an academic research laboratory. However, this technique can be easily adapted to create liquid injection molded devices for many other applications.

  10. Pharmaceutical services cost analysis using time-driven activity-based costing: A contribution to improve community pharmacies' management.

    Science.gov (United States)

    Gregório, João; Russo, Giuliano; Lapão, Luís Velez

    2016-01-01

    The current financial crisis is pressing health systems to reduce costs while looking to improve service standards. In this context, the necessity to optimize health care systems management has become an imperative. However, little research has been conducted on health care and pharmaceutical services cost management. Pharmaceutical services optimization requires a comprehensive understanding of resources usage and its costs. This study explores the development of a time-driven activity-based costing (TDABC) model, with the objective of calculating the cost of pharmaceutical services to help inform policy-making. Pharmaceutical services supply patterns were studied in three pharmacies during a weekday through an observational study. Details of each activity's execution were recorded, including time spent per activity performed by pharmacists. Data on pharmacy costs was obtained through pharmacies' accounting records. The calculated cost of a dispensing service in these pharmacies ranged from €3.16 to €4.29. The cost of a counseling service when no medicine was supplied ranged from €1.24 to €1.46. The cost of health screening services ranged from €2.86 to €4.55. The presented TDABC model gives us new insights on management and costs of community pharmacies. This study shows the importance of cost analysis for health care services, specifically on pharmaceutical services, in order to better inform pharmacies' management and the elaboration of pharmaceutical policies. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    African Journals Online (AJOL)

    Objectives. To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

  12. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

    Science.gov (United States)

    Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

    2014-09-01

    An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality. Copyright © 2014. Published by Elsevier Ltd.

  13. Measuring and Improving Value of Care in Oncology Practices: ASCO Programs from Quality Oncology Practice Initiative to the Rapid Learning System.

    Science.gov (United States)

    Jacobson, Joseph O; Neuss, Michael N; Hauser, Robert

    2012-01-01

    Rising cancer care costs are no longer sustainable. Medical oncologists must focus on providing the maximum value to their patients; improving short-term, intermediate and long-term outcomes; and managing overall costs. Accurate measurement of outcomes and overall cost is essential to informing providers and institutions and in the quest for continuous improvement in value. The ASCO Quality Oncology Practice Initiative (QOPI) is an excellent tool for sampling processes of care in medical oncology practices. To achieve the larger goal of improving the value of cancer care, ASCO is investing in the development of a Rapid Learning System, which will leverage emerging information technologies to more accurately measure outcomes (including those reported by the patient) and costs, resulting in highly efficient, effective, and safe cancer care.

  14. Improving Space Project Cost Estimating with Engineering Management Variables

    Science.gov (United States)

    Hamaker, Joseph W.; Roth, Axel (Technical Monitor)

    2001-01-01

    Current space project cost models attempt to predict space flight project cost via regression equations, which relate the cost of projects to technical performance metrics (e.g. weight, thrust, power, pointing accuracy, etc.). This paper examines the introduction of engineering management parameters to the set of explanatory variables. A number of specific engineering management variables are considered and exploratory regression analysis is performed to determine if there is statistical evidence for cost effects apart from technical aspects of the projects. It is concluded that there are other non-technical effects at work and that further research is warranted to determine if it can be shown that these cost effects are definitely related to engineering management.

  15. The cost effectiveness of rapid-acting insulin aspart compared with human insulin in type 2 diabetes patients: an analysis from the Japanese third-party payer perspective.

    Science.gov (United States)

    Pollock, R F; Valentine, W J; Pilgaard, T; Nishimura, H

    2011-01-01

    The Nippon Ultra-Rapid Insulin and Diabetic Complication Evaluation Study (NICE Study) (NCT00575172) was a 5-year, open-label, randomised controlled trial which compared cardiovascular outcomes in Japanese type 2 diabetes patients intensively treated with regular human insulin or insulin aspart (NovoRapid; Novo Nordisk A/S, Bagsvaerd, Denmark), a rapid-acting insulin analogue. The aim of the present analysis was to evaluate the cost effectiveness of insulin aspart versus regular human insulin from the perspective of a Japanese third-party healthcare payer. A discrete event-simulation model was developed in Microsoft Excel to assess the within-trial cost effectiveness and make longer-term clinical projections in patients treated with regular human insulin or insulin aspart. In addition to severe hypoglycaemia, the model captured myocardial and cerebral infarction events and percutaneous coronary intervention and coronary artery bypass graft procedures. Within-trial mortality, incidence of severe hypoglycaemia and cardiovascular event probabilities were derived from the annual rates observed during the trial period, while post-trial outcomes were calculated using the event rates from the trial, adjusted for increasing patient age. Event costs were accounted from the healthcare payer perspective and expressed in 2008 Japanese yen (JPY), while health-related quality of life (HRQoL) was captured using event and state utilities. Future costs and clinical benefits were discounted at 3% annually. Life expectancy, quality-adjusted life expectancy, cardiovascular event rates and costs were evaluated over 5- and 10-year time horizons and sensitivity analyses were performed to assess variability in model outcomes. Over 5 years of treatment, insulin aspart dominated human insulin both in incremental life expectancy and in incremental quality-adjusted life-years (QALYS). Insulin aspart was associated with a small improvement in discounted life expectancy of 0.005 years (4.688 vs

  16. A Marginal Cost Based "Social Cost of Carbon" Provides Inappropriate Guidance in a World That Needs Rapid and Deep Decarbonization

    Science.gov (United States)

    Morgan, M. G.; Vaishnav, P.; Azevedo, I. L.; Dowlatabadi, H.

    2016-12-01

    An interagency working group in the U.S. government has used three integrated assessment models of climate change to estimate "the social cost of carbon" and U.S. Federal Agencies and many others are using these figures as the benchmark for sound public policy. We argue that assessing the cost of emissions of CO2 on the margin is inappropriate for at least four reasons: 1) Greenhouse gas concentrations are cumulative and their radiative forcing is a non-linear function of the atmospheric concentration of many radiatively active gases. A marginal approach ignores these interactions and dependence of net forcing on concentrations of other greenhouse gases in the atmosphere. 2) Geologic evidence points to three quasi-equilibrium climate states. We know that the response of the climate system to changes in radiative forcing is non-linear. We also know that the feedbacks that have blessed us with a stable "climate optimum" for the past 10,000 years are uncertain in magnitude and operate over limited perturbations. Beyond that perturbation, it is likely that climate system dynamics will tip to a very different climate state. The probability and consequences of such climate transitions cannot be treated using a marginal approach. 3) Climate change and its impacts will vary by location, ecosystem and socio-economic context. The responses of social, economic and ecological systems are also likely to be non-linear, display hysteresis, and "tipping" or bifurcation. 4) We neither know how to characterize such impacts nor how they will be valued across different cultures and societies. Indeed, monetizing and discounting these heterogeneous and contextual impacts as a single global metric displays a hubris that has been roundly condemned by ethicists and decision-analysts. After outlining these limitations, we describe several strategies that could be used to inform climate policy to achieving deep decarbonization.

  17. Operating cost budgeting methods: quantitative methods to improve the process

    Directory of Open Access Journals (Sweden)

    José Olegário Rodrigues da Silva

    Full Text Available Abstract Operating cost forecasts are used in economic feasibility studies of projects and in budgeting process. Studies have pointed out that some companies are not satisfied with the budgeting process and chief executive officers want updates more frequently. In these cases, the main problem lies in the costs versus benefits. Companies seek simple and cheap forecasting methods without, at the same time, conceding in terms of quality of the resulting information. This study aims to compare operating cost forecasting models to identify the ones that are relatively easy to implement and turn out less deviation. For this purpose, we applied ARIMA (autoregressive integrated moving average and distributed dynamic lag models to data from a Brazilian petroleum company. The results suggest that the models have potential application, and that multivariate models fitted better and showed itself a better way to forecast costs than univariate models.

  18. Rapid and low-cost fabrication of polystyrene-based molds for PDMS microfluidic devices using a CO2 laser

    KAUST Repository

    Li, Huawei

    2011-11-01

    In this article, we described a rapid and low-cost method to fabricate polystyrene molds for PDMS microfluidic devices using a CO2 laser system. It takes only several minutes to fabricate the polystyrene mold with bump pattern on top of it using a CO2 laser system. The bump pattern can be easily transferred to PDMS and fabricate microchannles as deep as 3μm on PDMS. © (2012) Trans Tech Publications, Switzerland.

  19. Applying Insights from Transaction Cost Economics (TCE) to Improve DoD Cost Estimation

    Science.gov (United States)

    2007-07-12

    and year). For example, the Marine Corps Advanced Amphibious Assault Vehicle ( AAAV )17 reported Program Office costs in exhibit R-3 under “Support...how they are funded. The AAAV reported costs for the more general category “Support and Management” for FY97 – FY06, but the line-items included in

  20. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  1. Improvement of an existing low cost wooden groundnut sheller ...

    African Journals Online (AJOL)

    An existing manually operated groundnut sheller was re-designed, fabricated and tested. About 90% of the components of the 18 kg./hr capacity rasp-bar sheller, equipped with a kernelcleaning device, were fabricated using the sawn wood of Cordia millennii. A one-off prototype of the sheller was produced at a total cost of ...

  2. Improving World Health: A Least Cost Strategy. Worldwatch Paper 59.

    Science.gov (United States)

    Chandler, William U.

    Least-cost health strategies designed to attack the world's leading causes of unnecessary death are explored. Section 1 emphasizes the value of primary health-care procedures--midwifery, maternal education on breastfeeding and weaning, vaccinations, oral rehydration of victims of diarrhea, and antibiotics against respiratory infections--in…

  3. Regulating the Dutch pharmaceutical market: improving efficiency or controlling costs?

    NARCIS (Netherlands)

    Wolf, de P.; Brouwer, W.B.F.; Rutten, F.H.

    2005-01-01

    In this paper, we describe the Dutch pharmaceutical market, which is heavily regulated by the government. Through the regulation of prices and promoting prudent use, the Dutch government tries to bring down the cost of pharmaceuticals, which increases every year at a higher rate than total health

  4. Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition

    Directory of Open Access Journals (Sweden)

    Alberto Caprioglio

    2017-04-01

    Full Text Available Abstract Background The aim of this study is to identify cephalometric pretreatment parameters for prediction of Class II improvement induced by rapid maxillary expansion. Methods Lateral cephalograms of 30 patients (mean age 8.3 ± 1.6 years old showing Class II molar relationship and undergone to rapid maxillary expansion on the upper deciduous molars were traced before treatment, and molar relation changes were evaluated on dental casts before and after treatment. Overall treatment time lasted 10.2 ± 2 months. Good responders (18 subjects, 10 females and 8 males showed improvement of at least 2.50 mm, and bad responders (12 subjects, 7 females and 5 males showed no improvement, improvement less than 2.50 mm, or worsening of molar relationship after treatment. Student’s t test was used to assess significance of differences between groups, and discriminant analysis allowed identification of predictive pretreatment variables. Results Articular angle, superior gonial angle, and mandibular dimensions (Co-Gn, S-Ar, Ar-Go, Go-Me showed significant differences in the comparison between groups. Mandibular length Co-Gn and superior gonial angle were selected as significant predictive variable for discrimination. Conclusions Patients with smaller mandibular length and more acute superior gonial angle are expected to have more chances to improve molar Class II after rapid maxillary expansion.

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

    Science.gov (United States)

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

    2014-01-01

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

  6. Hyperthyroidism in molar pregnancy: rapid preoperative preparation by plasmapheresis and complete improvement after evacuation.

    Science.gov (United States)

    Azezli, Adil; Bayraktaroglu, Taner; Topuz, Samet; Kalayoglu-Besisik, Sevgi

    2007-02-01

    Human chorionic gonadotropin bears structural homology to pituitary thyrotropin. The extremely elevated levels of human chorionic gonadotropin in patients with molar pregnancy or other trophoblastic diseases can lead to hyperthyroidism. We describe a patient with molar pregnancy who had secondary hyperthyroidism prepared rapidly by plasmapheresis for surgery. The clinical picture improved dramatically after the first plasmapheresis. Three subsequent plasmapheresis provided a 75.1% decrease in serum free T3 concentrations and 63.9% free T4 concentrations and recovery after evacuation. This is the first use of plasmapheresis in rapid preparation of a patient who had secondary hyperthyroidism due to molar pregnancy.

  7. 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

    at rural operational primary care centres. METHODS: Three health centres (HCs) were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis) in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients...... 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...

  8. Costs of Rapid HIV Screening in an Urban Emergency Department and a Nearby County Jail in the Southeastern United States.

    Directory of Open Access Journals (Sweden)

    Anne C Spaulding

    Full Text Available Emergency departments and jails provide medical services to persons at risk for HIV infection and are recommended venues for HIV screening. Our main objective in this study was to analyze the cost per new HIV diagnosis associated with the HIV screening program in these two venues. The emergency department's parallel testing program was conducted at Grady Memorial Hospital in Atlanta, Georgia starting in 2008; the jail's integrated testing program began at the Fulton County (GA Jail in 2011. The two sites, four miles apart from one another, employed the same rapid HIV test. Ascertainment that cases were new differed by site; only the jail systematically checked identities against health department HIV registries. The program in the emergency department used dedicated HIV test counselors and made 242 diagnoses over a 40-month period at a cost of $2,981 per diagnosis. The jail program used staff nurses, and found 41 new HIV cases over 10.5 months at a cost of $6,688 per new diagnosis. Differences in methods for ascertainment of new diagnoses, previously undiagnosed HIV sero-positivity, and methodologies used for assessing program costs prevent concluding that one program was more economical than the other. Nonetheless, our findings show that testing in both venues yielded many new diagnoses, with the costs within the range reported in the literature.

  9. Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

    2015-01-01

    OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour...... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

  10. IMPROVING THE LABOUR COSTS EFFICIENCY AT UKRAINIAN ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Olga Sukach

    2014-04-01

    Full Text Available Generally, labor costs are more complicated than other inputs. But wages and labor productivity in Ukraine are significantly lower than in the market economies. Also the share of the basic wages consisted by 61.1 per cent at Ukrainian enterprises. While, the developed countries keep a basic wage at the rate of about 80-85 per cent. Consequently, wage is transformed into one of the version of a social assistance, which in less degree dependents on the results. The main purpose of the article is a theoretical studied of a system of economic indicators of labor costs efficiency and a critical analysis of their calculations in Ukrainian enterprises and abroad. In support of correlation between the share of basic wages and labor productivity the multiplicative model of labor productivity is developed and was practically used by the author on one of Ukrainian enterprises.

  11. A rapid and low-cost DNA extraction method for isolating ...

    African Journals Online (AJOL)

    The price of commercial DNA extraction methods makes the routine use of polymerase chain reaction amplification (PCR) based methods rather costly for scientists in developing countries. A guanidium thiocayante-based DNA extraction method was investigated in this study for the isolation of Escherichia coli (E. coli) DNA ...

  12. Preliminary feasibility studies in times of rapid cost escalation. [Oil shale and tar sand industries

    Energy Technology Data Exchange (ETDEWEB)

    Oliver, E.D.; Moll, A.J.

    1976-01-01

    Not the least of the problems delaying the development and commercialization of synthetic fuel processes has been the extraordinary escalation of cost estimates by factors of up to ten in the past eight years. This study identifies and analyzes some of the most important contributing factors that have converged in the last few years. These factors include overoptimism and ill-defined project scope in the early stages, tightening environmental controls, difficulties in obtaining raw materials and fuels, general inflationary trends, ''hyperinflation'' of the costs of critical equipment, local labor shortages, and increased times required for procurement and construction. Cost increases have been particularly dramatic for ''offsites,'' liberally defined as nonprocess related parts of projects. Case histories of oil shale and tar sand developments are analyzed. Learning curves of costs during development and commercial use are studied. The analysis suggests that the worst of the extraordinary increases (above general inflationary trends) are probably over. Criteria to judge the state of development of processes are given, and some procedures to avoid future pitfalls are suggested.

  13. Dimensional Error in Rapid Prototyping with Open Source Software and Low-cost 3D-printer.

    Science.gov (United States)

    Rendón-Medina, Marco A; Andrade-Delgado, Laura; Telich-Tarriba, Jose E; Fuente-Del-Campo, Antonio; Altamirano-Arcos, Carlos A

    2018-01-01

    Rapid prototyping models (RPMs) had been extensively used in craniofacial and maxillofacial surgery, especially in areas such as orthognathic surgery, posttraumatic or oncological reconstructions, and implantology. Economic limitations are higher in developing countries such as Mexico, where resources dedicated to health care are limited, therefore limiting the use of RPM to few selected centers. This article aims to determine the dimensional error of a low-cost fused deposition modeling 3D printer (Tronxy P802MA, Shenzhen, Tronxy Technology Co), with Open source software. An ordinary dry human mandible was scanned with a computed tomography device. The data were processed with open software to build a rapid prototype with a fused deposition machine. Linear measurements were performed to find the mean absolute and relative difference. The mean absolute and relative difference was 0.65 mm and 1.96%, respectively ( P = 0.96). Low-cost FDM machines and Open Source Software are excellent options to manufacture RPM, with the benefit of low cost and a similar relative error than other more expensive technologies.

  14. A novel low-cost mobile robot for rapid prototyping of precision farming applications

    DEFF Research Database (Denmark)

    Jensen, Kjeld; Neerup, Mathias Mikkel; Larsen, Leon Bonde

    field experiments using field robots which is typically a demanding task in terms of time consumption and logistics. Small indoor robots are sometimes used to emulate the larger field robots which allows for rapid prototyping and intermediate testing in the laboratory before moving to the field...... experiments. In this work we present a novel FrobitPro robot platform designed for rapid prototyping of FroboMind field robot applications. FrobitPro has a fundamental design similar to many current wheeled and tracked robots such as the Kongskilde Robotti, and the workflow of migrating from simulation...... to FrobitPro to field robot is therefore merely a matter of using different low level interface components. The FrobitPro robot is capable of carrying larger sensors such as RTK- GNSS, LIDAR and 3d stereo vision cameras. The platform supports interchangeable wheels for accurate indoor driving as well...

  15. Low-cost rapid prototyping of flexible plastic paper based microfluidic devices

    KAUST Repository

    Fan, Yiqiang

    2013-04-01

    This research presents a novel rapid prototyping method for paper-based flexible microfluidic devices. The microchannels were fabricated using laser ablation on a piece of plastic paper (permanent paper), the dimensions of the microchannels was carefully studied for various laser powers and scanning speeds. After laser ablation of the microchannels on the plastic paper, a transparent poly (methyl methacrylate)(PMMA) film was thermally bonded to the plastic paper to enclose the channels. After connection of tubing, the device was ready to use. An example microfluidic device (droplet generator) was also fabricated using this technique. Due to the flexibility of the fabricated device, this technique can be used to fabricate 3D microfluidic devices. The fabrication process was simple and rapid without any requirement of cleanroom facilities. © 2013 IEEE.

  16. 75 FR 78798 - Airport Improvement Program: Proposed Changes to Benefit Cost Analysis (BCA) Threshold

    Science.gov (United States)

    2010-12-16

    ... Federal Aviation Administration Airport Improvement Program: Proposed Changes to Benefit Cost Analysis... requiring benefit cost analyses (BCA) for capacity projects when applying for Airport Improvement Program... Friday, except Federal holidays. Privacy: We will post all comments we receive, without change, to http...

  17. Integrating Low-Cost Rapid Usability Testing into Agile System Development of Healthcare IT: A Methodological Perspective.

    Science.gov (United States)

    Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    The development of more usable and effective healthcare information systems has become a critical issue. In the software industry methodologies such as agile and iterative development processes have emerged to lead to more effective and usable systems. These approaches highlight focusing on user needs and promoting iterative and flexible development practices. Evaluation and testing of iterative agile development cycles is considered an important part of the agile methodology and iterative processes for system design and re-design. However, the issue of how to effectively integrate usability testing methods into rapid and flexible agile design cycles has remained to be fully explored. In this paper we describe our application of an approach known as low-cost rapid usability testing as it has been applied within agile system development in healthcare. The advantages of the integrative approach are described, along with current methodological considerations.

  18. FURTHER COMMENT ON "A RAPID ASSESSMENT MODEL FOR UNDERSTANDING THE SOCIAL COST OF CARBON"

    OpenAIRE

    STEPHEN C. NEWBOLD; CHARLES GRIFFITHS; CHRIS MOORE; ANN WOLVERTON; ELIZABETH KOPITS

    2014-01-01

    In this reply to the comment by Gerlagh, we confirm an error in our estimate of the certainty-equivalent social cost of carbon (SCC) reported in Newbold et al. (2013), and we discuss the underlying conceptual difficulties that arise in conducting a social welfare analysis when preferences are heterogeneous or uncertain. The certainty-equivalent SCC depends crucially on the reference level of per capita consumption used to normalize marginal utility across possible preference parameters, and o...

  19. Screening and Rapid Molecular Diagnosis of Tuberculosis in Prisons in Russia and Eastern Europe: A Cost-Effectiveness Analysis

    Science.gov (United States)

    Winetsky, Daniel E.; Negoescu, Diana M.; DeMarchis, Emilia H.; Almukhamedova, Olga; Dooronbekova, Aizhan; Pulatov, Dilshod; Vezhnina, Natalia; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

    2012-01-01

    Background Prisons of the former Soviet Union (FSU) have high rates of multidrug-resistant tuberculosis (MDR-TB) and are thought to drive general population tuberculosis (TB) epidemics. Effective prison case detection, though employing more expensive technologies, may reduce long-term treatment costs and slow MDR-TB transmission. Methods and Findings We developed a dynamic transmission model of TB and drug resistance matched to the epidemiology and costs in FSU prisons. We evaluated eight strategies for TB screening and diagnosis involving, alone or in combination, self-referral, symptom screening, mass miniature radiography (MMR), and sputum PCR with probes for rifampin resistance (Xpert MTB/RIF). Over a 10-y horizon, we projected costs, quality-adjusted life years (QALYs), and TB and MDR-TB prevalence. Using sputum PCR as an annual primary screening tool among the general prison population most effectively reduced overall TB prevalence (from 2.78% to 2.31%) and MDR-TB prevalence (from 0.74% to 0.63%), and cost US$543/QALY for additional QALYs gained compared to MMR screening with sputum PCR reserved for rapid detection of MDR-TB. Adding sputum PCR to the currently used strategy of annual MMR screening was cost-saving over 10 y compared to MMR screening alone, but produced only a modest reduction in MDR-TB prevalence (from 0.74% to 0.69%) and had minimal effect on overall TB prevalence (from 2.78% to 2.74%). Strategies based on symptom screening alone were less effective and more expensive than MMR-based strategies. Study limitations included scarce primary TB time-series data in FSU prisons and uncertainties regarding screening test characteristics. Conclusions In prisons of the FSU, annual screening of the general inmate population with sputum PCR most effectively reduces TB and MDR-TB prevalence, doing so cost-effectively. If this approach is not feasible, the current strategy of annual MMR is both more effective and less expensive than strategies using self

  20. Screening and rapid molecular diagnosis of tuberculosis in prisons in Russia and Eastern Europe: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Daniel E Winetsky

    Full Text Available Prisons of the former Soviet Union (FSU have high rates of multidrug-resistant tuberculosis (MDR-TB and are thought to drive general population tuberculosis (TB epidemics. Effective prison case detection, though employing more expensive technologies, may reduce long-term treatment costs and slow MDR-TB transmission.We developed a dynamic transmission model of TB and drug resistance matched to the epidemiology and costs in FSU prisons. We evaluated eight strategies for TB screening and diagnosis involving, alone or in combination, self-referral, symptom screening, mass miniature radiography (MMR, and sputum PCR with probes for rifampin resistance (Xpert MTB/RIF. Over a 10-y horizon, we projected costs, quality-adjusted life years (QALYs, and TB and MDR-TB prevalence. Using sputum PCR as an annual primary screening tool among the general prison population most effectively reduced overall TB prevalence (from 2.78% to 2.31% and MDR-TB prevalence (from 0.74% to 0.63%, and cost US$543/QALY for additional QALYs gained compared to MMR screening with sputum PCR reserved for rapid detection of MDR-TB. Adding sputum PCR to the currently used strategy of annual MMR screening was cost-saving over 10 y compared to MMR screening alone, but produced only a modest reduction in MDR-TB prevalence (from 0.74% to 0.69% and had minimal effect on overall TB prevalence (from 2.78% to 2.74%. Strategies based on symptom screening alone were less effective and more expensive than MMR-based strategies. Study limitations included scarce primary TB time-series data in FSU prisons and uncertainties regarding screening test characteristics.In prisons of the FSU, annual screening of the general inmate population with sputum PCR most effectively reduces TB and MDR-TB prevalence, doing so cost-effectively. If this approach is not feasible, the current strategy of annual MMR is both more effective and less expensive than strategies using self-referral or symptom screening alone

  1. Cost and Reliability Improvement for CIGS-Based PV on Flexible Substrate: May 24, 2006 -- July 31, 2010

    Energy Technology Data Exchange (ETDEWEB)

    Wiedeman, S.

    2011-05-01

    Global Solar Energy rapidly advances the cost and performance of commercial thin-film CIGS products using roll-to-roll processing on steel foil substrate in compact, low cost deposition equipment, with in-situ sensors for real-time intelligent process control. Substantial increases in power module efficiency, which now exceed 13%, are evident at GSE factories in two countries with a combined capacity greater than 75 MW. During 2009 the average efficiency of cell strings (3780 cm2) was increased from 7% to over 11%, with champion results exceeding 13% Continued testing of module reliability in rigid product has reaffirmed extended life expectancy for standard glass product, and has qualified additional lower-cost methods and materials. Expected lifetime for PV in flexible packages continues to increase as failure mechanisms are elucidated, and resolved by better methods and materials. Cost reduction has been achieved through better materials utilization, enhanced vendor and material qualification and selection. The largest cost gains have come as a result of higher cell conversion efficiency and yields, higher processing rates, greater automation and improved control in all process steps. These improvements are integral to this thin film PV partnership program, and all realized with the 'Gen2' manufacturing plants, processes and equipment.

  2. Rapid Health Care Improvement Science Curriculum Integration Across Programs in a School of Nursing.

    Science.gov (United States)

    Oliver, Brant J; Potter, Mertie; Pomerleau, Mimi; Phillips, Andrew; O'Donnell, Mimi; Cowley, Connie; Sipe, Margie

    This article describes the systematic efforts undertaken by a school of nursing in the Northeastern United States to foster innovation in health professions education. We present an application of modified team coaching and plan-do-study-act improvement methods in an educational context to rapidly integrate a quality and safety curriculum across programs. We discuss applications in generalist, advanced practice, doctoral, residency, and advanced fellowship programs and provide examples of each.

  3. Novel methods for improving rapid paper-based protein assays with gold nanoparticle detection

    OpenAIRE

    Lama, Lara

    2017-01-01

    This thesis describes methods for improving sensitivity in rapid singleplex and multiplex microarray assays. The assays utilize the optical characteristics of colloidal gold nanoparticles for the colorimetric detection of proteins. Multiplexed detection in sandwich immunoassays is limited by cross-reactivity between different detection antibodies. The cross-reactivity between antibodies can contribute to increased background noise - decreasing the Limit-of-Detection of the assay - or generate...

  4. Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer's disease

    OpenAIRE

    Gross Hyman; Tobinick Edward L

    2008-01-01

    Abstract Background Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer's disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the b...

  5. Improvement of Cost Calculation in Constructions – Application of the Standard Cost Method

    Directory of Open Access Journals (Sweden)

    Adela Breuer

    2010-12-01

    Full Text Available Grace to the analysis of several commercial companies effectively performed “on the field”, we could remark the necessity to change the method of cost calculation, our motivation being related to the simplification of calculations and the reduction of the labour volume, but especially the necessity to know in due time the deviations occurred as well as the causes having led to their apparition. The importance of knowing the deviations in due time results from the very basic characteristics of the constructions execution, i.e. the performance of works during several budgetary years, which leads to the modifications of prices and materials, the introduction of new technologies, and to the performance of open air activities, making the execution of constructions works be influenced by the atmospheric condition. But the most important aspect of knowing the deviations is the correct determination of expenses and their inscribing in the corresponding period, in view of determining the result of the budgetary year. Our proposal for the enhancement of the method of cost calculation in constructions is the application of the standard cost method in the variant “single standard cost”.

  6. The effect of construction cost estimating (CCE software on job performance: An improvement plan

    Directory of Open Access Journals (Sweden)

    Mohd Mukelas M.F.

    2014-01-01

    Full Text Available This paper presents a comprehensive statistical research on the effect of construction cost estimating software’s features towards estimating job performance. The objectives of this study are identification of cost estimating software features, analyzing the significant relation of cost estimating software’s features towards job performance, Explore the problem faced during the implementation and lastly propose a plan to improve the cost estimating software usage among contractors in Malaysia. The study statistically reveals four features of cost estimating software that significantly impact towards changes in cost estimating job performance. These features were refined by performing interview to focus group of respondent to observe the actual possible problems during the implementation. Eventually, the proposed improvement plan was validated by the focus group of respondents to enhance the cost estimating software implementation among contractors in Malaysia.

  7. Decreasing pressure ulcer risk during hospital procedures: a rapid process improvement workshop.

    Science.gov (United States)

    Haugen, Vicki; Pechacek, Judy; Maher, Travis; Wilde, Joy; Kula, Larry; Powell, Julie

    2011-01-01

    A 300-bed acute care community hospital used a 2-day "Rapid Process Improvement Workshop" to identify factors contributing to facility-acquired pressure ulcers (PU). The Rapid Process Improvement Workshop included key stakeholders from all procedural areas providing inpatient services and used standard components of rapid process improvement: data analysis, process flow charting, factor identification, and action plan development.On day 1, the discovery process revealed increased PU risk related to prolonged immobility when transporting patients for procedures, during imaging studies, and during the perioperative period. On day 2, action plans were developed that included communication of PU risk or presence of an ulcer,measures to shorten procedure times when clinically appropriate, implementation of prevention techniques during procedures, and recommendations for mattress upgrades. In addition, educational programs about PU prevention were developed, schedules for presentations were established, and an online power point presentation was completed and placed in a learning management system module. Finally, our nursing department amended a hospital wide handoff communication tool to include skin status and PU risk level. This tool is used in all patient handoff situations, including nonnursing departments such as radiology. Patients deemed at risk for ulcers were provided "Braden Risk" armbands to enhance interdepartmental awareness.

  8. Durable, Low-cost, Improved Fuel Cell Membranes

    Energy Technology Data Exchange (ETDEWEB)

    Chris Roger; David Mountz; Wensheng He; Tao Zhang

    2011-03-17

    The development of low cost, durable membranes and membranes electrode assemblies (MEAs) that operate under reduced relative humidity (RH) conditions remain a critical challenge for the successful introduction of fuel cells into mass markets. It was the goal of the team lead by Arkema, Inc. to address these shortages. Thus, this project addresses the following technical barriers from the fuel cells section of the Hydrogen Fuel Cells and Infrastructure Technologies Program Multi-Year Research, Development and Demonstration Plan: (A) Durability (B) Cost Arkema’s approach consisted of using blends of polyvinylidenefluoride (PVDF) and proprietary sulfonated polyelectrolytes. In the traditional approach to polyelectrolytes for proton exchange membranes (PEM), all the required properties are “packaged” in one macromolecule. The properties of interest include proton conductivity, mechanical properties, durability, and water/gas transport. This is the case, for example, for perfluorosulfonic acid-containing (PFSA) membranes. However, the cost of these materials is high, largely due to the complexity and the number of steps involved in their synthesis. In addition, they suffer other shortcomings such as mediocre mechanical properties and insufficient durability for some applications. The strength and originality of Arkema’s approach lies in the decoupling of ion conductivity from the other requirements. Kynar® PVDF provides an exceptional combination of properties that make it ideally suited for a membrane matrix (Kynar® is a registered trademark of Arkema Inc.). It exhibits outstanding chemical resistance in highly oxidative and acidic environments. In work with a prior grant, a membrane known as M41 was developed by Arkema. M41 had many of the properties needed for a high performance PEM, but had a significant deficiency in conductivity at low RH. In the first phase of this work, the processing parameters of M41 were explored as a means to increase its proton

  9. A Novel System for Rapid and Cost-Effective Production of Detection and Diagnostic Reagents of West Nile Virus in Plants

    Directory of Open Access Journals (Sweden)

    Junyun He

    2012-01-01

    Full Text Available The threat of West Nile virus (WNV epidemics necessitates the development of a technology platform that can produce reagents to support detection and diagnosis rapidly and inexpensively. A plant expression system is attractive for protein production due to its low-cost and high-scalability nature and its ability to make appropriate posttranslational modifications. Here, we investigated the feasibility of using plants to produce two WNV detection and diagnostic reagents to address the current cost and scalability issues. We demonstrated that WNV DIII antigen and E16 monoclonal antibody are rapidly produced at high levels in two plant species and are easily purified. Furthermore, they are effective in identifying WNV and in detecting human IgM response to WNV infection. E16 mAb does not cross-react with other flaviviruses, therefore, is valuable for improving diagnostic accuracy. This study provides a proof of principle for using plants as a robust and economical system to produce diagnostic reagents for arboviruses.

  10. Rapid cross platform healthcare gaming design and implementation: The cost effective methodology.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M

    2016-11-14

    There have been massive advances in E-Health and M-Health technology, with recent interest in the utility of games for healthcare and the promotion of well-being and recovery as well as patient empowerment. There has been various review demonstrating the clinical effectiveness and efficacy of games for healthcare. It is the aim of this technical note to illustrate how appropriate gaming engines could be used by non-expert clinicians to program games that could run across various platforms, as well as games that could integrate well with existing mechanical sensors. This would address the limitations with regards to the evidence base of games, as well as the limitations in the deployment of games to various participants. More importantly, games designed are also more likely to be cost-effective and lower in cost. The ability of integration with existing mechanical sensors would value-add existing games and enable recovery and remediation in various domains of health. This would further expand the potential of games as an adjunctive treatment for patients, or at least, to maintain the gains that they have made in their recovery process.

  11. Rapid, low cost prototyping of transdermal devices for personal healthcare monitoring.

    Science.gov (United States)

    Sharma, Sanjiv; Saeed, Anwer; Johnson, Christopher; Gadegaard, Nikolaj; Cass, Anthony Eg

    2017-04-01

    The next generation of devices for personal healthcare monitoring will comprise molecular sensors to monitor analytes of interest in the skin compartment. Transdermal devices based on microneedles offer an excellent opportunity to explore the dynamics of molecular markers in the interstitial fluid, however good acceptability of these next generation devices will require several technical problems associated with current commercially available wearable sensors to be overcome. These particularly include reliability, comfort and cost. An essential pre-requisite for transdermal molecular sensing devices is that they can be fabricated using scalable technologies which are cost effective. We present here a minimally invasive microneedle array as a continuous monitoring platform technology. Method for scalable fabrication of these structures is presented. The microneedle arrays were characterised mechanically and were shown to penetrate human skin under moderate thumb pressure. They were then functionalised and evaluated as glucose, lactate and theophylline biosensors. The results suggest that this technology can be employed in the measurement of metabolites, therapeutic drugs and biomarkers and could have an important role to play in the management of chronic diseases.

  12. Cell-on-hydrogel platform made of agar and alginate for rapid, low-cost, multidimensional test of antimicrobial susceptibility.

    Science.gov (United States)

    Sun, Han; Liu, Zhengzhi; Hu, Chong; Ren, Kangning

    2016-08-02

    Antimicrobial resistance (AMR) is a rapidly increasing threat to the effective treatment of infectious diseases worldwide. The two major remedies include: (1) using narrow-spectrum antibiotics based on rapid diagnosis; and (2) developing new antibiotics. A key part of both remedies is the antimicrobial susceptibility test (AST). However, the current standard ASTs that monitor colony formation are costly and time-consuming and the new strategies proposed are not yet practical to be implemented. Herein, we report a strategy to fabricate whole-hydrogel microfluidic chips using alginate-doped agar. This agar-based microfabrication makes it possible to prepare inexpensive hydrogel devices, and allows a seamless link between microfluidics and conventional agar-based cell culture. Different from common microfluidic systems, in our system the cells are cultured on top of the device, similar to normal agar plate culture; on the other hand, the microfluidic channels inside the hydrogel allow precise generation of linear gradient of drugs, thus giving a better performance than the conventional disk diffusion method. Cells in this system are not exposed to any shear flow, which allows the reliable tracking of individual cells and AST results to be obtained within 2-3 hours. Furthermore, our system could test the synergistic effect of drugs through two-dimensional gradient generation. Finally, the platform could be directly implemented to new drug discovery and other applications wherein a fast, cost-efficient method for studying the response of microorganisms upon drug administration is desirable.

  13. Improving the Defense Acquisition System and Reducing System Costs

    Science.gov (United States)

    1981-03-30

    meet personally with PMs, but found they were answerable to long chains of command within the Services) - Increased layering and numbers of reviews...34 attitude throughout the chain of command discourages tailoring strc-egies to shorten the cycle. Figure 1. SYSTEMS ACQUISITION PROCESS EVOLUTION...SYSl’CM SUPIMKT TESTING o RISK REDUCTION/ MVmilAIlOU PLAN »EARLY IMPROVEMENT) SUPPORT RESOURCE DEVOP . oo FIRM-UP CONTRACT SUPPORT PLANS oo

  14. Rapid, sensitive and cost effective method for isolation of viral DNA from feacal samples of dogs

    Directory of Open Access Journals (Sweden)

    Savi.

    2010-06-01

    Full Text Available A simple method for viral DNA extraction using chelex resin was developed. The method used was eco-friendly and cost effective compared to other methods such as phenol chloroform method which use health hazardous organic reagents. Further, a polymerase chain reaction (PCR based detection of canine parvovirus (CPV using primers from conserved region of VP2 gene was developed. To increase the sensitivity and specificity of reaction, nested PCR was designed. PCR reaction was optimized to amplify 747bp product of VP2 gene. The assay can be completed in few hours and doesn’t need hazardous chemicals. Thus, the sample preparation using chelating resin along with nested PCR seems to be a sensitive, specific and practical method for the detection of CPV in diarrhoeal feacal samples. [Vet. World 2010; 3(3.000: 105-106

  15. Rapid, Low-Cost, and Ecofriendly Approach for Iron Nanoparticle Synthesis Using Aspergillus oryzae TFR9

    Directory of Open Access Journals (Sweden)

    Jagadish Chandra Tarafdar

    2013-01-01

    Full Text Available Development of reliable and ecofriendly green approach for synthesis of metallic nanoparticles biologically is an important step in the field of application of nanoscience and nanotechnology. The present paper reports the green approach for iron nanoparticle synthesis using Aspergillus oryzae TFR9 using FeCl3 as a precursor metal salt. Valid characterization techniques employed for biosynthesized iron nanoparticles including dynamic light scattering (DLS, transmission electron microscopy (TEM, and high resolution-transmission electron microscopy (HR-TEM for morphological study. X-ray energy dispersive spectroscopy (EDS spectrum confirmed the presence of elemental iron signal in high percentage. Apart from ecofriendliness and easy availability, low-cost biomass production will be more advantageous when compared to other chemical methods. Biosynthesis of iron nanoparticles using fungus has greater commercial viability that it may be used in agriculture, biomedicals and engineering sector.

  16. Improving the accuracy of admitted subacute clinical costing: an action research approach.

    Science.gov (United States)

    Hakkennes, Sharon; Arblaster, Ross; Lim, Kim

    2017-08-01

    Objective The aim of the present study was to determine whether action research could be used to improve the breadth and accuracy of clinical costing data in an admitted subacute setting Methods The setting was a 100-bed in-patient rehabilitation centre. Using a pre-post study design all admitted subacute separations during the 2011-12 financial year were eligible for inclusion. An action research framework aimed at improving clinical costing methodology was developed and implemented. Results In all, 1499 separations were included in the study. A medical record audit of a random selection of 80 separations demonstrated that the use of an action research framework was effective in improving the breadth and accuracy of the costing data. This was evidenced by a significant increase in the average number of activities costed, a reduction in the average number of activities incorrectly costed and a reduction in the average number of activities missing from the costing, per episode of care. Conclusions Engaging clinicians and cost centre managers was effective in facilitating the development of robust clinical costing data in an admitted subacute setting. Further investigation into the value of this approach across other care types and healthcare services is warranted. What is known about this topic? Accurate clinical costing data is essential for informing price models used in activity-based funding. In Australia, there is currently a lack of robust admitted subacute cost data to inform the price model for this care type. What does this paper add? The action research framework presented in this study was effective in improving the breadth and accuracy of clinical costing data in an admitted subacute setting. What are the implications for practitioners? To improve clinical costing practices, health services should consider engaging key stakeholders, including clinicians and cost centre managers, in reviewing clinical costing methodology. Robust clinical costing data has

  17. Streamlined library programming how to improve services and cut costs

    CERN Document Server

    Porter-Reynolds, Daisy

    2014-01-01

    In their roles as community centers, public libraries offer many innovative and appealing programs; but under current budget cuts, library resources are stretched thin. With slashed budgets and limited staff hours, what can libraries do to best serve their publics? This how-to guide provides strategies for streamlining library programming in public libraries while simultaneously maintaining-or even improving-quality delivery. The wide variety of principles and techniques described can be applied on a selective basis to libraries of all sizes. Based upon the author's own extensive experience as

  18. A conceptual model to estimate cost effectiveness of the indoor environment improvements

    Energy Technology Data Exchange (ETDEWEB)

    Seppanen, Olli; Fisk, William J.

    2003-06-01

    Macroeconomic analyses indicate a high cost to society of a deteriorated indoor climate. The few example calculations performed to date indicate that measures taken to improve IEQ are highly cost-effective when health and productivity benefits are considered. We believe that cost-benefit analyses of building designs and operations should routinely incorporate health and productivity impacts. As an initial step, we developed a conceptual model that shows the links between improvements in IEQ and the financial gains from reductions in medical care and sick leave, improved work performance, lower employee turn over, and reduced maintenance due to fewer complaints.

  19. Locomotor Adaptation Improves Balance Control, Multitasking Ability and Reduces the Metabolic Cost of Postural Instability

    Science.gov (United States)

    Bloomberg, J. J.; Peters, B. T.; Mulavara, A. P.; Brady, R. A.; Batson, C. D.; Miller, C. A.; Ploutz-Snyder, R. J.; Guined, J. R.; Buxton, R. E.; Cohen, H. S.

    2011-01-01

    During exploration-class missions, sensorimotor disturbances may lead to disruption in the ability to ambulate and perform functional tasks during the initial introduction to a novel gravitational environment following a landing on a planetary surface. The overall goal of our current project is to develop a sensorimotor adaptability training program to facilitate rapid adaptation to these environments. We have developed a unique training system comprised of a treadmill placed on a motion-base facing a virtual visual scene. It provides an unstable walking surface combined with incongruent visual flow designed to enhance sensorimotor adaptability. Greater metabolic cost incurred during balance instability means more physical work is required during adaptation to new environments possibly affecting crewmembers? ability to perform mission critical tasks during early surface operations on planetary expeditions. The goal of this study was to characterize adaptation to a discordant sensory challenge across a number of performance modalities including locomotor stability, multi-tasking ability and metabolic cost. METHODS: Subjects (n=15) walked (4.0 km/h) on a treadmill for an 8 -minute baseline walking period followed by 20-minutes of walking (4.0 km/h) with support surface motion (0.3 Hz, sinusoidal lateral motion, peak amplitude 25.4 cm) provided by the treadmill/motion-base system. Stride frequency and auditory reaction time were collected as measures of locomotor stability and multi-tasking ability, respectively. Metabolic data (VO2) were collected via a portable metabolic gas analysis system. RESULTS: At the onset of lateral support surface motion, subj ects walking on our treadmill showed an increase in stride frequency and auditory reaction time indicating initial balance and multi-tasking disturbances. During the 20-minute adaptation period, balance control and multi-tasking performance improved. Similarly, throughout the 20-minute adaptation period, VO2 gradually

  20. Improving risk equalization for individuals with persistently high costs: Experiences from the Netherlands.

    Science.gov (United States)

    Eijkenaar, Frank; van Vliet, René C J A

    2017-11-01

    Risk-equalization (RE) models in competitive health insurance markets have become increasingly sophisticated. However, these models still have important imperfections. A specific problem in the Netherlands is that insurers are insufficiently compensated for individuals who can persistently be found in the right-end tail of the cost distribution. The goal of this study is to explore and evaluate options for improving compensation for persistently high-cost individuals in the Dutch basic health insurance. Prescription drugs claims (2012) and administrative data on costs and risk-characteristics (2010-2013) for the entire Dutch population are used to identify high-cost individuals and evaluate improvement options. These options - including new risk-classes and a form of risk-sharing - are evaluated in terms of insurers' incentives for risk-selection and efficiency. Three significantly undercompensated high-cost groups are identified: users of specific expensive drugs for rare diseases, hemophilia-patients, and individuals whose costs are in the top-0.50% in 3 prior years. The improvement options effectively remove the undercompensations for these groups and lead to a considerable improvement in individual-level model fit. However, the options differ in terms of their (potential) effects on insurers' efficiency incentives. Although this study provides useful insights in the possibilities for improving RE-models for persistently high-cost individuals, improving compensation remains challenging and dependent on the ongoing debate regarding coverage and reimbursement of expensive drugs. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. A model to estimate the cost effectiveness of the indoorenvironment improvements in office work

    Energy Technology Data Exchange (ETDEWEB)

    Seppanen, Olli; Fisk, William J.

    2004-06-01

    Deteriorated indoor climate is commonly related to increases in sick building syndrome symptoms, respiratory illnesses, sick leave, reduced comfort and losses in productivity. The cost of deteriorated indoor climate for the society is high. Some calculations show that the cost is higher than the heating energy costs of the same buildings. Also building-level calculations have shown that many measures taken to improve indoor air quality and climate are cost-effective when the potential monetary savings resulting from an improved indoor climate are included as benefits gained. As an initial step towards systemizing these building level calculations we have developed a conceptual model to estimate the cost-effectiveness of various measures. The model shows the links between the improvements in the indoor environment and the following potential financial benefits: reduced medical care cost, reduced sick leave, better performance of work, lower turn over of employees, and lower cost of building maintenance due to fewer complaints about indoor air quality and climate. The pathways to these potential benefits from changes in building technology and practices go via several human responses to the indoor environment such as infectious diseases, allergies and asthma, sick building syndrome symptoms, perceived air quality, and thermal environment. The model also includes the annual cost of investments, operation costs, and cost savings of improved indoor climate. The conceptual model illustrates how various factors are linked to each other. SBS symptoms are probably the most commonly assessed health responses in IEQ studies and have been linked to several characteristics of buildings and IEQ. While the available evidence indicates that SBS symptoms can affect these outcomes and suspects that such a linkage exists, at present we can not quantify the relationships sufficiently for cost-benefit modeling. New research and analyses of existing data to quantify the financial

  2. A low-cost microfluidic chip for rapid genotyping of malaria-transmitting mosquitoes.

    Science.gov (United States)

    Liu, Changchun; Mauk, Michael G; Hart, Robert; Bonizzoni, Mariangela; Yan, Guiyun; Bau, Haim H

    2012-01-01

    Vector control is one of the most effective measures to prevent the transmission of malaria, a disease that causes over 600,000 deaths annually. Around 30-40 Anopheles mosquito species are natural vectors of malaria parasites. Some of these species cannot be morphologically distinguished, but have behavioral and ecological differences. Emblematic of this is the Anopheles gambiae species complex. The correct identification of vector species is fundamental to the development of control strategies and epidemiological studies of disease transmission. An inexpensive, disposable, field-deployable, sample-to-answer, microfluidic chip was designed, constructed, and tested for rapid molecular identification of Anopheles gambiae and Anopheles arabiensis. The chip contains three isothermal amplification reactors. One test reactor operates with specific primers to amplify Anopheles gambiae DNA, another with specific primers for Anopheles arabiensis DNA, and the third serves as a negative control. A mosquito leg was crushed on an isolation membrane. Two discs, laden with mosquito tissue, were punched out of the membrane and inserted into the two test chambers. The isolated, disc-bound DNA served as a template in the amplification processes. The amplification products were detected with intercalating fluorescent dye that was excited with a blue light-emitting diode. The emitted light was observed by eye and recorded with a cell-phone camera. When the target consisted of Anopheles gambiae, the reactor containing primers specific to An. gambiae lit up while the other two reactors remained dark. When the target consisted of Anopheles arabiensis, the reactor containing primers specific to An. arabiensis lit up while the other two reactors remained dark. The microfluidic chip provides a means to identify mosquito type through molecular analysis. It is suitable for field work, allowing one to track the geographical distribution of mosquito populations and community structure

  3. 76 FR 65769 - Airport Improvement Program: Modifications to Benefit Cost Analysis (BCA) Threshold

    Science.gov (United States)

    2011-10-24

    ... Federal Aviation Administration Airport Improvement Program: Modifications to Benefit Cost Analysis (BCA... Airport Improvement Program (AIP) discretionary funds. On December 16, 2010, the FAA issued a Notice of... which BCAs are required from $5 million to $10 million in Airport Improvement Program (AIP...

  4. Improved Cost Management at Small and Medium Sized Road Transport Companies: Case Hungary

    Directory of Open Access Journals (Sweden)

    Zoltan Bokor

    2015-10-01

    Full Text Available Small and medium sized road freight transport companies located in Hungary are facing strong competition on the logistics market. An advanced cost management system supporting decisions on capacity allocations or pricing may be a competitive advantage for them and indirectly for the whole economy as well. Still, they generally apply simple, traditional cost calculation regimes, potentially sufficient in case of a homogeneous service portfolio. Nevertheless, road haulage companies with heterogeneous service structures may witness information distortions when using traditional costing methods. So it might be recommended for them to introduce better costing principles. To support an improved transport costing, a multi-level full cost allocation model has been set up and tested in this paper. The research results have pointed out that such a methodological development accompanied by the extension of the data collection mechanism can contribute to making the cost management systems of road freight transport companies more effective.

  5. Design and Development of an Equipotential Voltage Reference (Grounding) System for a Low-Cost Rapid-Development Modular Spacecraft Architecture

    Science.gov (United States)

    Lukash, James A.; Daley, Earl

    2011-01-01

    This work describes the design and development effort to adapt rapid-development space hardware by creating a ground system using solutions of low complexity, mass, & cost. The Lunar Atmosphere and Dust Environment Explorer (LADEE) spacecraft is based on the modular common spacecraft bus architecture developed at NASA Ames Research Center. The challenge was building upon the existing modular common bus design and development work and improving the LADEE spacecraft design by adding an Equipotential Voltage Reference (EVeR) system, commonly referred to as a ground system. This would aid LADEE in meeting Electromagnetic Environmental Effects (E3) requirements, thereby making the spacecraft more compatible with itself and its space environment. The methods used to adapt existing hardware are presented, including provisions which may be used on future spacecraft.

  6. Traveling-wave-tube efficiency improvement by a low-cost technique for deposition of carbon on multistage depressed collector

    Science.gov (United States)

    Ebihara, Ben T.; Ramins, Peter; Peet, Shelly

    1987-01-01

    A simple method of improving the traveling-wave-tube (TWT) and multistage depressed collector (MDC) efficiency has been demonstrated. The efficiency improvement was produced by the application of a thin layer of carbon to the copper electrodes of the MDC by means of a rapid, low-cost technique involving the pyrolysis of hydrocarbon oil in electric arc discharges. Experimental results with a representative TWT and MDC showed an 11 percent improvement in both the TWT and MDC efficiencies as compared to those of the same TWT and MDC efficiencies with bare copper electrode surfaces. An extended test with a 500-W, continuous wave (CW) TWT and small-sized MDC indicated good stability of the carbon coated electrode surfaces after a relatively small initial degradation in TWT overall and apparent MDC efficiencies.

  7. Myoinositol administration improves survival and reduces myelinolysis after rapid correction of chronic hyponatremia in rats.

    Science.gov (United States)

    Silver, Stephen M; Schroeder, Barbara M; Sterns, Richard H; Rojiani, Amyn M

    2006-01-01

    When chronic hyponatremia is rapidly corrected, reaccumulation of brain organic osmolytes is delayed and brain cell shrinkage occurs, leading to the osmotic demyelination syndrome (ODS). We hypothesized that treatment with myoinositol, a major organic osmolyte, could prevent ODS. Severe hyponatremia was induced in adult male rats by administration of arginine vasopressin and intravenous infusion of dextrose and water. Sixty-four hours after induction of hyponatremia, all animals underwent rapid correction of hyponatremia with infusion of hypertonic saline over 4 hours, increasing the serum sodium from 105 to 135 mM; half of the animals were also given myoinositol intravenously beginning 20 minutes before correction and continuing for 28 hours. Serum sodium concentrations were equivalent in both groups at all time points. At 7 days, 7 of 8 animals that received myoinositol survived compared with one of the 9 control animals (p myoinositol. Animals were killed 96 hours after correction of hyponatremia was begun. Myoinositol-treated animals had significantly fewer demyelinating lesions than mannitol (2.25 +/- 1.1 versus 6.42 +/- 1.4 lesions/brain, p myoinositol administration improves survival and reduces myelinolysis after rapid correction of chronic hyponatremia in rats.

  8. Calotropis procera seedlings could be used as a rapid cost effective bioindicator for measuring aluminum environmental pollution

    Science.gov (United States)

    Mosa, Kareem A.; El-Keblawy, Ali; Najar, Atyat

    2017-04-01

    Calotropis procera seedlings could be used as a rapid cost effective bioindicator for measuring aluminum environmental pollution Kareem A. Mosa, Ali El-Keblawy, Atyat Najar Department of Applied Biology, College of Sciences, University of Sharjah, UAE Rapid industrialization and urbanization processes has led to the incorporation of different heavy metals in natural resources like soil, water and air thus affecting their quality. Aluminum (Al) is a dominant heavy metal pollutant that causes serious toxic effects to living systems including plants. Therefore, it is critical to regularly monitor the changes in Al levels in natural resources. Living organisms could be used as bioindicators for monitoring and measuring the levels of heavy metals in environmental samples. The aim of this study was to develop a cost effective bioindicator for monitoring aluminum (Al) and assess the damage caused by Al bioaccumulation using the root system of Calotropis Procera seedlings. A hydroponic system was developed for growing C. Procera in four different concentrations of Al (20, 40, 60 and 80 ppm). Root length and shoot fresh and dry weights were assessed after 5, 10, 15 and 20 days of Al treatment. The results showed remarkable sensitivity of C. Procera seedlings for the different concentrations of Al. There was gradual but significant decrease in C. Procera root length with the increase in the Al concentrations. X-ray fluorescence microscopy (XRF) analysis indicated a significant increase in Al concentration in C. Procera roots with the increase of both Al concentration in the hydroponic solution and the growing period. Moreover, electrical conductivity analysis showed that Al induced damage to C. Procera root plasma membrane as indicated by the increase in electrolyte leakages. Randomly amplified polymorphic DNA (RAPD) PCR analysis confirmed the genotoxin effect of Al which induced C. Procera genomic DNA modification. Altogether, the result demonstrated that C. Procera could

  9. Acanthamoeba keratitis: improving the Scottish diagnostic service for the rapid molecular detection of Acanthamoeba species.

    Science.gov (United States)

    Alexander, Claire Low; Coyne, Michael; Jones, Brian; Anijeet, Deepa

    2015-07-01

    Acanthamoeba species are responsible for causing the potentially sight-threatening condition, Acanthamoeba keratitis, which is commonly associated with contact lens use. In this report, we highlight the challenges faced using conventional laboratory identification methods to identify this often under-reported pathogen, and discuss the reasons for introducing the first national service in Scotland for the rapid and sensitive molecular identification of Acanthamoeba species. By comparing culture and molecular testing data from a total of 63 patients (n = 80 samples) throughout Scotland presenting with ocular eye disease, we describe the improvement in detection rates where an additional four positive cases were identified using a molecular assay versus culture. The testing of a further ten patients by confocal imaging is also presented. This report emphasizes the importance of continuing to improve clinical laboratory services to ensure a prompt, correct diagnosis and better prognosis, in addition to raising awareness of this potentially debilitating opportunistic pathogen.

  10. Rapid changes in brain structure predict improvements induced by perceptual learning.

    Science.gov (United States)

    Ditye, Thomas; Kanai, Ryota; Bahrami, Bahador; Muggleton, Neil G; Rees, Geraint; Walsh, Vincent

    2013-11-01

    Practice-dependent changes in brain structure can occur in task relevant brain regions as a result of extensive training in complex motor tasks and long-term cognitive training but little is known about the impact of visual perceptual learning on brain structure. Here we studied the effect of five days of visual perceptual learning in a motion-color conjunction search task using anatomical MRI. We found rapid changes in gray matter volume in the right posterior superior temporal sulcus, an area sensitive to coherently moving stimuli, that predicted the degree to which an individual's performance improved with training. Furthermore, behavioral improvements were also predicted by volumetric changes in an extended white matter region underlying the visual cortex. These findings point towards quick and efficient plastic neural mechanisms that enable the visual brain to deal effectively with changing environmental demands. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Using time-driven activity-based costing to identify value improvement opportunities in healthcare.

    Science.gov (United States)

    Kaplan, Robert S; Witkowski, Mary; Abbott, Megan; Guzman, Alexis Barboza; Higgins, Laurence D; Meara, John G; Padden, Erin; Shah, Apurva S; Waters, Peter; Weidemeier, Marco; Wertheimer, Sam; Feeley, Thomas W

    2014-01-01

    As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This costing approach, however, is new to healthcare and has not yet been systematically implemented and evaluated. This article describes early time-driven activity-based costing work at several leading healthcare organizations in the United States and Europe. It identifies the opportunities they found to improve value for patients and demonstrates how this costing method can serve as the foundation for new bundled payment reimbursement approaches.

  12. Costs and benefits of automotive fuel economy improvement: A partial analysis

    Energy Technology Data Exchange (ETDEWEB)

    Greene, D.L. [Oak Ridge National Lab., TN (United States); Duleep, K.G. [Energy and Environmental Analysis, Inc., Arlington, VA (United States)

    1992-03-01

    This paper is an exercise in estimating the costs and benefits of technology-based fuel economy improvements for automobiles and light trucks. Benefits quantified include vehicle cots, fuel savings, consumer`s surplus effects, the effect of reduced weight on vehicle safety, impacts on emissions of CO{sub 2} and criteria pollutants, world oil market and energy security benefits, and the transfer of wealth from US consumes to oil producers. A vehicle stock model is used to capture sales, scrappage, and vehicle use effects under three fuel price scenarios. Three alternative fuel economy levels for 2001 are considered, ranging from 32.9 to 36.5 MPG for cars and 24.2 to 27.5 MPG for light trucks. Fuel economy improvements of this size are probably cost-effective. The size of the benefit, and whether there is a benefit, strongly depends on the financial costs of fuel economy improvement and judgments about the values of energy security, emissions, safety, etc. Three sets of values for eight parameters are used to define the sensitivity of costs and benefits to key assumptions. The net present social value (1989$) of costs and benefits ranges from a cost of $11 billion to a benefit of $286 billion. The critical parameters being the discount rate (10% vs. 3%) and the values attached to externalities. The two largest components are always the direct vehicle costs and fuel savings, but these tend to counterbalance each other for the fuel economy levels examined here. Other components are the wealth transfer, oil cost savings, CO{sub 2} emissions reductions, and energy security benefits. Safety impacts, emissions of criteria pollutants, and consumer`s surplus effects are relatively minor components. The critical issues for automotive fuel economy are therefore: (1) the value of present versus future costs and benefits, (2) the values of external costs and benefits, and (3) the financially cost-effective level of MPG achievable by available technology. 53 refs.

  13. Costs and benefits of automotive fuel economy improvement: A partial analysis

    Energy Technology Data Exchange (ETDEWEB)

    Greene, D.L. (Oak Ridge National Lab., TN (United States)); Duleep, K.G. (Energy and Environmental Analysis, Inc., Arlington, VA (United States))

    1992-03-01

    This paper is an exercise in estimating the costs and benefits of technology-based fuel economy improvements for automobiles and light trucks. Benefits quantified include vehicle cots, fuel savings, consumer's surplus effects, the effect of reduced weight on vehicle safety, impacts on emissions of CO{sub 2} and criteria pollutants, world oil market and energy security benefits, and the transfer of wealth from US consumes to oil producers. A vehicle stock model is used to capture sales, scrappage, and vehicle use effects under three fuel price scenarios. Three alternative fuel economy levels for 2001 are considered, ranging from 32.9 to 36.5 MPG for cars and 24.2 to 27.5 MPG for light trucks. Fuel economy improvements of this size are probably cost-effective. The size of the benefit, and whether there is a benefit, strongly depends on the financial costs of fuel economy improvement and judgments about the values of energy security, emissions, safety, etc. Three sets of values for eight parameters are used to define the sensitivity of costs and benefits to key assumptions. The net present social value (1989$) of costs and benefits ranges from a cost of $11 billion to a benefit of $286 billion. The critical parameters being the discount rate (10% vs. 3%) and the values attached to externalities. The two largest components are always the direct vehicle costs and fuel savings, but these tend to counterbalance each other for the fuel economy levels examined here. Other components are the wealth transfer, oil cost savings, CO{sub 2} emissions reductions, and energy security benefits. Safety impacts, emissions of criteria pollutants, and consumer's surplus effects are relatively minor components. The critical issues for automotive fuel economy are therefore: (1) the value of present versus future costs and benefits, (2) the values of external costs and benefits, and (3) the financially cost-effective level of MPG achievable by available technology. 53 refs.

  14. Rapid experimental evolution of pesticide resistance in C. elegans entails no costs and affects the mating system.

    Directory of Open Access Journals (Sweden)

    Patricia C Lopes

    Full Text Available Pesticide resistance is a major concern in natural populations and a model trait to study adaptation. Despite the importance of this trait, the dynamics of its evolution and of its ecological consequences remain largely unstudied. To fill this gap, we performed experimental evolution with replicated populations of Caenorhabditis elegans exposed to the pesticide Levamisole during 20 generations. Exposure to Levamisole resulted in decreased survival, fecundity and male frequency, which declined from 30% to zero. This was not due to differential susceptibility of males. Rather, the drug affected mobility, resulting in fewer encounters, probably leading to reduced outcrossing rates. Adaptation, i.e., increased survival and fecundity, occurred within 10 and 20 generations, respectively. Male frequency also increased by generation 20. Adaptation costs were undetected in the ancestral environment and in presence of Ivermectin, another widely-used pesticide with an opposite physiological effect. Our results demonstrate that pesticide resistance can evolve at an extremely rapid pace. Furthermore, we unravel the effects of behaviour on life-history traits and test the environmental dependence of adaptation costs. This study establishes experimental evolution as a powerful tool to tackle pesticide resistance, and paves the way to further investigations manipulating environmental and/or genetic factors underlying adaptation to pesticides.

  15. FREQ-Seq: a rapid, cost-effective, sequencing-based method to determine allele frequencies directly from mixed populations.

    Directory of Open Access Journals (Sweden)

    Lon M Chubiz

    Full Text Available Understanding evolutionary dynamics within microbial populations requires the ability to accurately follow allele frequencies through time. Here we present a rapid, cost-effective method (FREQ-Seq that leverages Illumina next-generation sequencing for localized, quantitative allele frequency detection. Analogous to RNA-Seq, FREQ-Seq relies upon counts from the >10(5 reads generated per locus per time-point to determine allele frequencies. Loci of interest are directly amplified from a mixed population via two rounds of PCR using inexpensive, user-designed oligonucleotides and a bar-coded bridging primer system that can be regenerated in-house. The resulting bar-coded PCR products contain the adapters needed for Illumina sequencing, eliminating further library preparation. We demonstrate the utility of FREQ-Seq by determining the order and dynamics of beneficial alleles that arose as a microbial population, founded with an engineered strain of Methylobacterium, evolved to grow on methanol. Quantifying allele frequencies with minimal bias down to 1% abundance allowed effective analysis of SNPs, small in-dels and insertions of transposable elements. Our data reveal large-scale clonal interference during the early stages of adaptation and illustrate the utility of FREQ-Seq as a cost-effective tool for tracking allele frequencies in populations.

  16. A low cost and palm-size analyzer for rapid and sensitive protein detection by AC electrokinetics capacitive sensing.

    Science.gov (United States)

    Liu, Xiaozhu; Cheng, Cheng; Wu, Jayne; Eda, Shigetoshi; Guo, Yongcai

    2017-04-15

    Specific detection of protein biomarkers has a wide range of applications in areas such as medical science, diagnostics, and pharmacology. Quantitative detection of protein biomarkers in biological media, such as serum, is critically important in detecting disease or physiological malfunction, or tracking disease progression. Among various detection methods, electrical detection is particularly well suited for point-of-care (POC) specific protein detection, being of low cost, light weight and small form factor. A portable system for sensitive and quantitative detection of protein biomarkers will be highly valuable in controlling and preventing diseases outbreaks. Recently, an alternating current electrokinetic (ACEK) capacitive sensing method has been reported to demonstrate very promising performance on rapid and sensitive detection of specific protein from serum. In this work, a low cost and portable analyzer with good accuracy is developed to use with ACEK capacitive sensing to produce a true POC technology. The development of a board-level capacitance readout system is presented, as well as the adaption of the protocol for use with ACEK capacitive sensing. Results showed that the developed system could achieve a limit of detection of 10ng/mL, comparable to a sophisticated benchtop instrument. With its small size and light-weight similar to a smart phone, the developed system is ready to be applicable to POC diagnostics. Further, the readout system can be readily expanded for multichannel monitoring and telecommunication capabilities. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Rapid and Low-Cost CRP Measurement by Integrating a Paper-Based Microfluidic Immunoassay with Smartphone (CRP-Chip).

    Science.gov (United States)

    Dong, Meili; Wu, Jiandong; Ma, Zimin; Peretz-Soroka, Hagit; Zhang, Michael; Komenda, Paul; Tangri, Navdeep; Liu, Yong; Rigatto, Claudio; Lin, Francis

    2017-03-26

    Traditional diagnostic tests for chronic diseases are expensive and require a specialized laboratory, therefore limiting their use for point-of-care (PoC) testing. To address this gap, we developed a method for rapid and low-cost C-reactive protein (CRP) detection from blood by integrating a paper-based microfluidic immunoassay with a smartphone (CRP-Chip). We chose CRP for this initial development because it is a strong biomarker of prognosis in chronic heart and kidney disease. The microfluidic immunoassay is realized by lateral flow and gold nanoparticle-based colorimetric detection of the target protein. The test image signal is acquired and analyzed using a commercial smartphone with an attached microlens and a 3D-printed chip-phone interface. The CRP-Chip was validated for detecting CRP in blood samples from chronic kidney disease patients and healthy subjects. The linear detection range of the CRP-Chip is up to 2 μg/mL and the detection limit is 54 ng/mL. The CRP-Chip test result yields high reproducibility and is consistent with the standard ELISA kit. A single CRP-Chip can perform the test in triplicate on a single chip within 15 min for less than 50 US cents of material cost. This CRP-Chip with attractive features of low-cost, fast test speed, and integrated easy operation with smartphones has the potential to enable future clinical PoC chronic disease diagnosis and risk stratification by parallel measurements of a panel of protein biomarkers.

  18. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

    Science.gov (United States)

    Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

    2015-08-01

    Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for

  19. Scaling up success to improve health: Towards a rapid assessment guide for decision makers

    Directory of Open Access Journals (Sweden)

    Jason Paltzer

    2015-01-01

    Full Text Available Introduction Evidence-based health interventions exist and are effectively implemented throughout resource-limited settings. The literature regarding scale-up strategies and frameworks is growing. The purpose of this paper is to identify and systematically document the variation in scale-up strategies to develop a rapid assessment tool for decision-makers looking to identify the most appropriate strategy for their organizational and environmental contexts. Methods A list of scale-up strategies and frameworks were identified through an in-depth literature review and conversations with scale-up and quality improvement leaders. The literature search included a broad range of terms that might be used interchangeably with scale-up of best practices. Terms included: implementation research, knowledge translation, translational research, quality improvement research, health systems improvement, scale-up, best practices, improvement collaborative, and community based research. Based on this research, 18 strategies and frameworks were identified, and nine met our inclusion criteria for scale-up of health-related strategies. We interviewed the key contact for four of the nine strategies to obtain additional information regarding the strategy’s scale-up components, targets, underlying theories, evaluation efforts, facilitating factors, and barriers. A comparative analysis of common elements and strategy characteristics was completed by two of the authors on the nine selected strategies. Key strategy characteristics and common factors that facilitate or hinder the strategy’s success in scaling up health-related interventions were identified. Results Common features of scale-up strategies include: 1 the development of context-specific evidence; 2 collaborative partnerships; 3 iterative processes; and 4 shared decision-making. Facilitating factors include strong leadership, community engagement, communication, government collaboration, and a focus on

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

    NARCIS (Netherlands)

    Koleva, D.A.

    2007-01-01

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

  1. Accounting software cost management on health and safety, legal framework and areas of improvement

    National Research Council Canada - National Science Library

    K.I. Samchuk

    2017-01-01

    ... of safety measures, the necessity and directions of its improvement. Improving your security management costs of safety measures based on the determination of the legal framework, which aims to provide legal protection for employees, agencies and organizations, entities in the relationship work.

  2. West Coast tree improvement programs: a break-even, cost-benefit analysis

    Science.gov (United States)

    F. Thomas Ledig; Richard L Porterfield

    1981-01-01

    Three tree improvement programs were analyzed by break-even, cost-benefit technique: one for ponderosa pine in the Pacific Northwest, and two for Douglas-fir in the Pacific Northwest-one of low intensity and the other of high intensity. A return of 8 percent on investment appears feasible by using short rotations or by accompanying tree improvement with thinning....

  3. IMPROVING PERFORMANCES BY USING COST CONTROLLING IN THE MINING INDUSTRY ENTITIES

    Directory of Open Access Journals (Sweden)

    SORINEL CĂPUŞNEANU

    2016-06-01

    Full Text Available The aim of this article is to highlight the improving performances of entities from mining industry entities by using cost controlling as an important tool of management accounting, applying the target costing method. The survey is based on questions that led investigation made in the Romanian entities from mining industry and based on data a thorough analysis was done for fulfillment of authors’ purpose. The results obtained by applying the target costing method has allowed a very strict cost control, which ultimately led to increased performances of economic entities from mining industry in Romania. The secondary purpose of this article is to try adjusting the target costing method to the specific of entities in the mining industry. According to studies of specialists this method based on target costing calculation is rather unusual in this sector of mining industry and it relies heavily on the activity-based costing method. The article ends with the authors' conclusions on improving the performances of entities from mining industry based on cost controlling and use of mix information obtained through the applied methods

  4. 36 CFR 51.57 - How does a concessioner request arbitration of the construction cost of a capital improvement?

    Science.gov (United States)

    2010-07-01

    ... request arbitration of the construction cost of a capital improvement? 51.57 Section 51.57 Parks, Forests... Surrender Interest § 51.57 How does a concessioner request arbitration of the construction cost of a capital improvement? If a concessioner requests arbitration of the construction cost of a capital improvement...

  5. An improved design of water-soluble propofol prodrugs characterized by rapid onset of action.

    Science.gov (United States)

    Lang, Bing-Chen; Yang, Jun; Wang, Yu; Luo, Yun; Kang, Yi; Liu, Jin; Zhang, Wen-Sheng

    2014-04-01

    Phosphate ester prodrugs of propofol (fospropofol, HX0969W) were designed to avoid the unsatisfactory water solubility of the parent drug. However, in previous clinical trials, there were reported prodrug side effects such as paresthesia and pruritus. The accumulation of a phosphate ester component was found to be the main culprit. To exclude this potential risk, we designed 2 amino acid propofol prodrugs (HX0969-Gly-F3, HX0969-Ala-HCl) based on the lead compound (HX0969) by introducing the amino acid group into the structures of the propofol prodrugs. We hypothesized that the improved propofol prodrugs could not only eliminate those adverse effects but also retain their rapid action and good water solubility. The lead compound HX0969 was synthesized by the sodium borohydride-iodine system. HX0969W, HX0969-Gly-F3, and HX0969-Ala-HCl were synthesized from HX0969. The solubility of fospropofol, HX0969W, HX0969-Gly-F3, and HX0969-Ala-HCl in normal saline was tested. The bioconversions from those prodrugs to propofol in different physiological media (rat plasma, rhesus monkey plasma, and rat hepatic microsomes) were determined in vitro. An in vivo test in the rats was performed to measure the 50% effective dose (ED50) of the 4 propofol prodrugs. Their action onset time and duration time were also measured after their equipotent doses were given. (1) The water solubility of fospropofol, HX0969W, HX0969-Gly-F3, and HX0969-Ala-HCl was 461.46 ± 26.40 mg/mL, 189.45 ± 5.02 mg/mL, 49.88 ± 0.58 mg/mL, and 245.99 ± 4.83 mg/mL, respectively; (2) The hydrolysis tests in both the rat plasma and the rhesus monkey plasma revealed that the 2 amino acid prodrugs released propofol to a greater extent at a more rapid rate than the 2 phosphate prodrugs during the testing period of 5 hours. All 4 prodrugs released propofol rapidly in the presence of rat hepatic enzymes; (3) Compared with the previous prodrugs (fospropofol, HX0969W), the 2 novel compounds (HX0969-Gly-F3, HX0969-Ala

  6. Science Partnerships Enabling Rapid Response: Designing a Strategy for Improving Scientific Collaboration during Crisis Response

    Science.gov (United States)

    Mease, L.; Gibbs, T.; Adiseshan, T.

    2014-12-01

    The 2010 Deepwater Horizon disaster required unprecedented engagement and collaboration with scientists from multiple disciplines across government, academia, and industry. Although this spurred the rapid advancement of valuable new scientific knowledge and tools, it also exposed weaknesses in the system of information dissemination and exchange among the scientists from those three sectors. Limited government communication with the broader scientific community complicated the rapid mobilization of the scientific community to assist with spill response, evaluation of impact, and public perceptions of the crisis. The lessons and new laws produced from prior spills such as Exxon Valdez were helpful, but ultimately did not lead to the actions necessary to prepare a suitable infrastructure that would support collaboration with non-governmental scientists. As oil demand pushes drilling into increasingly extreme environments, addressing the challenge of effective, science-based disaster response is an imperative. Our study employs a user-centered design process to 1) understand the obstacles to and opportunity spaces for effective scientific collaboration during environmental crises such as large oil spills, 2) identify possible tools and strategies to enable rapid information exchange between government responders and non-governmental scientists from multiple relevant disciplines, and 3) build a network of key influencers to secure sufficient buy-in for scaled implementation of appropriate tools and strategies. Our methods include user ethnography, complex system mapping, individual and system behavioral analysis, and large-scale system design to identify and prototype a solution to this crisis collaboration challenge. In this talk, we will present out insights gleaned from existing analogs of successful scientific collaboration during crises and our initial findings from the 60 targeted interviews we conducted that highlight key collaboration challenges that government

  7. Energy Efficiency Improvement and Cost Saving Oportunities for the Concrete Industry

    Energy Technology Data Exchange (ETDEWEB)

    Kermeli, Katerina; Worrell, Ernst; Masanet, Eric

    2011-12-01

    The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for more than 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials accounting for more than 50% of total concrete production costs - cement only accounts for nearly 24%. In 2009, energy costs of the U.S. concrete industry were over $610 million. Hence, energy efficiency improvements along with efficient use of materials without negatively affecting product quality and yield, especially in times of increased fuel and material costs, can significantly reduce production costs and increase competitiveness. The Energy Guide starts with an overview of the U.S. concrete industry’s structure and energy use, a description of the various manufacturing processes, and identification of the major energy consuming areas in the different industry segments. This is followed by a description of general and process related energy- and cost-efficiency measures applicable to the concrete industry. Specific energy and cost savings and a typical payback period are included based on literature and case studies, when available. The Energy Guide intends to provide information on cost reduction opportunities to energy and plant managers in the U.S. concrete industry. Every cost saving opportunity should be assessed carefully prior to implementation in individual plants, as the economics and the potential energy and material savings may differ.

  8. Using Rapid Improvement Events for Disaster After-Action Reviews: Experience in a Hospital Information Technology Outage and Response.

    Science.gov (United States)

    Little, Charles M; McStay, Christopher; Oeth, Justin; Koehler, April; Bookman, Kelly

    2018-02-01

    The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management. Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using rapid improvement events for disaster after-action reviews: experience in a hospital information technology outage and response. Prehosp Disaster Med. 2018;33(1):98-100.

  9. Visual attention distracter insertion for improved EEG rapid serial visual presentation (RSVP) target stimuli detection

    Science.gov (United States)

    Khosla, Deepak; Huber, David J.; Martin, Kevin

    2017-05-01

    This paper† describes a technique in which we improve upon the prior performance of the Rapid Serial Visual Presentation (RSVP) EEG paradigm for image classification though the insertion of visual attention distracters and overall sequence reordering based upon the expected ratio of rare to common "events" in the environment and operational context. Inserting distracter images maintains the ratio of common events to rare events at an ideal level, maximizing the rare event detection via P300 EEG response to the RSVP stimuli. The method has two steps: first, we compute the optimal number of distracters needed for an RSVP stimuli based on the desired sequence length and expected number of targets and insert the distracters into the RSVP sequence, and then we reorder the RSVP sequence to maximize P300 detection. We show that by reducing the ratio of target events to nontarget events using this method, we can allow RSVP sequences with more targets without sacrificing area under the ROC curve (azimuth).

  10. Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme

    Science.gov (United States)

    Anopa, Yulia; McMahon, Alex D.; Conway, David I.; Ball, Graham E.; McIntosh, Emma; Macpherson, Lorna M. D.

    2015-01-01

    Dental caries is one of the most common diseases of childhood. The aim of this study was to compare the cost of providing the Scotland-wide nursery toothbrushing programme with associated National Health Service (NHS) cost savings from improvements in the dental health of five-year-old children: through avoided dental extractions, fillings and potential treatments for decay. Methods Estimated costs of the nursery toothbrushing programme in 2011/12 were requested from all Scottish Health Boards. Unit costs of a filled, extracted and decayed primary tooth were calculated using verifiable sources of information. Total costs associated with dental treatments were estimated for the period from 1999/00 to 2009/10. These costs were based on the unit costs above and using the data of the National Dental Inspection Programme and then extrapolated to the population level. Expected cost savings were calculated for each of the subsequent years in comparison with the 2001/02 dental treatment costs. Population standardised analysis of hypothetical cohorts of 1000 children per deprivation category was performed. Results The estimated cost of the nursery toothbrushing programme in Scotland was £1,762,621 per year. The estimated cost of dental treatments in the baseline year 2001/02 was £8,766,297, while in 2009/10 it was £4,035,200. In 2002/03 the costs of dental treatments increased by £213,380 (2.4%). In the following years the costs decreased dramatically with the estimated annual savings ranging from £1,217,255 in 2003/04 (13.9% of costs in 2001/02) to £4,731,097 in 2009/10 (54.0%). Population standardised analysis by deprivation groups showed that the largest decrease in modelled costs was for the most deprived cohort of children. Conclusions The NHS costs associated with the dental treatments for five-year-old children decreased over time. In the eighth year of the toothbrushing programme the expected savings were more than two and a half times the costs of the

  11. Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme.

    Science.gov (United States)

    Anopa, Yulia; McMahon, Alex D; Conway, David I; Ball, Graham E; McIntosh, Emma; Macpherson, Lorna M D

    2015-01-01

    Dental caries is one of the most common diseases of childhood. The aim of this study was to compare the cost of providing the Scotland-wide nursery toothbrushing programme with associated National Health Service (NHS) cost savings from improvements in the dental health of five-year-old children: through avoided dental extractions, fillings and potential treatments for decay. Estimated costs of the nursery toothbrushing programme in 2011/12 were requested from all Scottish Health Boards. Unit costs of a filled, extracted and decayed primary tooth were calculated using verifiable sources of information. Total costs associated with dental treatments were estimated for the period from 1999/00 to 2009/10. These costs were based on the unit costs above and using the data of the National Dental Inspection Programme and then extrapolated to the population level. Expected cost savings were calculated for each of the subsequent years in comparison with the 2001/02 dental treatment costs. Population standardised analysis of hypothetical cohorts of 1000 children per deprivation category was performed. The estimated cost of the nursery toothbrushing programme in Scotland was £1,762,621 per year. The estimated cost of dental treatments in the baseline year 2001/02 was £8,766,297, while in 2009/10 it was £4,035,200. In 2002/03 the costs of dental treatments increased by £213,380 (2.4%). In the following years the costs decreased dramatically with the estimated annual savings ranging from £1,217,255 in 2003/04 (13.9% of costs in 2001/02) to £4,731,097 in 2009/10 (54.0%). Population standardised analysis by deprivation groups showed that the largest decrease in modelled costs was for the most deprived cohort of children. The NHS costs associated with the dental treatments for five-year-old children decreased over time. In the eighth year of the toothbrushing programme the expected savings were more than two and a half times the costs of the programme implementation.

  12. The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

    DEFF Research Database (Denmark)

    Meacock, R.; Kristensen, Søren Rud; Sutton, M.

    2014-01-01

    , and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m......Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers...

  13. Moving Beyond Blind Men and Elephants: Providing Total Estimated Annual Costs Improves Health Insurance Decision Making.

    Science.gov (United States)

    Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas; Long, Sharon K

    2017-10-01

    Health insurance is among the most important financial and health-related decisions that people make. Choosing a health insurance plan that offers sufficient risk protection is difficult, in part because total expected health care costs are not transparent. This study examines the effect of providing total costs estimates on health insurance decisions using a series of hypothetical choice experiments given to 7,648 individuals responding to the fall 2015 Health Reform Monitoring Survey. Participants were given two health scenarios presented in random order asking which of three insurance plans would best meet their needs. Half received total estimated costs, which increased the probability of choosing a cost-minimizing plan by 3.0 to 10.6 percentage points, depending on the scenario ( p < .01). With many consumers choosing or failing to switch out of plans that offer insufficient coverage, incorporating insights on consumer decision making with personalized information to estimate costs can improve the quality of health insurance choices.

  14. Can information on cost improve clinicians' behavior? Lessons from health care trials and management theory.

    Science.gov (United States)

    Lowet, P F; Eisenberg, J M

    1997-01-01

    Facing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.

  15. Improved Neural Signal Classification in a Rapid Serial Visual Presentation Task Using Active Learning.

    Science.gov (United States)

    Marathe, Amar R; Lawhern, Vernon J; Wu, Dongrui; Slayback, David; Lance, Brent J

    2016-03-01

    The application space for brain-computer interface (BCI) technologies is rapidly expanding with improvements in technology. However, most real-time BCIs require extensive individualized calibration prior to use, and systems often have to be recalibrated to account for changes in the neural signals due to a variety of factors including changes in human state, the surrounding environment, and task conditions. Novel approaches to reduce calibration time or effort will dramatically improve the usability of BCI systems. Active Learning (AL) is an iterative semi-supervised learning technique for learning in situations in which data may be abundant, but labels for the data are difficult or expensive to obtain. In this paper, we apply AL to a simulated BCI system for target identification using data from a rapid serial visual presentation (RSVP) paradigm to minimize the amount of training samples needed to initially calibrate a neural classifier. Our results show AL can produce similar overall classification accuracy with significantly less labeled data (in some cases less than 20%) when compared to alternative calibration approaches. In fact, AL classification performance matches performance of 10-fold cross-validation (CV) in over 70% of subjects when training with less than 50% of the data. To our knowledge, this is the first work to demonstrate the use of AL for offline electroencephalography (EEG) calibration in a simulated BCI paradigm. While AL itself is not often amenable for use in real-time systems, this work opens the door to alternative AL-like systems that are more amenable for BCI applications and thus enables future efforts for developing highly adaptive BCI systems.

  16. Improved, low cost inorganic-organic separators for rechargeable silver-zinc batteries

    Science.gov (United States)

    Sheibley, D. W.

    1979-01-01

    Several flexible, low-cost inorganic-organic separators with performance characteristics and cycle life equal to, or better than, the Lewis Research Center Astropower separator were developed. These new separators can be made on continuous-production equipment at about one-fourth the cost of the Astropower separator produced the same way. In test cells, these new separators demonstrate cycle life improvement, acceptable operating characteristics, and uniform current density. The various separator formulas, test cell construction, and data analysis are described.

  17. A cost-efficiency and health benefit approach to improve urban air quality.

    Science.gov (United States)

    Miranda, A I; Ferreira, J; Silveira, C; Relvas, H; Duque, L; Roebeling, P; Lopes, M; Costa, S; Monteiro, A; Gama, C; Sá, E; Borrego, C; Teixeira, J P

    2016-11-01

    When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored. Copyright © 2016. Published by Elsevier B.V.

  18. The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

    Science.gov (United States)

    Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

    2016-01-01

    Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

  19. Cost-benefit analysis of improved air quality in an office building

    DEFF Research Database (Denmark)

    Djukanovic, R.; Wargocki, Pawel; Fanger, Povl Ole

    2002-01-01

    A cost-benefit analysis of measures to improve air quality in an existing air-conditoned office building (11581 m2, 864 employees) was carried out for hot, temperate and cold climates and for two operating modes: Variable Air Volume (VAV) with economizer; and Constant Air Volume (CAV) with heat...... productivity for every 10% reduction in the proportion of occupants entering a space who are dissatisfied with the air quality. With this assumption, the annual benefit due to improved air quality was always at least 10 times higher than the increase in annual energy and maintenance costs. The payback time...

  20. Rapid, scalable, and low-cost purification of recombinant adeno-associated virus produced by baculovirus expression vector system

    Directory of Open Access Journals (Sweden)

    Pierre-Olivier Buclez

    2016-01-01

    Full Text Available Recombinant adeno-associated viruses (rAAV are largely used for gene transfer in research, preclinical developments, and clinical trials. Their broad in vivo biodistribution and long-term efficacy in postmitotic tissues make them good candidates for numerous gene transfer applications. Upstream processes able to produce large amounts of rAAV were developed, particularly those using baculovirus expression vector system. In parallel, downstream processes present a large panel of purification methods, often including multiple and time consuming steps. Here, we show that simple tangential flow filtration, coupled with an optimized iodixanol-based isopycnic density gradient, is sufficient to purify several liters of crude lysate produced by baculovirus expression vector system in only one working day, leading to high titers and good purity of rAAV products. Moreover, we show that the viral vectors retain their in vitro and in vivo functionalities. Our results demonstrate that simple, rapid, and relatively low-cost methods can easily be implemented for obtaining a high-quality grade of gene therapy products based on rAAV technology.

  1. Rapid detection of Clostridium difficile via magnetic bead aggregation in cost-effective polyester microdevices with cell phone image analysis.

    Science.gov (United States)

    DuVall, Jacquelyn A; Cabaniss, Scott T; Angotti, Morgan L; Moore, John H; Abhyankar, Mayuresh; Shukla, Nishant; Mills, Daniel L; Kessel, Bryan G; Garner, Gavin T; Swami, Nathan S; Landers, James P

    2016-10-07

    Pathogen detection has traditionally been accomplished by utilizing methods such as cell culture, immunoassays, and nucleic acid amplification tests; however, these methods are not easily implemented in resource-limited settings because special equipment for detection and thermal cycling is often required. In this study, we present a magnetic bead aggregation assay coupled to an inexpensive microfluidic fabrication technique that allows for cell phone detection and analysis of a notable pathogen in less than one hour. Detection is achieved through the use of a custom-built system that allows for fluid flow control via centrifugal force, as well as manipulation of magnetic beads with an adjustable rotating magnetic field. Cell phone image capture and analysis is housed in a 3D-printed case with LED backlighting and a lid-mounted Android phone. A custom-written application (app.) is employed to interrogate images for the extent of aggregation present following loop-mediated isothermal amplification (LAMP) coupled to product-inhibited bead aggregation (PiBA) for detection of target sequences. Clostridium difficile is a pathogen of increasing interest due to its causative role in intestinal infections following antibiotic treatment, and was therefore chosen as the pathogen of interest in the present study to demonstrate the rapid, cost-effective, and sequence-specific detection capabilities of the microfluidic platform described herein.

  2. Establishing a safe, rapid, convenient and low-cost antiviral assay of interferon bioactivity based on recombinant VSV expressing GFP.

    Science.gov (United States)

    Chen, Weiye; Wen, Zhiyuan; Zhang, Jialin; Li, Cuicui; Huang, Kehe; Bu, Zhigao

    2017-08-20

    The methods of the quantitative assay of the antiviral activity of interferons (IFNs) (type I, II or III) are very important during carrying out of the research of them, since they were found. Here a recombinant vesicular stomatitis virus expressing green fluorescent protein (GFP) (VSV/GFP) and MDBK cells were used to develop an antiviral assay (AVA) for IFNs. This method was carried out on a 96-well cell culture plate, and the half reduction of virus replication was quantified by assaying GFP. To quantify GFP, cell lysis buffer was directly added to the wells infected with VSV/GFP to lyse cells, the VSV/GFP was then inactivated, and relative fluorescence unit (RFU) of GFP was measured and used to calculate the antiviral activity. This method needed only one step instead of three steps in the staining method with naphthol blue black, medium with phenol red can be used, and it had good reproducibility. The GFP-containing samples could be stored at 4°C in a wet box for at least 1 week without affecting the assay results. In addition, the results obtained with this method were similar to those obtained with the staining method. In conclusion, a safe, rapid, convenient and low-cost AVA of IFN based on recombinant VSV/GFP was established. Copyright © 2017. Published by Elsevier B.V.

  3. Rapid, low-cost photogrammetry to monitor volcanic eruptions: an example from Mount St. Helens, Washington, USA

    Science.gov (United States)

    Diefenbach, Angela K.; Crider, Juliet G.; Schilling, Steve P.; Dzurisin, Daniel

    2012-01-01

    We describe a low-cost application of digital photogrammetry using commercially available photogrammetric software and oblique photographs taken with an off-the-shelf digital camera to create sequential digital elevation models (DEMs) of a lava dome that grew during the 2004–2008 eruption of Mount St. Helens (MSH) volcano. Renewed activity at MSH provided an opportunity to devise and test this method, because it could be validated against other observations of this well-monitored volcano. The datasets consist of oblique aerial photographs (snapshots) taken from a helicopter using a digital single-lens reflex camera. Twelve sets of overlapping digital images of the dome taken during 2004–2007 were used to produce DEMs and to calculate lava dome volumes and extrusion rates. Analyses of the digital images were carried out using photogrammetric software to produce three-dimensional coordinates of points identified in multiple photos. The evolving morphology of the dome was modeled by comparing successive DEMs. Results were validated by comparison to volume measurements derived from traditional vertical photogrammetric surveys by the US Geological Survey Cascades Volcano Observatory. Our technique was significantly less expensive and required less time than traditional vertical photogrammetric techniques; yet, it consistently yielded volume estimates within 5% of the traditional method. This technique provides an inexpensive, rapid assessment tool for tracking lava dome growth or other topographic changes at restless volcanoes.

  4. Low-cost, rapidly-developed, 3D printed in vitro corpus callosum model for mucopolysaccharidosis type I.

    Science.gov (United States)

    Tabet, Anthony; Gardner, Matthew; Swanson, Sebastian; Crump, Sydney; McMeekin, Austin; Gong, Diana; Tabet, Rebecca; Hacker, Benjamin; Nestrasil, Igor

    2016-01-01

    The rising prevalence of high throughput screening and the general inability of (1) two dimensional (2D) cell culture and (2) in vitro release studies to predict in vivo neurobiological and pharmacokinetic responses in humans has led to greater interest in more realistic three dimensional (3D) benchtop platforms. Advantages of 3D human cell culture over its 2D analogue, or even animal models, include taking the effects of microgeometry and long-range topological features into consideration. In the era of personalized medicine, it has become increasingly valuable to screen candidate molecules and synergistic therapeutics at a patient-specific level, in particular for diseases that manifest in highly variable ways. The lack of established standards and the relatively arbitrary choice of probing conditions has limited in vitro drug release to a largely qualitative assessment as opposed to a predictive, quantitative measure of pharmacokinetics and pharmacodynamics in tissue. Here we report the methods used in the rapid, low-cost development of a 3D model of a mucopolysaccharidosis type I patient's corpus callosum, which may be used for cell culture and drug release. The CAD model is developed from in vivo brain MRI tracing of the corpus callosum using open-source software, printed with poly (lactic-acid) on a Makerbot Replicator 5X, UV-sterilized, and coated with poly (lysine) for cellular adhesion. Adaptations of material and 3D printer for expanded applications are also discussed.

  5. Cost-effectiveness of treatment strategies for pancreatic head adenocarcinoma and potential opportunities for improvement.

    Science.gov (United States)

    Abbott, Daniel E; Merkow, Ryan P; Cantor, Scott B; Fleming, Jason B; Varadhachary, Gauri R; Crane, Christopher; Bentrem, David J; Bilimoria, Karl Y

    2012-11-01

    Generally dismal outcomes have led to a nihilistic attitude toward treating pancreatic cancer, while fiscal constraints have increased scrutiny of treatments costs. Our objective was to compare the cost-effectiveness of various treatment strategies for resectable pancreatic head adenocarcinoma, and to identify opportunities for improved cost effectiveness. A decision model compared 6 strategies: no treatment, radiotherapy only, chemotherapy only, chemotherapy plus radiotherapy, surgery alone, and surgery plus adjuvant therapy. Outcomes and probabilities were identified using the National Cancer Data Base, the American Cancer Society National Surgical Quality Improvement Program, and the literature. Costs were estimated using Medicare payment. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses were performed by varying potentially modifiable parameters of the model. Survival was reported in quality-adjusted life-months (QALMs). Surgery plus adjuvant therapy, chemotherapy alone, and no treatment were the only viable strategies in terms of cost effectiveness. Surgery plus adjuvant therapy versus no treatment demonstrated an incremental cost-effectiveness ratio (ICER) of $7,663/QALM. Theoretically increasing survival in node-negative, margin-negative patients from 14 to 22 QALMs produced the largest reduction in the ICER for surgery plus adjuvant therapy compared to no treatment ($6,386/QALM), whereas reducing the perioperative mortality from 3 to 1 % had only a marginal effect. The ICER was significantly lower for high-performing centers ($5,991/QALM) than for low-performing centers ($9,144/QALM). Surgery plus adjuvant therapy for resectable pancreatic head adenocarcinoma extends survival, but at considerable expense. Significant cost reductions could be realized by improving treatment outcomes to levels of high-performing centers and development of increasingly effective adjuvant therapies.

  6. A new function of rapid eye movement sleep: improvement of muscular efficiency.

    Science.gov (United States)

    Cai, Zi-Jian

    2015-05-15

    Previously I demonstrated that the slow wave sleep (SWS) functioned to adjust the emotional balance disrupted by emotional memories randomly accumulated during waking, while the rapid eye movement (REM) sleep played the opposite role. Many experimental results have unambiguously shown that various emotional memories are processed during REM sleep. In this article, it is attempted to combine this confirmed function of REM sleep with the atonic state unique to REM sleep, and to integrate a new theory suggesting that improvement of muscular efficiency be a new function of REM sleep. This new function of REM sleep is more advantageous than the function of REM sleep in emotional memories and disinhibited drives to account for the phylogenetic variations of REM sleep, especially the absence of REM sleep in dolphins and short duration of REM sleep in birds in contrary to that in humans and rodents, the absence of penile erections in REM sleep in armadillo, as well as the higher voltage in EEG during REM sleep in platypus and ostrich. Besides, this new function of REM sleep is also advantageous to explain the association of REM sleep with the atonic episodes in SWS, the absence of drastic menopausal change in duration of REM sleep, and the effects of ambient temperature on the duration of REM sleep. These comparative and experimental evidences support the improvement of muscular efficiency as a new and major function of REM sleep. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Improving air pollution control policy in China--A perspective based on cost-benefit analysis.

    Science.gov (United States)

    Gao, Jinglei; Yuan, Zengwei; Liu, Xuewei; Xia, Xiaoming; Huang, Xianjin; Dong, Zhanfeng

    2016-02-01

    To mitigate serious air pollution, the State Council of China promulgated the Air Pollution Prevention and Control Action Plan in 2013. To verify the feasibility and validity of industrial energy-saving and emission-reduction policies in the action plan, we conducted a cost-benefit analysis of implementing these policies in 31 provinces for the period of 2013 to 2017. We also completed a scenario analysis in this study to assess the cost-effectiveness of different measures within the energy-saving and the emission-reduction policies individually. The data were derived from field surveys, statistical yearbooks, government documents, and published literatures. The results show that total cost and total benefit are 118.39 and 748.15 billion Yuan, respectively, and the estimated benefit-cost ratio is 6.32 in the S3 scenario. For all the scenarios, these policies are cost-effective and the eastern region has higher satisfactory values. Furthermore, the end-of-pipe scenario has greater emission reduction potential than energy-saving scenario. We also found that gross domestic product and population are significantly correlated with the benefit-cost ratio value through the regression analysis of selected possible influencing factors. The sensitivity analysis demonstrates that benefit-cost ratio value is more sensitive to unit emission-reduction cost, unit subsidy, growth rate of gross domestic product, and discount rate among all the parameters. Compared with other provinces, the benefit-cost ratios of Beijing and Tianjin are more sensitive to changes of unit subsidy than unit emission-reduction cost. These findings may have significant implications for improving China's air pollution prevention policy. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Improving organizational capacity to address health literacy in public health: a rapid realist review.

    Science.gov (United States)

    Willis, C D; Saul, J E; Bitz, J; Pompu, K; Best, A; Jackson, B

    2014-06-01

    Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services. A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group. Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited. Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing

  9. Cost effectiveness and reliability improvement capabilities of CHECWORKS and SWIPS based inspection and maintenance plans

    Energy Technology Data Exchange (ETDEWEB)

    Singh, S. [United Dynamics, Malvern, PA (United States); Borodotsky, A. [Rochester Gas and Electric Corp., NY (United States)

    1996-11-01

    CHECWORKS and SWIPS are computer programs that undertaken degradation analysis and generate prioritized lists for scheduling inspections. A simplified analysis presented in this paper demonstrates that application of such computer aided degeneration analysis and prioritized list based I and M plans can achieve full system reliability along with high cost effectiveness. For purposes of developing insight and a basic understanding, relative cost-effectiveness and system reliability improvement analysis is conducted on a small service water system for five types of inspection and maintenance plans. The following plans are considered: a full inspection plan, a random sampling plan, an experienced based sampling plan, a computer aided degeneration analysis based plan, and a superman based plan. The results obtained show that a computer aided inspection plan is the most effective of the feasible plans. For a realistic system, the plan can pay for the analysis cost and generate additional cost savings while maintaining full system reliability.

  10. Improving access to high-cost cancer drugs in Latin America: Much to be done.

    Science.gov (United States)

    Ruiz, Rossana; Strasser-Weippl, Kathrin; Touya, Diego; Herrero Vincent, Carmen; Hernandez-Blanquisett, Abraham; St Louis, Jessica; Bukowski, Alexandra; Goss, Paul E

    2017-04-15

    Lack of access to high-cost medications is a complex issue at the intersection of economics, medicine, politics, and ethics, and it poses a significant threat to global health care. The problem is even more significant in low- and middle-income countries, such as those in Latin America, where governments and individuals struggle to pay for products that are priced at several times the level of their per capita gross domestic product. In this review, we examine the determinants for increasing drug costs and how Latin American countries face this burgeoning crisis. We emphasize that a number of opportunities and strategies to reduce costs and improve access exist and should be identified and implemented, ideally within a regional approach with multiple stakeholders involved and based on systematic and transparent cost-effectiveness analyses. Cancer 2017;123:1313-1323. © 2016 American Cancer Society. © 2017 American Cancer Society.

  11. Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer's disease

    Directory of Open Access Journals (Sweden)

    Gross Hyman

    2008-07-01

    Full Text Available Abstract Background Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer's disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the brain. We hypothesized that perispinal etanercept had the potential to improve verbal function in Alzheimer's disease, so we included several standarized measures of verbal ability to evaluate language skills in a clinical trial of perispinal etanercept for Alzheimer's disease. Methods This was a prospective, single-center, open-label, pilot study, in which 12 patients with mild-to-severe Alzheimer's disease were administered etanercept, 25–50 mg, weekly by perispinal administration for six months. Two additional case studies are presented. Results Two-tailed, paired t-tests were conducted comparing baseline performance to 6-month performance on all neuropsychological measures. Test batteries included the California Verbal Learning Test-Second Edition, Adult Version; Logical Memory I and II(WMS-LM-II from the Wechsler Memory Scale-Abbreviated; the Comprehensive Trail Making Test (TMT; Boston Naming Test; and letter(FAS and category verbal fluency. All measures revealed a significant effect except for the Boston Naming Test and the TMT-4, with WMS-LM-II being marginally significant at p = .05. The FAS test for letter fluency was most highly significant with a p Conclusion In combination with the previously reported results of perispinal etanercept in Alzheimer's disease and primary progressive aphasia, these results further argue that larger scale studies of this therapeutic intervention, including Phase 3 trials, are warranted in dementias. In addition

  12. Cost-effectiveness analysis of cervical cancer prevention based on a rapid human papillomavirus screening test in a high-risk region of China.

    Science.gov (United States)

    Levin, Carol E; Sellors, John; Shi, Ju-Fang; Ma, Li; Qiao, You-lin; Ortendahl, Jesse; O'Shea, Meredith K H; Goldie, Sue J

    2010-09-01

    This study assessed the cost-effectiveness of a new, rapid human papillomavirus (HPV)-DNA screening test for cervical cancer prevention in the high-risk region of Shanxi, China. Using micro-costing methods, we estimated the resources needed to implement preventive strategies using cervical cytology or HPV-DNA testing, including the Hybrid Capture 2 (hc2) test (QIAGEN Corp., Gaithersburg, MD) and the rapid HPV-DNA careHPV test (QIAGEN). Data were used in a previously published model and empirically calibrated to country-specific epidemiological data. Strategies differed by initial test, targeted age, frequency of screening, number of clinic visits required (1, 2 or 3) and service delivery setting (national, county and township levels). Outcomes included lifetime risk of cancer, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios (cost per YLS). For all screening frequencies, the most efficient strategy used 2-visit rapid HPV-DNA testing at the county level, including screening and diagnostics in the first visit, and treatment in the second visit. Screening at ages 35, 40 and 45 reduced cancer risk by 50% among women compliant with all 3 screening rounds, and was US$ 150 per YLS, compared with this same strategy applied twice per lifetime. This would be considered very cost-effective evaluated against China's per-capita gross domestic product (US$ 1,702). By enhancing the linkage between screening and treatment through a reduced number of visits, rapid HPV-DNA testing 3 times per lifetime is more effective than traditional cytology, and is likely to be cost-effective in high-risk regions of China.

  13. Strong efficiency improvements in ultra-low-cost inorganic nanowire solar cells

    Energy Technology Data Exchange (ETDEWEB)

    Musselman, Kevin P.; Iza, Diana C.; MacManus-Driscoll, Judith L. [Department of Materials Science, University of Cambridge (United Kingdom); Wisnet, Andreas; Scheu, Christina [Department of Chemistry, Ludwig-Maximilians University, Munich (Germany); Hesse, Holger C.; Schmidt-Mende, Lukas [Department of Physics and Center for Nanoscience (CeNS), Ludwig-Maximilians University, Munich (Germany)

    2010-09-15

    Cu{sub 2}O-ZnO nanowire solar cells are synthesized by electrodeposition from solutions near room temperature. A high-quality, self-assembling, nanostructured heterojunction is produced, which is found to dramatically improve the charge collection efficiency in these ultra-low-cost devices. Incident-photon-to-electron conversion efficiencies approaching unity are measured and considerable efficiency improvements are observed. (Abstract Copyright [2010], Wiley Periodicals, Inc.)

  14. EFFICIENCY IMPROVEMENT OF MENEGMENT'S PROCESS COST MENEGMENT IN NETWORK RETAIL BUSINESSES

    OpenAIRE

    Aida Rezyapova

    2016-01-01

    The paper describes the proprietary methodology of distributing administrative expenses in the network retail businesses within the process approach to management, which has been developed to improve the quality of trade expenses administration. To this end, the author suggests using the original base unit (cost driver) in the course of distribution of the subject expenses to improve the accuracy of calculating the trade process efficiency. The author gives reasons to the necessity of applyin...

  15. Improving Efficiency Using Time-Driven Activity-Based Costing Methodology.

    Science.gov (United States)

    Tibor, Laura C; Schultz, Stacy R; Menaker, Ronald; Weber, Bradley D; Ness, Jay; Smith, Paula; Young, Phillip M

    2017-03-01

    The aim of this study was to increase efficiency in MR enterography using a time-driven activity-based costing methodology. In February 2015, a multidisciplinary team was formed to identify the personnel, equipment, space, and supply costs of providing outpatient MR enterography. The team mapped the current state, completed observations, performed timings, and calculated costs associated with each element of the process. The team used Pareto charts to understand the highest cost and most time-consuming activities, brainstormed opportunities, and assessed impact. Plan-do-study-act cycles were developed to test the changes, and run charts were used to monitor progress. The process changes consisted of revising the workflow associated with the preparation and administration of glucagon, with completed implementation in November 2015. The time-driven activity-based costing methodology allowed the radiology department to develop a process to more accurately identify the costs of providing MR enterography. The primary process modification was reassigning responsibility for the administration of glucagon from nurses to technologists. After implementation, the improvements demonstrated success by reducing non-value-added steps and cost by 13%, staff time by 16%, and patient process time by 17%. The saved process time was used to augment existing examination time slots to more accurately accommodate the entire enterographic examination. Anecdotal comments were captured to validate improved staff satisfaction within the multidisciplinary team. This process provided a successful outcome to address daily workflow frustrations that could not previously be improved. A multidisciplinary team was necessary to achieve success, in addition to the use of a structured problem-solving approach. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center

    Science.gov (United States)

    Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.

    2006-01-01

    Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

  17. The Cost of Improved Overview: An analysis of the Use of Electronic Whiteboards in Emergency Departments

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2017-01-01

    Forming and maintaining an overview of an information space is key to competent action in many situations and often supported by overview displays. We investigate the cost of the improved overview associated with the introduction of electronic whiteboards in four emergency departments (EDs...

  18. Improving parental involvement in primary education in Indonesia : Implementation, effects and costs

    NARCIS (Netherlands)

    van der Werf, Greetje; Creemers, Bert; Guldemond, H

    2001-01-01

    Ina large-scale school improvement project in Indonesia the implementation, effects and costs of initiatives to increase parental involvement were compared with those of other interventions (teacher development, educational management and books and learning materials). It turned out that although

  19. A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia.

    Science.gov (United States)

    Obure, Carol Dayo; Gaitan-Duarte, Hernando; Losada Saenz, Ricardo; Gonzalez, Lina; Angel-Muller, Edith; Laverty, Maura; Perez, Freddy

    2017-11-01

    HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited. A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated. A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US$10.26 and US$607.99, respectively in the single RDT arm. For the dual RDTs, the cost per pregnant woman tested for HIV and syphilis and cost per woman treated for syphilis were US$15.89 and US$1859.26, respectively. Overall costs per woman tested for HIV and syphilis and cost per woman treated for syphilis were lower in Cali compared with Bogota across both intervention arms. Staff costs accounted for the largest proportion of costs while treatment costs comprised <1% of the preventive programme. Findings show lower average costs for single RDTs compared with dual RDTs with costs sensitive to personnel costs and the scale of output at the health facilities. NCT02454816; results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Presenting Symptoms and Dysphagia Screen Predict Outcome in Mild and Rapidly Improving Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Gadodia, Gaurav; Rizk, Nibal; Camp, Deborah; Bryant, Katja; Zimmerman, Susan; Brasher, Cynthia; Connelly, Kerrin; Dunn, Joshua; Frankel, Michael; Ido, Moges Seymour; Lugtu, James; Nahab, Fadi

    2016-12-01

    There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes. Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home. There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Low-volume high-intensity interval training rapidly improves cardiopulmonary function in postmenopausal women.

    Science.gov (United States)

    Klonizakis, Markos; Moss, James; Gilbert, Stephen; Broom, David; Foster, Jeff; Tew, Garry A

    2014-10-01

    This study compared the effects of a 2-week program of low-volume high-intensity interval training (HIT) with the effects of higher-volume moderate-intensity continuous training (CT) on cardiopulmonary and vascular functions in postmenopausal women. Twenty-two postmenopausal women were randomly assigned to undertake six HIT (n = 12) or CT (n = 10) sessions for 2 weeks. HIT sessions consisted of ten 1-minute intervals of cycling exercise at 100% of peak power output separated by 1 minute of active recovery. CT sessions involved 40 minutes of continuous cycling at 65% of peak power output. Variables assessed at baseline and 2 weeks included cardiopulmonary function (ventilatory threshold, peak oxygen uptake), macrovascular endothelial function (flow-mediated dilation of the brachial artery), and microvascular function (reactive hyperemia and local thermal hyperemia of forearm skin). Eighteen participants completed the study (HIT, 11; CT, 7). Adherence to the exercise programs was excellent, with 107 of 108 sessions completed. Despite substantially lower total time commitment (∼2.5 vs. ∼5 h) and training volume (558 vs. 1,237 kJ) for HIT versus CT, increases from baseline in peak oxygen uptake achieved significance (P = 0.01) for the HIT group only (Δ = 2.2 mL kg min; P for interaction = 0.688). Improvements in exercise test duration were observed in both groups (HIT, 13%; CT, 5%; P for interaction = 0.194). There were no significant changes in macrovascular or microvascular function in either group. The findings suggest that low-volume HIT is feasible and can lead to rapid improvements in cardiopulmonary function in postmenopausal women.

  2. Improving permanent magnetic properties of rapidly solidified nanophase RE-TM-B alloys by compositional modification

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Z.W. [School of Materials Science and Engineering, South China University of Technology, Guangzhou 510640 (China); School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798 (Singapore); Department of Engineering Materials, University of Sheffield, Sheffield S1 3JD (United Kingdom)], E-mail: zwliu@scut.edu.cn; Liu, Yan; Deheri, P.K.; Ramanujan, R.V. [School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798 (Singapore); Davies, H.A. [Department of Engineering Materials, University of Sheffield, Sheffield S1 3JD (United Kingdom)

    2009-08-15

    Rapid solidification is one of the most important techniques to produce nanocrystalline rare-earth-transition metal-boron (RE-TM-B) hard magnetic materials. To achieve high performance on these NdFeB-based alloys, compositional modification and microstructure optimization have been frequently employed. In this short review, various substitutions and doping elements have been discussed regarding to their behaviors in adjusting the individual or combined hard magnetic properties as well as the microstructure based on our recent results. It has been demonstrated that Pr and Dy enhance coercivity {sub j}H{sub C}, whereas Sm reduces {sub j}H{sub C} due to their effects on intrinsic properties. Co improves the thermal stability as well as the microstructure. Introducing Fe{sub 65}Co{sub 35} is a possible approach to enhance the magnetization and maximum energy product (BH){sub max}. As a doping element, Ta was found to play an important role to obtain an appropriate combination of magnetic properties for this type of alloys.

  3. A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients.

    Science.gov (United States)

    Kuo, James C; De Silva, Madhawa; Diwakarla, Chandra; Yip, Desmond

    2017-06-01

    Cancer patients may find it challenging to access timely advice and care. We evaluated the improvement in delivering ambulatory care in establishing a Rapid Assessment Clinic (RAC) in a cancer center. Patients receiving chemotherapy who presented for assessment at the RAC from September 2013 to June 2014 were included for review. Patient demographics, tumor characteristics, presenting complaints, time to assessment, total time spent at the RAC and assessment outcome were extracted. Similar data for cancer patients presented to the emergency department (ED) but were appropriate for RAC assessment from February 2012 to August 2012 were reviewed for comparison. For patients with febrile neutropenia, time to empirical antibiotic therapy was also reviewed and analyzed. Comparing to ED presentation (n = 152), patients reviewed at the RAC (n = 217) had a shorter waiting time to medical review (28.5 vs 40 min, P = 0.12), shorter total time spent for review (3.1 vs 9.7 hrs, P care, resulting in a lower rate of hospital admission and inpatient length of stay for cancer patients. There was, however, no difference in the management of febrile neutropenia. © 2016 John Wiley & Sons Australia, Ltd.

  4. Participatory ergonomics and an evaluation of a low-cost improvement effect on cleaners' working posture.

    Science.gov (United States)

    Kumar, Rupesh; Chaikumarn, Montakarn; Lundberg, Jan

    2005-01-01

    Cleaning is a highly physically demanding job with a high frequency of awkward postures and working environments as contributing risk factors. Participatory ergonomics is a method in which end-users take an active role in identifying risk factors and solutions. The aim of this study was to apply the participatory ergonomics method to identify cleaning problems and to evaluate the effect of a low-cost improvement on cleaners' working postures in an office environment. The results show that the cleaning problem was identified, and the low-cost ergonomics solution suggested by the cleaners was implemented. Thus an improved working environment reduced the number of awkward cleaning postures and the Ovako Working Posture Analysis System (OWAS) action category for floor mopping decreased. It can be concluded that working in an improved environment can lead to better working postures which, in turn, leads to the cleaners' better health and better cleaning results.

  5. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity.

    Science.gov (United States)

    O'Meara, S; Riemsma, R; Shirran, L; Mather, L; ter Riet, G

    2001-01-01

    resolved by discussion. METHODS - METHODS OF ANALYSIS/SYNTHESIS: This report is a narrative summary, with results grouped according to study endpoint. Statistical pooling was undertaken in groups of trials that were considered to be sufficiently similar. METHODS - ESTIMATION OF QUALITY OF LIFE, COSTS AND COST-EFFECTIVENESS AND/OR COST PER QUALITY-ADJUSTED LIFE-YEAR: Relevant economic evaluations were identified from the search strategy described above. Assessment of methodological quality was undertaken using principles outlined in published guidelines. METHODS - COMPANY SUBMISSIONS: Data from company submissions were subject to the same selection and appraisal processes as other studies considered for inclusion in the review, except that only RCTs with a duration of at least 1 year were selected. RESULTS - RESULTS OF THE SEARCH STRATEGY: Fourteen RCTs (including three company submissions) and two economic evaluations (including one company submission) were included in the review. RESULTS - RESULTS OF THE QUALITY ASSESSMENT: Methodological quality of trials was moderate to good. The main problems were lack of detail on methods used to produce true randomisation, small sample sizes in some cases and failure to use intention-to-treat analysis. It is likely that maintenance of blinding was difficult due to adverse effects associated with the study medication. RESULTS - EVIDENCE OF CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS: Most of the trials showed greater weight loss and better weight maintenance with orlistat compared to placebo at all endpoints (statistically significant differences for both outcomes). Orlistat 120 mg three times daily was the optimum regimen in terms of weight loss. Most trials showed significant improvement in at least some lipid concentration parameters, and, in three RCTs, orlistat produced statistically significant reductions in blood pressure relative to placebo. In obese patients with type 2 diabetes, orlistat resulted in a significantly greater

  6. Improved low-cost, non-hazardous, all-iron cell for the developing world

    Science.gov (United States)

    Tucker, Michael C.; Lambelet, David; Oueslati, Mohamed; Williams, Benjamin; Wang, Wu-Chieh Jerry; Weber, Adam Z.

    2016-11-01

    A low-cost, non-hazardous personal-power system based on an aqueous all-iron electrochemical cell is demonstrated. The system is intended to be assembled and operated by developing-world households that lack sufficient access to electricity, thereby enabling LED lighting or mobile phone charging on demand. Lab-scale hardware is used to assess the performance of individual cell components. It is found that coffee filter paper is an effective low-cost separator. Carbon felt is a low-cost electrode material, and its performance and wetting by the electrolyte solution is greatly improved by pre-treatment with sulfuric acid. The carbon felt does not degrade after a week of daily use. By using these components, performance of the system is significantly improved over the previous baseline, with power density more than doubling to 40 mW cm-2, and iron utilization improving from 78% to 88%. The operating cost is estimated to be less than US0.03 per mobile phone charge. Based on the lab-scale results, a stand-alone prototype consumer product is designed, fabricated, and tested. It successfully provides 2.5 h of LED illumination while consuming 200 mL of electrolyte solution via gravity feed. We anticipate these results will enable deployment of this innovative system to energy-impoverished individuals in the developing world.

  7. Cost benefit analysis of a transport improvement in the case of search unemployment

    DEFF Research Database (Denmark)

    Pilegaard, Ninette; Fosgerau, Mogens

    2008-01-01

    We examine the implications of search unemployment for the evaluation of a transport investment in a conventional cost benefit analysis (CBA) assuming perfect competition. Lower transport costs induce search over a larger area and longer commuting distances. The expected duration of vacancies...... is reduced with ensuing benefits outweighing the loss to increased transport. The search imperfection drives a wedge between the marginal product of labour and the wage, such that the final benefits of a transport improvement exceed those of a conventional CBA. Using a simulation model we find...

  8. Costs and cost-effectiveness of a mobile phone text-message reminder programmes to improve health workers' adherence to malaria guidelines in Kenya.

    Science.gov (United States)

    Zurovac, Dejan; Larson, Bruce A; Sudoi, Raymond K; Snow, Robert W

    2012-01-01

    Simple interventions for improving health workers' adherence to malaria case-management guidelines are urgently required across Africa. A recent trial in Kenya showed that text-message reminders sent to health workers' mobile phones improved management of pediatric outpatients by 25 percentage points. In this paper we examine costs and cost-effectiveness of this intervention. We evaluate costs and cost-effectiveness in 2010 USD under three implementation scenarios: (1) as implemented under study conditions in study areas; (2) if the intervention was routinely implemented by the Ministry of Health (MoH) in the same areas; and (3) if the intervention was scaled up nationally. Under study conditions, intervention costs were 19,342 USD, of which 45% were for developing and pretesting text-messages, 12% for developing text-message distribution system, 29% for collecting health workers' phone numbers, and 13% were costs of sending text-messages and monitoring of the system. If the intervention was implemented in the same areas by the MoH, the costs would be 28% lower (13,920 USD) due to lower costs of collecting health workers' numbers. The cost of national scale-up would be 97,350 USD, and the majority of these costs (66%) would be for sending text-messages. The cost per additional child correctly managed was 0.50 USD under study conditions, 0.36 USD if implemented by the MoH in the same area, and estimated at only 0.03 USD if implemented nationally. Even if the effect size was only 5% or the cost on the national scale was 400% higher than estimated, the cost per additional child correctly managed would be only 0.16 USD. A simple text-messaging intervention improving health worker adherence to malaria guidelines is effective and inexpensive. Further research is justified to optimize delivery of the intervention and expand targets beyond children and malaria disease.

  9. Moving toward rapid and low-cost point-of-care molecular diagnostics with a repurposed 3D printer and RPA.

    Science.gov (United States)

    Chan, Kamfai; Wong, Pui-Yan; Parikh, Chaitanya; Wong, Season

    2018-01-12

    Traditionally, the majority of nucleic acid amplification-based molecular diagnostic tests are done in centralized settings. In recent years, point-of-care tests have been developed for use in low-resource settings away from central laboratories. While most experts agree that point-of-care molecular tests are greatly needed, their availability as cost-effective and easy-to-operate tests remains an unmet goal. In this article, we discuss our efforts to develop a recombinase polymerase amplification reaction-based test that will meet these criteria. First, we describe our efforts in repurposing a low-cost 3D printer as a platform that can carry out medium-throughput, rapid, and high-performing nucleic acid extraction. Next, we address how these purified templates can be rapidly amplified and analyzed using the 3D printer's heated bed or the deconstructed, low-cost thermal cycler we have developed. In both approaches, real-time isothermal amplification and detection of template DNA or RNA can be accomplished using a low-cost portable detector or smartphone camera. Last, we demonstrate the capability of our technologies using foodborne pathogens and the Zika virus. Our low-cost approach does not employ complicated and high-cost components, making it suitable for resource-limited settings. When integrated and commercialized, it will offer simple sample-to-answer molecular diagnostics. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Rapid Identification of Microorganisms by FilmArray Blood Culture Identification Panel Improves Clinical Management in Children.

    Science.gov (United States)

    Ray, Stephen T J; Drew, Richard J; Hardiman, Fiona; Pizer, Barry; Riordan, Andrew

    2016-05-01

    Blood cultures are a common investigation for children admitted to hospital. In routine practice, it takes at least 24 hours to identify an organism as a contaminant or clinically significant. FilmArray Blood Culture Identification Panel (FA-BCIP) is a multiplex polymerase chain reaction that can detect 24 pathogens within 1 hour. We assessed whether results from FA-BCIP lead to changes in clinical management in a tertiary referral paediatric hospital. We prospectively studied children having blood cultures taken at our tertiary children's hospital. Blood cultures were monitored and organisms identified using standard methods. FA-BCIP was performed when growth was initially detected in first positive blood cultures per episode, between January 1 and June 30, 2014. Assessment of whether the FA-BCIP result altered clinical management was made, specifically focused on antimicrobial stewardship and length of stay. FA-BCIP was done on 117 positive blood cultures; 74 (63%) grew clinically significant organisms, 43 (37%) grew contaminants. FA-BCIP results were judged to alter clinical management in 63 of the 117 episodes (54%). Antimicrobials were started/altered in 23 (19%) episodes and de-escalated/withheld/stopped in 29 (25%) episodes. Ten children were discharged from hospital earlier, which saved a cumulative total of 14 bed days. Rapid identification of microorganisms in pediatric blood cultures by FA-BCIP, led to changes in clinical management for half of the episodes. This improved antimicrobial stewardship and allowed early discharge from hospital for 10% of children. Future studies should focus on how best to use this technology in a cost-effective manner.

  11. Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs.

    Science.gov (United States)

    Puchner, R; Hochreiter, R; Pieringer, H; Vavrovsky, A

    2017-01-07

    In our current economic climate of scarce resources there is a lot of debate around the best - and most efficient - way of delivering care, which points patients towards the right physician at the earliest opportunity. The aim of the study was to assess whether an improvement in the interdisciplinary management of rheumatoid arthritis (RA) has the potential to simultaneously improve health outcomes and reduce costs. In a first step, we modelled the ways which lead patients with RA to the correct diagnosis, and the relevant specialist, respectively. On average, a patient experiences 3 GP visits before referral to a specialist. We compared this situation against a reconfiguration of current practice towards a more proactive identification and referral method with initiation of care by a rheumatologist early in the disease. We evaluated the impact of this reconfiguration on the number of RA patients diagnosed and the costs associated with the diagnostic process. Using data on epidemiology and Austrian practice patterns, we estimate a total of 5294 people with undifferentiated arthritis per year, of which 1765 suffer from RA. Modelling for diagnostic accuracy, we found that 1200 of these patients are initially misdiagnosed in a primary care setting and 95 at a rheumatologist. Our model found that a reconfiguration of current practice towards an approach of more integrated care has the potential to be not only cost-effective, but cost-saving: EUR 100,188 could be saved annually by exclusively adopting the new approach. Our results show that by better directing the flow of people with RA, simultaneous clinical and economic benefits may be reaped:.

  12. Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder.

    Science.gov (United States)

    MacDonald, Danielle E; Trottier, Kathryn; Olmsted, Marion P

    2017-10-01

    Rapid and substantial behavior change (RSBC) early in cognitive behavior therapy (CBT) for eating disorders is the strongest known predictor of treatment outcome. Rapid change in other clinically relevant variables may also be important. This study examined whether rapid change in emotion regulation predicted treatment outcomes, beyond the effects of RSBC. Participants were diagnosed with bulimia nervosa or purging disorder (N = 104) and completed ≥6 weeks of CBT-based intensive treatment. Hierarchical regression models were used to test whether rapid change in emotion regulation variables predicted posttreatment outcomes, defined in three ways: (a) binge/purge abstinence; (b) cognitive eating disorder psychopathology; and (c) depression symptoms. Baseline psychopathology and emotion regulation difficulties and RSBC were controlled for. After controlling for baseline variables and RSBC, rapid improvement in access to emotion regulation strategies made significant unique contributions to the prediction of posttreatment binge/purge abstinence, cognitive psychopathology of eating disorders, and depression symptoms. Individuals with eating disorders who rapidly improve their belief that they can effectively modulate negative emotions are more likely to achieve a variety of good treatment outcomes. This supports the formal inclusion of emotion regulation skills early in CBT, and encouraging patient beliefs that these strategies are helpful. © 2017 Wiley Periodicals, Inc.

  13. Low-Cost and Rapid Fabrication of Metallic Nanostructures for Sensitive Biosensors Using Hot-Embossing and Dielectric-Heating Nanoimprint Methods

    Directory of Open Access Journals (Sweden)

    Kuang-Li Lee

    2017-07-01

    Full Text Available We propose two approaches—hot-embossing and dielectric-heating nanoimprinting methods—for low-cost and rapid fabrication of periodic nanostructures. Each nanofabrication process for the imprinted plastic nanostructures is completed within several seconds without the use of release agents and epoxy. Low-cost, large-area, and highly sensitive aluminum nanostructures on A4 size plastic films are fabricated by evaporating aluminum film on hot-embossing nanostructures. The narrowest bandwidth of the Fano resonance is only 2.7 nm in the visible light region. The periodic aluminum nanostructure achieves a figure of merit of 150, and an intensity sensitivity of 29,345%/RIU (refractive index unit. The rapid fabrication is also achieved by using radio-frequency (RF sensitive plastic films and a commercial RF welding machine. The dielectric-heating, using RF power, takes advantage of the rapid heating/cooling process and lower electric power consumption. The fabricated capped aluminum nanoslit array has a 5 nm Fano linewidth and 490.46 nm/RIU wavelength sensitivity. The biosensing capabilities of the metallic nanostructures are further verified by measuring antigen–antibody interactions using bovine serum albumin (BSA and anti-BSA. These rapid and high-throughput fabrication methods can benefit low-cost, highly sensitive biosensors and other sensing applications.

  14. Rapid Diagnostic Testing of Hospitalized Malawian Children Reveals Opportunities for Improved HIV Diagnosis and Treatment.

    Science.gov (United States)

    Madaline, Theresa F; Hochman, Sarah E; Seydel, Karl B; Liomba, Alice; Saidi, Alex; Matebule, Grace; Mowrey, Wenzhu B; O'Hare, Bernadette; Milner, Danny A; Kim, Kami

    2017-12-01

    Recent World Health Organization (WHO) guidelines recommend antiretroviral therapy (ART) for all HIV-infected people; previously CD4+ T lymphocyte quantification (CD4 count) or clinical staging determined eligibility for children ≥ 5 years old in low- and middle-income countries. We examined positive predictive value (PPV) of a rapid diagnostic test (RDT) algorithm and ART eligibility for hospitalized children with newly diagnosed HIV infection. We enrolled 363 hospitalized Malawian children age 2 months to 16 years with two serial positive HIV RDT from 2013 to 2015. Children aged ≤ 18 months whose nucleic acid testing was negative or unavailable were later excluded from the analysis (N = 16). If RNA PCR was undetectable, human immunodeficiency virus (HIV) enzyme immunoassay (EIA) and western blot (WB) were performed. Those with negative or discordant EIA and WB were considered HIV negative and excluded from further analysis (N = 6). ART eligibility was assessed using age, CD4 count, and clinical HIV stage. Among 150 patients with HIV RNA PCR results, 15 had undetectable HIV RNA. Of those, EIA and WB were positive in nine patients and negative or discordant in six patients. PPV of serial RDT was 90% versus RNA PCR alone and 96% versus combined RNA PCR, EIA, and WB. Of all patients aged ≥ 5 years, 8.9% were ineligible for ART under previous WHO guidelines. Improved HIV testing algorithms are needed for accurate diagnosis of HIV infection in children as prevalence of pediatric HIV declines. Universal treatment will significantly increase the numbers of older children who qualify for ART.

  15. Improved protocol for rapid identification of certain spa types using high resolution melting curve analysis.

    Science.gov (United States)

    Mayerhofer, Benjamin; Stöger, Anna; Pietzka, Ariane T; Fernandez, Haizpea Lasa; Prewein, Bernhard; Sorschag, Sieglinde; Kunert, Renate; Allerberger, Franz; Ruppitsch, Werner

    2015-01-01

    Methicillin-resistant Staphylococcus aureus is one of the most significant pathogens associated with health care. For efficient surveillance, control and outbreak investigation, S. aureus typing is essential. A high resolution melting curve analysis was developed and evaluated for rapid identification of the most frequent spa types found in an Austrian hospital consortium covering 2,435 beds. Among 557 methicillin-resistant Staphylococcus aureus isolates 38 different spa types were identified by sequence analysis of the hypervariable region X of the protein A gene (spa). Identification of spa types through their characteristic high resolution melting curve profiles was considerably improved by double spiking with genomic DNA from spa type t030 and spa type t003 and allowed unambiguous and fast identification of the ten most frequent spa types t001 (58%), t003 (12%), t190 (9%), t041 (5%), t022 (2%), t032 (2%), t008 (2%), t002 (1%), t5712 (1%) and t2203 (1%), representing 93% of all isolates within this hospital consortium. The performance of the assay was evaluated by testing samples with unknown spa types from the daily routine and by testing three different high resolution melting curve analysis real-time PCR instruments. The ten most frequent spa types were identified from all samples and on all instruments with 100% specificity and 100% sensitivity. Compared to classical spa typing by sequence analysis, this gene scanning assay is faster, cheaper and can be performed in a single closed tube assay format. Therefore it is an optimal screening tool to detect the most frequent endemic spa types and to exclude non-endemic spa types within a hospital.

  16. Improving space domain awareness through unequal-cost multiple hypothesis testing in the space surveillance telescope.

    Science.gov (United States)

    Hardy, Tyler; Cain, Stephen; Jeon, Jae; Blake, Travis

    2015-06-10

    This paper investigates algorithms to improve the detection of space objects with the space surveillance telescope (SST) system. These space objects include natural objects such as asteroids and artificial satellites in Earth orbit. Using a proposed multiple hypothesis test (MHT), the detection performance is compared to the currently used algorithm as well as a matched filter and an equal-cost MHT algorithm. To compare these algorithms, a data set collected by the SST of a geosynchronous Earth orbit satellite, ANIK-F1 entering the Earth's eclipse, is utilized. It is found that an unequal-cost MHT gives increased performance over a point detector, a matched filter, and equal-cost MHT over a large range of potential intensities. Results are presented as probability of detection and receiver operating characteristic curves. In addition, the performance of the algorithm as a function of number of hypotheses used is investigated.

  17. Benefits and costs of improved IEQ in U.S. offices.

    Science.gov (United States)

    Fisk, W J; Black, D; Brunner, G

    2011-10-01

    This study estimates some of the benefits and costs of implementing scenarios that improve indoor environmental quality (IEQ) in the stock of U.S. office buildings. The scenarios include increasing ventilation rates when they are below 10 or 15 l/s per person, adding outdoor air economizers and controls when absent, eliminating winter indoor temperatures >23°C, and reducing dampness and mold problems. The estimated benefits of the scenarios analyzed are substantial in magnitude, including increased work performance, reduced Sick Building Syndrome symptoms, reduced absence, and improved thermal comfort for millions of office workers. The combined potential annual economic benefit of a set of nonoverlapping scenarios is approximately $20 billion. While the quantitative estimates have a high uncertainty, the opportunity for substantial benefits is clear. Some IEQ improvement measures will save energy while improving health or productivity, and implementing these measures should be the highest priority. Owners, designers, and operators of office buildings have an opportunity to improve IEQ, health, work performance, and comfort of building occupants and to obtain economic benefits by improving IEQ. These benefits can be achieved with simultaneous energy savings or with only small increases in energy costs. © 2011 John Wiley & Sons A/S.

  18. The improvement of movement and speech during rapid eye movement sleep behaviour disorder in multiple system atrophy.

    Science.gov (United States)

    De Cock, Valérie Cochen; Debs, Rachel; Oudiette, Delphine; Leu, Smaranda; Radji, Fatai; Tiberge, Michel; Yu, Huan; Bayard, Sophie; Roze, Emmanuel; Vidailhet, Marie; Dauvilliers, Yves; Rascol, Olivier; Arnulf, Isabelle

    2011-03-01

    Multiple system atrophy is an atypical parkinsonism characterized by severe motor disabilities that are poorly levodopa responsive. Most patients develop rapid eye movement sleep behaviour disorder. Because parkinsonism is absent during rapid eye movement sleep behaviour disorder in patients with Parkinson's disease, we studied the movements of patients with multiple system atrophy during rapid eye movement sleep. Forty-nine non-demented patients with multiple system atrophy and 49 patients with idiopathic Parkinson's disease were interviewed along with their 98 bed partners using a structured questionnaire. They rated the quality of movements, vocal and facial expressions during rapid eye movement sleep behaviour disorder as better than, equal to or worse than the same activities in an awake state. Sleep and movements were monitored using video-polysomnography in 22/49 patients with multiple system atrophy and in 19/49 patients with Parkinson's disease. These recordings were analysed for the presence of parkinsonism and cerebellar syndrome during rapid eye movement sleep movements. Clinical rapid eye movement sleep behaviour disorder was observed in 43/49 (88%) patients with multiple system atrophy. Reports from the 31/43 bed partners who were able to evaluate movements during sleep indicate that 81% of the patients showed some form of improvement during rapid eye movement sleep behaviour disorder. These included improved movement (73% of patients: faster, 67%; stronger, 52%; and smoother, 26%), improved speech (59% of patients: louder, 55%; more intelligible, 17%; and better articulated, 36%) and normalized facial expression (50% of patients). The rate of improvement was higher in Parkinson's disease than in multiple system atrophy, but no further difference was observed between the two forms of multiple system atrophy (predominant parkinsonism versus cerebellar syndrome). Video-monitored movements during rapid eye movement sleep in patients with multiple system

  19. Design of Boiler Welding for Improvement of Lifetime and Cost Control.

    Science.gov (United States)

    Thong-On, Atcharawadi; Boonruang, Chatdanai

    2016-11-03

    Fe-2.25Cr-1Mo a widely used material for headers and steam tubes of boilers. Welding of steam tube to header is required for production of boiler. Heat affected zone of the weld can have poor mechanical properties and poor corrosion behavior leading to weld failure. The cost of material used for steam tube and header of boiler should be controlled. This study propose a new materials design for boiler welding to improve the lifetime and cost control, using tungsten inert gas (TIG) welding of Fe-2.25Cr-1Mo tube to carbon steel pipe with chromium-containing filler. The cost of production could be reduced by the use of low cost material such as carbon steel pipe for boiler header. The effect of chromium content on corrosion behavior of the weld was greater than that of the microstructure. The lifetime of the welded boiler can be increased by improvement of mechanical properties and corrosion behavior of the heat affected zone.

  20. Design of Boiler Welding for Improvement of Lifetime and Cost Control

    Directory of Open Access Journals (Sweden)

    Atcharawadi Thong-On

    2016-11-01

    Full Text Available Fe-2.25Cr-1Mo a widely used material for headers and steam tubes of boilers. Welding of steam tube to header is required for production of boiler. Heat affected zone of the weld can have poor mechanical properties and poor corrosion behavior leading to weld failure. The cost of material used for steam tube and header of boiler should be controlled. This study propose a new materials design for boiler welding to improve the lifetime and cost control, using tungsten inert gas (TIG welding of Fe-2.25Cr-1Mo tube to carbon steel pipe with chromium-containing filler. The cost of production could be reduced by the use of low cost material such as carbon steel pipe for boiler header. The effect of chromium content on corrosion behavior of the weld was greater than that of the microstructure. The lifetime of the welded boiler can be increased by improvement of mechanical properties and corrosion behavior of the heat affected zone.

  1. Design of Boiler Welding for Improvement of Lifetime and Cost Control

    Science.gov (United States)

    Thong-On, Atcharawadi; Boonruang, Chatdanai

    2016-01-01

    Fe-2.25Cr-1Mo a widely used material for headers and steam tubes of boilers. Welding of steam tube to header is required for production of boiler. Heat affected zone of the weld can have poor mechanical properties and poor corrosion behavior leading to weld failure. The cost of material used for steam tube and header of boiler should be controlled. This study propose a new materials design for boiler welding to improve the lifetime and cost control, using tungsten inert gas (TIG) welding of Fe-2.25Cr-1Mo tube to carbon steel pipe with chromium-containing filler. The cost of production could be reduced by the use of low cost material such as carbon steel pipe for boiler header. The effect of chromium content on corrosion behavior of the weld was greater than that of the microstructure. The lifetime of the welded boiler can be increased by improvement of mechanical properties and corrosion behavior of the heat affected zone. PMID:28774014

  2. The Kaiser Permanente implant registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities.

    Science.gov (United States)

    Paxton, Elizabeth W; Inacio, Maria Cs; Kiley, Mary-Lou

    2012-01-01

    Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research. Eight KP implant registries leverage the integrated health care system's administrative databases and electronic health records system. Registry data collected undergo quality control and validation as well as statistical analysis. Patient safety has been enhanced through identification of affected patients during major recalls, identification of risk factors associated with outcomes of interest, development of risk calculators, and surveillance programs for infections and adverse events. Effective quality improvement activities included medical center- and surgeon-specific profiles for use in benchmarking reports, and changes in practice related to registry information output. Among the cost-effectiveness strategies employed were collaborations with sourcing and contracting groups, and assistance in adherence to formulary device guidelines. Research studies using registry data included postoperative complications, resource utilization, infection risk factors, thromboembolic prophylaxis, effects of surgical delay on concurrent injuries, and sports injury patterns. The unique KP implant registries provide important information and affect several areas of our organization, including patient safety, quality improvement, cost-effectiveness, and research.

  3. Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

    Science.gov (United States)

    Hunt, Priscillia; Hunter, Sarah B; Levan, Deborah

    2017-06-01

    Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI. Copyright © 2017. Published by Elsevier Inc.

  4. Cost-effectiveness of improved primary care treatment of depression in women in Chile.

    Science.gov (United States)

    Siskind, Dan; Araya, Ricardo; Kim, Jane

    2010-10-01

    Low- and middle-income countries lack information on contextualised mental health interventions to aid resource allocation decisions regarding healthcare. To undertake a cost-effectiveness analysis of treatments for depression contextualised to Chile. Using data from studies in Chile, we developed a computer-based Markov cohort model of depression among Chilean women to evaluate the cost-effectiveness of usual care or improved stepped care. The incremental cost-effectiveness ratio (ICER) of usual care was I$113 per quality-adjusted life-year (QALY) gained, versus no treatment, whereas stepped care had an ICER of I$468 per QALY versus usual care. This compared favourably with Chile's per-capita GDP. Results were most sensitive to variation in recurrent episode coverage, marginally sensitive to cost of treatment, and insensitive to changes in health-state utility of depression and rate of recurrence. Our results suggest that treatments for depression in low- and middle-income countries may be more cost-effective than previously estimated.

  5. Improved mine blast algorithm for optimal cost design of water distribution systems

    Science.gov (United States)

    Sadollah, Ali; Guen Yoo, Do; Kim, Joong Hoon

    2015-12-01

    The design of water distribution systems is a large class of combinatorial, nonlinear optimization problems with complex constraints such as conservation of mass and energy equations. Since feasible solutions are often extremely complex, traditional optimization techniques are insufficient. Recently, metaheuristic algorithms have been applied to this class of problems because they are highly efficient. In this article, a recently developed optimizer called the mine blast algorithm (MBA) is considered. The MBA is improved and coupled with the hydraulic simulator EPANET to find the optimal cost design for water distribution systems. The performance of the improved mine blast algorithm (IMBA) is demonstrated using the well-known Hanoi, New York tunnels and Balerma benchmark networks. Optimization results obtained using IMBA are compared to those using MBA and other optimizers in terms of their minimum construction costs and convergence rates. For the complex Balerma network, IMBA offers the cheapest network design compared to other optimization algorithms.

  6. EFFICIENCY IMPROVEMENT OF MENEGMENT'S PROCESS COST MENEGMENT IN NETWORK RETAIL BUSINESSES

    Directory of Open Access Journals (Sweden)

    Aida Rezyapova

    2016-12-01

    Full Text Available The paper describes the proprietary methodology of distributing administrative expenses in the network retail businesses within the process approach to management, which has been developed to improve the quality of trade expenses administration. To this end, the author suggests using the original base unit (cost driver in the course of distribution of the subject expenses to improve the accuracy of calculating the trade process efficiency. The author gives reasons to the necessity of applying a comprehensive approach in its selection. This implies use, as the base unit, of a coefficient representing shop turnover per 1m2 of sales area. The author has made a coefficient rating to formalize the relationship between the management results and economic factors of the trade businesses risk. This approach takes into account the commodity prime cost, and the quality and economic efficiency of the management processes in selling subdivisions of a network business.

  7. Energy Efficiency Improvement and Cost Saving Opportunities for Cement Making An ENERGY STAR® Guide for Energy and Plant Managers

    NARCIS (Netherlands)

    Worrell, E.|info:eu-repo/dai/nl/106856715; Kermeli, Katerina|info:eu-repo/dai/nl/411260553; Galitsky, Christina

    The cost of energy as part of the total production costs in the cement industry is significant, typically at 20 to 40% of operational costs, warranting attention for energy efficiency to improve the bottom line. Historically, energy intensity has declined, although more recently energy intensity

  8. Field evaluation of the performance and testing costs of a rapid point-of-care test for syphilis in a red-light district of Manaus, Brazil.

    Science.gov (United States)

    Benzaken, A S; Sabidó, M; Galban, E G; Pedroza, V; Vasquez, F; Araújo, A; Peeling, R W; Mayaud, P

    2008-08-01

    To assess the performance, usefulness and cost of a rapid treponemal antibody assay (VisiTect Syphilis) to detect syphilis in high risk populations. People who attended STI clinics in Manaus, Brazil, were screened for syphilis using the fluorescent treponemal antibody absorption (FTA-Abs) test and a non-treponemal test (Venereal Diseases Research Laboratory (VDRL)), and for HIV. Finger prick blood samples were tested with VisiTect Syphilis. The rapid test was evaluated against the reference FTA-Abs and for its usefulness in detecting active syphilis (FTA-Abs and VDRL positive). Operational performance was assessed through providers' and patients' interviews. An economic evaluation was conducted from the provider's perspective. 510 patients (60% men) were enrolled, of whom 13 (2.5%) were HIV-1 seropositive. Syphilis prevalence (FTA-Abs) was 18% and active syphilis prevalence was 7.5%. 11% (57/506) of samples were positive by VisiTect. The sensitivity, specificity, positive and negative predictive values of VisiTect Syphilis were 57% (95% CI 45.8 to 66.7), 99% (95% CI 97.0 to 99.6), 91% (95% CI 80.0 to 96.7) and 91% (95% CI 88.0 to 93.5), respectively. VisiTect Syphilis identified 79% (30/38) of active syphilis cases. The cost per case of syphilis was $16.8 for VDRL, $33.2 for low cost and $56.3 for high cost VisiTect Syphilis; the cost per case of active syphilis was $21.3, $57.5 and $97.6, respectively. Patients identified finger prick pain and preference for venous blood collection as minor barriers to test use. VisiTect Syphilis had low sensitivity in field use and was less cost effective than conventional VDRL. However, rapid and correct identification of a high proportion of active syphilis cases combined with operational characteristics suggest a role in high risk populations.

  9. Participatory ergonomics and an evaluation of a low-cost improvement effect on cleaners' working posture

    OpenAIRE

    Kumar, Rupesh; Chaikumarn, Montakarn; Lundberg, Jan

    2005-01-01

      Cleaning is a highly physically demanding job with a high frequency of awkward postures and working environments as contributing risk factors. Participatory ergonomics is a method in which end-users take an active role in identifying risk factors and solutions. The aim of this study was to apply the participatory ergonomics method to identify cleaning problems and to evaluate the effect of a low-cost improvement on cleaners' working postures in an office environment. The results show tha...

  10. Improving Balance in TBI Using a Low Cost Customized Virtual Reality Rehabilitation Tool

    Science.gov (United States)

    2015-10-01

    The proposed study will implement and evaluate a novel, low-cost, Virtual Reality ( VR ) rehabilitation tool (Mystic Isle; MI) targeting somatosensory... vestibular , and vision systems through a double-blind RCT. Given the importance of dual-task skills for real-world functioning, we will also...evaluate the relative effectiveness of dual task (balance and cognitive) VR training to improve balance. A total of 180 participants (Service Members

  11. Benefits and Costs of Improved IEQ in U.S. Offices

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William J.; Black, Douglas; Brunner, Gregory

    2011-06-01

    This paper estimates some of the benefits and costs of implementing scenarios that improve indoor environmental quality (IEQ) in the stock of U.S. office buildings. The scenarios include increasing ventilation rates when they are below 10 or 15 L/s per person, adding outdoor-air economizers and controls when absent, eliminating winter indoor temperatures greater than 23 oC, and reducing dampness and mold problems. The estimated benefits of the scenarios analyzed are substantial in magnitude, including increased work performance, reduced sick building syndrome symptoms, reduced absence, and improved thermal comfort for millions of office workers. The combined potential annual economic benefit of a set ofnon-overlapping scenarios is approximately $20 billion. While the quantitative estimates have a high uncertainty, the opportunity for substantial benefits is clear. Some IEQ improvement measures will save energy while improving health or productivity, and implementing these measures should be the highest priority.

  12. Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

    Directory of Open Access Journals (Sweden)

    Christina A.W. Macano

    2017-11-01

    Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

  13. Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: a rebirth of economic and policy considerations.

    Science.gov (United States)

    Barnet, Beth; Rapp, Thomas; DeVoe, Margo; Mullins, C Daniel

    2010-04-01

    To determine the cost-effectiveness of an intervention that successfully reduced rapid repeated births within 2 years of an index birth to adolescent mothers. Randomized, controlled trial conducted from February 2003 to October 2007. Home-based intervention with participants recruited from 5 urban clinics that provide care to low-income African American communities. Two hundred thirty-five pregnant teenagers (n = 235) aged 18 years or younger who were at 24 or more weeks of gestation at recruitment were followed up for 27 months. Participants were randomly assigned to usual care (n = 68) or 1 of 2 home-based interventions conducted by community outreach workers: (1) computer-assisted motivational intervention (CAMI) conducted quarterly with additional visits (CAMI+ [n = 80]) or (2) CAMI only (n = 87), a single-component motivational intervention conducted quarterly. Additional births by 24 months post partum determined from birth certificates, total and weighted mean intervention costs, cost per participant, and incremental cost-effectiveness ratios, defined as cost per prevented repeated birth. Relative to usual care, CAMI significantly reduced repeated births (adjusted odds ratio, 0.47; 95% confidence interval, 0.22-0.97). Mean intervention costs per adolescent were $2064, with incremental cost-effectiveness ratios per prevented repeated birth of $21 895 (unadjusted), $17 388 (adjusted), and $13 687 for a high-risk subgroup termed newly insured (eligible for but not enrolled in public insurance). The CAMI costs and cost-effectiveness compare favorably with other effective programs aimed at preventing repeated teenage births. Replication of these results in broader samples of adolescents would provide policy guidance for what works, for whom, and at what cost.

  14. An improved non-contact thermometer and hygrometer with rapid response

    Science.gov (United States)

    Underwood, R.; Gardiner, T.; Finlayson, A.; Bell, S.; de Podesta, M.

    2017-02-01

    Previously (Underwood et al 2015 Meteorol. Appl. 22 830) we reported first tests of a device capable of simultaneous, non-contact, temperature and humidity (NCTAH) measurements in air. The device used an acoustic thermometer and a tuneable diode laser absorption spectrometer (TDLAS), a combination which should be capable of an extremely rapid response to changes in humidity as it does not require moisture in a solid-state matrix to equilibrate with the surrounding air. In this paper we report recent developments of the instrument focussed on reducing its response time so that it can be used as a reference instrument for assessing the response time of conventional humidity sensors. In addition, the interdependence of the temperature and humidity estimates is now accounted for in real-time using an iterative procedure, which eliminates the need for data post-processing. The TDLAS measures water molecule number density based on the transmission of an infrared beam (approximate wavelength 1360 nm) through a 0.6 m path length. The acoustic thermometer is based around a fixed-path acoustic interferometer. The improved NCTAH device now produces estimates of the water molecule number density every 20 ms and the temperature output displays an RC filter-like response, with a time constant of approximately 30 ms. The instrument has been tested in a climatic chamber through a temperature range of  -40 °C to  +40 °C and a dew point range of  -43 °C to  +38 °C, at atmospheric pressure, comparing the instrument readings with those from a calibrated hygrometer and four platinum resistance thermometers. In steady-state conditions, the instrument readings are in good agreement with the conventional sensors, with temperature differences less than 1 °C (repeatability 0.1 °C), and humidity differences mostly within 5% of mixing ratio. Under transient conditions, we demonstrate how the instrument can be used to evaluate the response times of conventional

  15. Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost.

    Science.gov (United States)

    Holmes, Alison Volpe; Atwood, Emily C; Whalen, Bonny; Beliveau, Johanna; Jarvis, J Dean; Matulis, John C; Ralston, Shawn L

    2016-06-01

    The incidence and associated costs of neonatal abstinence syndrome (NAS) have recently risen sharply; newborns with NAS occupy 4% of NICU beds. We implemented a coordinated program for NAS including standardized protocols for scoring, medications and weaning, and a calm rooming-in environment, to improve family-centered care and to decrease both length of stay (LOS) and hospital costs. In early 2013, a multidisciplinary quality improvement team began consecutive plan-do-study-act (PDSA) cycles. We trained nurses in modified Finnegan scoring, ensured scoring only after on-demand feeds during skin-to-skin care, and standardized physician score interpretation. We provided prenatal family education, increased family involvement in symptom monitoring and nonpharmacologic treatment, and treated otherwise healthy infants on the inpatient pediatric unit instead of in the NICU. We measured outcomes using statistical process control methods. At baseline, 46% of inborn infants at-risk for NAS were treated with morphine; by 2015, this decreased to 27%. Adjunctive use of phenobarbital decreased from 13% to 2% in the same period. Average LOS for morphine-treated newborns decreased from 16.9 to 12.3 days, average hospital costs per treated infant decreased from $19 737 to $8755, and costs per at-risk infant dropped from $11 000 to $5300. Cumulative morphine dose decreased from 13.7 to 6.6 mg per treated newborn. There were no adverse events, and 30-day readmission rates remained stable. A coordinated, standardized NAS program safely reduced pharmacologic therapy, LOS, and hospital costs. Rooming-in with family and decreased use of NICU beds were central to achieved outcomes. Copyright © 2016 by the American Academy of Pediatrics.

  16. Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model.

    Science.gov (United States)

    Brown, Jack; Paladino, Joseph A

    2010-01-01

    Patients hospitalized with Staphylococcus aureus bacteraemia have an unacceptably high mortality rate. Literature available to date has shown that timely selection of the most appropriate antibacterial may reduce mortality. One tool that may help with this selection is a polymerase chain reaction (PCR) assay that distinguishes methicillin (meticillin)-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) in less than 1 hour. To date, no information is available evaluating the impact of this PCR technique on clinical or economic outcomes. To evaluate the effect of a rapid PCR assay on mortality and economics compared with traditional empiric therapy, using a literature-derived model. A literature search for peer-reviewed European (EU) and US publications regarding treatment regimens, outcomes and costs was conducted. Information detailing the rates of infection, as well as the specificity and sensitivity of a rapid PCR assay (Xpert MRSA/SA Blood Culture PCR) were obtained from the peer-reviewed literature. Sensitivity analysis varied the prevalence rate of MRSA from 5% to 80%, while threshold analysis was applied to the cost of the PCR test. Hospital and testing resource consumption were valued with direct medical costs, adjusted to year 2009 values. Adjusted life-years were determined using US and WHO life tables. The cost-effectiveness ratio was defined as the cost per life-year saved. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the additional cost necessary to produce additional effectiveness. All analyses were performed using TreeAge Software (2008). The mean mortality rates were 23% for patients receiving empiric vancomycin subsequently switched to semi-synthetic penicillin (SSP) for MSSA, 36% for patients receiving empiric vancomycin treatment for MRSA, 59% for patients receiving empiric SSP subsequently switched to vancomycin for MRSA and 12% for patients receiving empiric SSP for MSSA. Furthermore, with an

  17. Utilizing Information Technology to Facilitate Rapid Acquisition

    Science.gov (United States)

    2006-06-01

    ordering systems to facilitate streamlined commercial item acquisitions that reap the benefits of improved efficiency, reduced overall costs, and...PAGES 109 14. SUBJECT TERMS Rapid Acquisition, eCommerce , eProcurement, Information Technology, Contracting, Global Information Network...streamlined commercial item acquisitions that reap the benefits of improved efficiency, reduced overall costs, and timeliness. This thesis

  18. Reperfusion does not improve impaired rapid-onset cortical plasticity in patients with severe stenosis of the internal carotid artery.

    Directory of Open Access Journals (Sweden)

    Jonathan List

    Full Text Available BACKGROUND: Severe stenosis of the internal carotid artery (ICA has been associated with impaired cognition in patients, but its effect on rapid-onset cortical plasticity is not known. Carotid endarterectomy (CEA in patients with severe ICA stenosis reduces stroke risk, but the impact on cognition or physiology of the respective hemisphere remains controversial. METHODS/RESULTS: 16 patients with severe stenosis of the ICA and 16 age and sex matched controls were included. Rapid-onset cortical plasticity was assessed using the paired-associative stimulation (PAS protocol. PAS models long-term synaptic potentiation in human motor cortex, combining repetitive stimulation of the peripheral ulnar nerve with transcranial magnetic stimulation of the contralateral motor cortex. Cognitive status was assessed with a neuropsychological test battery. In patients, verbal learning and rapid-onset cortical plasticity were significantly reduced as compared to controls. Identical follow-up tests in 9 of the 16 patients six months after CEA revealed no improvement of cognitive parameters or cortical plasticity. CONCLUSIONS: Decreased rapid-onset cortical plasticity in patients with severe stenosis of the ICA was not improved by reperfusion. Thus, other strategies known to increase plasticity should be tested for their potential to improve cortical plasticity and subsequently cognition in these patients.

  19. Calculating the Social Costs of Carbon without knowing preferences : Comment on “A rapid assessment model for understanding the social cost of carbon”

    NARCIS (Netherlands)

    Gerlagh, R.

    The Social Costs of Carbon (SCC) equals the marginal welfare loss associated with one unit of emitted CO2, divided by the marginal welfare gain associated with one unit of consumption. In stochastic assessments, both the nominator and denominator can depend on uncertain parameters; specifically they

  20. A contemporary cost analysis of postoperative morbidity after coronary artery bypass grafting with and without concomitant aortic valve replacement to improve patient quality and cost-effective care.

    Science.gov (United States)

    LaPar, Damien J; Crosby, Ivan K; Rich, Jeffrey B; Fonner, Edwin; Kron, Irving L; Ailawadi, Gorav; Speir, Alan M

    2013-11-01

    The financial burden of postoperative morbidity after cardiac operations remains ill defined. This study evaluated the costs associated with the performance of coronary artery bypass grafting (CABG) with and without aortic valve replacement (AVR) and determined the incremental costs associated with major postoperative complications. A total of 65,534 regional patients undergoing CABG (n = 55,167) ± AVR (n = 10,367) were evaluated from 2001 to 2011. Patient-related, hospital-related, and procedure-related cost data were analyzed by use of Medicare-based cost reports. Hierarchical multivariable regression modeling was used to estimate risk-adjusted incremental cost differences in postoperative complications. The mean age was 64 years, and women accounted for 31% of patients. CABG + AVR patients had higher rates of overall complication (40% vs 35%, p costs ($26,527 vs $24,475, p costs and major postoperative complications. Interestingly, the highest incremental costs among CABG patients included newly instituted hemodialysis ($71,833), deep sternal wound infection ($56,003), and pneumonia ($50,025). Among CABG + AVR patients, these complications along with perioperative myocardial infarction ($68,917) dominated costs. Postoperative complications after CABG ± AVR are associated with significantly increased incremental costs. The most costly complications include newly instituted hemodialysis, infectious complications, and perioperative myocardial infarction. Identification of the most common and the most costly complications provides opportunities to target improvement in patient quality and the delivery of cost-effective care. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. PS3-44: Can Health Insurance Improve Employee Health Outcome and Reduce Cost? An Evaluation of Geisinger's Value-Based Insurance Design

    National Research Council Canada - National Science Library

    Maeng, Daniel; Pitcavage, James

    2013-01-01

    Background/Aims Employers have recently seen rapid increases in their cost of providing health insurance benefits for their employees, partly because the traditional health insurance benefit design...

  2. Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC).

    Science.gov (United States)

    Sarkodie, F; Hassall, O; Owusu-Dabo, E; Owusu-Ofori, S; Bates, I; Bygbjerg, I C; Owusu-Ofori, A; Harritshøj, L H; Ullum, H

    2017-02-01

    Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana. From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros ® /Abbott-Architect ® algorithm as gold standard. A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%). Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors. © 2016 British Blood Transfusion Society.

  3. Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomized Controlled Trial.

    Science.gov (United States)

    Chan, Vincent W K; Chan, Ping-Keung; Chiu, Kwong-Yuen; Yan, Chun-Hoi; Ng, Fu-Yuen

    2017-05-01

    Wound closure is key to prevent infection, facilitate immediate rehabilitation, and improve efficiency of total knee arthroplasty (TKA). Continuous knotless suturing with barbed suture can potentially save time and distribute tension more evenly. However, its role in TKA in terms of cost-effectiveness and wound complications is not clear. This study aims at comparing barbed and traditional sutures' wound closure time and cost in primary TKA. One hundred nine knees were randomized into either barbed or traditional group. Synthetic absorbable sutures (Vicryl, Ethicon Inc) and bidirectional barbed sutures (Stratafix, Ethicon Inc) were used. Arthrotomy and subcutaneous wound closure time, wound complications, and rehabilitation parameters in terms of range of motion and Knee Society Score were compared. Patients were followed up to 3 months. Traditional sutures had significantly more positive leak tests (10 vs 2, P value sutures (arthrotomy 325 seconds vs 491 seconds; subcutaneous 306 seconds vs 381 seconds, P value suture material and operation time, barbed suture on average saved USD 48.7 per TKA in our local institute. Bidirectional barbed suture improves the cost-effectiveness of TKA through reducing wound closure time and wound complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Reducing costs and length of stay and improving efficiency and quality of care in cardiac surgery.

    Science.gov (United States)

    Cohn, L H; Rosborough, D; Fernandez, J

    1997-12-01

    The present era of health care places major emphasis on significantly reducing cost and resource utilization while maintaining quality of care and patient satisfaction. Clinicians are being challenged to achieve this within the framework of a patient subset that is increasing in severity of disease and risk-adjusted mortality. The Brigham and Women's Cardiac Surgical Services Management Group was formed in 1987 to help accomplish these goals. The principles we have followed involve protocols and people. The multidisciplinary group includes the chiefs of cardiac surgery and anesthesia, chief residents, physician assistants, perfusionists, intensive care unit nursing personnel, and case managers. Weekly meetings address every aspect of problems arising in the cardiac surgical service; separate weekly morbidity and mortality conferences are held. The Care Coordination Team establishes and monitors clinical pathways and recommends ways of improving all aspects of the service through a process of daily review on an individual patient basis. The volume of cardiac surgery at Brigham and Women's Hospital has increased steadily. The length of stay overall has decreased about 15%, and similarly, cost and total charges have also decreased. In addition, patient satisfaction has increased to a level of about 95%. The goals of cost-containment with improved patient care and outcome are possible through the collaborative efforts of representatives of all the personnel involved in cardiac care, as well as leadership by the surgical faculty.

  5. Cost-effectiveness analysis of antiviral treatment in the management of seasonal influenza A: point-of-care rapid test versus clinical judgment.

    Science.gov (United States)

    Nshimyumukiza, Léon; Douville, Xavier; Fournier, Diane; Duplantie, Julie; Daher, Rana K; Charlebois, Isabelle; Longtin, Jean; Papenburg, Jesse; Guay, Maryse; Boissinot, Maurice; Bergeron, Michel G; Boudreau, Denis; Gagné, Christian; Rousseau, François; Reinharz, Daniel

    2016-03-01

    A point-of-care rapid test (POCRT) may help early and targeted use of antiviral drugs for the management of influenza A infection. (i) To determine whether antiviral treatment based on a POCRT for influenza A is cost-effective and, (ii) to determine the thresholds of key test parameters (sensitivity, specificity and cost) at which a POCRT based-strategy appears to be cost effective. An hybrid « susceptible, infected, recovered (SIR) » compartmental transmission and Markov decision analytic model was used to simulate the cost-effectiveness of antiviral treatment based on a POCRT for influenza A in the social perspective. Data input parameters used were retrieved from peer-review published studies and government databases. The outcome considered was the incremental cost per life-year saved for one seasonal influenza season. In the base-case analysis, the antiviral treatment based on POCRT saves 2 lives/100,000 person-years and costs $7600 less than the empirical antiviral treatment based on clinical judgment alone, which demonstrates that the POCRT-based strategy is dominant. In one and two way-sensitivity analyses, results were sensitive to the POCRT accuracy and cost, to the vaccination coverage as well as to the prevalence of influenza A. In probabilistic sensitivity analyses, the POCRT strategy is cost-effective in 66% of cases, for a commonly accepted threshold of $50,000 per life-year saved. The influenza antiviral treatment based on POCRT could be cost-effective in specific conditions of performance, price and disease prevalence. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

  6. Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis

    Science.gov (United States)

    van’t Hoog, Anna H.; Cobelens, Frank; Vassall, Anna; van Kampen, Sanne; Dorman, Susan E.; Alland, David; Ellner, Jerrold

    2013-01-01

    Background High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. Methods In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. Findings A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. Conclusions A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such. PMID:24367555

  7. Improved approach for electric vehicle rapid charging station placement and sizing using Google maps and binary lightning search algorithm.

    Directory of Open Access Journals (Sweden)

    Md Mainul Islam

    Full Text Available The electric vehicle (EV is considered a premium solution to global warming and various types of pollution. Nonetheless, a key concern is the recharging of EV batteries. Therefore, this study proposes a novel approach that considers the costs of transportation loss, buildup, and substation energy loss and that incorporates harmonic power loss into optimal rapid charging station (RCS planning. A novel optimization technique, called binary lightning search algorithm (BLSA, is proposed to solve the optimization problem. BLSA is also applied to a conventional RCS planning method. A comprehensive analysis is conducted to assess the performance of the two RCS planning methods by using the IEEE 34-bus test system as the power grid. The comparative studies show that the proposed BLSA is better than other optimization techniques. The daily total cost in RCS planning of the proposed method, including harmonic power loss, decreases by 10% compared with that of the conventional method.

  8. Improved approach for electric vehicle rapid charging station placement and sizing using Google maps and binary lightning search algorithm.

    Science.gov (United States)

    Islam, Md Mainul; Shareef, Hussain; Mohamed, Azah

    2017-01-01

    The electric vehicle (EV) is considered a premium solution to global warming and various types of pollution. Nonetheless, a key concern is the recharging of EV batteries. Therefore, this study proposes a novel approach that considers the costs of transportation loss, buildup, and substation energy loss and that incorporates harmonic power loss into optimal rapid charging station (RCS) planning. A novel optimization technique, called binary lightning search algorithm (BLSA), is proposed to solve the optimization problem. BLSA is also applied to a conventional RCS planning method. A comprehensive analysis is conducted to assess the performance of the two RCS planning methods by using the IEEE 34-bus test system as the power grid. The comparative studies show that the proposed BLSA is better than other optimization techniques. The daily total cost in RCS planning of the proposed method, including harmonic power loss, decreases by 10% compared with that of the conventional method.

  9. Improved approach for electric vehicle rapid charging station placement and sizing using Google maps and binary lightning search algorithm

    Science.gov (United States)

    Shareef, Hussain; Mohamed, Azah

    2017-01-01

    The electric vehicle (EV) is considered a premium solution to global warming and various types of pollution. Nonetheless, a key concern is the recharging of EV batteries. Therefore, this study proposes a novel approach that considers the costs of transportation loss, buildup, and substation energy loss and that incorporates harmonic power loss into optimal rapid charging station (RCS) planning. A novel optimization technique, called binary lightning search algorithm (BLSA), is proposed to solve the optimization problem. BLSA is also applied to a conventional RCS planning method. A comprehensive analysis is conducted to assess the performance of the two RCS planning methods by using the IEEE 34-bus test system as the power grid. The comparative studies show that the proposed BLSA is better than other optimization techniques. The daily total cost in RCS planning of the proposed method, including harmonic power loss, decreases by 10% compared with that of the conventional method. PMID:29220396

  10. A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

    Science.gov (United States)

    Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

    2015-04-27

    In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal

  11. CALCULATING THE SOCIAL COSTS OF CARBON WITHOUT KNOWING PREFERENCES COMMENT ON "A RAPID ASSESSMENT MODEL FOR UNDERSTANDING THE SOCIAL COST OF CARBON"

    OpenAIRE

    REYER GERLAGH

    2014-01-01

    The Social Costs of Carbon (SCC) equals the marginal welfare loss associated with one unit of emitted CO2, divided by the marginal welfare gain associated with one unit of consumption. In stochastic assessments, both the nominator and denominator can depend on uncertain parameters; specifically they depend on the (implicit) scaling of the welfare function with the parameters. I discuss some pitfalls when calculating the expected value or the certainty equivalent of the SCC, and show that a mi...

  12. Defense Logistics: Improved Analysis and Cost Data Needed to Evaluate the Cost-Effectiveness of Performance Based Logistics

    National Research Council Canada - National Science Library

    Solis, William M; Denman, Julia; Brumm, Harold; Dove, Matt; Echard, Jennifer; Gaskin, Chanee; Gosling, Tom; Jebo, Jennifer; Jones, Mae; Keith, Kevin; Perdue, Charles; Prybyla, Janine; Thornton, Karen

    2008-01-01

    .... GAO was asked to evaluate the extent to which DoD has used business case analyses to guide decisions related to PBL arrangements and the impact PBL arrangements have had on weapon system support costs...

  13. The hickory project: controlling healthcare costs and improving outcomes for diabetes using the asheville project model.

    Science.gov (United States)

    Bunting, Barry A; Lee, Grover; Knowles, Grant; Lee, Christine; Allen, Paul

    2011-09-01

    The results of the Asheville Project have shown the success of a community-based, chronic disease management model in improving clinical outcomes in patients with chronic disease while reducing annual costs of care per participant. The question arose whether other programs using a similar management model and implemented in other communities could replicate the success of the Asheville Project in improving clinical outcomes and reducing costs for patients with a chronic disease. To assess the long-term clinical and financial outcomes of a chronic care management model for patients with diabetes, using the Asheville care management model that was successful in the management of several chronic diseases. Longitudinal, 3-year (2007-2009), quasi-experimental, multisite, pre-/postenrollment study. Self-insured health plan members with diabetes agreed to meet on a regular basis (ie, an average of every 3 months) with a healthcare professional. Participants received reduced copayments on diabetes-related medications and supplies as an incentive for participating in the study. Providers utilized a web-based electronic medical record system that provided updated medical and prescription data and highlighted gaps in care based on national standards. Program providers included community pharmacists, population health management company pharmacists, and nurses at on-site clinics, trained in use of evidence-based guidelines of care. Providers assessed patients' medications, knowledge level, and lifestyle; provided patient education and goal setting; and referred patients for physician follow-up and recommendations to physicians. The majority of the encounters were face-to-face. The study included 95 plan members in the clinical cohort participating for 1 year or more, and 54 members in the financial cohort who have been participating in the program for 3 years. At the end of 3 years, the percentages of those achieving guideline goals increased from baseline to the latest follow

  14. Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

    Science.gov (United States)

    McCray, Sally; Maunder, Kirsty; Krikowa, Renee; MacKenzie-Shalders, Kristen

    2018-02-01

    Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ 2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ 2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ 2 used for the plate waste analysis. Significance was assessed at Pservice compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0.005) and protein (52 g/day vs 66 g/day, P=0.003) intake, as well as energy and protein intake as a percentage of requirements (63% vs 75%; P=0.024 and

  15. Improved stress corrosion cracking resistance of a novel biodegradable EW62 magnesium alloy by rapid solidification, in simulated electrolytes

    Energy Technology Data Exchange (ETDEWEB)

    Hakimi, O.; Aghion, E. [Department of Materials Engineering, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105 (Israel); Goldman, J., E-mail: jgoldman@mtu.edu [Biomedical Engineering Department, Michigan Technological University, Houghton, MI, 49931 (United States)

    2015-06-01

    The high corrosion rate of magnesium (Mg) and Mg-alloys precludes their widespread acceptance as implantable biomaterials. Here, we investigated the potential for rapid solidification (RS) to increase the stress corrosion cracking (SCC) resistance of a novel Mg alloy, Mg–6%Nd–2%Y–0.5%Zr (EW62), in comparison to its conventionally cast (CC) counterpart. RS ribbons were extrusion consolidated in order to generate bioimplant-relevant geometries for testing and practical use. Microstructural characteristics were examined by SEM. Corrosion rates were calculated based upon hydrogen evolution during immersion testing. The surface layer of the tested alloys was analyzed by X-ray photoelectron spectroscopy (XPS). Stress corrosion resistance was assessed by slow strain rate testing and fractography. The results indicate that the corrosion resistance of the RS alloy is significantly improved relative to the CC alloy due to a supersaturated Nd enrichment that increases the Nd{sub 2}O{sub 3} content in the external oxide layer, as well as a more homogeneous structure and reduced grain size. These improvements contributed to the reduced formation of hydrogen gas and hydrogen embrittlement, which reduced the SCC sensitivity relative to the CC alloy. Therefore, EW62 in the form of a rapidly solidified extruded structure may serve as a biodegradable implant for biomedical applications. - Highlights: • Here we have evaluated the corrosion resistance of a novel Mg alloy (EW62). • Rapid solidification reduces the hydrogen gas evolution and hydrogen embrittlement. • Rapid solidification increases the stress corrosion cracking resistance of EW62. • Improvement is due to enrichment with supersaturated Nd in the external oxide film. • Rapidly solidified and extruded EW62 may serve as a biodegradable medical implant.

  16. An effective approach to improving low-cost GPS positioning accuracy in real-time navigation.

    Science.gov (United States)

    Islam, Md Rashedul; Kim, Jong-Myon

    2014-01-01

    Positioning accuracy is a challenging issue for location-based applications using a low-cost global positioning system (GPS). This paper presents an effective approach to improving the positioning accuracy of a low-cost GPS receiver for real-time navigation. The proposed method precisely estimates position by combining vehicle movement direction, velocity averaging, and distance between waypoints using coordinate data (latitude, longitude, time, and velocity) of the GPS receiver. The previously estimated precious reference point, coordinate translation, and invalid data check also improve accuracy. In order to evaluate the performance of the proposed method, we conducted an experiment using a GARMIN GPS 19xHVS receiver attached to a car and used Google Maps to plot the processed data. The proposed method achieved improvement of 4-10 meters in several experiments. In addition, we compared the proposed approach with two other state-of-the-art methods: recursive averaging and ARMA interpolation. The experimental results show that the proposed approach outperforms other state-of-the-art methods in terms of positioning accuracy.

  17. An Effective Approach to Improving Low-Cost GPS Positioning Accuracy in Real-Time Navigation

    Directory of Open Access Journals (Sweden)

    Md. Rashedul Islam

    2014-01-01

    Full Text Available Positioning accuracy is a challenging issue for location-based applications using a low-cost global positioning system (GPS. This paper presents an effective approach to improving the positioning accuracy of a low-cost GPS receiver for real-time navigation. The proposed method precisely estimates position by combining vehicle movement direction, velocity averaging, and distance between waypoints using coordinate data (latitude, longitude, time, and velocity of the GPS receiver. The previously estimated precious reference point, coordinate translation, and invalid data check also improve accuracy. In order to evaluate the performance of the proposed method, we conducted an experiment using a GARMIN GPS 19xHVS receiver attached to a car and used Google Maps to plot the processed data. The proposed method achieved improvement of 4–10 meters in several experiments. In addition, we compared the proposed approach with two other state-of-the-art methods: recursive averaging and ARMA interpolation. The experimental results show that the proposed approach outperforms other state-of-the-art methods in terms of positioning accuracy.

  18. Diagnostic needle arthroscopy and the economics of improved diagnostic accuracy: a cost analysis.

    Science.gov (United States)

    Voigt, Jeffrey D; Mosier, Michael; Huber, Bryan

    2014-10-01

    Hundreds of thousands of surgical arthroscopy procedures are performed annually in the United States (US) based on MRI findings. There are situations where these MRI findings are equivocal or indeterminate and because of this clinicians commonly perform the arthroscopy in order not to miss pathology. Recently, a less invasive needle arthroscopy system has been introduced that is commonly performed in the physician office setting and that may help improve the accuracy of diagnostic findings. This in turn may prevent unnecessary follow-on arthroscopy procedures from being performed. The purpose of this analysis is to determine whether the in-office diagnostic needle arthroscopy system can provide cost savings by reducing unnecessary follow on arthroscopy procedures. Data obtained from a recent trial and from a systematic review were used in comparing the accuracy of MRI and VisionScope needle arthroscopy (VSI) with standard arthroscopy (gold standard). The resultant false positive and false negative findings were then used to evaluate the costs of follow-on procedures. These differences were then modeled for the US patient population diagnosed and treated for meniscal knee pathology (most common disorder) to determine if a technology such as VSI could save the US healthcare system money. Data on surgical arthroscopy procedures in the US for meniscal knee pathology were used (calendar year [CY] 2010). The costs of performing diagnostic and surgical arthroscopy procedures (using CY 2013 Medicare reimbursement amounts), costs associated with false negative findings, and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were assessed. In patients presenting with medial meniscal pathology (International Classification of Diseases, 9th edition, Clinical Modification [ICD9CM] diagnosis 836.0), VSI in place of MRI (standard of care) resulted in a net cost savings to the US system of US$115-US$177 million (CY 2013

  19. The Contemporary Ways to Improve the Cost Management System in Order to Increase the Competitiveness of Enterprise

    Directory of Open Access Journals (Sweden)

    Chumak Larysa F.

    2017-03-01

    Full Text Available The article is aimed at studying the current directions and ways to improve the cost management systems, allowing to increase the competitiveness of enterprise. Costs of enterprise, in any conditions of existence, are the most significant aspect of the influence on formation of economic performance, as well as obtaining the important competitive advantages, playing a special role in achieving sustainable development. Cost management system of enterprise is one of the basic elements in developing and careful substantiating the managerial decisions, therefore its continuous improvement is necessary. Improving the enterprise’s cost management system requires an integrated approach to its formation, introduction of the latest modern approaches, methods, and elaborations. Analysis of directions for improving the efficiency of cost management systems allows to define the most promising way of adapting to the practical use of the most advanced automated systems.

  20. Development of a low cost medium for Tetraselmis sp. growth and biochemical profile improvement

    Directory of Open Access Journals (Sweden)

    Catarina Rosado Correia

    2014-06-01

    Full Text Available In aquaculture, food quality improvement – especially microalgae – is mandatory. Despite having many applications in this industry, few genera of microalgae are actively used and exploited, mainly because of its lack of requirements, such as digestibility, size and lack of toxicity. Tetraselmis sp. is one of the most commonly used microalgae on aquaculture. Despite their nutritional profile, this is a highly demanding industry that requires constant improvement concerning cost production and productivity, and a biochemical profile for end usage. Improvements can be achieved through culture condition manipulation, changing, for instance, culture media’s composition. In order to achieve better biochemical profiles, productivity and lower production costs, three mediums were tested – NutriBloom [NB] (commercial medium used at Necton’s facilities, Simplex [S] (no addition of iron or any micronutrient and Sea Mineral Solution [SMS], and Tetraselmis’s level of protein, carbohydrates, total lipid and PUFA’s profile were controlled at logarithmic and stationary phase, using classical techniques, according to Lowry (1951, Dubois (1956, Bligh and Dyer (1959 and Lepage & Roy (1986. SMS revealed better results than the others, achieving higher cell numbers, productivity and less duplication time. In logarithmic phase, this medium also had the higher lipid and PUFAs percentage. S medium showed higher protein content. In stationary phase, NB medium presented more proteins, lipid and sugars. S medium had better PUFAs percentage. Differences between micronutrient concentrations explain the verified variations in microalgae’s biochemical profile, developing a low-cost medium for Tetraselmis sp. culture.

  1. Costs and cost-effectiveness of a mobile phone text-message reminder programmes to improve health workers' adherence to malaria guidelines in Kenya.

    Directory of Open Access Journals (Sweden)

    Dejan Zurovac

    Full Text Available BACKGROUND: Simple interventions for improving health workers' adherence to malaria case-management guidelines are urgently required across Africa. A recent trial in Kenya showed that text-message reminders sent to health workers' mobile phones improved management of pediatric outpatients by 25 percentage points. In this paper we examine costs and cost-effectiveness of this intervention. METHODS/FINDINGS: We evaluate costs and cost-effectiveness in 2010 USD under three implementation scenarios: (1 as implemented under study conditions in study areas; (2 if the intervention was routinely implemented by the Ministry of Health (MoH in the same areas; and (3 if the intervention was scaled up nationally. Under study conditions, intervention costs were 19,342 USD, of which 45% were for developing and pretesting text-messages, 12% for developing text-message distribution system, 29% for collecting health workers' phone numbers, and 13% were costs of sending text-messages and monitoring of the system. If the intervention was implemented in the same areas by the MoH, the costs would be 28% lower (13,920 USD due to lower costs of collecting health workers' numbers. The cost of national scale-up would be 97,350 USD, and the majority of these costs (66% would be for sending text-messages. The cost per additional child correctly managed was 0.50 USD under study conditions, 0.36 USD if implemented by the MoH in the same area, and estimated at only 0.03 USD if implemented nationally. Even if the effect size was only 5% or the cost on the national scale was 400% higher than estimated, the cost per additional child correctly managed would be only 0.16 USD. CONCLUSIONS: A simple text-messaging intervention improving health worker adherence to malaria guidelines is effective and inexpensive. Further research is justified to optimize delivery of the intervention and expand targets beyond children and malaria disease.

  2. Hardware and software improvements to a low-cost horizontal parallax holographic video monitor.

    Science.gov (United States)

    Henrie, Andrew; Codling, Jesse R; Gneiting, Scott; Christensen, Justin B; Awerkamp, Parker; Burdette, Mark J; Smalley, Daniel E

    2018-01-01

    Displays capable of true holographic video have been prohibitively expensive and difficult to build. With this paper, we present a suite of modularized hardware components and software tools needed to build a HoloMonitor with basic "hacker-space" equipment, highlighting improvements that have enabled the total materials cost to fall to $820, well below that of other holographic displays. It is our hope that the current level of simplicity, development, design flexibility, and documentation will enable the lay engineer, programmer, and scientist to relatively easily replicate, modify, and build upon our designs, bringing true holographic video to the masses.

  3. Thermal and mechanical effect during rapid heating of astroloy for improving structural integrity

    Energy Technology Data Exchange (ETDEWEB)

    Popoolaa, A.P.I., E-mail: popoolaapi@tut.ac.za [Department of Chemical, Metallurgical and Materials Engineering, Tshwane University of Technology, Pretoria (South Africa); Oluwasegun, K.M. [Department of Materials Science and Engineering, Obafemi Awolowo University (Nigeria); Olorunniwo, O.E., E-mail: segun_nniwo@yahoo.com [Department of Chemical, Metallurgical and Materials Engineering, Tshwane University of Technology, Pretoria (South Africa); Department of Materials Science and Engineering, Obafemi Awolowo University (Nigeria); Atanda, P.O. [Department of Materials Science and Engineering, Obafemi Awolowo University (Nigeria); Aigbodion, V.S. [Department of Chemical, Metallurgical and Materials Engineering, Tshwane University of Technology, Pretoria (South Africa); Department of Metallurgical and Materials Engineering, University of Nigeria, Nsukka (Nigeria)

    2016-05-05

    The behaviour of γ′ phase to thermal and mechanical effects during rapid heating of Astroloy(Turbine Disc alloy) a Powder metallurgy (PM) nickel base superalloy has been investigated. The thermo-mechanical affected zone (TMAZ) and heat affected zone (HAZ) microstructure of an inertia friction welded Astroloy were simulated using a Gleeble thermo-mechanical simulation system. Detailed microstructural examination of the simulated TMAZ and HAZ and those present in actual inertial friction welded specimens showed that γ′ particles persisted during rapid heating up to a temperature where the formation of liquid is thermodynamically favoured, and subsequently re-solidified eutectically. The result obtained showed that forging during the thermo-mechanical simulation significantly enhanced resistance to weld liquation cracking of the alloy. This is attributable to strain-induced rapid isothermal dissolution of the constitutional liquation products within 150 μm from the centre of the forged sample. This was not observed in purely thermally simulated samples. The microstructure within the TMAZ of the as-welded alloy is similar to the microstructure in the forged Gleeble specimens. - Highlights: • The behaviour of γ′ phase to thermal and mechanical effects during rapid heating of Astrology • The thermo-mechanical affected zone (TMAZ) and heat affected zone (HAZ). • significantly enhanced resistance to weld liquation cracking of the alloy. • This was not observed in purely thermally simulated samples. • The microstructure within the TMAZ of the as-welded alloy is similar to the microstructure in the forged Gleeble specimens.

  4. Development of a rapid, cost-effective TaqMan Real-Time PCR Assay for identification and differentiation of Coccidioides immitis and Coccidioides posadasii.

    Science.gov (United States)

    Sheff, Kelly W; York, Emily R; Driebe, Elizabeth M; Barker, Bridget M; Rounsley, Steven D; Waddell, Victor G; Beckstrom-Sternberg, Stephen M; Beckstrom-Sternberg, James S; Keim, Paul S; Engelthaler, David M

    2010-05-01

    Coccidioidomycosis is an infection caused by Coccidioides immitis or C. posadasii. We developed a TaqMan real-time PCR assay that rapidly and accurately differentiates the species. This assay can be used as a tool to improve disease surveillance, increase understanding of the natural history of the infection, and assist in clinical differentiation studies.

  5. Cost Effective Surfactant Formulations for Improved Oil Recovery in Carbonate Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    William A. Goddard; Yongchun Tang; Patrick Shuler; Mario Blanco; Yongfu Wu

    2007-09-30

    This report summarizes work during the 30 month time period of this project. This was planned originally for 3-years duration, but due to its financial limitations, DOE halted funding after 2 years. The California Institute of Technology continued working on this project for an additional 6 months based on a no-cost extension granted by DOE. The objective of this project is to improve the performance of aqueous phase formulations that are designed to increase oil recovery from fractured, oil-wet carbonate reservoir rock. This process works by increasing the rate and extent of aqueous phase imbibition into the matrix blocks in the reservoir and thereby displacing crude oil normally not recovered in a conventional waterflood operation. The project had three major components: (1) developing methods for the rapid screening of surfactant formulations towards identifying candidates suitable for more detailed evaluation, (2) more fundamental studies to relate the chemical structure of acid components of an oil and surfactants in aqueous solution as relates to their tendency to wet a carbonate surface by oil or water, and (3) a more applied study where aqueous solutions of different commercial surfactants are examined for their ability to recover a West Texas crude oil from a limestone core via an imbibition process. The first item, regarding rapid screening methods for suitable surfactants has been summarized as a Topical Report. One promising surfactant screening protocol is based on the ability of a surfactant solution to remove aged crude oil that coats a clear calcite crystal (Iceland Spar). Good surfactant candidate solutions remove the most oil the quickest from the surface of these chips, plus change the apparent contact angle of the remaining oil droplets on the surface that thereby indicate increased water-wetting. The other fast surfactant screening method is based on the flotation behavior of powdered calcite in water. In this test protocol, first the calcite

  6. A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

    Science.gov (United States)

    Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

    2016-02-01

    Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

  7. Improvements in low-cost label-free QPI microscope for live cell imaging

    Science.gov (United States)

    Seniya, C.; Towers, C. E.; Towers, D. P.

    2017-07-01

    This paper reports an improvement in the development of a low-cost QPI microscope offering new capabilities in term of phase measurement accuracy for label-free live samples in the longer term (i.e., hours to days). The spatially separated scattered and non-scattered image light fields are reshaped in the Fourier plane and modulated to form an interference image at a CCD camera. The apertures that enable these two beams to be generated have been optimised by means of laser-cut apertures placed on the mirrors of a Michelson interferometer and has improved the phase measuring and reconstruction capability of the QPI microscope. The microscope was tested with transparent onion cells as an object of interest.

  8. An Improved Differential Evolution Based Dynamic Economic Dispatch with Nonsmooth Fuel Cost Function

    Directory of Open Access Journals (Sweden)

    R. Balamurugan

    2007-09-01

    Full Text Available Dynamic economic dispatch (DED is one of the major operational decisions in electric power systems. DED problem is an optimization problem with an objective to determine the optimal combination of power outputs for all generating units over a certain period of time in order to minimize the total fuel cost while satisfying dynamic operational constraints and load demand in each interval. This paper presents an improved differential evolution (IDE method to solve the DED problem of generating units considering valve-point effects. Heuristic crossover technique and gene swap operator are introduced in the proposed approach to improve the convergence characteristic of the differential evolution (DE algorithm. To illustrate the effectiveness of the proposed approach, two test systems consisting of five and ten generating units have been considered. The results obtained through the proposed method are compared with those reported in the literature.

  9. Low-cost Method for Obtaining Medical Rapid Prototyping Using Desktop 3D printing: A Novel Technique for Mandibular Reconstruction Planning.

    Science.gov (United States)

    Velasco, Ignacio; Vahdani, Soheil; Ramos, Hector

    2017-09-01

    Three-dimensional (3D) printing is relatively a new technology with clinical applications, which enable us to create rapid accurate prototype of the selected anatomic region, making it possible to plan complex surgery and pre-bend hardware for individual surgical cases. This study aimed to express our experience with the use of medical rapid prototype (MRP) of the maxillofacial region created by desktop 3D printer and its application in maxillofacial reconstructive surgeries. Three patients with benign mandible tumors were included in this study after obtaining informed consent. All patient's maxillofacial CT scan data was processed by segmentation and isolation software and mandible MRP was printed using our desktop 3D printer. These models were used for preoperative surgical planning and prebending of the reconstruction plate. MRP created by desktop 3D printer is a cost-efficient, quick and easily produced appliance for the planning of reconstructive surgery. It can contribute in patient orientation and helping them in a better understanding of their condition and proposed surgical treatment. It helps surgeons for pre-operative planning in the resection or reconstruction cases and represent an excellent tool in academic setting for residents training. The pre-bended reconstruction plate based on MRP, resulted in decreased surgery time, cost and anesthesia risks on the patients. Key words: 3D printing, medical modeling, rapid prototype, mandibular reconstruction, ameloblastoma.

  10. Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

    Science.gov (United States)

    French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

    2013-12-01

    The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

  11. Rapid Mapping for Built Heritage at Risk Using Low-Cost and Cots Sensors. a Test in the Duomo Vecchio of San Severino Marche

    Science.gov (United States)

    Calantropio, A.; Colucci, E.; Teppati Losè, L.

    2017-11-01

    In the last years, the researchers in the field of Geomatics have focused their attention in the experimentation and validation of new methodologies and techniques, stressing especially the potential of low-cost and COTS (Commercial Off The Shelf) solutions and sensors. In particular, these tools have been used with purposes of rapid mapping in different contexts (ranging from the construction industry, environmental monitoring, mining activities, etc.). The Built Heritage, due to its intrinsic nature of endangered artefact, can largely benefit from the technological and methodological innovations in this research field. The contribute presented in this paper will highlight these main topics: the rapid mapping of the Built Heritage (in particular the one subjected to different types of risk) using low-cost and COTS solutions. Different sensors and techniques were chosen to be evaluated on a specific test site: the Duomo Vecchio of San Severino Marche (MC - Italy), that was partially affected by the earthquake swarm that hit the area of Central Italy starting from the 24th of August 2016. One of the main aims of this work is to demonstrate how low-cost and COTS sensors can contribute to the documentation of the Built Heritage for its safeguard, for damage assessment in case of disastrous events and operations of restoration and preservation.

  12. Feasibility studies to improve plant availability and reduce total installed cost in IGCC plants

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, Kevin [General Electric Company, Houston, TX (United States); Anasti, William [General Electric Company, Houston, TX (United States); Fang, Yichuan [General Electric Company, Houston, TX (United States); Subramanyan, Karthik [General Electric Company, Houston, TX (United States); Leininger, Tom [General Electric Company, Houston, TX (United States); Zemsky, Christine [General Electric Company, Houston, TX (United States)

    2015-03-30

    The main purpose of this project is to look at technologies and philosophies that would help reduce the costs of an Integrated Gasification Combined Cycle (IGCC) plant, increase its availability or do both. GE’s approach to this problem is to consider options in three different areas: 1) technology evaluations and development; 2) constructability approaches; and 3) design and operation methodologies. Five separate tasks were identified that fall under the three areas: Task 2 – Integrated Operations Philosophy; Task 3 – Slip Forming of IGCC Components; Task 4 – Modularization of IGCC Components; Task 5 – Fouling Removal; and Task 6 – Improved Slag Handling. Overall, this project produced results on many fronts. Some of the ideas could be utilized immediately by those seeking to build an IGCC plant in the near future. These include the considerations from the Integrated Operations Philosophy task and the different construction techniques of Slip Forming and Modularization (especially if the proposed site is in a remote location or has a lack of a skilled workforce). Other results include ideas for promising technologies that require further development and testing to realize their full potential and be available for commercial operation. In both areas GE considers this project to be a success in identifying areas outside the core IGCC plant systems that are ripe for cost reduction and ity improvement opportunities.

  13. Improved TDEM formation using fused ladar/digital imagery from a low-cost small UAV

    Science.gov (United States)

    Khatiwada, Bikalpa; Budge, Scott E.

    2017-05-01

    Formation of a Textured Digital Elevation Model (TDEM) has been useful in many applications in the fields of agriculture, disaster response, terrain analysis and more. Use of a low-cost small UAV system with a texel camera (fused lidar/digital imagery) can significantly reduce the cost compared to conventional aircraft-based methods. This paper reports continued work on this problem reported in a previous paper by Bybee and Budge, and reports improvements in performance. A UAV fitted with a texel camera is flown at a fixed height above the terrain and swaths of texel image data of the terrain below is taken continuously. Each texel swath has one or more lines of lidar data surrounded by a narrow strip of EO data. Texel swaths are taken such that there is some overlap from one swath to its adjacent swath. The GPS/IMU fitted on the camera also give coarse knowledge of attitude and position. Using this coarse knowledge and the information from the texel image, the error in the camera position and attitude is reduced which helps in producing an accurate TDEM. This paper reports improvements in the original work by using multiple lines of lidar data per swath. The final results are shown and analyzed for numerical accuracy.

  14. A performance improvement and cost-efficient ACO-OFDM scheme for visible light communications

    Science.gov (United States)

    Zhang, Tiantian; Zhou, Ji; Zhang, Zhenshan; Qiao, Yaojun; Su, Fei; Yang, Aiying

    2017-11-01

    In this paper, we propose a performance improvement and cost-efficient discrete Hartley transform (DHT)-based asymmetrically clipped optical orthogonal frequency division multiplexing (ACO-OFDM) scheme for visible light communications (VLC). The simple one-dimensional modulation constellation and simplified encoding structure reduce the complexity of system considerably. The DHT-spreading technique is employed to reduce peak-to-average power ratio (PAPR) of ACO-OFDM signals. Moreover, the intra-symbol frequency-domain averaging (ISFA) technique is used to increase the accuracy of channel estimation by removing the effect of ambient noise in the VLC channel effectively. To verify the feasibility of the proposed scheme, we study its performance via simulation. This scheme reduces the requirement to the resolution of DAC and increases the tolerance to the nonlinear characteristics of LED, both of which are cost-efficient. At forward error correction (FEC) limit (BER = 1 × 10-3), simulation results illustrate that compared with DHT-based ACO-OFDM without the ISFA technique, our scheme has 3.2 dB and 2.7 dB improvement of the required Eb /N0 when BPSK and 4-PAM are modulated, respectively.

  15. Recovery Act: Low-Cost, Highly Lambertian Reflector Composite For Improved LED Fixture Efficiency and Lifetime

    Energy Technology Data Exchange (ETDEWEB)

    Teather, Eric

    2013-02-15

    The overall objective of the program was to demonstrate a 98% or greater reflective, highly diffuse, low-cost composite material that significantly improves luminaire efficiency, is able to withstand 50,000 hours or greater luminaire operation under expected LED system thermal and environmental operating extremes and meets the cost targets required to be an effective commercial solution for the Solid State Lighting industry. This project met most of the goals defined and contributed to the understanding of high reflectance, white coatings. Research under this program increased the understanding of coatings development using particle size reduction techniques and preparation of coating solutions with a broad range of particle types. The research explored scale-up of coating systems and generated understanding of processing required for high volume manufacturing applications. The work demonstrated how coating formulation and application technique can translate to material durability and LED system lifetime. The research also demonstrated improvements in lighting efficiency to be gained using high reflectance white coatings.

  16. A rapid interview protocol supporting patient-centered quality improvement: hearing the parent's voice in a pediatric cancer unit.

    Science.gov (United States)

    Sobo, Elisa J; Billman, Glenn; Lim, Lillian; Murdock, J Wilken; Romero, Elvia; Donoghue, Donna; Roberts, William; Kurtin, Paul S

    2002-09-01

    The Institute of Medicine's 2001 report on quality delimits six dimensions of optimal care: safety, effectiveness, efficiency, timeliness, patient centeredness, and equity. In fall 2001 parents of pediatric cancer patients were interviewed to determine how well they thought these dimensions were addressed with respect to medication administration. Immediate goals were to identify system weaknesses and devise strategies to prevent future errors. A higher-order goal was to develop and demonstrate a model protocol for rapid-cycle interview assessments. Hematology/oncology directors worked with a research expert to develop a semistructured interview protocol. After training, which included directed reading, oral instruction, and role-playing, a convenience sample of 20 English- and Spanish-speaking parents of inpatients was recruited. Parents were asked to characterize current medication administration practices and to describe problems that they had experienced or witnessed. Rapid content analysis techniques were used to identify issues of importance to the parents. Parents' medication concerns centered on their children's comfort. Parents called for communication improvements, standardization of all nursing procedures and techniques, and a guide or an outline providing a clear understanding of what to expect when and from whom. Viewing these concerns in relation to the Institute of Medicine's quality domains allowed the department to frame an improvement action plan aligned with organizational and national priorities. With good supervision and limited focused training, inexperienced staff can successfully administer semistructured qualitative interviews and help analyze findings for rapid cycle improvement purposes. The protocol can be adapted for use in organizations interested in rapid qualitative assessments of patient and parent preferences.

  17. The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

    Energy Technology Data Exchange (ETDEWEB)

    Ashcraft, Phillip Lynn [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Fogle, Blythe G. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cummings, Susan M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Lopez, Leon [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-07-29

    This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating the request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.

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

    NARCIS (Netherlands)

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

    2004-01-01

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

  19. A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment method.

    Science.gov (United States)

    Vallurupalli, Srikanth; Kasula, Srikanth; Kumar Agarwal, Shiv; Pothineni, Naga Venkata K; Abualsuod, Amjad; Hakeem, Abdul; Ahmed, Zubair; Uretsky, Barry F

    2017-08-01

    High-pressure inflation for coronary stent deployment is universally performed. However, the duration of inflation is variable and does not take into account differences in lesion compliance. We developed a standardized "pressure optimization protocol" (POP) using inflation pressure stability rather than an arbitrary inflation time or angiographic balloon appearance for stent deployment. Whether this approach improves long-term outcomes is unknown. 792 patients who underwent PCI using either rapid inflation/deflation (n = 376) or POP (n = 416) between January 2009 and March 2014 were included. Exclusion criteria included PCI for acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions. Primary endpoint was target vessel failure [TVF = combined end point of target vessel revascularization (TVR), myocardial infarction, and cardiac death]. Outcomes were analyzed in the entire cohort and in a propensity analysis. Stent implantation using POP with a median follow-up of 1317 days was associated with lower TVF compared with rapid inflation/deflation (10.1 vs. 17.8%, P inflation/deflation (10 vs. 18%, P < 0.0001). Stent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic.

    Science.gov (United States)

    Delaloge, Suzette; Bonastre, Julia; Borget, Isabelle; Garbay, Jean-Rémi; Fontenay, Rachel; Boinon, Diane; Saghatchian, Mahasti; Mathieu, Marie-Christine; Mazouni, Chafika; Rivera, Sofia; Uzan, Catherine; André, Fabrice; Dromain, Clarisse; Boyer, Bruno; Pistilli, Barbara; Azoulay, Sandy; Rimareix, Françoise; Bayou, El-Hadi; Sarfati, Benjamin; Caron, Hélène; Ghouadni, Amal; Leymarie, Nicolas; Canale, Sandra; Mons, Muriel; Arfi-Rouche, Julia; Arnedos, Monica; Suciu, Voichita; Vielh, Philippe; Balleyguier, Corinne

    2016-10-01

    Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Fundamental understanding and integration of rapid thermal processing, PECVD, and screen printing for cost-effective, high-efficiency silicon photovoltaic devices

    Science.gov (United States)

    Doshi, Parag Mahendra

    The final hurdle preventing widespread application of photovoltaics is cost-effectiveness. Solar cell efficiencies in the laboratory have reached 24%, but industrial cells, constrained by low-cost, high-throughput processes, are limited to 10-15%. This thesis focuses on industrially relevant technologies such as rapid thermal processing (RTP), PECVD, and screen-printing to simplify and speed up cell processing yet maintain the key features that give high efficiencies in the laboratory. RTP utilizes tungsten-halogen and UV lamps as a source of high energy photons that induce thermal and photophysical effects which can significantly increase the kinetics of semiconductor processes such as diffusion, oxidation, and annealing. PECVD also serves as a promising low-cost candidate for SiN/SiOsb2 antireflection coatings and passivation. Finally, screen printing serves as a very high-throughput technology for contact formation as a low-cost alternative to photolithography. Integration of these technologies into a single cell fabrication sequence, however, revealed the susceptibility to low internal quantum efficiencies in the long and short wavelengths. For example, the inherent rapid cooling during RTP can degrade minority-carrier lifetime and long wavelength response. Lack of knowledge in tailoring RTP emitter diffusion profiles coupled with less than perfect PECVD surface passivation and parasitic SiN absorption was found to limit short wavelength response. Problems like these limited RTP cell efficiencies to only 15.4% prior to this thesis. Through a combination of fundamental understanding of device physics, materials and device characterization, modeling, and cell fabrication these losses were quantified and overcome in this thesis. An in-situ annealing cycle during RTP was optimized to prevent quenching-induced lifetime degradation and to preserve high long wavelength response. Measurement of SiN extinction coefficients to compute parasitic absorption, optimization

  2. Rapid plasma treatment of polyimide for improved adhesive and durable copper film deposition

    Energy Technology Data Exchange (ETDEWEB)

    Usami, Kenji [Department of Electrical Engineering and Computer Science, Nagoya University (Japan); Ishijima, Tatsuo, E-mail: ishijima@nagoya-u.jp [Plasma Nanotechnology Research Center, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603 (Japan); Toyoda, Hirotaka [Department of Electrical Engineering and Computer Science, Nagoya University (Japan); Plasma Nanotechnology Research Center, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603 (Japan)

    2012-10-30

    To improve adhesion at the interface between Cupper (Cu) and polyimide (PI) layers, a PI film surface was treated with a microwave-excited plasma. The Ar/N{sub 2} plasma treatment improved the Cu adhesion force to 10 N/cm even for PI substrates with absorbed water. A dramatic improvement of the adhesion durability was achieved by depositing a thin carbon film (C) on the PI substrate as an interlayer between PI and Cu using a microwave plasma followed by treatment with the Ar/N{sub 2} plasma prior to the Cu deposition. After a 20-h accelerated aging test, the reduction of the adhesion force for the resulting Cu/C/PI sample was only 10%, whereas that for the Cu/PI sample was 55%. To gain insight into the film properties, the interface between the Cu and PI film was investigated by X-ray photoelectron spectroscopy.

  3. Stratification by Genetic and Demographic Characteristics Improves Diagnostic Accuracy of Cerebrospinal Fluid Biomarkers in Rapidly Progressive Dementia.

    Science.gov (United States)

    Karch, André; Llorens, Franc; Schmitz, Matthias; Arora, Amandeep Singh; Zafar, Saima; Lange, Peter; Schmidt, Christian; Zerr, Inga

    2016-10-18

    Cerebrospinal fluid (CSF) biomarkers are routinely used for the differential diagnosis of rapidly progressive dementia, but are also affected by patients' characteristics. To assess if stratification by age, sex, and genetic risk factors improves the accuracy of cerebrospinal fluid (CSF) biomarkers in patients with rapidly progressive dementia. 1,538 individuals with sporadic Creutzfeldt-Jakob disease (CJD), 173 with classic Alzheimer's disease (cAD), 37 with rapidly progressive Alzheimer's disease (rpAD), and 589 without signs of dementia were included in this retrospective diagnostic study. The effect of age, sex, PRNP codon 129, and APOE genotype on CSF levels of tau, p-tau, Aβ1-42, and Aβ1-40 values measured at time of diagnostic work-up was assessed. Tau was a better marker for the differentiation of CJD and rpAD in older (AUC:0.97; 95% CI:0.96-1.00) than in younger (AUC:0.91; 95% CI:0.87-0.94) patients as tau levels increased with age in CJD patients, but not in rpAD patients. PRNP codon 129 and APOE genotype had complex effects on biomarkers in all diseases, making stratification by genotype a powerful tool. In females (AUC:0.78; 95% CI:0.65-0.91) and patients older than 70 (AUC:0.78; 95% CI:0.62-0.93), tau was able to differentiate with moderate accuracy between cAD and rpAD patients. Implementation of stratum-specific reference ranges improves the diagnostic accuracy of CSF biomarkers for the differential diagnosis of rapidly progressive dementia. Diagnostic criteria developed for this setting have to take this into account.

  4. A Performance Improvement Method for Low-Cost Land Vehicle GPS/MEMS-INS Attitude Determination

    Science.gov (United States)

    Cong, Li; Li, Ercui; Qin, Honglei; Ling, Keck Voon; Xue, Rui

    2015-01-01

    Global positioning system (GPS) technology is well suited for attitude determination. However, in land vehicle application, low-cost single frequency GPS receivers which have low measurement quality are often used, and external factors such as multipath and low satellite visibility in the densely built-up urban environment further degrade the quality of the GPS measurements. Due to the low-quality receivers used and the challenging urban environment, the success rate of the single epoch ambiguity resolution for dynamic attitude determination is usually quite low. In this paper, a micro-electro-mechanical system (MEMS)—inertial navigation system (INS)-aided ambiguity resolution method is proposed to improve the GPS attitude determination performance, which is particularly suitable for land vehicle attitude determination. First, the INS calculated baseline vector is augmented with the GPS carrier phase and code measurements. This improves the ambiguity dilution of precision (ADOP), resulting in better quality of the unconstrained float solution. Second, the undesirable float solutions caused by large measurement errors are further filtered and replaced using the INS-aided ambiguity function method (AFM). The fixed solutions are then obtained by the constrained least squares ambiguity decorrelation (CLAMBDA) algorithm. Finally, the GPS/MEMS-INS integration is realized by the use of a Kalman filter. Theoretical analysis of the ADOP is given and experimental results demonstrate that our proposed method can significantly improve the quality of the float ambiguity solution, leading to high success rate and better accuracy of attitude determination. PMID:25760057

  5. The use of DNA markers for rapid improvement of crops in Africa ...

    African Journals Online (AJOL)

    Genetic engineering and biotechnology are providing new tools for genetic improvement of food crops. Molecular DNA markers are some of these tools which can be used in various fields of plant breeding and germplasm management. For example, molecular markers have been used to confirm the identity of hybrids in ...

  6. A Computational Library Design Protocol for Rapid Improvement of Protein Stability : FRESCO

    NARCIS (Netherlands)

    Wijma, Hein; Fürst, Maximilian; Janssen, Dick; Clifton, N.J.

    2017-01-01

    The ability to stabilize enzymes and other proteins has wide-ranging applications. Most protocols for enhancing enzyme stability require multiple rounds of high-throughput screening of mutant libraries and provide only modest improvements of stability. Here, we describe a computational library

  7. Collaboration in Pennsylvania: Rapidly Spreading Improved Chronic Care for Patients to Practices

    Science.gov (United States)

    Bricker, Patricia L.; Baron, Richard J.; Scheirer, Jorge J.; DeWalt, Darren A.; Derrickson, John; Yunghans, Suzanne; Gabbay, Robert A.

    2010-01-01

    Introduction: Pennsylvania's Improving Performance in Practice (IPIP) program is administered by the Pennsylvania (PA) chapters of the American Academy of Family Physicians, American College of Physicians, and American Academy of Pediatrics. The project has provided coaching, monthly measurement, and patient registry support for 155 primary-care…

  8. The use of DNA markers for rapid improvement of crops in Africa ...

    African Journals Online (AJOL)

    Genetic engineering and biotechnology are providing new tools for genetic improvement of food crops. Molecular DNA markers are some of ... The polymerase chain reaction (PCR) has become a popular technique for molecular genome mapping and the diagnosis of plant pathogens. The technique ensures amplification ...

  9. CCSD-PCM: Improving upon the reference reaction field approximation at no cost

    Science.gov (United States)

    Caricato, Marco

    2011-08-01

    The combination of the coupled cluster (CC) method with the polarizable continuum model (PCM) of solvation requires a much larger computational effort than gas phase CC calculations, since the PCM contribution depends nonlinearly on the CC reduced density: perturbation theory energy and density (PTED) scheme. An approximation can be introduced that neglects the "correlation" PCM contribution and only considers the "reference" PCM contribution to the free energy: PTE scheme. The PTE scheme is a computationally efficient strategy, since the cost is comparable to gas phase CC, but the difference in the free energy with respect to the PTED scheme can be significant. In this work, two intermediate approximations are presented, PTE(S) and PTES (where S stands for singles), which retain the computational efficiency of the PTE scheme while reducing the energy gap with the PTED scheme. PTE(S) only introduces an energy correction to the PTE free energy, while PTES introduces explicit PCM terms in the iterative solution of the CC equations. PTE(S) improves the PTE free energy, although such correction is small. PTES recovers 50%-80% of the PTE-PTED difference and represents a promising approach to perform calculations in solution of CC quality at a cost comparable to gas phase CC. The expressions for the CC-PTE(S) and -PTES wave functions, free energy, and free energy analytical gradients are presented, and the methods are tested with numerical examples.

  10. Determination of the minimum improvement in pain, disability, and health state associated with cost-effectiveness: introduction of the concept of minimum cost-effective difference.

    Science.gov (United States)

    Parker, Scott L; McGirt, Matthew J

    2012-12-01

    Minimum clinical important difference (MCID) has been adopted as the smallest improvement in patient-reported outcome needed to achieve a level of improvement thought to be meaningful to patients. To use a common MCID calculation method with a cost-utility threshold anchor to introduce the concept of minimum cost-effective difference (MCED). Forty-five patients undergoing transforaminal lumbar interbody fusion for degenerative spondylolisthesis were included. Outcome questionnaires were administered before and 2 years after surgery. Total cost per quality-adjusted life-year (QALY) gained was calculated for each patient. MCED was determined from receiver-operating characteristic curve analysis with a cost-effective anchor of surgery. With the use of cost-effective anchor of <  $50,000/QALY, MCED after transforaminal lumbar interbody fusion was 4 points for visual analog scale for low back pain, 3 points for visual analog scale for leg pain, 22 points for Oswestry disability index, and 0.31 QALYs for EuroQol 5D.

  11. A simple, low cost and fast improved fluorimetric method for Histamine measurement

    Directory of Open Access Journals (Sweden)

    Poorpak Z

    2001-11-01

    Full Text Available The well-known fluorimetric method for histamine measurement which is one of the common methods in diagnostic laboratories was modified to accelerate and facilitate measurement of serum histamine levels and decrease the costs and restrictions. The modified method needs only 1 ml of whole blood (or serum instead of about 10 ml in original method which is difficult almost or impossible specially for children. In addition, very small amounts of the expensive materials are needed and the samples are saved for about 15 days in -20°C which makes no significant changes. Because in most cases, sample can not be read at sampling day, the saving possibility is an advantage for improved method.

  12. Improved cost-benefit techniques in the US Nuclear Regulatory Commission

    Energy Technology Data Exchange (ETDEWEB)

    Cronin, F.J.; Nesse, R.J.; Vaeth, M.; Wusterbarth, A.R.; Currie, J.W.

    1983-06-01

    The major objective of this report is to help the US Nuclear Regulatory Commission (NRC) in its regulatory mission, particularly with respect to improving the use of cost-benefit analysis and the economic evaluation of resources within the NRC. The objectives of this effort are: (1) to identify current and future NRC requirements (e.g., licensing) for valuing nonmarket goods; (2) to identify, highlight, and present the relevant efforts of selected federal agencies, some with over two decades of experience in valuing nonmarket goods, in this area; and (3) to review methods for valuing nonmarket impacts and to provide estimats of their magnitudes. Recently proposed legislation may result in a requirement for not only more sophisticated valuation analyses, but more extensive applications of these techniques to issues of concern to the NRC. This paper is intended to provide the NRC with information to more efficiently meet such requirements.

  13. Global earthquake casualties due to secondary effects: A quantitative analysis for improving rapid loss analyses

    Science.gov (United States)

    Marano, K.D.; Wald, D.J.; Allen, T.I.

    2010-01-01

    This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and fire for events during the past 40 years. These processes are of great importance to the US Geological Survey's (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/significant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER's overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We find that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra-Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our findings, we have built country-specific disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability. ?? Springer Science+Business Media B.V. 2009.

  14. The application of rapid prototyping to improve bone reconstruction in immediate dentoalveolar restoration: a case report.

    Science.gov (United States)

    Martins da Rosa, José Carlos; Fadanelli, Marcos Alexandre; Zimmerman, Diego; de Oliveira Rosa, Ariádene Cristina Pértile

    This article describes the use of rapid prototyping (RP) for diagnosis, planning, and execution of the reconstruction of hard and soft tissue in socket defects using immediate dentoalveolar restoration (IDR). In cases of tissue loss in anterior dental areas, esthetic rehabilitation poses a major challenge with respect to treatment planning with the goal of long-term tissue maintenance. The IDR technique consists of immediate reconstruction in a single procedure of bone and soft tissue around implants placed immediately after extraction, and prosthetic rehabilitation. As this procedure is immediate and flapless, the correct diagnosis of tissue loss and correct graft adaptation are mandatory. RP can increase the precision of the procedure, as demonstrated using a clinical case characterized by total loss of the buccal bone wall and gingival recession. The results were evaluated by clinical assessment, photography, radiography, cone beam computed tomography (CBCT), and prototyping. The application of RP facilitated the execution of IDR as it enabled more accurate diagnosis of the socket defect and more precise adaptation of the tissue graft. A clinical study should be conducted to evaluate the effects of RP on the clinical results of the IDR technique.

  15. Improved Multiplex Polymerase Chain Reaction for Rapid Staphylococcus Aureus Detection in Meat and Milk Matrices

    Directory of Open Access Journals (Sweden)

    Šramková Zuzana

    2016-06-01

    Full Text Available Staphylococcal food poisoning represents one of the most frequently occurring intoxications, caused by staphylococcal enterotoxins (SE-s and staphylococcal enterotoxin-like proteins (SEl-s. Therefore, there is a need for rapid, sensitive and specific detection method for this human pathogen and its toxin genes in food matrices. The present work is focused on Staphylococcus aureus detection by a nonaplex polymerase chain reaction, which targets the 23S rRNA gene for identification of S. aureus at the species level, genes for classical SE-s (SEA, SEC, SED, new SE-s (SEH, SEI, SEl-s (SEK, SEL and tsst-1 gene (toxic shock syndrome toxin. Primers were properly designed to avoid undesirable interactions and to create a reliably identifiable profile of amplicons when visualized in agarose gel. According to obtained results, this approach is able to reach the detection sensitivity of 12 colony forming units from milk and meat matrices without prior culturing and DNA extraction.

  16. Improvement Strategies, Cost Effective Production, and Potential Applications of Fungal Glucose Oxidase (GOD: Current Updates

    Directory of Open Access Journals (Sweden)

    Manish K. Dubey

    2017-06-01

    Full Text Available Fungal glucose oxidase (GOD is widely employed in the different sectors of food industries for use in baking products, dry egg powder, beverages, and gluconic acid production. GOD also has several other novel applications in chemical, pharmaceutical, textile, and other biotechnological industries. The electrochemical suitability of GOD catalyzed reactions has enabled its successful use in bioelectronic devices, particularly biofuel cells, and biosensors. Other crucial aspects of GOD such as improved feeding efficiency in response to GOD supplemental diet, roles in antimicrobial activities, and enhancing pathogen defense response, thereby providing induced resistance in plants have also been reported. Moreover, the medical science, another emerging branch where GOD was recently reported to induce several apoptosis characteristics as well as cellular senescence by downregulating Klotho gene expression. These widespread applications of GOD have led to increased demand for more extensive research to improve its production, characterization, and enhanced stability to enable long term usages. Currently, GOD is mainly produced and purified from Aspergillus niger and Penicillium species, but the yield is relatively low and the purification process is troublesome. It is practical to build an excellent GOD-producing strain. Therefore, the present review describes innovative methods of enhancing fungal GOD production by using genetic and non-genetic approaches in-depth along with purification techniques. The review also highlights current research progress in the cost effective production of GOD, including key advances, potential applications and limitations. Therefore, there is an extensive need to commercialize these processes by developing and optimizing novel strategies for cost effective GOD production.

  17. Improving assessment of congenital heart disease through rapid patient specific modeling.

    Science.gov (United States)

    Gilbert, Kathleen; Farrar, Genevieve; Cowan, Brett; Suinesiaputra, Avan; Occleshaw, Christopher; Pontre, Beau; Perry, James; Hegde, Sanjeet; Omens, Jeffrey; McCulloch, Andrew; Young, Alistair

    2016-08-01

    Congenital heart disease is the most common birth defect, with an incidence of 75 in every 1000 births. As a result of improved interventions, 90% of people with congenital heart disease now survive to adulthood. They must undergo regular imaging to assess their biventricular (left and right ventricular) function. Analysis of the images is problematic due to the large variety of shapes and complex geometry. In this paper we extend a biventricular modeling method to improve the analysis of MR images from congenital heart disease patients. We used a subdivision surface method to create three customizable exemplars, representing common manifestations of anatomy, and incorporated these as priors into an interactive biventricular customization procedure. The CHD-specific priors were tested on 60 cases representing a variety of congenital heart diseases for which the gold standard manual contours were available. The introduction of multiple priors showed a significant decrease in analysis time while maintaining good correlation between the two methods (R2 >.82).

  18. Sparse-SEMAC: rapid and improved SEMAC metal implant imaging using SPARSE-SENSE acceleration.

    Science.gov (United States)

    Otazo, Ricardo; Nittka, Mathias; Bruno, Mary; Raithel, Esther; Geppert, Christian; Gyftopoulos, Soterios; Recht, Michael; Rybak, Leon

    2017-07-01

    To develop an accelerated SEMAC metal implant MRI technique (Sparse-SEMAC) with reduced scan time and improved metal distortion correction. Sparse-SEMAC jointly exploits the inherent sparsity along the additional phase-encoding dimension and multicoil encoding capabilities to significantly accelerate data acquisition. A prototype pulse sequence with pseudorandom ky -kz undersampling and an inline image reconstruction was developed for integration in clinical studies. Three patients with hip implants were imaged using the proposed Sparse-SEMAC with eight-fold acceleration and compared with the standard-SEMAC technique used in clinical studies (three-fold GRAPPA acceleration). Measurements were performed with SEMAC-encoding steps (SES) = 15 for Sparse-SEMAC and SES = 9 for Standard-SEMAC using high spatial resolution Proton Density (PD) and lower-resolution STIR acquisitions. Two expert musculoskeletal (MSK) radiologists performed a consensus reading to score image-quality parameters. Sparse-SEMAC enables up to eight-fold acceleration of data acquisition that results in two-fold scan time reductions, compared with Standard-SEMAC, with improved metal artifact correction for patients with hip implants without degrading spatial resolution. The high acceleration enabled by Sparse-SEMAC would enable clinically feasible examination times with improved correction of metal distortion. Magn Reson Med 78:79-87, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  19. Simple changes within dietary subgroups can rapidly improve the nutrient adequacy of the diet of French adults.

    Science.gov (United States)

    Verger, Eric O; Holmes, Bridget A; Huneau, Jean François; Mariotti, François

    2014-06-01

    Identifying the dietary changes with the greatest potential for improving diet quality is critical to designing efficient nutrition communication campaigns. Our objective was to simulate the effects of different types of dietary substitutions to improve diet quality at the individual level. Starting from the observed diets of 1330 adults participating in the national French Nutrition and Health Survey (Etude Nationale Nutrition Santé), we simulated the effects of 3 different types of food and beverage substitutions with graded implementation difficulty for the consumer in a stepwise dietary counseling model based on the improvement in the PANDiet index, which measures diet quality in terms of nutrient adequacy. In scenario 1, substitutions of a food or beverage for its "lighter" version resulted in a modest improvement in the PANDiet score (Δ = +3.3 ± 0.1) and a decrease in energy intake (Δ = -114 ± 2 kcal/d). In scenario 2, substitutions of a food or beverage within the same food subgroup resulted in a marked improvement in the PANDiet score (Δ = +26.4 ± 0.2) with no significant change in energy intake. In this second scenario, the improvement in nutrient adequacy was due to substitutions in many subgroups, with no single subgroup contributing >8% to the increase in the PANDiet score. In scenario 3, substitutions of a food or beverage within the same food group resulted in the greatest improvement in the PANDiet score (Δ = +31.8 ± 0.2) but with an increase in energy intake (Δ = +204 ± 9 kcal/d). In this third scenario, the improvement in nutrient adequacy was largely due to substitutions of fish for meat and processed meat (∼30% of the increase in the PANDiet score). This study shows that a strategy based on simple substitutions within food subgroups is effective in rapidly improving the nutritional adequacy of the diet of French adults and could be used in public health nutrition actions. © 2014 American Society for Nutrition.

  20. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

    Directory of Open Access Journals (Sweden)

    Sergio Garbarino

    2016-08-01

    Full Text Available Sleep disorders are frequent (18%–23% and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  1. Open microfluidic gel electrophoresis: Rapid and low cost separation and analysis of DNA at the nanoliter scale.

    Science.gov (United States)

    Gutzweiler, Ludwig; Gleichmann, Tobias; Tanguy, Laurent; Koltay, Peter; Zengerle, Roland; Riegger, Lutz

    2017-07-01

    Gel electrophoresis is one of the most applied and standardized tools for separation and analysis of macromolecules and their fragments in academic research and in industry. In this work we present a novel approach for conducting on-demand electrophoretic separations of DNA molecules in open microfluidic (OM) systems on planar polymer substrates. The approach combines advantages of slab gel, capillary- and chip-based methods offering low consumable costs (<0.1$) circumventing cost-intensive microfluidic chip fabrication, short process times (5 min per analysis) and high sensitivity (4 ng/μL dsDNA) combined with reasonable resolution (17 bases). The open microfluidic separation system comprises two opposing reservoirs of 2-4 μL in volume, a semi-contact written gel line acting as separation channel interconnecting the reservoirs and sample injected into the line via non-contact droplet dispensing and thus enabling the precise control of the injection plug and sample concentration. Evaporation is prevented by covering aqueous structures with PCR-grade mineral oil while maintaining surface temperature at 15°C. The liquid gel line exhibits a semi-circular cross section of adaptable width (∼200-600 μm) and height (∼30-80 μm) as well as a typical length of 15-55 mm. Layout of such liquid structures is adaptable on-demand not requiring time consuming and repetitive fabrication steps. The approach was successfully demonstrated by the separation of a standard label-free DNA ladder (100-1000 bp) at 100 V/cm via in-line staining and laser induced fluorescent end-point detection using an automated prototype. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Rapid, portable and cost-effective yeast cell viability and concentration analysis using lensfree on-chip microscopy and machine learning

    KAUST Repository

    Feizi, Alborz

    2016-09-24

    Monitoring yeast cell viability and concentration is important in brewing, baking and biofuel production. However, existing methods of measuring viability and concentration are relatively bulky, tedious and expensive. Here we demonstrate a compact and cost-effective automatic yeast analysis platform (AYAP), which can rapidly measure cell concentration and viability. AYAP is based on digital in-line holography and on-chip microscopy and rapidly images a large field-of-view of 22.5 mm2. This lens-free microscope weighs 70 g and utilizes a partially-coherent illumination source and an opto-electronic image sensor chip. A touch-screen user interface based on a tablet-PC is developed to reconstruct the holographic shadows captured by the image sensor chip and use a support vector machine (SVM) model to automatically classify live and dead cells in a yeast sample stained with methylene blue. In order to quantify its accuracy, we varied the viability and concentration of the cells and compared AYAP\\'s performance with a fluorescence exclusion staining based gold-standard using regression analysis. The results agree very well with this gold-standard method and no significant difference was observed between the two methods within a concentration range of 1.4 × 105 to 1.4 × 106 cells per mL, providing a dynamic range suitable for various applications. This lensfree computational imaging technology that is coupled with machine learning algorithms would be useful for cost-effective and rapid quantification of cell viability and density even in field and resource-poor settings.

  3. Rapid, portable and cost-effective yeast cell viability and concentration analysis using lensfree on-chip microscopy and machine learning.

    Science.gov (United States)

    Feizi, Alborz; Zhang, Yibo; Greenbaum, Alon; Guziak, Alex; Luong, Michelle; Chan, Raymond Yan Lok; Berg, Brandon; Ozkan, Haydar; Luo, Wei; Wu, Michael; Wu, Yichen; Ozcan, Aydogan

    2016-11-01

    Monitoring yeast cell viability and concentration is important in brewing, baking and biofuel production. However, existing methods of measuring viability and concentration are relatively bulky, tedious and expensive. Here we demonstrate a compact and cost-effective automatic yeast analysis platform (AYAP), which can rapidly measure cell concentration and viability. AYAP is based on digital in-line holography and on-chip microscopy and rapidly images a large field-of-view of 22.5 mm2. This lens-free microscope weighs 70 g and utilizes a partially-coherent illumination source and an opto-electronic image sensor chip. A touch-screen user interface based on a tablet-PC is developed to reconstruct the holographic shadows captured by the image sensor chip and use a support vector machine (SVM) model to automatically classify live and dead cells in a yeast sample stained with methylene blue. In order to quantify its accuracy, we varied the viability and concentration of the cells and compared AYAP's performance with a fluorescence exclusion staining based gold-standard using regression analysis. The results agree very well with this gold-standard method and no significant difference was observed between the two methods within a concentration range of 1.4 × 105 to 1.4 × 106 cells per mL, providing a dynamic range suitable for various applications. This lensfree computational imaging technology that is coupled with machine learning algorithms would be useful for cost-effective and rapid quantification of cell viability and density even in field and resource-poor settings.

  4. Combining ASTER multispectral imagery analysis and support vector machines for rapid and cost-effective post-fire assessment: a case study from the Greek wildland fires of 2007

    OpenAIRE

    Petropoulos, G. P.; Knorr, W.; Scholze, M.; Boschetti, L.; Karantounias, G.

    2010-01-01

    Remote sensing is increasingly being used as a cost-effective and practical solution for the rapid evaluation of impacts from wildland fires. The present study investigates the use of the support vector machine (SVM) classification method with multispectral data from the Advanced Spectral Emission and Reflection Radiometer (ASTER) for obtaining a rapid and cost effective post-fire assessment in a Mediterranean setting. A further objective is to perform a detailed intercomparison of available ...

  5. Using Six Sigma Tools to Improve Strategic Cost Management: Management Accounting Perspective

    Directory of Open Access Journals (Sweden)

    Nanang Shonhadji

    2017-03-01

    Full Text Available The company's commitment to implement Six Sigma has been said to fail, as a quality management strategies, as expected to lead to continuous improvement. This study has its objective to identify the use of Six Sigma as a tool to improve cost management strategies in the production of LED (light emitting diode on PT TMJ. It uses a case study approach to non-mainstream. The unit of analysis done on the application of six sigma strategies to evaluate quality management performance on the cleaning process of the LED light top-ring used in this study. The result of the evaluation measure phase, generally, informs that the company has increased sigma capability of the base performance so that the company's efforts to reduce the level of disability in circumference above the cleaning process should be defect-free LED light wrinkle, wave and widened in accordance with the target. All these can be said to be successful. The result also informed that at the stage of evaluating the attributes of data processing capability, informed that the company is in the process conditions. The fairly stable production, production process capability are quite capable to meet the specifications of the desired target customers.

  6. Rapid, low-cost fluorescent assay of β-lactamase-derived antibiotic resistance and related antibiotic susceptibility

    Science.gov (United States)

    Erdem, S. Sibel; Khan, Shazia; Palanisami, Akilan; Hasan, Tayyaba

    2014-10-01

    Antibiotic resistance (AR) is increasingly prevalent in low and middle income countries (LMICs), but the extent of the problem is poorly understood. This lack of knowledge is a critical deficiency, leaving local health authorities essentially blind to AR outbreaks and crippling their ability to provide effective treatment guidelines. The crux of the problem is the lack of microbiology laboratory capacity available in LMICs. To address this unmet need, we demonstrate a rapid and simple test of β-lactamase resistance (the most common form of AR) that uses a modified β-lactam structure decorated with two fluorophores quenched due to their close proximity. When the β-lactam core is cleaved by β-lactamase, the fluorophores dequench, allowing assay speeds of 20 min to be obtained with a simple, streamlined protocol. Furthermore, by testing in competition with antibiotics, the β-lactamase-associated antibiotic susceptibility can also be extracted. This assay can be easily implemented into standard lab work flows to provide near real-time information of β-lactamase resistance, both for epidemiological purposes as well as individualized patient care.

  7. A rapid and low-cost approach to evaluate the allergenicity of herbal injection using HPLC analysis

    Science.gov (United States)

    Yu, Li; Peng, Guoping; Li, Cunyu; Jiang, Baoping; Xu, Haokun; Ding, Ning; Zheng, Yunfeng; Leng, John Q.

    2013-01-01

    Herbal medicines have ever been thought harmless, but it is obviously not true. Many adverse reports emerged with the development of their popular application in the world. Allergic reactions, especially serious immediate hypersensitivity, frequently occurred when herbal injections were used in clinic and made this ever prevailing agent nearly disappear in China. The aim of this study is to establish a rapid and economical method for the prediction of the allergenicity of herbal injections. Ovalbumin (OVA) and four other herbal injections, in which two of them were well known for their allergenicity, were selected to sensitize and stimulate the animals. Serotonin in the animal serum was detected with HPLC to reflect the anaphylactic response and compared with the other cytokines which could mediate the anaphylaxis, including histamine, IgE and β-hexosaminidase. The results suggest that serotonin can be detected quickly and has good correlation with the other allergy-related cytokines. It is a promising way for predicting the allergenicity of the herbal injections and those complicated natural products. PMID:23587872

  8. Don't overlook disease management programs for low-incidence, high-cost diseases to improve your bottom line.

    Science.gov (United States)

    Bruce, D; Dickmeyer, J

    2001-01-01

    Comprehensive coordinated care management for low-incident, high-cost diseases, like chronic renal failure, can provide a great opportunity for health plans to add immediate and significant profit to their bottom line. The resultant benefits of improved operations, improved clinical outcomes and increased patient satisfaction add further incentive for health plans to take action to implement outsourced disease management for this condition.

  9. Applying an improved rapid impact assessment matrix method to strategic environmental assessment of urban planning in China

    Energy Technology Data Exchange (ETDEWEB)

    Li, Wei, E-mail: weili@bnu.edu.cn; Xie, Yuanbo, E-mail: former_007@163.com; Hao, Fanghua, E-mail: fanghua@bnu.edu.cn

    2014-04-01

    Strategic environmental assessment (SEA) has become an increasingly important decision-support tool for providing information on the environmental implications of a policy, plan, or program. The goal is to safeguard the environment and promote sustainable development at the strategic level. Despite major progress in implementing SEA practices internationally, developing countries, such as China, often lag behind in applying SEA methodology. Lack of available data and time constraints arising from tight schedules create problems. The rapid impact assessment matrix (RIAM) is a potential resource for breaking through such difficulties. Our analysis of RIAM applications suggested that it could become a tool for evaluating strategic alternatives because of its applicability in interdisciplinary settings, its transparency, and its short implementation timeframe. To make it more suitable for the SEA context, we have developed two major improvements to the conventional RIAM process: assignment of weights to assessment indicators and the development of an integrated environmental assessment score (IES). The improved RIAM process was employed in an SEA of the development plan for the Nansha District in Guangzhou, the capital city of Guangdong Province in China. It was used to assess five alternatives for development in Wanqingsha (WQS), a subunit of Nansha, where important ecological resources are located and where industrial development could impact the air quality in the neighboring Hong Kong Special Administrative Region (HKSAR). The evaluation identified WQS-A04 as the preferred alternative. This alternative involved a minimal amount of industrial development – 10% compared with the most intense development alternative – and included important wetland preservation plans. The assessment results have been incorporated into the officially approved development plan for Nansha. The improved RIAM methodology is well adapted to the technical aims of SEA and decision

  10. Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Harris, J; Felix, L; Miners, A; Murray, E; Michie, S; Ferguson, E; Free, C; Lock, K; Landon, J; Edwards, P

    2011-10-01

    UK public health policy strongly advocates dietary change for the improvement of population health and emphasises the importance of individual empowerment to improve health. A new and evolving area in the promotion of dietary behavioural change is 'e-learning', the use of interactive electronic media to facilitate teaching and learning on a range of issues including health. The high level of accessibility, combined with emerging advances in computer processing power, data transmission and data storage, makes interactive e-learning a potentially powerful and cost-effective medium for improving dietary behaviour. This review aims to assess the effectiveness and cost-effectiveness of adaptive e-learning interventions for dietary behaviour change, and also to explore potential psychological mechanisms of action and components of effective interventions. Electronic bibliographic databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Dissertation Abstracts, EMBASE, Education Resources Information Center, Global Health, Health Economic Evaluations Database, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science) were searched for the period January 1990 to November 2009. Reference lists of included studies and previous reviews were also screened; authors were contacted and trial registers were searched. Studies were included if they were randomised controlled trials, involving participants aged ≥ 13 years, which evaluated the effectiveness of interactive software programs for improving dietary behaviour. Primary outcomes were measures of dietary behaviours, including estimated intakes or changes in intake of energy, nutrients, dietary fibre, foods or food groups. Secondary outcome measures were clinical outcomes such as anthropometry or blood biochemistry. Psychological mediators of dietary behaviour change were also investigated. Two review authors independently screened results and extracted data from

  11. A Computational Library Design Protocol for Rapid Improvement of Protein Stability: FRESCO.

    Science.gov (United States)

    Wijma, Hein J; Fürst, Maximilian J L J; Janssen, Dick B

    2018-01-01

    The ability to stabilize enzymes and other proteins has wide-ranging applications. Most protocols for enhancing enzyme stability require multiple rounds of high-throughput screening of mutant libraries and provide only modest improvements of stability. Here, we describe a computational library design protocol that can increase enzyme stability by 20-35 °C with little experimental screening, typically fewer than 200 variants. This protocol, termed FRESCO, scans the entire protein structure to identify stabilizing disulfide bonds and point mutations, explores their effect by molecular dynamics simulations, and provides mutant libraries with variants that have a good chance (>10%) to exhibit enhanced stability. After experimental verification, the most effective mutations are combined to produce highly robust enzymes.

  12. Improved stress corrosion cracking resistance of a novel biodegradable EW62 magnesium alloy by rapid solidification, in simulated electrolytes.

    Science.gov (United States)

    Hakimi, O; Aghion, E; Goldman, J

    2015-06-01

    The high corrosion rate of magnesium (Mg) and Mg-alloys precludes their widespread acceptance as implantable biomaterials. Here, we investigated the potential for rapid solidification (RS) to increase the stress corrosion cracking (SCC) resistance of a novel Mg alloy, Mg-6%Nd-2%Y-0.5%Zr (EW62), in comparison to its conventionally cast (CC) counterpart. RS ribbons were extrusion consolidated in order to generate bioimplant-relevant geometries for testing and practical use. Microstructural characteristics were examined by SEM. Corrosion rates were calculated based upon hydrogen evolution during immersion testing. The surface layer of the tested alloys was analyzed by X-ray photoelectron spectroscopy (XPS). Stress corrosion resistance was assessed by slow strain rate testing and fractography. The results indicate that the corrosion resistance of the RS alloy is significantly improved relative to the CC alloy due to a supersaturated Nd enrichment that increases the Nd2O3 content in the external oxide layer, as well as a more homogeneous structure and reduced grain size. These improvements contributed to the reduced formation of hydrogen gas and hydrogen embrittlement, which reduced the SCC sensitivity relative to the CC alloy. Therefore, EW62 in the form of a rapidly solidified extruded structure may serve as a biodegradable implant for biomedical applications. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Simple, rapid and cost-effective method for high quality nucleic acids extraction from different strains of Botryococcus braunii.

    Directory of Open Access Journals (Sweden)

    Byung-Hyuk Kim

    Full Text Available This study deals with an effective nucleic acids extraction method from various strains of Botryococcus braunii which possesses an extensive extracellular matrix. A method combining freeze/thaw and bead-beating with heterogeneous diameter of silica/zirconia beads was optimized to isolate DNA and RNA from microalgae, especially from B. braunii. Eukaryotic Microalgal Nucleic Acids Extraction (EMNE method developed in this study showed at least 300 times higher DNA yield in all strains of B. braunii with high integrity and 50 times reduced working volume compared to commercially available DNA extraction kits. High quality RNA was also extracted using this method and more than two times the yield compared to existing methods. Real-time experiments confirmed the quality and quantity of the input DNA and RNA extracted using EMNE method. The method was also applied to other eukaryotic microalgae, such as diatoms, Chlamydomonas sp., Chlorella sp., and Scenedesmus sp. resulting in higher efficiencies. Cost-effectiveness analysis of DNA extraction by various methods revealed that EMNE method was superior to commercial kits and other reported methods by >15%. This method would immensely contribute to area of microalgal genomics.

  14. Different Training Modalities Improve Energy Cost and Performance in Master Runners

    Directory of Open Access Journals (Sweden)

    Lorenzo Pugliese

    2018-01-01

    Full Text Available Purpose: The aim of this study was to compare the effects of continuous moderate-intensity and discontinuous high-intensity training on running performance in master runners.Methods: Thirty-four male master runners (47.2 ± 7.4 years were assigned to three different groups: continuous moderate-intensity training (CMIT, discontinuous high-intensity training (DHIT, and control group (CON. CMIT and DHIT performed 8-week of supervised training (3 session·wk−1; ~35 km·wk−1 while CON maintained their normal training habits (3–4 session·wk−1; ~50 km·wk−1. Peak oxygen consumption (V˙O2peak and peak running speed (vpeak during incremental treadmill exercise, gas exchange threshold (GET, speed at GET, energy cost of running (Cr, and 5-km performance were evaluated before and after training.Results: Following the training period, both CMIT and DHIT significantly reduced Cr (−4.4 and −4.9%, respectively, P < 0.05, increased speed at GET (3.4 and 5.7%, P < 0.05 and improved 5-km time-trial performance (3.1 and 2.2%, P < 0.05 whereas no differences were found for V˙O2peak and GET (as %V˙O2peak. After training, vpeak improved only for DHIT (6%, P < 0.05. No differences were found in any variable for CON.Conclusions: This study indicates that both CMIT and DHIT may positively affect running performance in middle-aged master runners. This improvement was achieved despite a significant reduction of the amount of weekly training volume.

  15. Economic viewpoints in educational effectiveness : Cost-effectiveness analysis of an educational improvement project

    NARCIS (Netherlands)

    Creemers, B; van der Werf, G

    2000-01-01

    Cost-effectiveness analysis is not only important for decision making in educational policy and practice. Also within educational effectiveness research it is important to establish the costs of educational processes in relationship to their effects. The integrated multilevel educational

  16. Improving cost-effectiveness and mitigating risks of renewable energy requirements

    Science.gov (United States)

    Griffin, James P.

    Policy makers at the federal and state levels of government are debating actions to reduce U.S. greenhouse gas emissions and dependence on oil as an energy source. Several concerns drive this debate: sharp rises in energy prices, increasing unease about the risks of climate change, energy security, and interest in expanding the domestic renewable energy industry. Renewable energy requirements are frequently proposed to address these concerns, and are currently in place, in various forms, at the federal and state levels of government. These policies specify that a certain portion of the energy supply come from renewable energy sources. This dissertation focuses on a specific proposal, known as 25 X 25, which requires 25% of electricity and motor vehicle transportation fuels supplied to U.S. consumers to come from renewable energy sources, such as wind power and ethanol, by 2025. This dissertation builds on prior energy policy analysis, and more specifically analyses of renewable energy requirements, by assessing the social welfare implications of a 25 x 25 policy and applying new methods of uncertainty analysis to multiple policy options decision makers can use to implement the policy. These methods identify policy options that can improve the cost-effectiveness and reduce the risks of renewable energy requirements. While the dissertation focuses on a specific policy, the research methods and findings are applicable to other renewable energy requirement policies. In the dissertation, I analyze six strategies for implementing a 25 x 25 policy across several hundred scenarios that represent plausible futures for uncertainties in energy markets, such as renewable energy costs, energy demand, and fossil fuel prices. The strategies vary in the availability of resources that qualify towards the policy requirement and the use of a "safety valve" that allows refiners and utilities to pay a constant fee after renewable energy costs reach a predetermined threshold. I test

  17. Clustering approaches to improve the performance of low cost air pollution sensors.

    Science.gov (United States)

    Smith, Katie R; Edwards, Peter M; Evans, Mathew J; Lee, James D; Shaw, Marvin D; Squires, Freya; Wilde, Shona; Lewis, Alastair C

    2017-08-24

    frequent calibration. The use of a cluster median value eliminates unpredictable medium term response changes, and other longer term outlier behaviours, extending the likely period needed between calibration and making a linear interpolation between calibrations more appropriate. Through the use of sensor clusters rather than individual sensors, existing low cost technologies could deliver significantly improved quality of observations.

  18. Highlighting the evidence gap: how cost-effective are interventions to improve early childhood nutrition and development?

    Science.gov (United States)

    Batura, Neha; Hill, Zelee; Haghparast-Bidgoli, Hassan; Lingam, Raghu; Colbourn, Timothy; Kim, Sungwook; Sikander, Siham; Pulkki-Brannstrom, Anni-Maria; Rahman, Atif; Kirkwood, Betty; Skordis-Worrall, Jolene

    2015-01-01

    There is growing evidence of the effectiveness of early childhood interventions to improve the growth and development of children. Although, historically, nutrition and stimulation interventions may have been delivered separately, they are increasingly being tested as a package of early childhood interventions that synergistically improve outcomes over the life course. However, implementation at scale is seldom possible without first considering the relative cost and cost-effectiveness of these interventions. An evidence gap in this area may deter large-scale implementation, particularly in low- and middle-income countries. We conduct a literature review to establish what is known about the cost-effectiveness of early childhood nutrition and development interventions. A set of predefined search terms and exclusion criteria standardized the search across five databases. The search identified 15 relevant articles. Of these, nine were from studies set in high-income countries and six in low- and middle-income countries. The articles either calculated the cost-effectiveness of nutrition-specific interventions (n = 8) aimed at improving child growth, or parenting interventions (stimulation) to improve early childhood development (n = 7). No articles estimated the cost-effectiveness of combined interventions. Comparing results within nutrition or stimulation interventions, or between nutrition and stimulation interventions was largely prevented by the variety of outcome measures used in these analyses. This article highlights the need for further evidence relevant to low- and middle-income countries. To facilitate comparison of cost-effectiveness between studies, and between contexts where appropriate, a move towards a common outcome measure such as the cost per disability-adjusted life years averted is advocated. Finally, given the increasing number of combined nutrition and stimulation interventions being tested, there is a significant need for evidence of cost

  19. Lithography-Free, Low-Cost Method for Improving Photodiode Performance by Etching Silicon Nanocones as Antireflection Layer

    Directory of Open Access Journals (Sweden)

    Jing Jiang

    2016-01-01

    Full Text Available A three-step process has been demonstrated to improve the performance of photodiode by creating nanocone forest on the surface of photodiode as an antireflection layer. This high-throughput, low-cost process has been shown to decrease the reflectivity by 66.1%, enhance the quantum efficiency by 27%, and increase the responsivity by 25.7%. This low-cost manufacture process can be applied to increase the responsivity of silicon based photonic devices.

  20. Solar cost reduction through technical improvements: the concepts of learning and experience

    Energy Technology Data Exchange (ETDEWEB)

    Krawiec, F.; Flaim, T.

    1979-10-01

    The concepts of learning and experience are reviewed and their usefulness for predicting the future costs of solar technologies are evaluated. The literature review indicated that the cost estimates for solar energy technologies are typically made assuming a fixed production process, characterized by standard capacity factors, overhead, and labor costs. The learning curve is suggested as a generalization of the costs of potential solar energy systems. The concept of experience is too ambiguous to be useful for cost estimation. There is no logical reason to believe that costs will decline purely as a function of cumulative production, and experience curves do not allow the analyst to identify logical sources of cost reduction directly. The procedures for using learning and aggregated cost curves to estimate the costs of solar technologies are outlined. It is recommended that production histories of analogous products and processes are analyzed and the learning and cost curves for these surrogates are estimated. These curves, if judged applicable, can be used to predict the cost reductions in manufacturing solar energy technologies.

  1. Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in adiposis dolorosa

    Directory of Open Access Journals (Sweden)

    Karen L Herbst

    2010-08-01

    Full Text Available Karen L Herbst1, Thomas Rutledge21Department of Medicine, University of California, San Diego, California, USA; 2Department of Psychiatry, University of California, San Diego, California, USAAbstract: Adiposis dolorosa (AD is a rare disorder of painful nodular subcutaneous fat ­accompanied by fatigue, difficulty with weight loss, inflammation, increased fluid in ­adipose ­tissue (lipedema and lymphedema, and hyperalgesia. Sequential compression relieves ­lymphedema pain; we therefore hypothesized that whole body cyclic pneumatic hypobaric compression may relieve pain in AD. To avoid exacerbating hyperalgesia, we utilized a touch-free method, which is delivered via a high-performance altitude simulator, the Cyclic Variations in Altitude ConditioningTM (CVACTM process. As a pilot study, 10 participants with AD completed pain and quality of life questionnaires before and after 20–40 minutes of CVAC process daily for 5 days. Participants lost weight (195.5 ± 17.6–193.8 ± 17.3 lb; P = 0.03, and bioimpedance significantly decreased (510 ± 36–490 ± 38 ohm; P = 0.01. There was a significant decrease in scores on the Pain Catastrophizing Scale (P = 0.039, in average (P = 0.002, highest (P = 0.029, lowest (P = 0.04, and current pain severity (P = 0.02 on the Visual Analogue Scale, but there was no change in pain quality by the McGill Pain Questionnaire. There were no significant changes in total and physical SF-36 scores, but the mental score improved significantly (P = 0.049. There were no changes in the Pain Disability Index or Pittsburgh Sleep Quality Index. These data present a potential, new, noninvasive means of treating pain in AD by whole body pneumatic compression as part of the CVAC process. Although randomized, controlled trials are needed to confirm these data, the CVAC process could potentially help in treating AD pain and other chronic pain disorders.Keywords: bioimpedance, chronic pain, lipedema

  2. LOWER COST METHODS FOR IMPROVED OIL RECOVERY (IOR) VIA SURFACTANT FLOODING

    Energy Technology Data Exchange (ETDEWEB)

    William A. Goddard III; Yongchun Tang; Patrick Shuler; Mario Blanco; Seung Soon Jang; Shiang-Tai Lin; Prabal Maiti; Yongfu Wu; Stefan Iglauer; Xiaohang Zhang

    2004-09-01

    This report provides a summary of the work performed in this 3-year project sponsored by DOE. The overall objective of this project is to identify new, potentially more cost-effective surfactant formulations for improved oil recovery (IOR). The general approach is to use an integrated experimental and computational chemistry effort to improve our understanding of the link between surfactant structure and performance, and from this knowledge, develop improved IOR surfactant formulations. Accomplishments for the project include: (1) completion of a literature review to assemble current and new surfactant IOR ideas, (2) Development of new atomistic-level MD (molecular dynamic) modeling methodologies to calculate IFT (interfacial tension) rigorously from first principles, (3) exploration of less computationally intensive mesoscale methods to estimate IFT, Quantitative Structure Property Relationship (QSPR), and cohesive energy density (CED) calculations, (4) experiments to screen many surfactant structures for desirable low IFT and solid adsorption behavior, and (5) further experimental characterization of the more promising new candidate formulations (based on alkyl polyglycosides (APG) and alkyl propoxy sulfate surfactants). Important findings from this project include: (1) the IFT between two pure substances may be calculated quantitatively from fundamental principles using Molecular Dynamics, the same approach can provide qualitative results for ternary systems containing a surfactant, (2) low concentrations of alkyl polyglycoside surfactants have potential for IOR (Improved Oil Recovery) applications from a technical standpoint (if formulated properly with a cosurfactant, they can create a low IFT at low concentration) and also are viable economically as they are available commercially, and (3) the alkylpropoxy sulfate surfactants have promising IFT performance also, plus these surfactants can have high optimal salinity and so may be attractive for use in higher

  3. Rapid detection of Salmonella in meat: Comparative and collaborative validation of a non-complex and cost effective pre-PCR protocol

    DEFF Research Database (Denmark)

    Löfström, Charlotta; Hansen, F.; Mansdal, S.

    2011-01-01

    samples using a real-time PCR method. The protocol included incubation in buffered peptone water, centrifugation of an aliquot and a boiling procedure. The validation study included comparative and collaborative trials recommended by the Nordic Organization for Validation of Alternative Methods (Nord......Cost-effective and rapid monitoring of Salmonella in the meat production chain can contribute to food safety. The objective was, for the first time, to validate an easy-to-use pre-PCR sample preparation method based on a simple boiling protocol for screening of Salmonella in meat and carcass swab....../sample for the boiling, magnetic bead-based and NMKL187 methods, respectively. When comparing the boiling method with the magnetic beads, the relative accuracy (AC), relative sensitivity (SE) and relative specificity (SP) were found to be 98%, 102% and 98%, respectively (Cohen’s kappa index 0.95). When comparing results...

  4. Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

    Energy Technology Data Exchange (ETDEWEB)

    Phadke, Amol [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shah, Nihar [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Abhyankar, Nikit [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Park, Won Young [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Diddi, Saurabh [Bureau of Energy Efficiency, Government of India (India); Ahuja, Deepanshu [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Mukherjee, P. K. [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Walia, Archana [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States)

    2016-06-01

    Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant,and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. The finding that significant efficiency improvement is cost effective from a consumer perspective is robust over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one-star level) should be evaluated rigorously considering significant benefits to consumers, energy security, and environment

  5. Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Nihar [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Abhyankar, Nikit [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Park, Won Young [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Phadke, Amol [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Energy Analysis and Environmental Impacts Division; Diddi, Saurabh [Government of India, New Delhi (India). Bureau of Energy Efficiency; Ahuja, Deepanshu [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Mukherjee, P. K. [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States); Walia, Archana [Collaborative Labeling and Appliance Standards Program (CLASP), Washington, DC (United States)

    2016-06-30

    Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. We assess several efficiency levels, two of which are summarized below in the report. The finding that significant efficiency improvement is cost effective from a consumer perspective is robust over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one star level) should be evaluated rigorously considering significant benefits to consumers, energy security and environment.

  6. Towards improved characterization of northern wetlands (or other landscapes) by remote sensing - a rapid approach to collect ground truth data

    Science.gov (United States)

    Gålfalk, Magnus; Karlson, Martin; Crill, Patrick; Bastviken, David

    2017-04-01

    The calibration and validation of remote sensing land cover products is highly dependent on accurate ground truth data, which are costly and practically challenging to collect. This study evaluates a novel and efficient alternative to field surveys and UAV imaging commonly applied for this task. The method consists of i) a light weight, water proof, remote controlled RGB-camera mounted on an extendable monopod used for acquiring wide-field images of the ground from a height of 4.5 meters, and ii) a script for semi-automatic image classification. In the post-processing, the wide-field images are corrected for optical distortion and geometrically rectified so that the spatial resolution is the same over the surface area used for classification. The script distinguishes land surface components by color, brightness and spatial variability. The method was evaluated in wetland areas located around Abisko, northern Sweden. Proportional estimates of the six main surface components in the wetlands (wet and dry Sphagnum, shrub, grass, water, rock) were derived for 200 images, equivalent to 10 × 10 m field plots. These photo plots were then used as calibration data for a regional scale satellite based classification which separates the six wetland surface components using a Sentinel-1 time series. The method presented in this study is accurate, rapid, robust and cost efficient in comparison to field surveys (time consuming) and drone mapping (which require low wind speeds and no rain, suffer from battery limited flight times, have potential GPS/compass errors far north, and in some areas are prohibited by law).

  7. Project management can help to reduce costs and improve quality in health care services.

    Science.gov (United States)

    Sa Couto, Joaquim

    2008-02-01

    Health care spending has increased steadily over the last 50 years, but there is a consensus that this trend cannot continue indefinitely. The ideal solution would bring about cost reductions coupled with improvements in quality, but this has remained an elusive goal. In this article, a novel idea is proposed that consists of adopting a project type of production in health care, instead of the current mass production methods used in the modern 'health care factories'. The author demonstrates that health care services in general, and medical services in particular, fit the category of projects. This is accomplished through a comprehensive study of the main features of projects and medical services and a comparative analysis. The author infers that the productivity gains brought by project management to so many other human endeavours can be brought to health care. It is also claimed that if project management is adopted in health care, then physicians would be the natural project managers because of their proficiency with the casuistic method (one-off, non-repetitive production) and because of their experience in 'managing' their patient's cases that is indeed what doctors have been doing for as long as their profession exists.

  8. Call to action: APRNs in U.S. Nursing homes to improve care and reduce costs.

    Science.gov (United States)

    Rantz, Marilyn J; Birtley, Nancy M; Flesner, Marcia; Crecelius, Charles; Murray, Cathy

    2017-09-21

    Centers for Medicare and Medicaid Innovation Center sponsored the initiative to reduce avoidable hospitalizations among nursing facility residents. Missouri Quality Initiative (MOQI) designed inter-professional model in nursing homes with advanced practice registered nurses (APRNs). MOQI APRN model was implemented for 4 years in 16 nursing homes in a metro area of the Midwest. Hospitalizations were reduced (40% all-cause, 58% potentially avoidable), emergency room visits (54% all-cause, 65% potentially avoidable), Medicare expenditures for hospitalizations (34% all-cause, 45% potentially avoidable), and Medicare expenditures for emergency room visits (50% all-cause, 60% potentially avoidable) for long-stay nursing home residents. Success of the MOQI model reinforces decades of research demonstrating that care provided by APRNs is cost-effective, safe, and associated with positive health outcomes and patient satisfaction. Nursing homes can implement and benefit by hiring APRNs. However, changes in the Code of Federal Regulation (CFR 483.40) are necessary to improve patient access to care and encourage hiring APRNs in US nursing homes. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Sustainable Sanitation—A Cost-Effective Tool to Improve Plant Yields and the Environment

    Directory of Open Access Journals (Sweden)

    Päivi Karinen

    2010-01-01

    Full Text Available Human urine and faeces are products formed every day in every human society. The volume and fertilisation value of urine is higher than that of faeces. This paper reviews data that urine has been used successfully as a fertiliser for cereals and some vegetables. According to the literature, urine fertilised plants may have produced higher, similar or slightly lower yields than mineral fertilized plants but they invariably resulted in higher yields than non-fertilised plants. There have been no microbiological risks associated with any products. The taste and chemical quality of the products are similar to plants treated with mineral fertilisers. Separating toilets, where urine and faeces are separated already in the toilet, could be beneficial not only in poor but also in the industrialized countries. A separating toilet could be installed also in old buildings and it could allow individuals to live in coastal areas, mountainous or other sensitive environments. In poor areas, urine fertilisation could increase food production also in home plots and reduce hunger. It could also combat water contamination and help to reduce diseases caused by enteric micro-organisms. If urine were to be viewed as a resource rather than a waste product, more families could be encouraged to install low-cost toilets which would especially improve the wellbeing of women.

  10. Lung Cancer in a Rural Area of China: Rapid Rise in Incidence and Poor Improvement in Survival.

    Science.gov (United States)

    Yang, Juan; Zhu, Jian; Zhang, Yong-Hui; Chen, Yong-Sheng; Ding, Lu-Lu; Kensler, Thomas W; Chen, Jian-Guo

    2015-01-01

    Lung cancer has been a major health problem in developed countries for several decades, and has emerged recently as the leading cause of cancer death in many developing countries. The incidence of lung cancer appears to be increasing more rapidly in rural than in urban areas of China. This paper presents the trends of lung cancer incidence and survival derived from a 40-year population-based cancer monitoring program in a rural area, Qidong, China. The Qidong cancer registration data of 1972- 2011 were used to calculate the crude rate, age-standardized rate by Chinese population (CASR) and by world population (WASR), birth cohort rates, and other descriptive features. Active and passive methods were used to construct the data set, with a deadline of the latest follow-up of April 30, 2012. The total number of lung cancer cases was 15,340, accounting for 16.5% of all sites combined. The crude incidence rate, CASR and WASR of this cancer were 34.1, 15.7 and 25.4 per 100,000, respectively. Males had higher crude rates than females (49.7 vs 19.0). Rapidly increasing trends were found in annual percent change resulting in lung cancer being a number one cancer site after year 2010 in Qidong. Birth cohort analysis showed incidence rates have increased for all age groups over 24 years old. The 5 year observed survival rates were 3.55% in 1973-1977, 3.92 in 1983-1987, 3.69% in 1993-1997, and 6.32% in 2003-2007. Males experienced poorer survival than did females. Lung cancer has become a major cancer-related health problem in this rural area. The rapid increases in incidence likely result from an increased cigarette smoking rate and evolving environmental risk factors. Lung cancer survival, while showing some improvement in prognosis, still remains well below that observed in the developed areas of the world.

  11. Cost-effective and rapid lysis of Saccharomyces cerevisiae cells for quantitative western blot analysis of proteins, including phosphorylated eIF2α.

    Science.gov (United States)

    Lee, Su Jung; Ramesh, Rashmi; de Boor, Valerie; Gebler, Jan M; Silva, Richard C; Sattlegger, Evelyn

    2017-09-01

    The common method for liberating proteins from Saccharomyces cerevisiae cells involves mechanical cell disruption using glass beads and buffer containing inhibitors (protease, phosphatase and/or kinase inhibitors), followed by centrifugation to remove cell debris. This procedure requires the use of costly inhibitors and is laborious, in particular when many samples need to be processed. Also, enzymatic reactions can still occur during harvesting and cell breakage. As a result low-abundance and labile proteins may be degraded, and enzymes such as kinases and phosphatases may still modify proteins during and after cell lysis. We believe that our rapid sample preparation method helps overcome the above issues and offers the following advantages: (a) it is cost-effective, as no inhibitors and breaking buffer are needed; (b) cell breakage is fast (about 15 min) since it only involves a few steps; (c) the use of formaldehyde inactivates endogenous proteases prior to cell lysis, dramatically reducing the risk of protein degradation; (d) centrifugation steps only occur prior to cell lysis, circumventing the problem of losing protein complexes, in particular if cells were treated with formaldehyde intended to stabilize and capture large protein complexes; and (e) since formaldehyde has the potential to instantly terminate protein activity, this method also allows the study of enzymes in live cells, i.e. in their true physiological environment, such as the short-term effect of a drug on enzyme activity. Taken together, the rapid sample preparation procedure provides a more accurate snapshot of the cell's protein content at the time of harvesting. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis.

    Science.gov (United States)

    Bray, Nathan; Burns, Paul; Jones, Alice; Winrow, Eira; Edwards, Rhiannon Tudor

    2017-12-01

    We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing. An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards. Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (-£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p housing improvements may be a cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

  13. Improvements in Quality-Adjusted Life Years and Cost-Utility After Pharmacotherapy for Premenstrual Dysphoric Disorder: A Retrospective Study.

    Science.gov (United States)

    Kamagata, Eiichiro; Yamada, Kazuo

    2017-10-14

    To investigate the cost-effectiveness of pharmacotherapy for premenstrual dysphoric disorder (PMDD), a relatively new classification of depressive disorder that is characterized by recurrent depression during the premenstrual phase of the menstrual cycle. We performed a retrospective analysis of data from 49 previously untreated PMDD patients who visited our psychiatric department between October 2013 and February 2016 and received pharmacotherapy for 3 or 6 subsequent menstrual cycles. Quality-adjusted life years (QALYs) were estimated across individual menstrual cycles using mean EuroQoL-5D values. Direct costs per patient were estimated in order to conduct a preliminary cost-effectiveness analysis. Pharmacotherapy produced a 0.190-point increase in mean EuroQoL-5D score per menstrual cycle after 6 menstrual cycles and an improvement of approximately 0.2 QALYs. Based on direct costs of 156,000 yen per patient, the cost-effectiveness of pharmacotherapy was calculated to be 823,000 yen per QALY. A cost-effectiveness acceptability curve analysis indicated that escitalopram tended to be superior to sertraline when willingness to pay per QALY was over 4,000,000 yen, whereas sertraline was superior when willingness to pay was below 2,000,000 yen. Pharmacotherapy is cost effective for the treatment of PMDD. Moreover, escitalopram is a more cost-effective option than sertraline when willingness to pay is sufficiently high.

  14. Identifying attributes of care that may improve cost-effectiveness in the youth mental health service system.

    Science.gov (United States)

    Hamilton, Matthew P; Hetrick, Sarah E; Mihalopoulos, Cathrine; Baker, David; Browne, Vivienne; Chanen, Andrew M; Pennell, Kerryn; Purcell, Rosemary; Stavely, Heather; McGorry, Patrick D

    2017-11-20

    To identify attributes of youth mental health care for which there is evidence of potential cost-effectiveness. We performed a literature review of economic evaluations that examined both costs and outcomes for attributes of youth mental health care other than pharmacological or individual psychological therapies for full-threshold disorders. We searched the United Kingdom National Health Service Economic Evaluations Database for evaluations published to the end of 2014; and MEDLINE, Google Scholar and the citation lists of relevant publications for peer-reviewed studies published in English since 1997. Forty economic evaluations met inclusion criteria. Psychosis was the mental disorder with the most developed economic evidence base, with good evidence of cost-effectiveness for first-episode psychosis services. There was a developing cost-effectiveness evidence base for other disorders. The most common attributes of the interventions examined in the included studies were the location of services, engagement and support of families, assessment, prevention, early intervention, group delivery format and information provision. We used our findings to formulate a list of attributes of youth mental health care that may be acceptable to young people and potentially cost-effective. There is at least suggestive cost-effectiveness evidence for a range of attributes of youth mental health care. Further economic research is needed to substantiate most cost-effectiveness findings and to improve targeting of care among young people. Future economic evaluations should examine costs from both societal and health care perspectives and incorporate evidence regarding young people's preferences.

  15. Potential of RapidEye and WorldView-2 Satellite Data for Improving Rice Nitrogen Status Monitoring at Different Growth Stages

    Directory of Open Access Journals (Sweden)

    Shanyu Huang

    2017-03-01

    Full Text Available For in-season site-specific nitrogen (N management of rice to be successful, it is crucially important to diagnose rice N status efficiently across large areas within a short time frame. In recent studies, the FORMOSAT-2 satellite images with traditional blue (B, green (G, red (R, and near-infrared (NIR wavebands have been used to estimate rice N status due to its high spatial resolution, daily revisit capability, and relatively lower cost. This study aimed to evaluate the potential improvements of RapidEye and WorldView-2 data over FORMOSAT-2 for rice N status monitoring, as the former two sensors provide additional wavelengths besides the traditional four wavebands. Ten site-year N rate experiments were conducted in Jiansanjiang, Heilongjiang Province of Northeast China from 2008 to 2011. Plant samples and field hyperspectral data were collected at three growth stages: panicle initiation (PI, stem elongation (SE, and heading (HE. The canopy-scale hyperspectral data were upscaled to simulate the satellite bands. Vegetation index (VI analysis, stepwise multiple linear regression (SMLR, and partial least squares regression (PLSR were performed to derive plant N status indicators. The results indicated that the best-performed VIs calculated from the simulated RapidEye and WorldView-2 bands, especially those based on the red edge (RE bands, explained significantly more variability for above ground biomass (AGB, plant N uptake (PNU, and nitrogen nutrition index (NNI estimations than their FORMOSAT-2-based counterparts did, especially at the PI and SE stages. The SMLR and PLSR models based on the WorldView-2 bands generally had the best performance, followed by the ones based on the RapidEye bands. The SMLR results revealed that both the NIR and RE bands were important for N status estimation. In particular, the NIR1 band (760–900 nm from RapidEye or 770–895 nm from WorldView-2 was most important for estimating all the N status indicators. The RE

  16. Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic.

    Science.gov (United States)

    Tan, Ryan Y C; Met-Domestici, Marie; Zhou, Ke; Guzman, Alexis B; Lim, Soon Thye; Soo, Khee Chee; Feeley, Thomas W; Ngeow, Joanne

    2016-03-01

    To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery. Copyright © 2016 by American Society of Clinical Oncology.

  17. Rapid evidence review of the comparative effectiveness, harms, and cost-effectiveness of pharmacogenomics-guided antidepressant treatment versus usual care for major depressive disorder.

    Science.gov (United States)

    Peterson, Kimberly; Dieperink, Eric; Anderson, Johanna; Boundy, Erin; Ferguson, Lauren; Helfand, Mark

    2017-06-01

    This study aims to conduct an evidence review of the effectiveness, harms, and cost-effectiveness of pharmacogenomics-guided antidepressant treatment for major depressive disorder. We searched MEDLINE®, the Cochrane Central Registry of Controlled Trials, and PsycINFO through February 2017. We used prespecified criteria to select studies, abstract data, and rate internal validity and strength of the evidence (PROSPERO number CRD42016036358). We included two randomized trials (RCT), five controlled cohort studies, and six modeling studies of mostly women in their mid-40s with few comorbidities. CNSDose (ABCB1, ABCC1, CYP2C19, CYP2D6, UGT1A1) is the only pharmacogenomics test that significantly improved remission (one additional remitting patient in 12 weeks per three genotyped, 95% CI 1.7 to 3.5) and reduced intolerability in an RCT. ABCB1 genotyping leads to one additional remitting patient in 5 weeks per three genotyped (95% CI 3 to 20), but tolerability was not reported. In an RCT, GeneSight (CYP2D6, CYPC19, CYP1A2, SLC6A4, HTR2A) did not statistically significantly improve remission, and evidence is inconclusive about its tolerability. Evidence is generally low strength because RCTs were few and underpowered. Cost-effectiveness is unclear due to lack of directly observed cost-effectiveness outcomes. We found no studies that evaluated whether pharmacogenomics shortens time to optimal treatment, whether improvements were due to switches to genetically congruent medication, or whether effectiveness varies based on test and patient characteristics. Certain pharmacogenomics tools show promise of improving short-term remission rates in women in their mid-40s with few comorbidities. But, important evidence limitations preclude recommending their widespread use and indicate a need for further research.

  18. The ISPOR Good Practices for Quality Improvement of Cost-Effectiveness Research Task Force Report.

    Science.gov (United States)

    McGhan, William F; Al, Maiwenn; Doshi, Jalpa A; Kamae, Isao; Marx, Steven E; Rindress, Donna

    2009-01-01

    The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Health Science Policy Council recommended and the ISPOR Board of Directors approved the formation of a Task Force to critically examine the major issues related to Quality Improvement in Cost-effectiveness Research (QICER). The Council's primary recommendation for this Task Force was that it should report on the quality of cost-effectiveness research and make recommendations to facilitate the improvement of pharmacoeconomics and health outcomes research and its use in stimulating better health care and policy. Task force members were knowledgeable and experienced in medicine, pharmacy, biostatistics, health policy and health-care decision-making, biomedical knowledge transfer, health economics, and pharmacoeconomics. They were drawn from industry, academia, consulting organizations, and advisors to governments and came from Japan, the Netherlands, Canada and the United States. Face-to-face meetings of the Task Force were held at ISPOR North American and European meetings and teleconferences occurred every few months. Literature reviews and surveys were conducted and the first preliminary findings presented at an open forum at the May 2008 ISPOR meeting in Toronto. The final draft report was circulated to the expert reviewer group and then to the entire membership for comment. The draft report was posted on the ISPOR Web site in April 2009. All formal comments received were posted to the association Web site and presented for discussion at the Task Force forum during the ISPOR 14th Annual International Meeting in May 2009. Comments and feedback from the forums, reviewers and membership were considered in the final report. Once Task Force consensus was reached, the article was submitted to Value in Health. The QICER Task Force recommends that ISPOR implement the following: * With respect to CER guidelines, that ISPOR promote harmonization of guidelines, allowing for differences in

  19. Jaccoud’s arthropathy, an unusual manifestation of idiopathic retroperitoneal fibrosis: rapid improvement of symptoms after tocilizumab treatment

    Directory of Open Access Journals (Sweden)

    M. Benucci

    2017-08-01

    Full Text Available Jaccoud’s arthropathy (JA is a chronic, non erosive, rheumatoid-like deformity associated with rheumatic fever (RF and systemic lupus erythematosus and with other diseases such as psoriatic arthritis, connective tissue diseases, hypocomplementemic urticarial vasculitis, infections, sarcoidosis and neoplasia. We described a case of JA in a patient with cutaneous psoriasis but with a particular disease evolution associated with idiopathic retropritoneal fibrosis (IRF, evaluated with computed tomography, magnetic resonance and 18F-FDG PET/ CT. The patient, following failure with steroids, methotrexate and etanercept, was treated with tocilizumab (8 mg/kg once every 4 weeks for 6 months. A rapid improvement of symptoms and disappearance of 18F-FDG uptake was shown. We describe a review of literature of rheumatic manifestations of IRF and the possible role of interleukin-6 in the pathway of JA and IRF.

  20. Improved heavy-duty vehicle fuel efficiency in India, benefits, costs and environmental impacts

    Energy Technology Data Exchange (ETDEWEB)

    Gopal, Anand R. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Karali, Nihan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sharpe, Ben [International Council on Clean Transportation (United States); Delgado, Oscar [International Council on Clean Transportation (United States); Bandivadekar, Anup [International Council on Clean Transportation (United States); Garg, Mehul [International Council on Clean Transportation (United States)

    2017-06-14

    The main objectives of this analysis are to examine the benefits and costs of fuel-saving technologies for new heavy-duty vehicles (HDVs) in India over the next 10 years and, to explore how various scenarios for the deployment of vehicles with these technologies will impact petroleum consumption and carbon dioxide (CO2) emissions over the next three decades. The study team developed simulation models for three representative HDV types—a 40-tonne tractor-trailer, 25-tonne rigid truck, and 16-tonne transit bus—based on top-selling vehicle models in the Indian market. The baseline technology profiles for all three vehicles were developed using India-specific engine data and vehicle specification information from manufacturer literature and input from industry experts. For each of the three vehicles we developed a comprehensive set of seven efficiency technology packages drawing from five major areas: engine, transmission and driveline, tires, aerodynamics, and weight reduction. Our analysis finds that India has substantial opportunity to improve HDV fuel efficiency levels using cost-effective technologies. Results from our simulation modeling of three representative HDV types—a tractor-trailer, rigid truck, and transit bus—reveal that per-vehicle fuel consumption reductions between roughly 20% and 35% are possible with technologies that provide a return on the initial capital investment within 1 to 2 years. Though most of these technologies are currently unavailable in India, experiences in other more advanced markets such as the US and EU suggest that with sufficient incentives and robust regulatory design, significant progress can be made in developing and deploying efficiency technologies that can provide real-world fuel savings for new commercial vehicles in India over the next 10 years. Bringing HDVs in India up to world-class technology levels will yield substantial petroleum and GHG reductions. By 2030, the fuel and CO2 reductions of the

  1. Pre-capture multiplexing improves efficiency and cost-effectiveness of targeted genomic enrichment

    Directory of Open Access Journals (Sweden)

    Shearer A Eliot

    2012-11-01

    Full Text Available Abstract Background Targeted genomic enrichment (TGE is a widely used method for isolating and enriching specific genomic regions prior to massively parallel sequencing. To make effective use of sequencer output, barcoding and sample pooling (multiplexing after TGE and prior to sequencing (post-capture multiplexing has become routine. While previous reports have indicated that multiplexing prior to capture (pre-capture multiplexing is feasible, no thorough examination of the effect of this method has been completed on a large number of samples. Here we compare standard post-capture TGE to two levels of pre-capture multiplexing: 12 or 16 samples per pool. We evaluated these methods using standard TGE metrics and determined the ability to identify several classes of genetic mutations in three sets of 96 samples, including 48 controls. Our overall goal was to maximize cost reduction and minimize experimental time while maintaining a high percentage of reads on target and a high depth of coverage at thresholds required for variant detection. Results We adapted the standard post-capture TGE method for pre-capture TGE with several protocol modifications, including redesign of blocking oligonucleotides and optimization of enzymatic and amplification steps. Pre-capture multiplexing reduced costs for TGE by at least 38% and significantly reduced hands-on time during the TGE protocol. We found that pre-capture multiplexing reduced capture efficiency by 23 or 31% for pre-capture pools of 12 and 16, respectively. However efficiency losses at this step can be compensated by reducing the number of simultaneously sequenced samples. Pre-capture multiplexing and post-capture TGE performed similarly with respect to variant detection of positive control mutations. In addition, we detected no instances of sample switching due to aberrant barcode identification. Conclusions Pre-capture multiplexing improves efficiency of TGE experiments with respect to hands-on time

  2. Joining the in vitro immunization of alpaca lymphocytes and phage display: rapid and cost effective pipeline for sdAb synthesis.

    Science.gov (United States)

    Comor, Lubos; Dolinska, Saskia; Bhide, Katarina; Pulzova, Lucia; Jiménez-Munguía, Irene; Bencurova, Elena; Flachbartova, Zuzana; Potocnakova, Lenka; Kanova, Evelina; Bhide, Mangesh

    2017-01-23

    Camelids possess unique functional heavy chain antibodies, which can be produced and modified in vitro as a single domain antibody (sdAb or nanobody) with full antigen binding ability. Production of sdAb in conventional manner requires active immunization of Camelidae animal, which is laborious, time consuming, costly and in many cases not feasible (e.g. in case of highly toxic or infectious antigens). In this study, we describe an alternative pipeline that includes in vitro stimulation of naïve alpaca B-lymphocytes by antigen of interest (in this case endothelial cell binding domain of OspA of Borrelia) in the presence of recombinant alpaca interleukins 2 and 4, construction of sdAb phage library, selection of antigen specific sdAb expressed on phages (biopanning) and confirmation of binding ability of sdAb to the antigen. By joining the in vitro immunization and the phage display ten unique phage clones carrying sdAb were selected. Out of ten, seven sdAb showed strong antigen binding ability in phage ELISA. Furthermore, two soluble forms of sdAb were produced and their differential antigen binding affinity was measured with bio-layer interferometry. A proposed pipeline has potential to reduce the cost substantially required for maintenance of camelid herd for active immunization. Furthermore, in vitro immunization can be achieved within a week to enrich mRNA copies encoding antigen-specific sdAbs in B cell. This rapid and cost effective pipeline can help researchers to develop efficiently sdAb for diagnostic and therapeutic purposes.

  3. Final report on LDRD project: Low-cost Pd-catalyzed metallization technology for rapid prototyping of electronic substrates and devices

    Energy Technology Data Exchange (ETDEWEB)

    Chen, K.S.; Morgan, W.P.; Zich, J.L.

    1998-02-01

    A low-cost, thermally-activated, palladium-catalyzed metallization process was developed for rapid prototyping of polymeric electronic substrates and devices. The process was successfully applied in producing adhesiveless copper/polyimide laminates with high peel strengths and thick copper coating; copper/polyimide laminates are widely used in fabricating interconnects such as printed wiring boards (PWBs) and flexible circuits. Also successfully metallized using this low-cost metallization process were: (1) scaled-down models of radar-and-communication antenna and waveguide; (2) scaled-down model of pulsed-power-accelerator electrode; (3) three-dimensional micro-porous, open-cell vitreous carbon foams. Moreover, additive patterned metallization was successfully achieved by selectively printing or plotting the catalyst ink only on areas where metallization is desired, and by uniform thermal activation. Additive patterned metallization eliminates the time-consuming, costly and environmentally-unfriendly etching process that is routinely carried out in conventional subtractive patterned metallization. A metallization process via ultraviolet (UV) irradiation activation was also demonstrated. In this process palladium-catalyst solution is first uniformly coated onto the substrate. A masking pattern is used to cover the areas where metallization is not wanted. UV irradiation is applied uniformly to activate the palladium catalyst and to cure the polymer carrier in areas that are not covered by the mask. Metal is then deposited by electroless plating only or by a combination of electroless and electrolytic plating. This UV-activation technique is particularly useful in additive fine-line patterned metallization. Lastly, computer models for electrolytic and electroless plating processes were developed to provide guidance in plating-process design.

  4. Control of cost heftiness of castings production with improvement of PROJECTS

    Directory of Open Access Journals (Sweden)

    V. Kafka

    2008-07-01

    Full Text Available The Specialized Commission for Economy of Czech Foundrymen Society in the Czech Republic systematically follows a solution of particular phases of castings production from iron and non-ferrous metals already for eighth years. These separate studies are uniformly aimed at cost analysis of chosen phases of castings production. The analysis of cost heftiness and recommendations for concrete remedies for particular foundries are the results. The contribution is aimed at transparent description of topics of the PROJECTS I – VII. Further on it describes in more details the PROJECT VIII, especially the costs of preparation of moulding mixtures. The team solving this problem gathers the results of costs comparison of preparation of fifteen moulding mixtures in five Czech foundries in this project. The inquiry topics are bentonite moulding mixtures (unit, pattern, and heap, further on the self-setting mixtures (with waterglass and furane. The inquiry is closed with Cold-Box-Amine core mixture. The evaluation is aimed both at own cost comparison, and at prediction of moulding mixture costs resulting from knowledge of their structure. Further on it deals with the future growth of waste costs. Subsequently, the possibilities of costs specification concerning to power consumption are viewed. Very interesting results are described for studying the relations of costs of moulding mixtures and particular castings. Questions of determining the price of used return moulding mixture are remarkable too. The way to achieve another costs reduction is also the investigation of costs changeableness for mixing the mixtures.The work ends with summary suggestion of next progress.

  5. Improving Class II malocclusion as a side-effect of rapid maxillary expansion: a prospective clinical study.

    Science.gov (United States)

    Guest, Susan S; McNamara, James A; Baccetti, Tiziano; Franchi, Lorenzo

    2010-11-01

    The objective of this prospective clinical study was to evaluate the dentoalveolar and skeletal effects induced by rapid maxillary expansion (RME) therapy in mixed dentition patients with Class II Division 1 malocclusion compared with a matched untreated Class II Division 1 control group. The treatment sample consisted of cephalometric records of 50 patients with Class II malocclusion (19 boys, 31 girls) treated with an RME protocol including an acrylic splint expander. Some patients also had a removable mandibular Schwarz appliance or maxillary incisor bracketing as part of their treatment protocol. Postexpansion, the patients were stabilized with a removable maintenance plate or a transpalatal arch. The mean age at the start of treatment of the RME group was 8.8 years (T1), with a prephase 2 treatment cephalogram (T2) taken 4.0 years later. The control sample, derived from the records of 3 longitudinal growth studies, consisted of the cephalometric records of 50 Class II subjects (28 boys, 22 girls). The mean age of initial observation for the control group was 8.9 years, and the mean interval of observation was 4.1 years. All subjects in both groups were prepubertal at T1 and showed comparable prevalence rates for prepubertal or postpubertal stages at T2. Independent-sample Student t tests were used to examine between-group differences. Class II patients treated with the described bonded RME protocol showed statistically significant increases in mandibular length and advancement of pogonion relative to nasion perpendicular. The acrylic splint RME had significant effects on the anteroposterior relationship of the maxilla and the mandible, as shown by the improvements toward Class I in the maxillomandibular differential value, the Wits appraisal value, and the ANB angle. Patients treated with the bonded RME showed the greatest effects of therapy at the occlusal level, specifically highly significant improvement of Class II molar relationship and decrease in

  6. Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC)

    DEFF Research Database (Denmark)

    Sarkodie, F.; Hassall, O.; Owusu-Dabo, E.

    2017-01-01

    BACKGROUND: Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma...... reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana. MATERIALS AND METHODS: From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero......-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros(®) /Abbott-Architect(®) algorithm as gold standard. RESULTS: A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR...

  7. Improve forest inventory with access data-measure transport distance and cost to market.

    Science.gov (United States)

    Dennis P. Bradley

    1972-01-01

    Describes a method for relating forest inventory volumes to transport distances and costs. The process, originally developed in Sweden, includes a computer program that can be used to summarize volumes by transport costs per cord to specified delivery point. The method has many potential applications in all aspects of resource analysis.

  8. Improved Cost-Base Design of Water Distribution Networks using Genetic Algorithm

    Science.gov (United States)

    Moradzadeh Azar, Foad; Abghari, Hirad; Taghi Alami, Mohammad; Weijs, Steven

    2010-05-01

    Population growth and progressive extension of urbanization in different places of Iran cause an increasing demand for primary needs. The water, this vital liquid is the most important natural need for human life. Providing this natural need is requires the design and construction of water distribution networks, that incur enormous costs on the country's budget. Any reduction in these costs enable more people from society to access extreme profit least cost. Therefore, investment of Municipal councils need to maximize benefits or minimize expenditures. To achieve this purpose, the engineering design depends on the cost optimization techniques. This paper, presents optimization models based on genetic algorithm(GA) to find out the minimum design cost Mahabad City's (North West, Iran) water distribution network. By designing two models and comparing the resulting costs, the abilities of GA were determined. the GA based model could find optimum pipe diameters to reduce the design costs of network. Results show that the water distribution network design using Genetic Algorithm could lead to reduction of at least 7% in project costs in comparison to the classic model. Keywords: Genetic Algorithm, Optimum Design of Water Distribution Network, Mahabad City, Iran.

  9. An integrated TQM-model for continuous cost, process and product improvement. Konferencebidrag

    DEFF Research Database (Denmark)

    Kongsberg, Flemming

    Paperet beskriver hvorledes de tre teknikker: kvalitetsomkostningssystemer, target costing og benchmarking kan anvendes til at skabe bedre resultater i forbindelse med TQM.......Paperet beskriver hvorledes de tre teknikker: kvalitetsomkostningssystemer, target costing og benchmarking kan anvendes til at skabe bedre resultater i forbindelse med TQM....

  10. The Kaiser Permanente Implant Registries: Effect on Patient Safety, Quality Improvement, Cost Effectiveness, and Research Opportunities

    OpenAIRE

    Paxton, Elizabeth W.; Inacio, Maria CS; Kiley, Mary-Lou

    2012-01-01

    Introduction: Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research.

  11. Improving building performance using smart building concept: Benefit cost ratio comparison

    Science.gov (United States)

    Berawi, Mohammed Ali; Miraj, Perdana; Sayuti, Mustika Sari; Berawi, Abdur Rohim Boy

    2017-11-01

    Smart building concept is an implementation of technology developed in the construction industry throughout the world. However, the implementation of this concept is still below expectations due to various obstacles such as higher initial cost than a conventional concept and existing regulation siding with the lowest cost in the tender process. This research aims to develop intelligent building concept using value engineering approach to obtain added value regarding quality, efficiency, and innovation. The research combined quantitative and qualitative approach using questionnaire survey and value engineering method to achieve the research objectives. The research output will show additional functions regarding technology innovation that may increase the value of a building. This study shows that smart building concept requires higher initial cost, but produces lower operational and maintenance costs. Furthermore, it also confirms that benefit-cost ratio on the smart building was much higher than a conventional building, that is 1.99 to 0.88.

  12. Rapid Prototyping Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The ARDEC Rapid Prototyping (RP) Laboratory was established in December 1992 to provide low cost RP capabilities to the ARDEC engineering community. The Stratasys,...

  13. Anode gas recirculation for improving the performance and cost of a 5-kW solid oxide fuel cell system

    Science.gov (United States)

    Torii, Ryohei; Tachikawa, Yuya; Sasaki, Kazunari; Ito, Kohei

    2016-09-01

    Solid oxide fuel cells (SOFCs) have the potential to efficiently convert chemical energy into electricity and heat and are expected to be implemented in stationary combined heat and power (CHP) systems. This paper presents the heat balance analysis for a 5-kW medium-sized integrated SOFC system and the evaluation of the effect of anode gas recirculation on the system performance. The risk of carbon deposition on an SOFC anode due to anode gas recirculation is also assessed using the C-H-O diagram obtained from thermodynamic equilibrium calculations. These results suggest that a higher recirculation ratio increases net fuel utilization and improves the electrical efficiency of the SOFC system. Furthermore, cost simulation of the SOFC system and comparison with the cost of electricity supply by a power grid indicates that the capital cost is sufficiently low to popularize the SOFC system in terms of the total cost over one decade.

  14. Constraining Forest Certificate's Market to Improve Cost-Effectiveness of Biodiversity Conservation in São Paulo State, Brazil.

    Directory of Open Access Journals (Sweden)

    Paula Bernasconi

    Full Text Available The recently launched Brazilian "forest certificates" market is expected to reduce environmental compliance costs for landowners through an offset mechanism, after a long history of conservation laws based in command-and-control and strict rules. In this paper we assessed potential costs and evaluated the cost-effectiveness of the instrument when introducing to this market constraints that aim to address conservation objectives more specifically. Using the conservation planning software Marxan with Zones we simulated different scopes for the "forest certificates" market, and compared their cost-effectiveness with that of existing command-and-control (C&C, i.e. compliance to the Legal Reserve on own property, in the state of São Paulo. The simulations showed a clear potential of the constrained "forest certificates" market to improve conservation effectiveness and increase cost-effectiveness on allocation of Legal Reserves. Although the inclusion of an additional constraint of targeting the BIOTA Conservation Priority Areas doubled the cost (+95% compared with a "free trade" scenario constrained only by biome, this option was still 50% less costly than the baseline scenario of compliance with Legal Reserve at the property.

  15. Promoting health and improving health care in a cost-effective manner through a military digital library.

    Science.gov (United States)

    Stoloff, Peter H; D'Alessandro, Michael P; D'Alessandro, Donna M; Bakalar, Richard S

    2006-01-01

    The Virtual Naval Hospital (VNH) is a digital library designed to meet the information needs of U.S. Navy medical professionals. The goal of this study was to determine whether the VNH promoted health and improved patient care in a cost-effective manner. An economic analysis determining the costs and benefits from the perspective of the U.S. Navy was conducted. As part of this analysis, medical professionals were surveyed from February to August 2000. Respondents used the VNH for a variety of professional activities (average, 8.2 h/wk). Respondents (70%) thought that VNH usage improved patient care. Medical providers thought it improved their diagnosis (70%) and treatment (60%). Respondents stated that the VNH affected 81 medical evacuations and 668 sick-in-quarter days. Overall content satisfaction was 94%. The VNH had a net savings of $143,848/yr and a cost/benefit ratio of 55.9%. The VNH has a beneficial impact on the Navy's health care system by improving health promotion and patient care and by being economically cost-effective.

  16. Can rapid maxillary expansion cause auditory improvement in children and adolescents with hearing loss? A systematic review.

    Science.gov (United States)

    Fagundes, Nathalia Carolina Fernandes; Rabello, Nicole Melres; Maia, Lucianne Cople; Normando, David; Mello, Karina Corrêa Flexa Ribeiro

    2017-11-01

    To evaluate whether the use of palatal expansion techniques can influence hearing loss in children and adolescents with previous hearing impairment. Electronic searches in PubMed, Scopus, Web of Science, The Cochrane Library, Lilacs, OpenGrey, and Google Scholar were performed with a controlled vocabulary and free-text terms relating to palatal expansion and hearing loss. No language or time restrictions were imposed. Clinical trials that focused on human patients treated with rapid or semirapid maxillary expansion in children and teenagers with hearing loss were included. Data extraction was undertaken by two authors, with conflict resolution by a third author. Risk of bias assessment and data extraction were performed on the selected studies. Seventy-four citations were retrieved by the search. Initially, 12 studies were selected according to the eligibility criteria, but three studies were excluded because of the presence of adults, absence of hearing level evaluation, and oversampling, resulting in nine studies. The mean improvement in hearing levels varied from 2 to 19 dB among the studies. The risk of bias varied from low to moderate risk. The evidence indicated that there was a hearing improvement after maxillary expansion in patients with hearing loss in the evaluated studies, although more controlled and randomized studies are necessary to investigate this issue further.

  17. Rapid maxillary expansion versus middle ear tube placement: Comparison of hearing improvements in children with resistance otitis media with effusion.

    Science.gov (United States)

    Kılıç, Nihat; Yörük, Özgür; Kılıç, Songül Cömert; Çatal, Gülhan; Kurt, Sezgin

    2016-09-01

    To test the null hypothesis that there are significant differences in hearing improvements of children with resistance otitis media with effusion (OME) who undergo a rapid maxillary expansion (RME) procedure or ventilation tube placement. Forty-two children between 4.5 and 15 years old were divided into three groups: RME, ventilation tube, and control groups. The RME group consisted of 15 children with maxillary constriction and resistance OME that indicated ventilation tube placement. The ventilation tube group consisted of 16 children for whom ventilation tube placement was indicated but no maxillary constriction. The control group consisted of 11 children with no orthodontic and/or rhinologic problems. Hearing thresholds were evaluated with three audiometric records: (1) before RME/ventilation tube placement (T0); (2) after RME/ventilation tube placement (T1), and (3) after an observation period of 10 months (T2). The control group was matched to these periods, except T1. Hearing thresholds decreased significantly in both the RME and ventilation tube groups (P .05). Slight changes were observed in the control groups. The null hypothesis was rejected. RME showed similar effects as ventilation tube placement for release of otitis media and improvement of hearing thresholds levels. RME should be preferred as a first treatment option for children with maxillary constriction and resistance OME.

  18. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review

    Directory of Open Access Journals (Sweden)

    Kouyoumdjian Fiona

    2011-08-01

    Full Text Available Abstract Background Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. Methods A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. Results Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations

  19. Cancer Care Coordinators to Improve Tamoxifen Persistence in Breast Cancer: How Heterogeneity in Baseline Prognosis Impacts on Cost-Effectiveness.

    Science.gov (United States)

    Nair, Nisha; Kvizhinadze, Giorgi; Blakely, Tony

    2016-12-01

    To assess the cost-effectiveness of a cancer care coordinator (CCC) in helping women with estrogen receptor positive (ER+) early breast cancer persist with tamoxifen for 5 years. We investigated the cost-effectiveness of a CCC across eight breast cancer subtypes, defined by progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and local/regional spread. These subtypes range from excellent to poorer prognoses. The CCC helped in improving tamoxifen persistence by providing information, checking-in by phone, and "troubleshooting" concerns. We constructed a Markov macrosimulation model to estimate health gain (in quality-adjusted life-years or QALYs) and health system costs in New Zealand, compared with no CCC. Participants were modeled until death or till the age of 110 years. Some input parameters (e.g., the impact of a CCC on tamoxifen persistence) had sparse evidence. Therefore, we used estimates with generous uncertainty and conducted sensitivity analyses. The cost-effectiveness of a CCC for regional ER+/PR-/HER2+ breast cancer (worst prognosis) was NZ $23,400 (US $15,800) per QALY gained, compared with NZ $368,500 (US $248,800) for local ER+/PR+/HER2- breast cancer (best prognosis). Using a cost-effectiveness threshold of NZ $45,000 (US $30,400) per QALY, a CCC would be cost-effective only in the four subtypes with the worst prognoses. There is value in investigating cost-effectiveness by different subtypes within a disease. In this example of breast cancer, the poorer the prognosis, the greater the health gains from a CCC and the better the cost-effectiveness. Incorporating heterogeneity in a cost-utility analysis is important and can inform resource allocation decisions. It is also feasible to undertake in practice. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  20. Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal.

    Science.gov (United States)

    Besada, Donela; Rohde, Sarah; Goga, Ameena; Raphaely, Nika; Daviaud, Emmanuelle; Ramokolo, Vundli; Magasana, Vuyolwethu; Noveve, Nobuntu; Doherty, Tanya

    2016-01-01

    The World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This 'test and treat' approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol. Data were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country. Common strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups. The approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of 'male involvement' in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts

  1. Rapid improvement of depressive symptoms in suicide attempters following treatment with milnacipran and tricyclic antidepressants – a case series

    Directory of Open Access Journals (Sweden)

    Kirino E

    2011-12-01

    Full Text Available Eiji Kirino, Masao GitohDepartment of Psychiatry, Juntendo University, School of Medicine, Shizuoka, JapanAbstract: Suicide is a serious social problem in many countries, including Japan. The majority of people who commit suicide suffer from depression. Suicide attempt patients suffering from serious physical injuries are initially treated in hospital emergency departments. The present post hoc analysis examined data from patients admitted to an emergency hospital for treatment of physical injuries, resulting from a suicide attempt, and initial psychiatric treatment for depression and prevention of future suicide attempts. The effects on depressive symptoms were studied in two groups of patients using the 17-item Hamilton depression scale (HAMD. One group (n = 6 had received intravenous tricyclic antidepressants (TCA (amitriptyline or clomipramine while the other group (n = 7 had been treated orally with milnacipran, a serotonin and norepinephrine reuptake inhibitor antidepressant. Prior to treatment the four highest scoring items on the HAMD scale were the same in both groups namely, item 1 (depressed mood, item 3 (suicidality, item 7 (interest in work and activities, and item 10 (psychic anxiety. After 1 week of treatment, mean global HAMD scores were significantly reduced in both groups. Treatment resulted in a significant reduction of five HAMD items in the TCA group, whereas in the milnacipran group 12 HAMD items were significantly reduced. Suicidality (item 3 was significantly improved by 1 week treatment with milnacipran, but not by TCAs. Milnacipran rapidly improved a wide range of depressive symptoms, including suicidality within the first week. The improvement with milnacipran would appear to be, at least, equivalent to that achieved with TCAs, possibly affecting a wider range of symptoms. Since milnacipran has been shown in comparative studies to be better tolerated than TCAs, this antidepressant offers an interesting option for the

  2. Contract Management: DOD Begins New Effort to Improve Reporting of Contract Service Costs

    National Research Council Canada - National Science Library

    1999-01-01

    Although the Department of Defense (DOD) is increasing its reliance on contractor support, long-standing concerns exist regarding the accuracy and reliability of its accounting for the costs of contract services, particularly advisory...

  3. Assessing the costs and benefits of improved land management practices in three watershed areas in Ethiopia

    Directory of Open Access Journals (Sweden)

    Abonesh Tesfaye

    2016-03-01

    Full Text Available Unsustainable land use management and the resulting soil erosion are among the most pervasive problems in rural Ethiopia, where most of the country’s people live, jeopardizing food security. Despite various efforts to introduce soil conservation measures and assess their costs and benefits, it is unclear how efficient these measures are from an economic point of view in securing food production. This paper examines the costs and benefits of three soil conservation measures applied in the country in three different rural districts facing different degrees of soil erosion problems using survey data collected from 750 farm households. A production function is estimated to quantify the costs and benefits of more sustainable land use management practices. We show that the soil conservation measures significantly increase productivity and hence food security. Comparing the costs and benefits, the results indicate that implementing soil conservation measures would benefit farm communities in the case study areas through increased grain productivity and food security.

  4. Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

    Science.gov (United States)

    Schrader, Andrew J; Tribble, David R; Riddle, Mark S

    2017-12-01

    To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

  5. Army Corps of Engineers: Cost Increases in Flood Control Projects and Improving Communication with Nonfederal Sponsors

    Science.gov (United States)

    2013-12-01

    prestressed concrete that are driven into the ground to retain earth or prevent water seepage. 21According to the Corps, a flowage easement is...low estimates of land acquisition and associated costs, pipeline costs, utilities, and bridge adjustments. However, Corps officials attribute all...involves installing larger box culverts, day-lighting two sections of the river, and modifying a bridge and culvert headwall for flood risk management

  6. COST/BENEFIT ANALYSIS – A TOOL TO IMPROVE RECRUITMENT, SELECTION AND EMPLOYMENT IN ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Nicoleta Valentina FLOREA

    2013-11-01

    Full Text Available Human resource is a major source for organization to obtain competitive advantage and can be very important in obtaining long-term performance. The limits of recruitment process are the cost, the choice made, time and legislation. Any organization looks for minimizing the human resources recruitment, selection and employment costs. This article presents the importance of cost in choosing the best practices of recruitment, selection, employment and integration of new employees in the organization, though, the cost is an important variable for analysis. In this article is presented the research made in large organizations from Dambovita County, Romania, and are also presented the costs and their consequences on medium and long-term over the organization activities These activities are discrimination, sexual harassment, ethics, low performance and results, by choosing the “wrong” people, and implicitly diminishing the level of qualifications, knowledge and abilities, by growing the absenteeism, the direct and indirect costs of these processes and the direct consequences over the time management.

  7. Improving Power System Modeling. A Tool to Link Capacity Expansion and Production Cost Models

    Energy Technology Data Exchange (ETDEWEB)

    Diakov, Victor [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cole, Wesley [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sullivan, Patrick [National Renewable Energy Lab. (NREL), Golden, CO (United States); Brinkman, Gregory [National Renewable Energy Lab. (NREL), Golden, CO (United States); Margolis, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-11-01

    Capacity expansion models (CEM) provide a high-level long-term view at the prospects of the evolving power system. In simulating the possibilities of long-term capacity expansion, it is important to maintain the viability of power system operation in the short-term (daily, hourly and sub-hourly) scales. Production-cost models (PCM) simulate routine power system operation on these shorter time scales using detailed load, transmission and generation fleet data by minimizing production costs and following reliability requirements. When based on CEM 'predictions' about generating unit retirements and buildup, PCM provide more detailed simulation for the short-term system operation and, consequently, may confirm the validity of capacity expansion predictions. Further, production cost model simulations of a system that is based on capacity expansion model solution are 'evolutionary' sound: the generator mix is the result of logical sequence of unit retirement and buildup resulting from policy and incentives. The above has motivated us to bridge CEM with PCM by building a capacity expansion - to - production cost model Linking Tool (CEPCoLT). The Linking Tool is built to onset capacity expansion model prescriptions onto production cost model inputs. NREL's ReEDS and Energy Examplar's PLEXOS are the capacity expansion and the production cost models, respectively. Via the Linking Tool, PLEXOS provides details of operation for the regionally-defined ReEDS scenarios.

  8. Improvement in cost-effectiveness and customer satisfaction by a quality management system according to EN ISO 9001:2000.

    Science.gov (United States)

    Beholz, Sven; Konertz, Wolfgang

    2005-12-01

    The implementation of a quality management system (QMS) according to EN ISO 9001:2000 has proven to be possible for cardiac surgery departments. However, it remains unclear if a QMS can help to improve quality as indicated by cost-effectiveness and customer satisfaction. To control costs for medical goods and laboratory investigations an internal control system for the allocation of resources was implemented. Laboratory costs and medical goods per open heart procedure were investigated in the years 2000 to 2003. In terms of customer satisfaction, repeated questionnaire-based evaluation of referring physicians was obtained from 2001 to 2003 and the influence of repeated interventions on various aspects of communications was investigated. Costs of medical goods could be reduced by 6.1%, and for laboratory investigations by 35% per operation. Additionally, customer satisfaction could be increased efficiently with respect to accessibility and postoperative communication. By the introduction of a process based QMS, efficient control of the costs of medical goods and laboratory investigations could be achieved. Once a year repeat evaluation of satisfaction of advising physicians has proven to be a valuable tool in the process of continuous improvement.

  9. Potentials for Improvement of Resource Efficiency in Printed Circuit Board Manufacturing: A Case Study Based on Material Flow Cost Accounting

    Directory of Open Access Journals (Sweden)

    Yi-Xuan Wang

    2017-05-01

    Full Text Available The pursuit of sustainable resource use by manufacturing companies is driven by resource scarcity, environmental awareness, and cost savings potentials. To address these issues, Material Flow Cost Accounting (MFCA has been developed and applied as an effective environmental management tool. Within MFCA’s general allocation, the accounts of products and losses are overrated by weight or volume. However, such a method is incompatible with Printed Circuit Board (PCB manufacturing because of industry characteristics in which primary inputs and products are measured by area. Based on MFCA, this case study systematically established several linear cost calculation models along the production process for capturing the actual waste flows as well as performing cost-benefit analysis. The recognition of previously ignored losses offered the incentive to find appropriate indicators to conduct cost-benefit analysis on hotspots for losses. Loss identification and analysis indicated that machining and wiring are the necessities and priorities of process optimization for resource efficiency improvement measures. Therefore, this research could not only advance the achievement of a profitable and sustainable production while improving resource efficiency at the source but could also provide support for decision making in PCB manufacturing.

  10. O-antigen and virulence profiling of Shiga toxin-producing Escherichia coli by a rapid and cost-effective DNA microarray colorimetric method

    Directory of Open Access Journals (Sweden)

    Beatriz eQuiñones

    2012-05-01

    Full Text Available Shiga toxin-producing Escherichia coli (STEC is a leading cause of foodborne illness worldwide. The present study developed the use of DNA microarrays with the ampliPHOX colorimetric method to rapidly detect and genotype STEC strains. A low-density 30-mer oligonucleotide DNA microarray was designed to target O-antigen gene clusters of eleven E. coli serogroups (O26, O45, O91, O103, O104, O111, O113, O121, O128, O145 and O157 that have been associated with the majority of STEC infections. In addition, the DNA microarray targeted eleven virulence genes, encoding adhesins, cytotoxins, proteases, and receptor proteins, which have been implicated in conferring increased ability to cause disease for STEC. Results from the validation experiments demonstrated that this microarray-based colorimetric method allowed for a rapid and accurate genotyping of STEC reference strains from environmental and clinical sources and from distinct geographical locations. Positive hybridization signals were detected only for probes targeting serotype and virulence genes known to be present in the STEC reference strains. Quantification analysis indicated that the mean pixel intensities of the signal for probes targeting O-antigen or virulence genes were at least three times higher when compared to the background. Furthermore, this microarray-based colorimetric method was then employed to genotype a group of E. coli isolates from watershed sediment and animal fecal samples that were collected from an important region for leafy-vegetable production in the central coast of California. The results indicated an accurate identification of O-type and virulence genes in the tested isolates and confirmed that the ampliPHOX colorimetric method with low density DNA microarrays enabled a fast assessment of the virulence potential of STEC using low-cost reagents and instrumentation.

  11. A sodium-activated potassium channel supports high-frequency firing and reduces energetic costs during rapid modulations of action potential amplitude.

    Science.gov (United States)

    Markham, Michael R; Kaczmarek, Leonard K; Zakon, Harold H

    2013-04-01

    We investigated the ionic mechanisms that allow dynamic regulation of action potential (AP) amplitude as a means of regulating energetic costs of AP signaling. Weakly electric fish generate an electric organ discharge (EOD) by summing the APs of their electric organ cells (electrocytes). Some electric fish increase AP amplitude during active periods or social interactions and decrease AP amplitude when inactive, regulated by melanocortin peptide hormones. This modulates signal amplitude and conserves energy. The gymnotiform Eigenmannia virescens generates EODs at frequencies that can exceed 500 Hz, which is energetically challenging. We examined how E. virescens meets that challenge. E. virescens electrocytes exhibit a voltage-gated Na(+) current (I(Na)) with extremely rapid recovery from inactivation (τ(recov) = 0.3 ms) allowing complete recovery of Na(+) current between APs even in fish with the highest EOD frequencies. Electrocytes also possess an inwardly rectifying K(+) current and a Na(+)-activated K(+) current (I(KNa)), the latter not yet identified in any gymnotiform species. In vitro application of melanocortins increases electrocyte AP amplitude and the magnitudes of all three currents, but increased I(KNa) is a function of enhanced Na(+) influx. Numerical simulations suggest that changing I(Na) magnitude produces corresponding changes in AP amplitude and that K(Na) channels increase AP energy efficiency (10-30% less Na(+) influx/AP) over model cells with only voltage-gated K(+) channels. These findings suggest the possibility that E. virescens reduces the energetic demands of high-frequency APs through rapidly recovering Na(+) channels and the novel use of KNa channels to maximize AP amplitude at a given Na(+) conductance.

  12. A rapid and low-cost microscopic observation drug susceptibility assay for detecting TB and MDR-TB among individuals infected by HIV in South India

    Directory of Open Access Journals (Sweden)

    S Solomon

    2013-01-01

    Full Text Available Background: The converging epidemics of HIV and tuberculosis (TB pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. Objective: The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB directly from sputum specimens, in the Indian setting. Materials and Methods: This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. Results: Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P < 0.001. Conclusion: Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.

  13. Cost Analyses of Measures to Improve Residential Energy Ratings to 6 Stars - Playford North Development, South Australia

    Directory of Open Access Journals (Sweden)

    Timothy O'Leary

    2010-07-01

    Full Text Available  This paper reports the results of a study on the cost implications of achieving greater energy efficiency as measured by House Energy Rating(HER ‘stars’ for new housing on a greenfield development in the northern suburbs of Adelaide. Twelve house designs typical of the housing options available from a number of builders engaged with this development were modeled using the 2nd generation Building Code of Australia (BCA accredited energy rating assessment tool AccuRate. Where the model predicted a rating below the minimum rating (6 star proposed under the recently agreed Commonwealth of Australia, National Energy Efficiency strategy, the designs were modified in order to improve the rating to 6 stars using a combination of specification changes and energy efficient technology options. These changes or options were then priced at prevailing building suppliers and subcontractors retail cost levels in order that an average ‘extra cost to 6 star’ and range of indicative costs to achieve 6 star housing compliance could be articulated. The results revealed that standard and currently available technologies, such a reflective foil barriers, increased insulation and low emissivity ‘e’ type glazing provide a means to achieving 6 star ratings at a modest additional cost, i.e. 1-2% of total construction and development costs.

  14. Cost Analyses of Measures to Improve Residential Energy Ratings to 6 Stars - Playford North Development, South Australia

    Directory of Open Access Journals (Sweden)

    Martin Belusko

    2010-07-01

    Full Text Available This paper reports the results of a study on the cost implications of achieving greater energy efficiency as measured by House Energy Rating(HER ‘stars’ for new housing on a greenfield development in the northern suburbs of Adelaide. Twelve house designs typical of the housing options available from a number of builders engaged with this development were modeled using the 2nd generation Building Code of Australia (BCA accredited energy rating assessment tool AccuRate. Where the model predicted a rating below the minimum rating (6 star proposed under the recently agreed Commonwealth of Australia, National Energy Efficiency strategy, the designs were modified in order to improve the rating to 6 stars using a combination of specification changes and energy efficient technology options. These changes or options were then priced at prevailing building suppliers and subcontractors retail cost levels in order that an average ‘extra cost to 6 star’ and range of indicative costs to achieve 6 star housing compliance could be articulated. The results revealed that standard and currently available technologies, such a reflective foil barriers, increased insulation and low emissivity ‘e’ type glazing provide a means to achieving 6 star ratings at a modest additional cost, i.e. 1-2% of total construction and development costs.

  15. A low cost, safe, disposable, rapid and self-sustainable paper-based platform for diagnostic testing: lab-on-paper

    Science.gov (United States)

    Costa, M. N.; Veigas, B.; Jacob, J. M.; Santos, D. S.; Gomes, J.; Baptista, P. V.; Martins, R.; Inácio, J.; Fortunato, E.

    2014-03-01

    There is a strong interest in the use of biopolymers in the electronic and biomedical industries, mainly towards low-cost applications. The possibility of developing entirely new kinds of products based on cellulose is of current interest, in order to enhance and to add new functionalities to conventional paper-based products. We present our results towards the development of paper-based microfluidics for molecular diagnostic testing. Paper properties were evaluated and compared to nitrocellulose, the most commonly used material in lateral flow and other rapid tests. Focusing on the use of paper as a substrate for microfluidic applications, through an eco-friendly wax-printing technology, we present three main and distinct colorimetric approaches: (i) enzymatic reactions (glucose detection); (ii) immunoassays (antibodies anti-Leishmania detection); (iii) nucleic acid sequence identification (Mycobacterium tuberculosis complex detection). Colorimetric glucose quantification was achieved through enzymatic reactions performed within specific zones of the paper-based device. The colouration achieved increased with growing glucose concentration and was highly homogeneous, covering all the surface of the paper reaction zones in a 3D sensor format. These devices showed a major advantage when compared to the 2D lateral flow glucose sensors, where some carryover of the coloured products usually occurs. The detection of anti-Leishmania antibodies in canine sera was conceptually achieved using a paper-based 96-well enzyme-linked immunosorbent assay format. However, optimization is still needed for this test, regarding the efficiency of the immobilization of antigens on the cellulose fibres. The detection of Mycobacterium tuberculosis nucleic acids integrated with a non-cross-linking gold nanoprobe detection scheme was also achieved in a wax-printed 384-well paper-based microplate, by the hybridization with a species-specific probe. The obtained results with the above

  16. 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.

  17. 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

    2017-01-01

    ABSTRACT Background: 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. Methods: 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. Results: 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. Conclusion: 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. PMID:28877933

  18. Improving Library Management by Using Cost Analysis Tools: A Case Study for Cataloguing Processes

    Directory of Open Access Journals (Sweden)

    Lorena Siguenza-Guzman

    2014-02-01

    Full Text Available TTDABC is a relatively new costing management technique, initially developed for manufacturing processes, which is gaining attention in libraries. This is because TDABC is a fast and simple method that only requires two parameters, an estimation of time required to perform an activity and the unit cost per time of supplying capacity. A few case studies have been documented with regard to TDABC in libraries; all of them being oriented to analyse specific library activities such as inter-library loan, acquisition and circulation processes. The primary focus of this paper is to describe TDABC implementation in one of the most important library processes, namely cataloguing. In particular, original and copy cataloguing are analysed through a case study to demonstrate the applicability and usefulness of TDABC to perform cost analysis of cataloguing processes.

  19. A rapid, low-cost, and microfluidic chip-based system for parallel identification of multiple pathogens related to clinical pneumonia.

    Science.gov (United States)

    Huang, Guoliang; Huang, Qin; Xie, Lan; Xiang, Guangxin; Wang, Lei; Xu, Hui; Ma, Li; Luo, Xianbo; Xin, Juan; Zhou, Xinying; Jin, Xiangyu; Zhang, Lei

    2017-07-25

    An air-insulated microfluidic chip was designed for the automatic centrifugal distribution of samples to 24-test cells, enabling the parallel identification of multiple clinical pneumonia-related pathogens in 1.45-μL reactions without cross-contamination in 45 min. A portable nucleic acid analyzer that integrates mechanical, confocal optical, electronic, and software functions was also developed to collect fluorescence data in a Ø3 mm imaging field near the optical diffraction limit for highly sensitive fluorescence detection of nucleic acid amplification in real time. This microfluidic chip-based portable nucleic acid analyzer could detect low abundance nucleic acids present at as few as 10 copies. In a blinded experiment, specific identification of Mycoplasma pneumoniae, Staphylococcus aureus, and methicillin-resistant S. aureus was achieved with 229 clinical patient sputum samples. The total coincidence rate of our system and traditional RT-PCR with an ABI 7500 was 99.56%. Four samples accounting for the 0.44% inconformity were retested by gene sequencing, revealing that our system reported the correct results. This novel microfluidic chip-based detection system is cost-effective, rapid, sensitive, specific, and has a relatively high throughput for parallel identification, which is especially suitable for resource-limited facilities/areas and point-of-care testing.

  20. Low-cost, rapidly-developed, 3D printed in vitro corpus callosum model for mucopolysaccharidosis type I [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Anthony Tabet

    2016-12-01

    Full Text Available The rising prevalence of high throughput screening and the general inability of (1 two dimensional (2D cell culture and (2 in vitro release studies to predict in vivo neurobiological and pharmacokinetic responses in humans has led to greater interest in more realistic three dimensional (3D benchtop platforms. Advantages of 3D human cell culture over its 2D analogue, or even animal models, include taking the effects of microgeometry and long-range topological features into consideration. In the era of personalized medicine, it has become increasingly valuable to screen candidate molecules and synergistic therapeutics at a patient-specific level, in particular for diseases that manifest in highly variable ways. The lack of established standards and the relatively arbitrary choice of probing conditions has limited in vitro drug release to a largely qualitative assessment as opposed to a predictive, quantitative measure of pharmacokinetics and pharmacodynamics in tissue. Here we report the methods used in the rapid, low-cost development of a 3D model of a mucopolysaccharidosis type I patient’s corpus callosum, which may be used for cell culture and drug release. The CAD model is developed from in vivo brain MRI tracing of the corpus callosum using open-source software, printed with poly (lactic-acid on a Makerbot Replicator 5X, UV-sterilized, and coated with poly (lysine for cellular adhesion. Adaptations of material and 3D printer for expanded applications are also discussed.

  1. Low-cost, rapidly-developed, 3D printed in vitro corpus callosum model for mucopolysaccharidosis type I [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Anthony Tabet

    2017-03-01

    Full Text Available The rising prevalence of high throughput screening and the general inability of (1 two dimensional (2D cell culture and (2 in vitro release studies to predict in vivo neurobiological and pharmacokinetic responses in humans has led to greater interest in more realistic three dimensional (3D benchtop platforms. Advantages of 3D human cell culture over its 2D analogue, or even animal models, include taking the effects of microgeometry and long-range topological features into consideration. In the era of personalized medicine, it has become increasingly valuable to screen candidate molecules and synergistic therapeutics at a patient-specific level, in particular for diseases that manifest in highly variable ways. The lack of established standards and the relatively arbitrary choice of probing conditions has limited in vitro drug release to a largely qualitative assessment as opposed to a predictive, quantitative measure of pharmacokinetics and pharmacodynamics in tissue. Here we report the methods used in the rapid, low-cost development of a 3D model of a mucopolysaccharidosis type I patient’s corpus callosum, which may be used for cell culture and drug release. The CAD model is developed from in vivo brain MRI tracing of the corpus callosum using open-source software, printed with poly (lactic-acid on a Makerbot Replicator 5X, UV-sterilized, and coated with poly (lysine for cellular adhesion. Adaptations of material and 3D printer for expanded applications are also discussed.

  2. The Architecture Improvement Method: cost management and systematic learning about strategic product architectures

    NARCIS (Netherlands)

    de Weerd-Nederhof, Petronella C.; Wouters, Marc; Teuns, Steven J.A.; Hissel, Paul H.

    2007-01-01

    The architecture improvement method (AIM) is a method for multidisciplinary product architecture improvement, addressing uncertainty and complexity and incorporating feedback loops, facilitating trade-off decision making during the architecture creation process. The research reported in this paper

  3. Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal

    Directory of Open Access Journals (Sweden)

    Donela Besada

    2016-11-01

    Full Text Available Background: The World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT. This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol. Design: Data were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs and at district level with district management teams, facility-based health workers and community health cadres in each country. Results: Common strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups. Conclusions: The approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful

  4. Improving the performance of membrane bioreactors by powdered activated carbon dosing with cost considerations.

    Science.gov (United States)

    Yang, W; Paetkau, M; Cicek, N

    2010-01-01

    Effects of powdered activated carbon (PAC) dosing on the overall performance of membrane bioreactors (MBR) were investigated in two bench-scale submerged MBRs. Positive impacts of PAC dosing on membrane fouling and the removal of 17beta-estradiol (E2) and 17alpha-ethyinylestradiol (EE2) were demonstrated over a six-month stable operational period. PAC dosing in the MBR increased the removal rates of E2 and EE2 by 3.4% and 15.8%, respectively. The average soluble extracellular polymeric substances (EPS) and colloidal total organic carbon (TOC) concentrations in the PAC-MBR sludge was 60.1% and 61.8% lower than the control MBR sludge, respectively. Lower soluble EPS and colloidal TOC concentrations in the PAC-MBR sludge resulted in a slower rate of trans-membrane pressure (TMP) increase during MBRs operation, which could prolong the lifespan of membranes. Cost assessment showed that PAC dosing could reduce the operating cost for membrane cleaning and/or membrane replacement by about 25%. The operating cost for PAC dosing could be offset by the benefit from its reducing the cost for membrane maintenance.

  5. An assessment of interventions for improving communication and trust in cost benefit analysis processes

    NARCIS (Netherlands)

    Beukers, E.; Bertolini, L.; te Brömmelstroet, M.

    2014-01-01

    Evaluation literature suggests that assessments of integrated transport plans should be an inclusive dialogue, for which it is crucial that participants communicate with and trust each other. However, cost benefit analysis (CBA) of integrated transport plans is often characterized by communication

  6. Improving the Quality and Cost of Healthcare Delivery: The Potential of Radio Frequency Identification (RFID) Technology

    Science.gov (United States)

    Vilamovska, Anna-Marie

    2010-01-01

    The study investigated whether an upcoming class of health information technology (HIT) can be used to address currently outstanding issues in the quality and cost of healthcare delivery. Expert interviews and a literature review were used to describe the 2009 universe of in- and outpatient healthcare RFID applications and to identify those…

  7. Using value models to improve the cost/benefit analysis of inter-organizational system implementations

    NARCIS (Netherlands)

    Eckartz, S.M.; Katsma, Christiaan; Wieringa, Roelf J.

    2012-01-01

    Jointly developing a business case for inter-organizational information systems (IOS) is difficult as: (1) in a business network there are benefits that may not appear at the site where costs occur, and (2) the involved stakeholders often have different or even conflicting organizational goals. This

  8. Identifying Low Cost Energy Improvements for School Buildings: An Energy Audit Manual.

    Science.gov (United States)

    Minnesota State Dept. of Energy and Economic Development, St. Paul.

    This manual is a guide for performing energy audits in school buildings using low- and no-cost measures found effective in Minnesota. The manual helps school maintenance and administrative personnel conduct walk-through inspections of school buildings, focusing on the energy efficiency of their equipment and operations. The measures recommended…

  9. Report: EPA Needs to Improve Internal Controls to Increase Cost Recovery

    Science.gov (United States)

    Report #09-P-0144, April 27, 2009. Within a sample of removal actions we reviewed, EPA collected from responsible parties approximately 11 percent ($31.4 of $294.5 million) of the Federal Government’s costs for conducting the removal actions.

  10. Reduce fluctuations in capacity to improve the accessibility of radiotherapy treatment cost-effectively

    NARCIS (Netherlands)

    joustra, P. E.; Kolfin, R.; van Dijk, N. M.; Koning, C. C. E.; Bakker, P. J. M.

    2012-01-01

    This paper is motivated by a case study to reduce the throughput times for radiotherapy treatment. The goal is to find a cost-effective way to meet future throughput targets. A combination of queuing theory and computer simulation was used. First, computer simulation to detect the bottleneck(s) in a

  11. Assessing the costs and benefits of improved land management practices in three watershed areas in Ethiopia

    NARCIS (Netherlands)

    Tesfaye, Abonesh; Brouwer, Roy; van der Zaag, P.; Negatu, Workneh

    2016-01-01

    Unsustainable land use management and the resulting soil erosion are among the most pervasive problems in rural Ethiopia, where most of the country's people live, jeopardizing food security. Despite various efforts to introduce soil conservation measures and assess their costs and benefits, it is

  12. Making It Real: Incorporating Cost Management and Productivity Improvements into Financing Decisions

    Science.gov (United States)

    Wellman, Jane

    2010-01-01

    Higher education is being challenged to increase access and degree attainment for all student groups--a tall order under any circumstances, but particularly daunting in the current economy. To do this, institutional and policy leaders will need to find ways to reduce costs and permanently reduce spending demands while they maintain access. This…

  13. Integrating forest growth and harvesting cost models to improve forest management planning

    Science.gov (United States)

    J.E. Baumgras; C.B. LeDoux

    1991-01-01

    Two methods of estimating harvesting revenue--reported stumpage prices - and delivered prices minus estimated harvesting and haul costs were compared by estimating entry cash flows and rotation net present value for three simulated even-aged forest management options that included 1 to 3 thinnings over a 90 year rotation. Revenue estimates derived from stumpage prices...

  14. Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free

    NARCIS (Netherlands)

    Zijlstra, T.R.; Braakman-Jansen, Louise Marie Antoinette; Taal, Erik; Rasker, Johannes J.; van de Laar, Mart A F J

    2007-01-01

    Objectives: To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM). - Methods: 134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient

  15. Improved cost of energy comparison of permanent magnet generators for large offshore wind turbines

    NARCIS (Netherlands)

    Hart, K.; McDonald, A.; Polinder, H.; Corr, E.; Carroll, J.

    2014-01-01

    This paper investigates geared and direct-drive permanent magnet generators for a typical offshore wind turbine, providing a detailed comparison of various wind turbine drivetrain configurations in order to minimise the Cost of Energy. The permanent magnet generator topologies considered include a

  16. Physician Assistants Improve Efficiency and Decrease Costs in Outpatient Oral and Maxillofacial Surgery.

    Science.gov (United States)

    Resnick, Cory M; Daniels, Kimberly M; Flath-Sporn, Susan J; Doyle, Michael; Heald, Ronald; Padwa, Bonnie L

    2016-11-01

    To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice. This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Process maps were created to capture all activities from room preparation to patient discharge, and all activities were timed for each case. A time-driven activity-based costing method was used to calculate the average times and costs from the provider's perspective for each group. Complication rates were calculated during the periods for both groups. Descriptive statistics were calculated, and significance was set at P oral and maxillofacial surgeon was directly involved in the procedure decreased by an average of 19.2 minutes after the introduction of PAs (P complications were found. The addition of PAs into the procedural components of an outpatient oral and maxillofacial surgery practice resulted in decreased costs whereas complication rates remained constant. The increased availability of the oral and maxillofacial surgeon after the incorporation of PAs allows for more patients to be seen during a clinic session, which has the potential to further increase efficiency and revenue. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Energy Efficiency Improvement and Cost Saving Opportunities for the Concrete Industry

    NARCIS (Netherlands)

    Kermeli, Katerina; Worrell, E.; Masanet, Eric

    2011-01-01

    The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for about 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials

  18. The Daily Readiness Huddle: a process to rapidly identify issues and foster improvement through problem-solving accountability.

    Science.gov (United States)

    Donnelly, Lane F; Cherian, Shirley S; Chua, Kimberly B; Thankachan, Sam; Millecker, Laura A; Koroll, Alex G; Bisset, George S

    2017-01-01

    Because of the increasing complexities of providing imaging for pediatric health care services, a more reliable process to manage the daily delivery of care is necessary. Objective We describe our Daily Readiness Huddle and the effects of the process on problem identification and improvement. Our Daily Readiness Huddle has four elements: metrics review, clinical volume review, daily readiness assessment, and problem accountability. It is attended by radiologists, directors, managers, front-line staff with concerns, representatives from support services (information technology [IT] and biomedical engineering [biomed]), and representatives who join the meeting in a virtual format from off-site locations. Data are visually displayed on erasable whiteboards. The daily readiness assessment uses queues to determine whether anyone has concerns or outlier data in regard to S-MESA (Safety, Methods, Equipment, Supplies or Associates). Through this assessment, problems are identified and categorized as quick hits (will be resolved in 24-48 h, not requiring project management) and complex issues. Complex issues are assigned an owner, quality coach and report-back date. Additionally, projects are defined as improvements that are often strategic, are anticipated to take more than 60 days, and do not necessarily arise out of identified issues during the Daily Readiness Huddle. We tracked and calculated the mean, median and range of days to resolution and completion for complex issues and for projects during the first full year of implementing this process. During the first 12 months, 91 complex issues were identified and resolved, 11 projects were in progress and 33 completed, with 23 other projects active or in planning. Time to resolution of complex issues (in days) was mean 37.5, median 34.0, and range 1-105. For projects, time to completion (in days) was mean 86.0, median 84.0, and range 5-280. The Daily Readiness Huddle process has given us a framework to rapidly identify

  19. Cost-effectiveness of the implantable cardioverter-defibrillator: effect of improved battery life and comparison with amiodarone therapy.

    Science.gov (United States)

    Larsen, G C; Manolis, A S; Sonnenberg, F A; Beshansky, J R; Estes, N A; Pauker, S G

    1992-05-01

    The implantable cardioverter-defibrillator (ICD) greatly reduces the incidence of sudden cardiac death among patients with recurrent sustained ventricular tachycardia and fibrillation who do not respond to conventional antiarrhythmic therapy. A cost-effectiveness analysis was performed, comparing the ICD, amiodarone and conventional agents. Actual variable costs of hospitalization and follow-up care were used for 21 ICD- and 43 amiodarone-treated patients. Life expectancy and total variable costs were predicted with use of a Markov decision analytic model. Clinical event rates and probabilities were based on published reports or expert opinion. Life expectancy with an ICD (6.1 years) was 50% greater than that associated with treatment with amiodarone (3.9 years) and 2.5 times that associated with conventional treatment (2.5 years). Assuming replacement every 24 months, ICD lifetime treatment costs (in 1989 dollars) for a 55-year old patient are expected to be $89,600 compared with $24,800 for amiodarone and $16,100 for conventional therapy, yielding a marginal cost/effectiveness ratio for ICD versus amiodarone therapy of 1f429,200/year of life saved, which is comparable to that of other accepted medical treatments. If technologic improvements extend average battery life to 36 months, the marginal cost/effectiveness ratio would be $21,800/year of life saved, and at 96 months it would be $13,800/year of life saved. Patient age at implantation did not significantly affect these results. If quality of life on amiodarone therapy is 30% lower than that with the ICD, the marginal cost/effectiveness ratio decreases by 35%. If the quality of life for patients receiving drugs is 40% lower than that of patients treated with an ICD, use of the defibrillator becomes the dominant strategy.

  20. PV Inverter Products Manufacturing and Design Improvements for Cost Reduction and Performance Enhancements: Final Subcontract Report, November 2003 (Revised)

    Energy Technology Data Exchange (ETDEWEB)

    West, R.

    2004-04-01

    The specific objectives of this subcontracted development work by Xantrex Technology Inc. were to: (1) Capture the newest digital signal processor (DSP) technology to create high-impact,''next generation'' power conversion equipment for the PV industry; (2) Create a common resource base for three PV product lines. This standardized approach to both hardware and software control platforms will provide significant market advantage over foreign competition; (3) Achieve cost reductions through increased volume of common components, reduced assembly labor, and the higher efficiency of producing more products with fewer design, manufacturing, and production test variations; (4) Increase PV inverter product reliability. Reduce inverter size, weight and conversion losses. The contract goals were to achieve an overall cost reduction of 10% to 20% for the three inverters and with no compromise in performance. The cost of the 10-kW inverter was reduced by 56%, and the cost of the 25-kW inverter was reduced by 53%. The 2.5-kW inverter has no basis for comparison, but should benefit equally from this design approach. Not only were the contract cost reduction goals exceeded by a wide margin, but the performance and reliability of the products were also enhanced. The conversion efficiency improvement, as reflected in the 50% conversion loss reduction, adds significant value in renewable energy applications. The size and weight reductions also add value by providing less cumbersome product solutions for system designers.

  1. Using a new evidence-based trauma protocol to improve detection and reduce costs in patients with blunt cardiac injury.

    Science.gov (United States)

    Genrich, Ilean; OʼMara, Susan K; Sulo, Suela

    2015-01-01

    Management of blunt cardiac injury is often discussed in trauma literature due to the lack of a "gold standard" for early identification and cost-effective care. The effectiveness of an evidence-based trauma protocol was assessed by comparing patients treated with the new protocol to those managed with prior practice. The data of 80 patients prospectively managed using the new trauma protocol were compared with the medical records of 80 former patients treated according to existing practice. Implementing the new protocol improved detection of abnormal troponin I levels and resulted in cost savings. The length of time inpatients required continuous electrocardiographic monitoring decreased by 4.23 days and echocardiography use dropped by 70%. Implementation of the evidence-based trauma protocol at our facility improved the early identification of patients with blunt cardiac injury and reduced the number of laboratory and diagnostic tests.

  2. Energy Efficiency Improvement and Cost Saving Opportunities for Cement Making. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Worrell, Ernst; Galitsky, Christina

    2008-01-01

    The cost of energy as part of the total production costs in the cement industry is significant, warranting attention for energy efficiency to improve the bottom line. Historically, energy intensity has declined, although more recently energy intensity seems to have stabilized with the gains. Coal and coke are currently the primary fuels for the sector, supplanting the dominance of natural gas in the 1970s. Most recently, there is a slight increase in the use of waste fuels, including tires. Between 1970 and 1999, primary physical energy intensity for cement production dropped 1 percent/year from 7.3 MBtu/short ton to 5.3 MBtu/short ton. Carbon dioxide intensity due to fuel consumption and raw material calcination dropped 16 percent, from 609 lb. C/ton of cement (0.31 tC/tonne) to 510 lb. C/ton cement (0.26 tC/tonne). Despite the historic progress, there is ample room for energy efficiency improvement. The relatively high share of wet-process plants (25 percent of clinker production in 1999 in the U.S.) suggests the existence of a considerable potential, when compared to other industrialized countries. We examined over 40 energy efficient technologies and measures and estimated energy savings, carbon dioxide savings, investment costs, and operation and maintenance costs for each of the measures. The report describes the measures and experiences of cement plants around the wold with these practices and technologies. Substantial potential for energy efficiency improvement exists in the cement industry and in individual plants. A portion of this potential will be achieved as part of (natural) modernization and expansion of existing facilities, as well as construction of new plants in particular regions. Still, a relatively large potential for improved energy management practices exists.

  3. The cost efficiency of improved roof windows in two well-lit nearly zero-energy houses in Copenhagen

    DEFF Research Database (Denmark)

    Skarning, Gunnlaug Cecilie Jensen; Hviid, Christian Anker; Svendsen, Svend

    2017-01-01

    Roof windows are efficient and flexible daylight sources that are essential in certain types of houses if theyare to achieve sufficient daylighting throughout. Previous studies have indicated that, for such buildingsto meet nearly zero-energy targets in an easy and robust way without compromising.......The aim of this study was to quantify the scope for investing in improved roof window solutions inbuildings insulated to consume nearly zero-energy. Based on two single-family houses in Copenhagenwith typical roof windows and adequate daylighting, the study identified the prices at which various typesof...... roof window improvements would have to be made available to achieve the same cost efficiency asimproved insulation. If the improvements can be made available for less than these prices, the installationof improved roof windows would make it cheaper to construct well-lit and comfortable nearly zero...

  4. Development of improved enzyme-based and lateral flow immunoassays for rapid and accurate serodiagnosis of canine brucellosis.

    Science.gov (United States)

    Cortina, María E; Novak, Analía; Melli, Luciano J; Elena, Sebastián; Corbera, Natalia; Romero, Juan E; Nicola, Ana M; Ugalde, Juan E; Comerci, Diego J; Ciocchini, Andrés E

    2017-09-01

    Brucellosis is a widespread zoonotic disease caused by Brucella spp. Brucella canis is the etiological agent of canine brucellosis, a disease that can lead to sterility in bitches and dogs causing important economic losses in breeding kennels. Early and accurate diagnosis of canine brucellosis is central to control the disease and lower the risk of transmission to humans. Here, we develop and validate enzyme and lateral flow immunoassays for improved serodiagnosis of canine brucellosis using as antigen the B. canis rough lipopolysaccharide (rLPS). The method used to obtain the rLPS allowed us to produce more homogeneous batches of the antigen that facilitated the standardization of the assays. To validate the assays, 284 serum samples obtained from naturally infected dogs and healthy animals were analyzed. For the B. canis-iELISA and B. canis-LFIA the diagnostic sensitivity was of 98.6%, and the specificity 99.5% and 100%, respectively. We propose the implementation of the B. canis-LFIA as a screening test in combination with the highly accurate laboratory g-iELISA. The B. canis-LFIA is a rapid, accurate and easy to use test, characteristics that make it ideal for the serological surveillance of canine brucellosis in the field or veterinary laboratories. Finally, a blind study including 1040 serum samples obtained from urban dogs showed a prevalence higher than 5% highlighting the need of new diagnostic tools for a more effective control of the disease in dogs and therefore to reduce the risk of transmission of this zoonotic pathogen to humans. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Low-cost Citizen Science Balloon Platform for Measuring Air Pollutants to Improve Satellite Retrieval Algorithms

    Science.gov (United States)

    Potosnak, M. J.; Beck-Winchatz, B.; Ritter, P.

    2016-12-01

    High-altitude balloons (HABs) are an engaging platform for citizen science and formal and informal STEM education. However, the logistics of launching, chasing and recovering a payload on a 1200 g or 1500 g balloon can be daunting for many novice school groups and citizen scientists, and the cost can be prohibitive. In addition, there are many interesting scientific applications that do not require reaching the stratosphere, including measuring atmospheric pollutants in the planetary boundary layer. With a large number of citizen scientist flights, these data can be used to constrain satellite retrieval algorithms. In this poster presentation, we discuss a novel approach based on small (30 g) balloons that are cheap and easy to handle, and low-cost tracking devices (SPOT trackers for hikers) that do not require a radio license. Our scientific goal is to measure air quality in the lower troposphere. For example, particulate matter (PM) is an air pollutant that varies on small spatial scales and has sources in rural areas like biomass burning and farming practices such as tilling. Our HAB platform test flight incorporates an optical PM sensor, an integrated single board computer that records the PM sensor signal in addition to flight parameters (pressure, location and altitude), and a low-cost tracking system. Our goal is for the entire platform to cost less than $500. While the datasets generated by these flights are typically small, integrating a network of flight data from citizen scientists into a form usable for comparison to satellite data will require big data techniques.

  6. Consideration of Cost of Care in Pediatric Emergency Transfer-An Opportunity for Improvement.

    Science.gov (United States)

    Gattu, Rajender K; De Fee, Ann-Sophie; Lichenstein, Richard; Teshome, Getachew

    2017-05-01

    Pediatric interhospital transfers are an economic burden to the health care, especially when deemed unnecessary. Physicians may be unaware of the cost implications of pediatric emergency transfers. A cost analysis may be relevant to reduce cost. To characterize children transferred from outlying emergency departments (EDs) to pediatric ED (PED) with a specific focus on transfers who were discharged home in 12 hours or less after transfer without intervention in PED and analyze charges associated with them. Charts of 352 patients (age, 0-18 years) transferred from 31 outlying EDs to PED during July 2009 to June 2010 were reviewed. Data were collected on the range, unit charge and volume of services provided in PED, length of stay, and final disposition. The average charge per patient transfer is calculated based on unit charge times total service units per 1000 patients per year and divided by 1000. Hospital charges were divided into fixed and variable. Of 352 patients transferred, 108 (30.7%) were admitted to pediatric inpatient service, 42 (11.9%) to intensive care; 36 (10.2%) went to the operating room, and 166 (47.2%) were discharged home. The average hospital charge per transfer was US $4843. Most (89%) of the charges were fixed, and 11% were variable. One hundred one (28.7%) patients were discharged home from PED in 12 hours or less without intervention. The hospital charges for these transfers were US $489,143. Significant number of transfers was discharged 12 hours or less without any additional intervention in PED. Fixed charges contribute to majority of total charges. Cost saving can be achieved by preventing unnecessary transfer.

  7. A low-cost multielectrode system for data acquisition enabling real-time closed-loop processing with rapid recovery from stimulation artifacts

    Directory of Open Access Journals (Sweden)

    John D Rolston

    2009-07-01

    Full Text Available Commercially available data acquisition systems for multielectrode recording from freely moving animals are expensive, often rely on proprietary software, and do not provide detailed, modifiable circuit schematics. When used in conjunction with electrical stimulation, they are prone to prolonged, saturating stimulation artifacts that prevent the recording of short-latency evoked responses. Yet electrical stimulation is integral to many experimental designs, and critical for emerging brain-computer interfacing and neuroprosthetic applications. To address these issues, we developed an easy-to-use, modifiable, and inexpensive system for multielectrode neural recording and stimulation. Setup costs are less than US$10,000 for 64 channels, an order of magnitude lower than comparable commercial systems. Unlike commercial equipment, the system recovers rapidly from stimulation and allows short-latency action potentials (<1 ms post-stimulus to be detected, facilitating closed-loop applications and exposing neural activity that would otherwise remain hidden. To illustrate this capability, evoked activity from microstimulation of the rodent hippocampus is presented. The system is modular, in banks of 16 channels, and flexible in usage: while primarily designed for in vivo use, it can be combined with commercial preamplifiers to record from in vitro multielectrode arrays. The system’s open-source control software, NeuroRighter, is implemented in C#, with an easy-to-use graphical interface. As C# functions in a managed code environment, which may impact performance, analysis was conducted to ensure comparable speed to C++ for this application. Hardware schematics, layout files, and software are freely available. Since maintaining wired headstage connections with freely moving animals is difficult, we describe a new method of electrode-headstage coupling using neodymium magnets.

  8. Evaluation of thermally-modified calcium-rich attapulgite as a low-cost substrate for rapid phosphorus removal in constructed wetlands.

    Science.gov (United States)

    Yin, Hongbin; Yan, Xiaowei; Gu, Xiaohong

    2017-05-15

    The cost-effective and geographically available substrates are vital for the design of constructed wetlands (CWs), especially the saturated subsurface flow CWs, which are deemed as an efficient way to remove the inlet-lake phosphorus concentrations. In this study, phosphorus removal of thermally-treated calcium-rich attapulgite (TCAP) with varied particle sizes (0.2-0.5 mm, 0.5-1 mm and 1-2 mm) was assessed using batch and long-term column experiments to evaluate its feasibility as a CWs substrate. The phosphorus-bound mechanism in TCAP was identified in various initial phosphorus concentrations. Batch studies indicated that more than 95% of P can be rapidly (hydraulic retention time (HRT) exerts great influence on P removal performance and longer HRTs favor the dissolution of CaO in TCAP, consequently increasing the P removal rate. In a 150-day P removal experiment, TCAP removed an average of 93.1%-95.4% of the influent P with a HRT of eight hours. Both the batch and chemical extraction of the P fraction of TCAP showed that the P removed by TCAP was mainly through formation of Ca phosphate precipitation. However, the species of Ca-P precipitation formed might be varied in different phosphorus concentrations. All results indicated that TCAP can be a suitable substrate when used in CWs, and field experiments should be carried out to test its real P removal performance in the future. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. A rapid and systematic review and economic evaluation of the clinical and cost-effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder.

    Science.gov (United States)

    Bridle, C; Palmer, S; Bagnall, A-M; Darba, J; Duffy, S; Sculpher, M; Riemsma, R

    2004-05-01

    To evaluate the clinical and cost-effectiveness of quetiapine, olanzapine and valproate semisodium in the treatment of mania associated with bipolar disorder. Electronic databases; industry submissions made to the National Institute for Clinical Excellence. Randomised trials and economic evaluations that evaluated the effectiveness of quetiapine, olanzapine or valproate semisodium in the treatment of mania associated with bipolar disorder were selected for inclusion. Data were extracted by one reviewer into a Microsoft Access database and checked for quality and accuracy by a second. The quality of the cost-effectiveness studies was assessed using a checklist updated from that developed by Drummond and colleagues. Relative risk and mean difference data were presented as Forest plots but only pooled where this made sense clinically and statistically. Studies were grouped by drug and, within each drug, by comparator used. Chi-squared tests of heterogeneity were performed for the outcomes if pooling was indicated. A probabilistic model was developed to estimate costs from the perspective of the NHS, and health outcomes in terms of response rate, based on an improvement of at least 50% in a patient's baseline manic symptoms derived from an interview-based mania assessment scale. The model evaluated the cost-effectiveness of the alternative drugs when used as part of treatment for the acute manic episode only. Eighteen randomised trials met the inclusion criteria. Aspects of three of the quetiapine studies were commercial-in-confidence. The quality of the included trials was limited and overall, key methodological criteria were not met in most trials. Quetiapine, olanzapine and valproate semisodium appear superior to placebo in reducing manic symptoms, but may cause side-effects. There appears to be little difference between these treatments and lithium in terms of effectiveness, but quetiapine is associated with somnolence and weight gain, whereas lithium is associated

  10. Energy Efficiency Improvement and Cost Saving Opportunities for the Glass Industry. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Worrell, Ernst; Galitsky, Christina; Masanet, Eric; Graus, Wina

    2008-03-01

    The U.S. glass industry is comprised of four primary industry segments--flat glass, container glass, specialty glass, and fiberglass--which together consume $1.6 billion in energy annually. On average, energy costs in the U.S. glass industry account for around 14 percent of total glass production costs. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There is a variety of opportunities available at individual plants in the U.S. glass industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy-efficient technologies that can be implemented at the component, process, system, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the U.S. glass industry is provided along with a description of the major process steps in glass manufacturing. Expected savings in energy and energy-related costs are given for many energy efficiency measures, based on case study data from real-world applications in glass production facilities and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. The information in this Energy Guide is intended to help energy and plant managers in the U.S. glass industry reduce energy consumption in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of the measures--as well on as their applicability to different production practices--is needed to assess potential implementation of selected technologies at individual plants.

  11. Dietary nitrate does not reduce oxygen cost of exercise or improve muscle mitochondrial function in patients with mitochondrial myopathy.

    Science.gov (United States)

    Nabben, Miranda; Schmitz, Joep P J; Ciapaite, Jolita; le Clercq, Carlijn M P; van Riel, Natal A; Haak, Harm R; Nicolay, Klaas; de Coo, Irenaeus F M; Smeets, Hubert; Praet, Stephan F; van Loon, Luc J; Prompers, Jeanine J

    2017-05-01

    Muscle weakness and exercise intolerance negatively affect the quality of life of patients with mitochondrial myopathy. Short-term dietary nitrate supplementation has been shown to improve exercise performance and reduce oxygen cost of exercise in healthy humans and trained athletes. We investigated whether 1 wk of dietary inorganic nitrate supplementation decreases the oxygen cost of exercise and improves mitochondrial function in patients with mitochondrial myopathy. Ten patients with mitochondrial myopathy (40 ± 5 yr, maximal whole body oxygen uptake = 21.2 ± 3.2 ml·min-1·kg body wt-1, maximal work load = 122 ± 26 W) received 8.5 mg·kg body wt-1·day-1 inorganic nitrate (~7 mmol) for 8 days. Whole body oxygen consumption at 50% of the maximal work load, in vivo skeletal muscle oxidative capacity (evaluated from postexercise phosphocreatine recovery using 31P-magnetic resonance spectroscopy), and ex vivo mitochondrial oxidative capacity in permeabilized skinned muscle fibers (measured with high-resolution respirometry) were determined before and after nitrate supplementation. Despite a sixfold increase in plasma nitrate levels, nitrate supplementation did not affect whole body oxygen cost during submaximal exercise. Additionally, no beneficial effects of nitrate were found on in vivo or ex vivo muscle mitochondrial oxidative capacity. This is the first time that the therapeutic potential of dietary nitrate for patients with mitochondrial myopathy was evaluated. We conclude that 1 wk of dietary nitrate supplementation does not reduce oxygen cost of exercise or improve mitochondrial function in the group of patients tested. Copyright © 2017 the American Physiological Society.

  12. Improving quality in population surveys of headache prevalence, burden and cost

    DEFF Research Database (Denmark)

    Steiner, Timothy J; Stovner, Lars Jacob; Al Jumah, Mohammed

    2013-01-01

    Population-based studies of headache disorders are important. They inform needs assessment and underpin service policy for a set of disorders that are a public-health priority. On the one hand, our knowledge of the global burden of headache is incomplete, with major geographical gaps; on the other......, methodological differences and variable quality are notable among published studies of headache prevalence, burden and cost.The purpose here was to start the process of developing standardized and better methodology in these studies. An expert consensus group was assembled to identify the key methodological...

  13. Improve the Economics of your Capital Project by Finding its True Cost of Capital

    OpenAIRE

    Schmal, Tom

    2015-01-01

    Evaluating the risk behind capital projects can be one of management’s toughest calls. One reason is project risks are presented subjectively or as a metric without a practical relationship to return. The author addresses the problem by using a Monte Carlo simulation to find a project’s risk and uses that metric to find the project’s cost of capital. In this system, risk is determined by variation in free cash flow. Since every project in your company’s pipeline will have a free cash f...

  14. Energy Efficiency Improvement and Cost Saving Opportunities for Breweries: An ENERGY STAR(R) Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Martin, Nathan; Worrell, Ernst; Lehman, Bryan

    2003-09-01

    Annually, breweries in the United States spend over $200 million on energy. Energy consumption is equal to 38 percent of the production costs of beer, making energy efficiency improvement an important way to reduce costs, especially in times of high energy price volatility. After a summary of the beer making process and energy use, we examine energy efficiency opportunities available for breweries. We provide specific primary energy savings for each energy efficiency measure based on case studies that have implemented the measures, as well as references to technical literature. If available, we have also listed typical payback periods. Our findings suggest that given available technology, there are still opportunities to reduce energy consumption cost-effectively in the brewing industry. Brewers value highly the quality, taste and drinkability of their beer. Brewing companies have and are expected to continue to spend capital on cost-effective energy conservation measures that meet these quality, taste and drinkability requirements. For individual plants, further research on the economics of the measures, as well as their applicability to different brewing practices, is needed to assess implementation of selected technologies.

  15. Energy Efficiency Improvement and Cost Saving Opportunities for the Pharmaceutical Industry. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Galitsky, Christina; Chang, Sheng-chieh; Worrell, Ernst; Masanet, Eric

    2008-03-01

    The U.S. pharmaceutical industry consumes almost $1 billion in energy annually. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants in the U.S. pharmaceutical industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy efficient technologies that can be implemented at the component, process, system, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the U.S. pharmaceutical industry is provided along with a description of the major process steps in the pharmaceutical manufacturing process. Expected savings in energy and energy-related costs are given for many energy efficiency measures, based on case study data from real-world applications in pharmaceutical and related facilities worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. The information in this Energy Guide is intended to help energy and plant managers reduce energy consumption in a cost-effective manner while meeting regulatory requirements and maintaining the quality of products manufactured. At individual plants, further research on the economics of the measures?as well as their applicability to different production practices?is needed to assess potential implementation of selected technologies.

  16. A new paradigm to improve patient outcomes: a tongue-in-cheek look at the cost of patient satisfaction

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-07-01

    Full Text Available No abstract available. Article truncated at 150 words. A landmark article entitled “The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality” was recently published in the Archives of Internal Medicine by Fenton et al. (1. The authors conducted a prospective cohort study of adult respondents (n=51,946 to the 2000 through 2007 national Medical Expenditure Panel Survey. The results showed higher patient satisfaction was associated with higher admission rates to the hospital, higher overall health care expenditures, and increased mortality. The higher costs are probably not surprising to many health care administrators. Programs to improve patient satisfaction such as advertising, valet parking, gourmet meals for patients and visitors, massages, never-ending patient and family satisfaction surveys, etc. are expensive and would be expected to increase costs. Some would argue that these costs are simply the price of competing for patients in the present health care environment. Although the outcomes are poorer, substituting patient …

  17. Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost

    National Research Council Canada - National Science Library

    Holmes, Alison Volpe; Atwood, Emily C; Whalen, Bonny; Beliveau, Johanna; Jarvis, J Dean; Matulis, John C; Ralston, Shawn L

    2016-01-01

    ...; newborns with NAS occupy 4% of NICU beds. We implemented a coordinated program for NAS including standardized protocols for scoring, medications and weaning, and a calm rooming-in environment, to improve family-centered care and to decrease...

  18. A novel technique of needle setting for curvilinear endobronchial ultrasound: Improved efficiency with no cost.

    Science.gov (United States)

    Meena, Nikhil; Innabi, Ayoub; Alzghoul, Bashar; Bartter, Thaddeus

    2016-01-01

    Standard instructions for biopsy using the convex curvilinear endobronchial ultrasound scope include visualization and adjustment of the sheath housing the biopsy needle before every puncture. In our practice, we pre-set this relationship before inserting the endobronchial ultrasound scope and leave it fixed for every puncture. We postulated that this approach is more efficient than repeated re-adjustment and aimed to show that it would not increase the frequency of endobronchial ultrasound scope damage. Retrospective review of every biopsy using the endobronchial ultrasound scope over a 6-year period with documentation of damages and costs. There were 15 scope damages out of 1792 procedures (0.8%). Eight damages were determined to be due to needle damage, one due to patient bite, three due to Williams airway abrasions, and three were camera failures. All damages occurred during the first 5 years of the study. Costs totaled US$138,725, for an average of US$23,120 per year. This rate of damages appears to be similar to or lower than that reported when standard instructions are followed. Pre-setting of the biopsy needle when the endobronchial ultrasound scope is used leads to greater efficiency and no increase in scope damages.

  19. A novel training program for Police Officers that improves interactions with mentally ill individuals and is cost-effective

    Directory of Open Access Journals (Sweden)

    Yasmeen eKrameddine

    2013-03-01

    Full Text Available Police and law enforcement providers frequently come into contact with individuals who have psychiatric disorders, sometimes with tragic results. Repeated studies suggest that greater understanding of psychiatric conditions by police officers would be beneficial. Here we present a novel approach to training police officers to improve their interactions with those who might have a mental illness. This approach involved developing a carefully scripted role-play training, which involved police officers (n=663 interacting with highly trained actors during six realistic scenarios. The primary goal of the training was to improve empathy, communication skills, and the ability of officers to de-escalate potentially difficult situations. Uniquely, feedback was given to officers after each scenario by several individuals including experienced police officers, a mental health professional, and by the actors involved (with insights such as this is how you made me feel. Results showed that there were no changes in attitudes of the police towards the mentally ill comparing data at baseline and at 6 months after the training in those who completed both ratings (n=170. In contrast, there were significant improvements in directly measured behaviours (n=142 as well as in indirect measurements of behaviour throughout the police force. Thus, compared to previous years, there was a significant increase in the recognition of mental health issues as a reason for a call (40%, improved efficiency in dealing with mental health issues, and a decrease in weapon or physical interactions with mentally ill individuals. The training cost was $120 per officer but led to significant cost savings (more than $80,000 in the following 6 months. In conclusion, this novel one-day training course significantly changed behaviour of police officers in meaningful ways and also led to cost savings. We propose that this training model could be adopted by other police agencies.

  20. Cost of integrated vector control with improved sanitation and road infrastructure coupled with the use of slow-release Bacillus sphaericus granules in a tropical urban setting.

    Science.gov (United States)

    Skovmand, Ole; Ouedraogo, Thierry D A; Sanogo, Edith; Samuelsen, Helle; Toé, Lea Paré; Bosselmann, Rune; Czajkowski, Tonny; Baldet, Thierry

    2011-07-01

    A field test of integrated vector control was conducted in a tropical urban setting with a combination of a floating, slow-release, granular formulation of Bacillus sphaericus and environmental engineering measures (renovation of roads, collective water pumps, and cesspool lids). The targets were Culex quinquefasciatus and Anopheles gambiae in the two biggest towns of Burkina Faso (West Africa). Within the intervention zone, water pumping stations were improved and the surroundings drained to prevent the accumulation of stagnant water. Roads were leveled and given either simple gutters on each side or a concrete channel on one side to drain runoff water. Garbage containers were installed to provide an alternative to the drainage channels for waste disposal. Septic tanks were modified so that they could be emptied without destroying their lid. This study showed that it is possible to implement mosquito control in a tropical urban environment with teams of young people rapidly trained to apply a biological larvicide without any tools other than an iron bar to lift cesspool lids. Environmental improvements were initially costly, but demanded little subsequent expenditure. Local inhabitants' committees were mobilized to provide people with information and monitor the efficacy of the measures. Compared with what people spent individually on mosquito prevention and malaria medicine, these measures were not expensive, but many expected the community to pay for them from existing taxes, e.g., for water treatment and disposal. The necessary funding and logistics require a municipal organization with neighborhood support, if the measures are to be effective.

  1. Improvements in fast-neutron spectroscopy methods (1961); Amelioration des methodes de spectrometrie des neutrons rapides (1961)

    Energy Technology Data Exchange (ETDEWEB)

    Cambou, F. [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

    1961-02-15

    This research aimed at improving fast-neutron electronic detectors based on n-p elastic scattering. The first part concerns proportional counters; careful constructional methods have made it possible to plot mono-energetic neutron spectra in the range 700 keV - 3 MeV with a resolution of 7 per cent. The second part concerns scintillation counters: an organic scintillator and an inorganic scintillator covered with a thin layer of a scattering agent. An exact study of the types of scintillation has made it possible to develop efficient discriminator circuits. Different neutron spectra plotted in the presence of a strong gamma background are presented. The last part deals with the development of form discrimination methods for the study, in the actual beam, of the elastic scattering of 14.58 MeV electrons. With hydrogen, the distribution f ({phi}) of the recoil protons is f({phi}) = 1 + 0.034 cos {phi} + 0.042 cos{sup 2} {phi}. With tritium the scattering is strongly anisotropic; the curve representing the variation of the differential cross-section for the elastic scattering in the centre of mass system is obtained with a target containing 1 cm{sup 3} of tritium. (author) [French] Le travail a porte sur l'amelioration des detecteurs electroniques de neutrons rapides bases sur la diffusion elastique n-p. La premiere partie est relative aux compteurs proportionnels; des methodes soignees de fabrication ont permis des traces de spectres de neutrons monoenergetiques dans le domaine 700 keV - 3 MeV avec une resolution de 7 pour cent. La deuxieme partie est relative au compteur a scintillations; scintillateur organique et scintillateur mineral recouvert d'un diffuseur mince. Une etude precise des formes de scintillations a permis la mise au point de circuits discriminateurs efficaces. Differents spectres de neutrons traces en presence d'un fond gamma intense sont presentes. La derniere partie est relative a la mise en oeuvre des methodes de discrimination de

  2. Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: before and after study.

    Science.gov (United States)

    Monteleoni, Carol; Clark, Elizabeth

    2004-08-28

    Despite lack of evidence that enteral feeding tubes benefit patients with dementia, and often contrary to the wishes of patient and family, patients with dementia who have difficulty swallowing or reduced food intake often receive feeding tubes when hospitalised for an acute illness. We conducted a retrospective chart review of all patients receiving percutaneous endoscopic gastrostomy or jejunostomy tubes between March and September 2002. QI interventions including a palliative care consulting service and educational programmes were instituted. We conducted a second chart review for all patients receiving feeding tubes between March and September 2003. 652 bed urban acute care hospital. We measured the number of feeding tubes placed in patients with dementia, the number of feeding tubes placed in patients with dementia capable of taking food by mouth, and the number of feeding tubes placed in patients with dementia with an advance directive stating the wish to forgo artificial nutrition and hydration. Medical and allied health staff received educational programmes on end of life care and on feeding management of patients with dementia. A palliative care consulting team was established. After the interventions, the number of feeding tubes placed in all patients and in patients with dementia was greatly reduced. Multidisciplinary involvement, including participation by the administration, was essential to effect change in practice. The intensive focus on a particular issue and rapid change led to "culture shift" within the hospital community. The need to establish unified goals of care for each patient was highlighted. A growing body of research over the past decade has questioned the utility of placing feeding tubes (percutaneous endoscopic gastrostomy (PEG) or jejunostomy) in patients with advanced dementia. Studies have found no evidence that feeding tubes in this population prevent aspiration, prolong life, improve overall function, or reduce pressure sores

  3. An Assessment of Cost Improvements in the NASA COTS - CRS Program and Implications for Future NASA Missions

    Science.gov (United States)

    Zapata, Edgar

    2017-01-01

    This review brings rigorous life cycle cost (LCC) analysis into discussions about COTS program costs. We gather publicly available cost data, review the data for credibility, check for consistency among sources, and rigorously define and analyze specific cost metrics.

  4. Assessing the effectiveness and cost effectiveness of adaptive e-Learning to improve dietary behaviour: protocol for a systematic review

    Directory of Open Access Journals (Sweden)

    Michie Susan

    2010-04-01

    Full Text Available Abstract Background The composition of habitual diets is associated with adverse or protective effects on aspects of health. Consequently, UK public health policy strongly advocates dietary change for the improvement of population health and emphasises the importance of individual empowerment to improve health. A new and evolving area in the promotion of dietary behavioural change is e-Learning, the use of interactive electronic media to facilitate teaching and learning on a range of issues, including diet and health. The aims of this systematic review are to determine the effectiveness and cost-effectiveness of adaptive e-Learning for improving dietary behaviours. Methods/Design The research will consist of a systematic review and a cost-effectiveness analysis. Studies will be considered for the review if they are randomised controlled trials, involving participants aged 13 or over, which evaluate the effectiveness or efficacy of interactive software programmes for improving dietary behaviour. Primary outcome measures will be those related to dietary behaviours, including estimated intakes of energy, nutrients and dietary fibre, or the estimated number of servings per day of foods or food groups. Secondary outcome measures will be objective clinical measures that are likely to respond to changes in dietary behaviours, such as anthropometry or blood biochemistry. Knowledge, self-efficacy, intention and emotion will be examined as mediators of dietary behaviour change in order to explore potential mechanisms of action. Databases will be searched using a comprehensive four-part search strategy, and the results exported to a bibliographic database. Two review authors will independently screen results to identify potentially eligible studies, and will independently extract data from included studies, with any discrepancies at each stage settled by a third author. Standardised forms and criteria will be used. A descriptive analysis of included

  5. Assessing the effectiveness and cost effectiveness of adaptive e-Learning to improve dietary behaviour: protocol for a systematic review.

    Science.gov (United States)

    Edwards, Phil; Felix, Lambert; Harris, Jody; Ferguson, Elaine; Free, Caroline; Landon, Jane; Lock, Karen; Michie, Susan; Miners, Alec; Murray, Elizabeth

    2010-04-21

    The composition of habitual diets is associated with adverse or protective effects on aspects of health. Consequently, UK public health policy strongly advocates dietary change for the improvement of population health and emphasises the importance of individual empowerment to improve health. A new and evolving area in the promotion of dietary behavioural change is e-Learning, the use of interactive electronic media to facilitate teaching and learning on a range of issues, including diet and health. The aims of this systematic review are to determine the effectiveness and cost-effectiveness of adaptive e-Learning for improving dietary behaviours. The research will consist of a systematic review and a cost-effectiveness analysis. Studies will be considered for the review if they are randomised controlled trials, involving participants aged 13 or over, which evaluate the effectiveness or efficacy of interactive software programmes for improving dietary behaviour. Primary outcome measures will be those related to dietary behaviours, including estimated intakes of energy, nutrients and dietary fibre, or the estimated number of servings per day of foods or food groups. Secondary outcome measures will be objective clinical measures that are likely to respond to changes in dietary behaviours, such as anthropometry or blood biochemistry. Knowledge, self-efficacy, intention and emotion will be examined as mediators of dietary behaviour change in order to explore potential mechanisms of action. Databases will be searched using a comprehensive four-part search strategy, and the results exported to a bibliographic database. Two review authors will independently screen results to identify potentially eligible studies, and will independently extract data from included studies, with any discrepancies at each stage settled by a third author. Standardised forms and criteria will be used.A descriptive analysis of included studies will describe study design, participants, the

  6. An empirical study of costs and advantages of improved corporate environmental management performance

    DEFF Research Database (Denmark)

    Ulhøi, John Parm

    2000-01-01

    and environmental reporting, increased dialogues with various stakeholders, etc. It has often been argued that to really speed up the process of corporate greening, it is pivotal that investments into environmental management improvements are paying off. The predominantly normative literature, however, does...... not leave much specific evidence to support the underlying assertion that it does pay off to be green. Apart from some isolated, predominantly superficial and anecdotal examples, little evidence exists which allows for assessment of whether further investments into improved environmental management...

  7. NWTC Aerodynamics Studies Improve Energy Capture and Lower Costs of Wind-Generated Electricity

    Energy Technology Data Exchange (ETDEWEB)

    2015-08-01

    Researchers at the National Wind Technology Center (NWTC) at the National Renewable Energy Laboratory (NREL) have expanded wind turbine aerodynamic research from blade and rotor aerodynamics to wind plant and atmospheric inflow effects. The energy capture from wind plants is dependent on all of these aerodynamic interactions. Research at the NWTC is crucial to understanding how wind turbines function in large, multiple-row wind plants. These conditions impact the cumulative fatigue damage of turbine structural components that ultimately effect the useful lifetime of wind turbines. This work also is essential for understanding and maximizing turbine and wind plant energy production. Both turbine lifetime and wind plant energy production are key determinants of the cost of wind-generated electricity.

  8. Improved low-cost, MR-compatible olfactometer to deliver tobacco smoke odor.

    Science.gov (United States)

    Lowen, Steven B; Farmer, Stacey L; Lukas, Scott E

    2017-02-01

    We describe a low-cost, MRI-compatible olfactometer that delivers fresh cigarette smoke odor, a challenging odorant to present, as well as other odorants. This new olfactometer retains all of the advantages of an earlier design that was capable of only delivering volatile odors (Lowen & Lukas, Behavior Research Methods, 38, 307-313, 2006). The new system incorporates a novel switching mechanism that allows it to deliver fresh smoke generated from a burning cigarette during a stimulus presentation paradigm that might be employed in a cue-reactivity experiment. An evaluation study established that the olfactometer reliably delivered smoke to the participants and that tobacco smoke was discriminated from other odorants; there were no adverse reactions to the device.

  9. Successful protocol for eliminating excessive urine microscopies: Quality improvement and cost savings with physician support.

    Science.gov (United States)

    Chen, Michael; Eintracht, Shaun; MacNamara, Elizabeth

    2017-01-01

    Clinical laboratories are under growing pressure to provide faster turn-around-time and maintain high quality while decreasing costs. In a setting of rising test volumes, implementation of evidence-based protocols with physician cooperation and feedback may provide frameworks and support for laboratory utilization optimization. The purpose of this study was to eliminate wasteful urine microscopy by targeting physician ordering behavior, and to ensure quality of care with physician satisfaction surveys. We evaluated how physicians use the laboratory for routine urine testing. Urinalysis requisition was redesigned with emphasis on clinical indications for testing. In collaboration with requesting physicians, restriction in reflex microscopy testing was applied with exceptions. Cost saving analysis was conducted based on test volume. After policy change, 2 physician satisfaction surveys were conducted 5year apart to address potential complaints. Over 47,000 urine microscopies have been eliminated annually, while the number of urine dipsticks and cultures remained stable. This translated into a 95% reduction in manual microscopy performed, and an estimated annual saving of $200,000. In both satisfaction surveys, 9 out of 10 physicians considered the change to have "no" or "a beneficial effect" on their clinical practice. Our laboratory did not receive any formal complaints in regards to the protocol change. By implementing changes to the way physicians order urinalysis, the number of tests can be substantially reduced. Satisfaction survey proved to be an effective tool for obtaining physician feedback, and support. The results of surveys indicated that new policy achieved significant savings without compromising on patient care. This experience has provided us with strategies on taking initiatives to further optimize utilization of laboratory tests. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  10. How to Improve Pupils' Literacy? A Cost-Effectiveness Analysis of a French Educational Project

    Science.gov (United States)

    Massoni, Sebastien; Vergnaud, Jean-Christophe

    2012-01-01

    The "Action Lecture" program is an innovative teaching method run in some nursery and primary schools in Paris and designed to improve pupils' literacy. We report the results of an evaluation of this program. We describe the experimental protocol that was built to estimate the program's impact on several types of indicators. Data were…

  11. Cost implications of improving food safety in the Dutch dairy chain

    NARCIS (Netherlands)

    Valeeva, N.I.; Meuwissen, M.P.M.; Oude Lansink, A.G.J.M.; Huirne, R.B.M.

    2006-01-01

    This paper examines control measures for improving food safety in the dairy chain, using an integer linear programming model. The chain includes feed (compound feed production and delivery), farm (dairy farm) and dairy processing (transport and processing of raw milk, delivery of pasteurised milk)

  12. How much does it cost to improve access to voluntary medical male circumcision among high-risk, low-income communities in Uganda?

    Directory of Open Access Journals (Sweden)

    Bruce Larson

    Full Text Available The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015. Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites. The difference between such costs is the cost of improving access to VMMC.A micro-costing approach was used to estimate costs from the service provider's perspective of a circumcision. Supply chain and higher-level program support costs are not included.The average cost (US$2012 of resources used per circumcision was $61 in the mobile program ($72 for more remote locations compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time.The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment.

  13. Cost-effectiveness analysis of a voucher scheme combined with obstetrical quality improvements: quasi experimental results from Uganda.

    Science.gov (United States)

    Alfonso, Y Natalia; Bishai, David; Bua, John; Mutebi, Aloysius; Mayora, Crispus; Ekirapa-Kiracho, Elizabeth

    2015-02-01

    The maternal mortality ratio (MMR) in Uganda has declined significantly during the last 20 years, but Uganda is not on track to reach the millennium development goal of reducing MMR by 75% by 2015. More evidence on the cost-effectiveness of supply- and demand-side financing programs to reduce maternal mortality could inform future strategies. This study analyses the cost-effectiveness of a voucher scheme (VS) combined with health system strengthening in rural Uganda against the status quo. The VS, implemented in 2010, provided vouchers for delivery services at public and private health facilities (HF), as well as round-trip transportation provided by private sector workers (bicycles or motorcycles generally). The VS was part of a quasi-experimental non-randomized control trial. Improvements in institutional delivery coverage (IDC) rates can be estimated using a difference-in-difference impact evaluation method and the number of maternal lives saved is modelled using the evidence-based Lives Saved Tool. Costs were estimated from primary and secondary data. Results show that the demand for births at HFs enrolled in the VS increased by 52.3 percentage points. Out of this value, conservative estimates indicate that at least 9.4 percentage points are new HF users. This 9.4% bump in IDC implies 20 deaths averted, which is equivalent to 1356 disability-adjusted-life years (DALYs) averted. Cost-effectiveness analysis comparing the status quo and VS's most conservative effectiveness estimates shows that the VS had an incremental cost-effectiveness ratio per DALY averted of US$302 and per death averted of US$20 756. Although there are limitations in the data measures, a favourable cost-effectiveness ratio persists even under extreme assumptions. Demand-side vouchers combined with supply-side financing programs can increase attended deliveries and reduce maternal mortality at a cost that is acceptable. Published by Oxford University Press in association with The London School

  14. IMPROVING ENERGY EFFICIENCY AND REDUCING COSTS IN THE DRINKING WATER SUPPLY INDUSTRY: An ENERGY STAR Resource Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Melody, Moya; Dunham Whitehead, Camilla; Brown, Richard

    2010-09-30

    As American drinking water agencies face higher production costs, demand, and energy prices, they seek opportunities to reduce costs without negatively affecting the quality of the water they deliver. This guide describes resources for cost-effectively improving the energy efficiency of U.S. public drinking water facilities. The guide (1) describes areas of opportunity for improving energy efficiency in drinking water facilities; (2) provides detailed descriptions of resources to consult for each area of opportunity; (3) offers supplementary suggestions and information for the area; and (4) presents illustrative case studies, including analysis of cost-effectiveness.

  15. Best practices: improving patient outcomes and costs in an ACO through comprehensive medication therapy management.

    Science.gov (United States)

    Brummel, Amanda; Lustig, Adam; Westrich, Kimberly; Evans, Michael A; Plank, Gary S; Penso, Jerry; Dubois, Robert W

    2014-12-01

    2007 data found that the percentage of diabetes patients optimally managed (as measured by a composite of hemoglobin A1c, low-density lipoprotein, blood pressure, aspirin use, and no smoking) was significantly higher for MTM patients (21% vs. 45%, P manage and optimize pharmaceuticals will be a cornerstone to managing the health of a population. Important lessons have been learned that may be helpful to other health systems developing MTM programs. In an accountable care environment measuring the return on the investment of all care interventions, including MTM will be essential to maintain the program. The ACO will also have to be able to correctly identify which patients are candidates for MTM services and provide pharmacists with enough autonomy, including scheduling face-to-face interactions with patients and the ability to change prescriptions if necessary, to ensure that timely and effective care is delivered. In order for an ACO to deliver high quality patient-centered medication services, there must be clear lines of communication between providers, pharmacists, and the other care providers within the organization. Finally, a strong and visionary leader is critical to ensuring the success of an MTM program and ultimately the ACO itself. While there is a plethora of literature touting the benefits of either in-person or telephonic-based MTM, there is little research to date that directly compares these 2 MTM delivery types. It is critical for research to address the direct and indirect costs associated with starting and maintaining an MTM program. Information such as technologies required to start a program and length of time until a program breaks even or meets a sufficient ROI can be helpful for health care providers in similar health systems pitching a similar type of program. Finally, there has yet to be significant empirical research into the cost savings of utilizing a pharmacist and MTM services associated with meeting quality and cost benchmarks in an

  16. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet.

    Science.gov (United States)

    Assad, M; Elliott, M J; Abraham, J H

    2016-03-01

    Human milk is the best form of nutrition for preterm infants and has been associated with a lower incidence of necrotizing enterocolitis (NEC). Infants that develop NEC have a higher incidence of feeding intolerance and longer hospitalizations. The combination of a donor milk bank and donor milk-derived fortifier has changed feeding practices in neonatal intensive care units (NICU). The purpose of this study is to assess the benefits and cost of an exclusive human milk (EHM) diet in very low birth weight (VLBW) infants in a community level III NICU. This is a retrospective study including preterm infants ⩽28 weeks and/or VLBW (⩽1500 g) who were enrolled from March 2009 until March 2014. Infants were grouped as follows: group H (entirely human milk based, born March 2012 to 2014), group B (bovine-based fortifier and maternal milk, born March 2009 to 2012), group M (mixed combination of maternal milk, bovine-based fortifier and formula, born March 2009 to 2012) and group F (formula fed infants, born March 2009 to 2012). Baseline characteristics among the four groups were similar. The study included 293 infants between gestational ages 23 to 34 weeks and birth weights between 490 and 1700 g. Feeding intolerance occurred less often (P<0.0001), number of days to full feeds was lower (P<0.001), incidence of NEC was lower (P<0.011), and total hospitalization costs were lower by up to $106,968 per infant (P<0.004) in those fed an EHM diet compared with the other groups. Average weight gain per day was similar among the four groups (18.5 to 20.6 g per day). Implementing an EHM diet in our VLBW infants has led to a significant decrease in the incidence of NEC. Other benefits of this diet include: decreased feeding intolerance, shorter time to full feeds, shorter length of stay, and lower hospital and physician charges for extremely premature and VLBW infants.

  17. Using cost-benefit concepts in design floods improves communication of uncertainty

    Science.gov (United States)

    Ganora, Daniele; Botto, Anna; Laio, Francesco; Claps, Pierluigi

    2017-04-01

    Flood frequency analysis, i.e. the study of the relationships between the magnitude and the rarity of high flows in a river, is the usual procedure adopted to assess flood hazard, preliminary to the plan/design of flood protection measures. It grounds on the fit of a probability distribution to the peak discharge values recorded in gauging stations and the final estimates over a region are thus affected by uncertainty, due to the limited sample availability and of the possible alternatives in terms of the probabilistic model and the parameter estimation methods used. In the last decade, the scientific community dealt with this issue by developing a number of methods to quantify such uncertainty components. Usually, uncertainty is visually represented through confidence bands, which are easy to understand, but are not yet demonstrated to be useful for design purposes: they usually disorient decision makers, as the design flood is no longer univocally defined, making the decision process undetermined. These considerations motivated the development of the uncertainty-compliant design flood estimator (UNCODE) procedure (Botto et al., 2014) that allows one to select meaningful flood design values accounting for the associated uncertainty by considering additional constraints based on cost-benefit criteria. This method suggests an explicit multiplication factor that corrects the traditional (without uncertainty) design flood estimates to incorporate the effects of uncertainty in the estimate at the same safety level. Even though the UNCODE method was developed for design purposes, it can represent a powerful and robust tool to help clarifying the effects of the uncertainty in statistical estimation. As the process produces increased design flood estimates, this outcome demonstrates how uncertainty leads to more expensive flood protection measures, or insufficiency of current defenses. Moreover, the UNCODE approach can be used to assess the "value" of data, as the costs

  18. VA Construction: Improved Processes Needed to Monitor Contract Modifications, Develop Schedules, and Estimate Costs

    Science.gov (United States)

    2017-03-01

    Steps Intended to Address Administration and Oversight Challenges of Medical -Facility Construction Projects 8 Improvements Managing Change Orders and...included a provision requiring us to report on VA’s oversight and administration of the design and construction of major medical -facility projects...Affairs, and Related Agencies to meet our mandated reporting date. This report assesses VA’s administration and oversight of the medical facility

  19. Improved InGaN LED System Efficacy and Cost via Droop Reduction

    Energy Technology Data Exchange (ETDEWEB)

    Wildeson, Isaac; Armitage, Robert

    2017-11-29

    Efficiency droop is a non-thermal process intrinsic to indium gallium nitride light emitting diodes (LEDs) in which the external quantum efficiency (EQE) decreases with increasing drive current density. Mitigating droop would allow one to reduce the size of LEDs driven at a given current or to drive LEDs of given size at higher current while maintaining high efficiencies. In other words, droop mitigation can lead to significant gains in light output per dollar and/or light output per watt of input power. This project set an EQE improvement goal at high drive current density which was to be attained by improving the LED active region design and growth process following a droop mitigation strategy. The interactions between LED active region design parameters and efficiency droop were studied by modeling and experiments. The crystal defects that tend to form in more complex LED designs intended to mitigate droop were studied with advanced characterization methods that provided insight into the structural and electronic properties of the material. This insight was applied to improve the epitaxy process both in terms of active region design and optimization of growth parameters. The final project goals were achieved on schedule and an epitaxy process leading to LEDs with EQE exceeding the project target was demonstrated.

  20. Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management.

    Science.gov (United States)

    Brummel, Amanda; Lustig, Adam; Westrich, Kimberly; Evans, Michael A; Plank, Gary S; Penso, Jerry; Dubois, Robert W

    2014-12-01

    2007 data found that the percentage of diabetes patients optimally managed (as measured by a composite of hemoglobin A1c, low-density lipoprotein, blood pressure, aspirin use, and no smoking) was significantly higher for MTM patients (21% vs. 45%, P  less than  0.01). The Fairview MTM also showed a 12:1 return on investment (ROI) when comparing the overall health care costs of patients receiving MTM services with patients who did not receive those services.  Developing an MTM program to manage and optimize pharmaceuticals will be a cornerstone to managing the health of a population. Important lessons have been learned that may be helpful to other health systems developing MTM programs. In an accountable care environment measuring the return on the investment of all care interventions, including MTM will be essential to maintain the program. The ACO will also have to be able to correctly identify which patients are candidates for MTM services and provide pharmacists with enough autonomy, including scheduling face-to-face interactions with patients and the ability to change prescriptions if necessary, to ensure that timely and effective care is delivered. In order for an ACO to deliver high quality patient-centered medication services, there must be clear lines of communication between providers, pharmacists, and the other care providers within the organization. Finally, a strong and visionary leader is critical to ensuring the success of an MTM program and ultimately the ACO itself. While there is a plethora of literature touting the benefits of either in-person or telephonic-based MTM, there is little research to date that directly compares these 2 MTM delivery types. It is critical for research to address the direct and indirect costs associated with starting and maintaining an MTM program. Information such as technologies required to start a program and length of time until a program breaks even or meets a sufficient ROI can be helpful for health care providers

  1. Leveraging Cloud Computing to Improve Storage Durability, Availability, and Cost for MER Maestro

    Science.gov (United States)

    Chang, George W.; Powell, Mark W.; Callas, John L.; Torres, Recaredo J.; Shams, Khawaja S.

    2012-01-01

    The Maestro for MER (Mars Exploration Rover) software is the premiere operation and activity planning software for the Mars rovers, and it is required to deliver all of the processed image products to scientists on demand. These data span multiple storage arrays sized at 2 TB, and a backup scheme ensures data is not lost. In a catastrophe, these data would currently recover at 20 GB/hour, taking several days for a restoration. A seamless solution provides access to highly durable, highly available, scalable, and cost-effective storage capabilities. This approach also employs a novel technique that enables storage of the majority of data on the cloud and some data locally. This feature is used to store the most recent data locally in order to guarantee utmost reliability in case of an outage or disconnect from the Internet. This also obviates any changes to the software that generates the most recent data set as it still has the same interface to the file system as it did before updates

  2. Abbreviated epitaxial growth mode (AGM) method for reducing cost and improving quality of LEDs and lasers

    Science.gov (United States)

    Tansu, Nelson; Chan, Helen M; Vinci, Richard P; Ee, Yik-Khoon; Biser, Jeffrey

    2013-09-24

    The use of an abbreviated GaN growth mode on nano-patterned AGOG sapphire substrates, which utilizes a process of using 15 nm low temperature GaN buffer and bypassing etch-back and recovery processes during epitaxy, enables the growth of high-quality GaN template on nano-patterned AGOG sapphire. The GaN template grown on nano-patterned AGOG sapphire by employing abbreviated growth mode has two orders of magnitude lower threading dislocation density than that of conventional GaN template grown on planar sapphire. The use of abbreviated growth mode also leads to significant reduction in cost of the epitaxy. The growths and characteristics of InGaN quantum wells (QWs) light emitting diodes (LEDs) on both templates were compared. The InGaN QWs LEDs grown on the nano-patterned AGOG sapphire demonstrated at least a 24% enhancement of output power enhancement over that of LEDs grown on conventional GaN templates.

  3. A cost-effective alkaline multicrystalline silicon surface polishing solution with improved smoothness

    Energy Technology Data Exchange (ETDEWEB)

    Basu, P.K.; Thakur, D.K. [Department of Electronics and Communication Engineering, Lingaya' s University, Nachauli, Faridabad 121003, Haryana (India); Dhasmana, H. [Department of Applied Science and Humanities, Lingaya' s University, Nachauli, Faridabad 121003, Haryana (India); Center of Energy Studies, Indian Institute of Technology, Delhi, Hauz Khas, New Delhi 110016 (India); Varandani, D.; Mehta, B.R. [Department of Physics, Indian Institute of Technology, Delhi, Hauz Khas, New Delhi 110016 (India)

    2009-10-15

    In the present paper, intragain surface morphology of multicrystalline silicon (mC-Si) wafer surface of area 3 {mu}m x 3 {mu}m polished by the acid-based solution comprising of hydrofluoric (HF), nitric (HNO{sub 3}) and acetic (CH{sub 3}COOH) acids and new alkaline solution containing sodium hydroxide (NaOH) and sodium hypochlorite (NaOCl) has been studied using an atomic force microscope (AFM). From the roughness and section analysis study of the intergrain surface by the AFM, it is revealed that the NaOH-NaOCl polishing process is quite superior to the existing acid polishing one. Quantitative measurements indicate better smoothness of polished silicon surface after the NaOH-NaOCl treatment as compared with acid polishing. Also process cost per wafer involved in the NaOH-NaOCl polishing process is far lower than that by the acid polishing process along with additional advantageous features of high productivity, environment friendliness and safety. All these factors finally contribute to make the NaOH-NaOCl solution a better polisher for mC-Si surface. (author)

  4. Statin Pharmacogenomics: Opportunities to Improve Patient Outcomes and Healthcare Costs with Genetic Testing

    Directory of Open Access Journals (Sweden)

    William J. Canestaro

    2012-10-01

    Full Text Available HMG-CoA reductase inhibitors, commonly known as statins, are some of the most widely prescribed medications worldwide and have been shown to be effective at lowering cholesterol in numerous long-term prospective trials, yet there are significant limitations to their use. First, patients receiving statin therapy have relatively low levels of medication adherence compared with other drug classes. Next, numerous statin formulations are available, each with its own unique safety and efficacy profile, and it may be unclear to prescribers which treatment is optimal for their patients. Finally, statins have class-wide side effects of myopathy and rhabdomyolysis that have resulted in a product recall and dosage limitations. Recent evidence suggests that two genomic markers, KIF6 and SLCO1B1, may inform the therapy choice of patients initiating statins. Given the prevalence of statin usage, their potential health advantages and their overall cost to the healthcare system, there could be significant clinical benefit from creating personalized treatment regimens. Ultimately, if this approach is effective it may encourage higher adoption of generic statins when appropriate, promote adherence, lower rates of myopathy, and overall achieve higher value cardiovascular care. This paper will review the evidence for personalized prescribing of statins via KIF6 and SLCO1B1 and consider some of the implications for testing these markers as part of routine clinical care.

  5. Dancing bees improve colony foraging success as long-term benefits outweigh short-term costs.

    Directory of Open Access Journals (Sweden)

    Roger Schürch

    Full Text Available Waggle dancing bees provide nestmates with spatial information about high quality resources. Surprisingly, attempts to quantify the benefits of this encoded spatial information have failed to find positive effects on colony foraging success under many ecological circumstances. Experimental designs have often involved measuring the foraging success of colonies that were repeatedly switched between oriented dances versus disoriented dances (i.e. communicating vectors versus not communicating vectors. However, if recruited bees continue to visit profitable food sources for more than one day, this procedure would lead to confounded results because of the long-term effects of successful recruitment events. Using agent-based simulations, we found that spatial information was beneficial in almost all ecological situations. Contrary to common belief, the benefits of recruitment increased with environmental stability because benefits can accumulate over time to outweigh the short-term costs of recruitment. Furthermore, we found that in simulations mimicking previous experiments, the benefits of communication were considerably underestimated (at low food density or not detected at all (at medium and high densities. Our results suggest that the benefits of waggle dance communication are currently underestimated and that different experimental designs, which account for potential long-term benefits, are needed to measure empirically how spatial information affects colony foraging success.

  6. Dancing bees improve colony foraging success as long-term benefits outweigh short-term costs.

    Science.gov (United States)

    Schürch, Roger; Grüter, Christoph

    2014-01-01

    Waggle dancing bees provide nestmates with spatial information about high quality resources. Surprisingly, attempts to quantify the benefits of this encoded spatial information have failed to find positive effects on colony foraging success under many ecological circumstances. Experimental designs have often involved measuring the foraging success of colonies that were repeatedly switched between oriented dances versus disoriented dances (i.e. communicating vectors versus not communicating vectors). However, if recruited bees continue to visit profitable food sources for more than one day, this procedure would lead to confounded results because of the long-term effects of successful recruitment events. Using agent-based simulations, we found that spatial information was beneficial in almost all ecological situations. Contrary to common belief, the benefits of recruitment increased with environmental stability because benefits can accumulate over time to outweigh the short-term costs of recruitment. Furthermore, we found that in simulations mimicking previous experiments, the benefits of communication were considerably underestimated (at low food density) or not detected at all (at medium and high densities). Our results suggest that the benefits of waggle dance communication are currently underestimated and that different experimental designs, which account for potential long-term benefits, are needed to measure empirically how spatial information affects colony foraging success.

  7. Latest improvements in microbolometer thin film packaging: paving the way for low-cost consumer applications

    Science.gov (United States)

    Yon, J. J.; Dumont, G.; Goudon, V.; Becker, S.; Arnaud, A.; Cortial, S.; Tisse, C. L.

    2014-06-01

    Silicon-based vacuum packaging is a key enabling technology for achieving affordable uncooled Infrared Focal Plane Arrays (IRFPA) required by a promising mass market that shows momentum for some extensive consumer applications, such as automotive driving assistance, smart presence localization and building management. Among the various approaches studied worldwide, CEA, LETI in partnership with ULIS is committed to the development of a unique technology referred to as PLP (Pixel Level Packaging). In this PLP technology, each bolometer pixel is sealed under vacuum using a transparent thin film deposition on wafer. PLP operates as an array of hermetic micro caps above the focal plane, each enclosing a single microbolometer. In continuation of our on-going studies on PLP for regular QVGA IRFPAs, this paper emphasizes on the innate scalability of the technology which was successfully demonstrated through the development of an 80 × 80 pixel IRFPA. The relevance of the technology with regard to the two formats is discussed, considering both performance and cost issues. We show that the suboptimal fill factor inherent to the PLP arrangement is not so critical when considering smaller arrays preferably fitted for consumer applications. The discussion is supported with the electro-optical performance measurements of the PLP-based 80×80 demonstrator.

  8. Improving Gas Sensing Properties of Tin Oxide Nanowires Palladium-Coated Using a Low Cost Technique

    Directory of Open Access Journals (Sweden)

    M. Barzegar

    2012-12-01

    Full Text Available Thin films of SnO2 nanowires were successfully prepared by using chemical vapor deposition (CVD process on quartz substrates. Afterwards, a thin  layer of palladium (Pd as a catalyst was coated on top of nanowires. For the deposition of Pd, a simple and low cost technique of spray pyrolysis was employed, which caused an intensive enhancement on the sensing response of fabricated sensors. Prepared sensor devices were exposed to liquid petroleum gas (LPG and vapor of ethanol (C2H5OH. Results indicate that SnO2 nanowires sensors coated with Pd as a catalyst show decreasing in response time (~40s to 1000ppm of LPG at a relatively low operating temperature (200o C. SnO2 /Pd nanowire devices show gas sensing response time and recovery time as short as 50s and 10s respectively with a high sensitivity value of ~120 for C2H5OH, that is remarkable in comparison with other reports.

  9. The Medicare Cost Report and the limits of hospital accountability: improving financial accounting data.

    Science.gov (United States)

    Kane, N M; Magnus, S A

    2001-02-01

    Health policy makers, legislators, providers, payers, and a broad range of other players in the health care market routinely seek information on hospital financial performance. Yet the data at their disposal are limited, especially since hospitals' audited financial statements--the "gold standard" in hospital financial reporting--are not publicly available in many states. As a result, the Medicare Cost Report (MCR), filed annually by most U.S. hospitals in order to receive payment for treating Medicare patients, has become the primary public source of hospital financial information. However, financial accounting elements in the MCR are unreliable, poorly defined, and lacking in critical detail. Comparative analyses of MCRs and matched, audited financial statements reveal long-standing problems with the MCR's data, including major differences in reported profits; variations in the reporting of both revenues and expenses; an absence of relevant details, such as charity care, bad debt, operating versus nonoperating income, and affiliate transactions; an inconsistent classification of changes in net assets; and a failure to provide cash flow statements. Because of these problems, MCR financial data give only a limited and often inaccurate picture of the financial position of hospitals. Audited financial statements provide a more complete perspective, enabling analysts to address important questions left unanswered by the MCR data. Regulatory action is needed to create a national database of financial information based upon audited statements.

  10. Improvement of Photorhabdus temperata bioinsecticides production in low-cost media through adequate fermentation technology.

    Science.gov (United States)

    Jallouli, Wafa; Jaoua, Samir; Zouari, Nabil

    2012-01-01

    To develop a cost effective process for bioinsecticides production by Photorhabdus temperata, dissolved oxygen (DO) requirements were investigated in both the complex and the optimized media using diluted seawater as a source of micronutrients. By varying DO concentrations, tolerance to hydrogen peroxide was shown to be medium dependant. Indeed, P. temperata cells grown in the complex medium, exhibited higher tolerance than cells grown in the optimized medium (OM). Tolerance to H(2)O(2) was shown to be related to intracellular reactive oxygen species (ROS) accumulation during soya bean meal or glucose assimilation, as shown by flow cytometry analysis. To avoid oxidative stress damages in P. temperata cells cultured in the OM, DO concentration should be constant 50% saturation throughout the fermentation. However, a DO-shift control strategy was demonstrated to be beneficial for P. temperata bioinsecticide production in the complex medium. By using such a strategy biomass, culturability, and oral toxicity reached 16.5 × 10(8), 1.15 × 10(8) cells/mL and 64.2%, respectively, thus was 16.19, 26.37, and 12.2% more than in the cultures carried out at a constant 50% saturation. Copyright © 2012 American Institute of Chemical Engineers (AIChE).

  11. Why is it so difficult to prove that rapid response systems improve patient outcome? : Directions for further research

    NARCIS (Netherlands)

    H.G. van der Hoeven; Joke Mintjes; Lisette Schoonhoven; Friede Simmes; B.G. Fikkers

    2012-01-01

    The implementation of rapid response systems (RRS) is based on the knowledge that deteriorating physiological processes are frequently present for hours or days before clear clinical deterioration is recognized [1,2]. It is assumed that this physiological deterioration is often treatable and that

  12. Needle-free jet injection of rapid-acting insulin improves early postprandial glucose control in patients with diabetes

    NARCIS (Netherlands)

    Engwerda, E.E.; Tack, C.J.J.; Galan, B.E. de

    2013-01-01

    OBJECTIVE: Clamp studies have shown that the absorption and action of rapid-acting insulin are faster with injection by a jet injector than with administration by conventional pen. To determine whether these pharmacokinetic changes also exist in patients with diabetes and benefit postprandial

  13. Method for Cost-Benefit Analysis of Improved Indoor Climate Conditions and Reduced Energy Consumption in Office Buildings

    Directory of Open Access Journals (Sweden)

    Viktoras Dorosevas

    2013-09-01

    Full Text Available Indoor climate affects health and productivity of the occupants in office buildings, yet in many buildings of this type indoor climate conditions are not well-controlled due to insufficient heating or cooling capacity, high swings of external or internal heat loads, improper control or operation of heating, ventilation and air conditioning (HVAC equipment, etc. However, maintenance of good indoor environmental conditions in buildings requires increased investments and possible higher energy consumption. This paper focuses on the relation between investment costs for retrofitting HVAC equipment as well as decreased energy use and improved performance of occupants in office buildings. The cost-benefit analysis implementation algorithm is presented in this paper, including energy survey of the building, estimation of occupants dissatisfied by key indoor climate indicators using questionnaire survey and measurements. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS analysis is used in the proposed method for data processing. A case study of an office building is presented in order to introduce an application example of the proposed method. Results of the study verify the applicability of the proposed algorithm and TOPSIS analysis as a practical tool for office building surveys in order to maximize productivity by means of cost efficient technical building retrofitting solutions.

  14. Improving quality and decreasing cost in gynecologic oncology care. Society of gynecologic oncology recommendations for clinical practice.

    Science.gov (United States)

    Rimel, B J; Burke, William M; Higgins, Robert V; Lee, Paula S; Lutman, Christopher V; Parker, Lynn

    2015-05-01

    To identify potential cost savings in gynecologic oncology care without sacrificing quality. Members of the Clinical Practice Committee of the Society of Gynecologic Oncology were asked to review current practice patterns in gynecologic oncology and assess the potential for cost savings founded on evidence-based medicine and current guidelines. Five clinical practices were identified including the following: vaginal cytology for endometrial cancer survivors; colposcopy for low grade cytologic abnormalities for cervical cancer survivors; routine imaging studies for gynecologic cancer survivors; screening for ovarian cancer with serum biomarkers and ultrasound; and improving palliative care for gynecologic cancer patients. Review of the published literature and guidelines were performed to make evidence-based recommendations for cost effective quality gynecologic oncology care. • Do not perform Pap tests of the vaginal cuff in patients with a history of endometrial cancer. • Do not perform colposcopy for low grade Pap tests in women with a history of cervical cancer. • Avoid routine imaging for cancer surveillance in asymptomatic women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer. • Do not screen women at low risk for ovarian cancer with ultrasound or CA-125 or other biomarkers. • Do not delay basic level palliative care for women with advanced or relapsed gynecologic cancer, do refer to a palliative care specialist when needed, and avoid unnecessary treatments at life's end. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Modeled effects of an improved building insulation scenario in Europe on air pollution, health and societal costs

    DEFF Research Database (Denmark)

    Bønløkke, Jakob Hjort; Holst, Gitte Juel; Sigsgaard, Torben

    2015-01-01

    Background: In Europe a substantial share of the energy supply is used for domestic heating and cooling. The quality of building insulation thus significantly impacts air pollution. Objectives: To model the effects of an improved building insulation scenario in Europe on air pollution levels...... and the resulting effects on health and economy. Methods: Projected energy savings between 2005 and 2020 were calculated for an improved building insulation scenario and a business as usual scenario. The resulting changes in emissions (e.g. from power plants) were used in the Comprehensive Air-Quality Model...... with extensions. Mean annual changes in the main air pollutants were derived for each country. World Health Organization (WHO) and European Union (EU) data on populations and on impacts of pollutants were used to derive health effects and costs. Effects on indoor air quality were not assessed. Results: Projected...

  16. [QR-Code based patient tracking: a cost-effective option to improve patient safety].

    Science.gov (United States)

    Fischer, M; Rybitskiy, D; Strauß, G; Dietz, A; Dressler, C R

    2013-03-01

    Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs.

    Science.gov (United States)

    Cosgrove, Delos M; Fisher, Michael; Gabow, Patricia; Gottlieb, Gary; Halvorson, George C; James, Brent C; Kaplan, Gary S; Perlin, Jonathan B; Petzel, Robert; Steele, Glenn D; Toussaint, John S

    2013-02-01

    Patient-centeredness--the idea that care should be designed around patients' needs, preferences, circumstances, and well-being--is a central tenet of health care delivery. For CEOs of health care organizations, patient-centered care is also quickly becoming a business imperative, with payments tied to performance on measures of patient satisfaction and engagement. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. In this article we describe how implementation of these strategies benefits both health care organizations and patients. For example, Kaiser Permanente's Healthy Bones Program resulted in a 30 percent reduction in hip fracture rates for at-risk patients. And at Virginia Mason Health System in Seattle, nurses reorganized care patterns and increased the time they spent on direct patient care to 90 percent. Our experiences show that patient-engaged care can be delivered in ways that simultaneously improve quality and reduce costs.

  18. Heavy-metal contamination of soils in Saxony/Germany by foundry fumes and low-cost rapid analyses of contaminated soils by XRF

    Science.gov (United States)

    Mucke, D.

    2012-04-01

    Heavy-metal contamination of soils in Saxony/Germany by foundry fumes and low-cost rapid analysis of contaminated soils by XRF Dieter Mucke, Rolf Kumann, Sebastian Baldauf GEOMONTAN Gesellschaft für Geologie und Bergbau mbH&Co.KG, Muldentalstrasse 56, 09603 Rothenfurth, Saxony/Germany For hundreds of years in the Ore Mountains between Bohemia and Saxony silver and other ores are produced and smelted. Sulphide- and sulpharsenide-ores needed to be roasted first. In doing so the sulphide sulphur was oxidised under formation of sulphur dioxide SO2 and arsenide conversed into elemental arsenic and arsenide trioxide As2O3 respectively. Also the metals lead, cadmium and zinc are components of hut smokes, in the field of nickel foundries also nickel. The contents of soils basically reflect the geogenic conditions, which are caused by decomposition- and relocation-effects of the mineralisations, in the area of foundries also with influences by with the hut smokes anthropogenic mobilised elements. The Saxonian Agency for Environment and Geology drafted in 1992 a Soil Investigation Program with the aim of investigation of the contamination of Saxonian soils with arsenic and toxic heavy metals. In order of this Agency GEOMONTAN investigated 1164 measuring points in the grid 4 * 4 km.soil profiles and extracted soil samples for analysis. In the result of the laboratory examinations the Agency edited the "Soil atlas of the Free State of Saxony". 27 elements, pH and PAK are shown in detailed maps and allow in whole Saxony the first assessment of the contamination of soils with arsenic and toxic heavy metals. Each of the investigated soil profiles represent an area of 16 km2. Already by the different use of the districts (agricultural, industrial, urban) restricts representative values. GEOMONTAN in the meantime used at the exploration of a copper deposit in Brandenburg/Germany with approx. 50,000 single tests at drill cores a very fast low-cost method: the X Ray fluorescence

  19. Importance of Requirements Analysis & Traceability to Improve Software Quality and Reduce Cost and Risk

    Science.gov (United States)

    Kapoor, Manju M.; Mehta, Manju

    2010-01-01

    The goal of this paper is to emphasize the importance of developing complete and unambiguous requirements early in the project cycle (prior to Preliminary Design Phase). Having a complete set of requirements early in the project cycle allows sufficient time to generate a traceability matrix. Requirements traceability and analysis are the key elements in improving verification and validation process, and thus overall software quality. Traceability can be most beneficial when the system changes. If changes are made to high-level requirements it implies that low-level requirements need to be modified. Traceability ensures that requirements are appropriately and efficiently verified at various levels whereas analysis ensures that a rightly interpreted set of requirements is produced.

  20. Higher Quality and Lower Cost from Improving Hospital Discharge Decision Making*

    Science.gov (United States)

    Cox, James C.; Sadiraj, Vjollca; Schnier, Kurt E.; Sweeney, John F.

    2015-01-01

    This paper reports research on improving decisions about hospital discharges – decisions that are now made by physicians based on mainly subjective evaluations of patients’ discharge status. We report an experiment on uptake of our clinical decision support software (CDSS) which presents physicians with evidence-based discharge criteria that can be effectively utilized at the point of care where the discharge decision is made. One experimental treatment we report prompts physician attentiveness to the CDSS by replacing the default option of universal “opt in” to patient discharge with the alternative default option of “opt out” from the CDSS recommendations to discharge or not to discharge the patient on each day of hospital stay. We also report results from experimental treatments that implement the CDSS under varying conditions of time pressure on the subjects. The experiment was conducted using resident physicians and fourth-year medical students at a university medical school as subjects. PMID:28239219

  1. A Memetic Approach for Improving Minimum Cost of Economic Load Dispatch Problems

    Directory of Open Access Journals (Sweden)

    Jinho Kim

    2014-01-01

    Full Text Available Economic load dispatch problem is a popular optimization problem in electrical power system field, which has been so far tackled by various mathematical and metaheuristic approaches including Lagrangian relaxation, branch and bound method, genetic algorithm, tabu search, particle swarm optimization, harmony search, and Taguchi method. On top of these techniques, this study proposes a novel memetic algorithm scheme combining metaheuristic algorithm and gradient-based technique to find better solutions for an economic load dispatch problem with valve-point loading. Because metaheuristic algorithms have the strength in global search and gradient-based techniques have the strength in local search, the combination approach obtains better results than those of any single approach. A bench-mark example of 40 generating-unit economic load dispatch problem demonstrates that the memetic approach can further improve the existing best solutions from the literature.

  2. A Rapid and Efficient Sonogashira Protocol and Improved Synthesis of Free Fatty Acid 1 (FFA1) Receptor Agonists

    DEFF Research Database (Denmark)

    Christiansen, Elisabeth; Due-Hansen, Maria E; Ulven, Trond

    2010-01-01

    A protocol for rapid and efficient Pd/Cu-catalyzed coupling of aryl bromides and iodides to terminal alkynes has been developed with use of 2-(di-tert-butylphosphino)-N-phenylindole (cataCXium PIntB) as ligand in TMEDA and water. The new protocol successfully couples substrates which failed with ...... with standard Sonogashira conditions, and enables an efficient general synthetic route to free fatty acid 1 (FFA1) receptor ligands from 3-(4-bromophenyl)propionic acid....

  3. Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal

    OpenAIRE

    Doherty, Tanya; Besada, Donela; Rohde, Sarah; Goga, Ameena; Raphaely, Nika; Daviaud, Emmanuelle; Ramokolo, Vundli; Magasana, Vuyolwethu; Noveve, Nobuntu

    2016-01-01

    Background: The World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d’Ivoire in the conte...

  4. Towards Universal Screening for Toxoplasmosis: Rapid, Cost-effective and Simultaneous Detection of Toxoplasma Anti-IgG, IgM and IgA Antibodies Using Very Small Serum Volumes

    Science.gov (United States)

    No dataset associated with this publication.This dataset is associated with the following publication:Augustine, S. Towards Universal Screening for Toxoplasmosis: Rapid, Cost-effective and Simultaneous Detection of Toxoplasma Anti-IgG, IgM and IgA Antibodies Using Very Small Serum Volumes. JOURNAL OF CLINICAL MICROBIOLOGY. American Society for Microbiology, Washington, DC, USA, 56(7): 1-2, (2016).

  5. Improvement and Evaluation of Loop-Mediated Isothermal Amplification for Rapid Detection of Toxoplasma gondii Infection in Human Blood Samples.

    Directory of Open Access Journals (Sweden)

    Xi-Meng Sun

    Full Text Available Loop-mediated isothermal amplification (LAMP, an attractive DNA amplification method, was developed as a valuable tool for the rapid detection of Toxoplasma gondii. In this study, species-specific LAMP primers were designed by targeting the AF146527 sequence, which was a conserved sequence of 200- to 300-fold repetitive 529 bp fragment of T.gondii. LAMP reaction system was optimized so that it could detect the minimal DNA sample such as a single tachyzoite or 10 copies of recombinant plasmid. No cross-reactivity was found when using DNA from other parasites as templates. Subsequently, a total of 200 human blood samples were directly investigated by two diagnostic methods, LAMP and conventional PCR. Fourteen of 200 (7% samples were positive for Toxoplasma by LAMP (the primers developed in this study, whereas only 5 of 200 (2.5% were proved positive by conventional PCR. The procedure of the LAMP assay was very simple, as the reaction would be carried out in a single tube under isothermal conditions at 64°C and the result would be read out with 1 h (as early as 35 min with loop primers. Thus, this method has the advantages of rapid amplification, simple operation, and easy detection and would be useful for rapid and reliable clinical diagnosis of acute toxoplasmosis, especially in developing countries.

  6. Improved method for rapid and accurate isolation and identification of Streptococcus mutans and Streptococcus sobrinus from human plaque samples.

    Science.gov (United States)

    Villhauer, Alissa L; Lynch, David J; Drake, David R

    2017-08-01

    Mutans streptococci (MS), specifically Streptococcus mutans (SM) and Streptococcus sobrinus (SS), are bacterial species frequently targeted for investigation due to their role in the etiology of dental caries. Differentiation of S. mutans and S. sobrinus is an essential part of exploring the role of these organisms in disease progression and the impact of the presence of either/both on a subject's caries experience. Of vital importance to the study of these organisms is an identification protocol that allows us to distinguish between the two species in an easy, accurate, and timely manner. While conducting a 5-year birth cohort study in a Northern Plains American Indian tribe, the need for a more rapid procedure for isolating and identifying high volumes of MS was recognized. We report here on the development of an accurate and rapid method for MS identification. Accuracy, ease of use, and material and time requirements for morphological differentiation on selective agar, biochemical tests, and various combinations of PCR primers were compared. The final protocol included preliminary identification based on colony morphology followed by PCR confirmation of species identification using primers targeting regions of the glucosyltransferase (gtf) genes of SM and SS. This method of isolation and identification was found to be highly accurate, more rapid than the previous methodology used, and easily learned. It resulted in more efficient use of both time and material resources. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Using an aqueous two-phase polymer-salt system to rapidly concentrate viruses for improving the detection limit of the lateral-flow immunoassay.

    Science.gov (United States)

    Jue, Erik; Yamanishi, Cameron D; Chiu, Ricky Y T; Wu, Benjamin M; Kamei, Daniel T

    2014-12-01

    The development of point-of-need (PON) diagnostics for viruses has the potential to prevent pandemics and protects against biological warfare threats. Here we discuss the approach of using aqueous two-phase systems (ATPSs) to concentrate biomolecules prior to the lateral-flow immunoassay (LFA) for improved viral detection. In this paper, we developed a rapid PON detection assay as an extension to our previous proof-of-concept studies which used a micellar ATPS. We present our investigation of a more rapid polymer-salt ATPS that can drastically improve the assay time, and show that the phase containing the concentrated biomolecule can be extracted prior to macroscopic phase separation equilibrium without affecting the measured biomolecule concentration in that phase. We could therefore significantly decrease the time of the diagnostic assay with an early extraction time of just 30 min. Using this rapid ATPS, the model virus bacteriophage M13 was concentrated between approximately 2 and 10-fold by altering the volume ratio between the two phases. As the extracted virus-rich phase contained a high salt concentration which destabilized the colloidal gold indicator used in LFA, we decorated the gold nanoprobes with polyethylene glycol (PEG) to provide steric stabilization, and used these nanoprobes to demonstrate a 10-fold improvement in the LFA detection limit. Lastly, a MATLAB script was used to quantify the LFA results with and without the pre-concentration step. This approach of combining a rapid ATPS with LFA has great potential for PON applications, especially as greater concentration-fold improvements can be achieved by further varying the volume ratio. Biotechnol. Bioeng. 2014;111: 2499-2507. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  8. Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.

    Science.gov (United States)

    Theodore, Brian R; Whittington, Jan; Towle, Cara; Tauben, David J; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z

    2015-06-01

    With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. Wiley Periodicals, Inc.

  9. Cost-effectiveness of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: A cluster randomised trial

    NARCIS (Netherlands)

    Brink-Huis, A.M.; Hulscher, M.E.J.L.; Adang, E.M.; Grol, R.P.; Achterberg, T. van; Schoonhoven, L.

    2013-01-01

    BACKGROUND: Many strategies have been designed and evaluated to address poor hand hygiene compliance. Unfortunately, well-designed economic evaluations of hand hygiene improvement strategies are lacking. OBJECTIVE: To compare the cost-effectiveness of two successful implementation strategies for

  10. Improving accessibility and mobility in the Masia traditional council area in Vhembe district municipality, Limpopo: Application of low-cost access and mobility technologies

    CSIR Research Space (South Africa)

    Nhemachena, C

    2011-07-01

    Full Text Available This study focused on the potential application of low-cost, integrated mobility and access technology interventions as key elements for improving socio-economic conditions and spatial livelihoods in rural areas. A feasibility was conducted...

  11. An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience.

    Science.gov (United States)

    Byrn, John C; Hrabe, Jennifer E; Charlton, Mary E

    2014-11-01

    Data are limited about the robotic platform in rectal dissections, and its use may be perceived as prohibitively expensive or difficult to learn. We report our experience with the initial robotic-assisted rectal dissections performed by a single surgeon, assessing learning curve and cost. Following IRB approval, a retrospective chart review was conducted of the first 85 robotic-assisted rectal dissections performed by a single surgeon between 9/1/2010 and 12/31/2012. Patient demographic, clinicopathologic, procedure, and outcome data were gathered. Cost data were obtained from the University HealthSystem Consortium (UHC) database. The first 43 cases (Time 1) were compared to the next 42 cases (Time 2) using multivariate linear and logistic regression models. Indications for surgery were cancer for 51 patients (60 %), inflammatory bowel disease for 18 (21 %), and rectal prolapse for 16 (19 %). The most common procedures were low anterior resection (n = 25, 29 %) and abdominoperineal resection (n = 21, 25 %). The patient body mass index (BMI) was statistically different between the two patient groups (Time 1, 26.1 kg/m(2) vs. Time 2, 29.4 kg/m(2), p = 0.02). Complication and conversion rates did not differ between the groups. Mean operating time was significantly shorter for Time 2 (267 min vs. 224 min, p = 0.049) and remained significant in multivariate analysis. Though not reaching statistical significance, the mean observed direct hospital cost decreased ($17,349 for Time 1 vs. $13,680 for Time 2, p = 0.2). The observed/expected cost ratio significantly decreased (1.47 for Time 1 vs. 1.05 for Time 2, p = 0.007) but did not remain statistically significant in multivariate analyses. Over the series, we demonstrated a significant improvement in operating times. Though not statistically significant, direct hospital costs trended down over time. Studies of larger patient groups are needed to confirm these findings and to correlate them with procedure volume to better

  12. Empirical evidence of the continuing improvement in cost efficiency of an endoscopic surveillance programme for gastric cancer in Singapore from 2004 to 2010.

    Science.gov (United States)

    Zhou, Hui Jun; Li, Shu Chuen; Naidoo, Nasheen; Zhu, Feng; Yeoh, Khay Guan

    2013-04-15

    Endoscopic surveillance has been proven effective in prolonging the survival of gastric cancer (GC) patients. However, there is limited evidence on the cost efficiency of delivering this intervention, especially on a national level in spite of cost efficiency being a major determinant of the actual cost-effectiveness of a cancer prevention programme. The Singapore Gastric Cancer Epidemiology Clinical and Genetic Programme (GCEP) is a demonstration project offering scheduled endoscopy to the Chinese population aged 50 years or older in Singapore. By assessing the cost efficiency of the GCEP, this study aimed to provide empirical evidence on the cost structure and mechanisms underlying cost generation in conducting GC surveillance, thus informing resource allocation and programme budgeting for the Singapore government. From a societal perspective, we reported on the direct cost (resource consumption) of conducting endoscopic surveillance through the GCEP network. We retrospectively collected individual-level data of 216 subjects recruited at the National University Hospital, Singapore from 01/04/2004 to 31/10/2010. The Overall Cost, Clinical Cost, GCEP Cost and Personal Cost incurred in serving one subject was computed and discounted as 2004 US dollar (US$) per capita for every year. The Generalized Estimation Equation (GEE) was used to model the data. All cost indices continuously declined over the 6.5-year costing period. For the total sample, Overall Cost, Clinical Cost, GCEP Cost and Personal Cost declined by 42.3%, 54.1%, 30% and 25.7% respectively. This downward trend existed for age and gender subgroups and the high risk group only with cost reductions varying between 3.5% and 58.4%. The GEE models confirmed statistical significance of the downward trend and of its association with risk profile, where the moderate risk group had cost indices at most 77% of the high risk group. Our study offered empirical evidence of improved cost efficiency of a surveillance

  13. Rapid Quantitative Chiral Amphetamines Liquid Chromatography-Tandem Mass Spectrometry Method in Plasma and Oral Fluid with a Cost-effective Chiral Derivatizing Reagent

    Science.gov (United States)

    Newmeyer, Matthew N.; Concheiro, Marta; Huestis, Marilyn A.

    2014-01-01

    Methamphetamine is a widely abused psychostimulant containing a chiral center. Consumption of over-the-counter and prescription medications may yield positive amphetamines results, but chiral separation of l- and d- methamphetamine and its metabolite amphetamine can help determine whether the source was licit or illicit. We present the first LC-MS/MS method with precolumn derivatization for methamphetamine and amphetamine chiral resolution in plasma and oral fluid collected with the Oral-Eze® and Quantisal™ devices. To 0.5 mL plasma, 0.75 mL Oral-Eze, or 1 mL Quantisal specimen racemic d11-methamphetamine and amphetamine internal standards were added, followed by protein precipitation. Samples were centrifuged and supernatants loaded onto pre-conditioned Phenomenex® Strata™-XC Polymeric Strong Cation solid phase extraction columns. After washing, analytes were eluted with 5% ammonium hydroxide in methanol. The eluate was evaporated to dryness and reconstituted in water. Derivatization was performed with 1-fluoro-2,4-dinitrophenyl-5-l-alanineamide (Marfey's reagent) and heating at 45°C for 1 h. Derivatized enantiomer separations were performed under isocratic conditions (methanol:water, 60:40) with a Phenomenex® Kinetex® 2.6 μm C18 column. Analytes were identified and quantified by two MRM transitions and their ratio on a 3200 QTrap (AB Sciex) mass spectrometer in ESI negative mode. In all three matrices, the method was linear for all enantiomers from 1-500 μg/L, with imprecision and accuracy of ≤11.3% and 85.3-108%, respectively. Extraction efficiencies ranged from 67.4-117% and matrix effects from -17.0-468%, with variation always ≤19.1%. Authentic plasma and OF specimens were collected from an IRB-approved study that included controlled Vicks® VapoInhaler™ administration. The present method is sensitive, selective, economic and rapid (separations accomplished in <10 min), and improves methamphetamine result interpretation. PMID:25065924

  14. Rapid quantitative chiral amphetamines liquid chromatography-tandem mass spectrometry: method in plasma and oral fluid with a cost-effective chiral derivatizing reagent.

    Science.gov (United States)

    Newmeyer, Matthew N; Concheiro, Marta; Huestis, Marilyn A

    2014-09-05

    Methamphetamine is a widely abused psychostimulant containing a chiral center. Consumption of over-the-counter and prescription medications may yield positive amphetamines results, but chiral separation of l- and d-methamphetamine and its metabolite amphetamine can help determine whether the source was licit or illicit. We present the first LC-MS/MS method with precolumn derivatization for methamphetamine and amphetamine chiral resolution in plasma and oral fluid collected with the Oral-Eze(®) and Quantisal™ devices. To 0.5mL plasma, 0.75mL Oral-Eze, or 1mL Quantisal specimen racemic d11-methamphetamine and amphetamine internal standards were added, followed by protein precipitation. Samples were centrifuged and supernatants loaded onto pre-conditioned Phenomenex(®) Strata™-XC Polymeric Strong Cation solid phase extraction columns. After washing, analytes were eluted with 5% ammonium hydroxide in methanol. The eluate was evaporated to dryness and reconstituted in water. Derivatization was performed with 1-fluoro-2,4-dinitrophenyl-5-l-alanineamide (Marfey's reagent) and heating at 45°C for 1h. Derivatized enantiomer separations were performed under isocratic conditions (methanol:water, 60:40) with a Phenomenex(®) Kinetex(®) 2.6μm C18 column. Analytes were identified and quantified by two MRM transitions and their ratio on a 3200 QTrap (AB Sciex) mass spectrometer in ESI negative mode. In all three matrices, the method was linear for all enantiomers from 1 to 500μg/L, with imprecision and accuracy of ≤11.3% and 85.3-108%, respectively. Extraction efficiencies ranged from 67.4 to 117% and matrix effects from -17.0 to 468%, with variation always ≤19.1%. Authentic plasma and OF specimens were collected from an IRB-approved study that included controlled Vicks(®) VapoInhaler™ administration. The present method is sensitive, selective, economic and rapid (separations accomplished in <10min), and improves methamphetamine result interpretation. Published

  15. Rapid Operational Access and Maneuver Support (ROAMS) Platform for Improved Military Logistics Lines of Communication and Operational Vessel Routing

    Science.gov (United States)

    2017-06-01

    Platform for Improved Military Logistics Lines of Communication and Operational Vessel Routing by Drew Loney, Kimberly Pevey, Jennifer McAlpin...provides improved knowledge of potential lines of communication and vessel routes through hydrodynamic modeling and path optimization under a variety of...classified into two types of activities: logistics and operational. Logistics activities are concerned with the establishment of lines of communication

  16. Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

    Science.gov (United States)

    Gomez, Gabriela B; Foster, Nicola; Brals, Daniella; Nelissen, Heleen E; Bolarinwa, Oladimeji A; Hendriks, Marleen E; Boers, Alexander C; van Eck, Diederik; Rosendaal, Nicole; Adenusi, Peju; Agbede, Kayode; Akande, Tanimola M; Boele van Hensbroek, Michael; Wit, Ferdinand W; Hankins, Catherine A; Schultsz, Constance

    2015-01-01

    While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI) in rural Nigeria. We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER) of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA) based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program's scale up within the State's healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted) is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730). Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible interval 21

  17. Paediatric palliative care improves patient outcomes and reduces healthcare costs: evaluation of a home-based program.

    Science.gov (United States)

    Chong, P H; De Castro Molina, J A; Teo, K; Tan, W S

    2018-01-03

    Around the world, different models of paediatric palliative care have responded to the unique needs of children with life shortening conditions. However, research confirming their utility and impact is still lacking. This study compared patient-related outcomes and healthcare expenditures between those who received home-based paediatric palliative care and standard care. The quality of life and caregiver burden for patients receiving home-based paediatric palliative care were also tracked over the first year of enrolment to evaluate the service's longitudinal impact. A structured impact and cost evaluation of Singapore-based HCA Hospice Care's Star PALS (Paediatric Advance Life Support) programme was conducted over a three-year period, employing both retrospective and prospective designs with two patient groups. Compared to the control group (n = 67), patients receiving home-based paediatric palliative care (n = 71) spent more time at home than in hospital in the last year of life by 52 days (OR = 52.30, 95% CI: 25.44-79.17) with at least two fewer hospital admissions (OR = 2.46, 95% CI: 0.43-4.48); and were five times more likely to have an advance care plan formulated (OR = 5.51, 95% CI: 1.55-19.67). Medical costs incurred by this group were also considerably lower (by up to 87%). Moreover, both patients' quality of life (in terms of pain and emotion), and caregiver burden showed improvement within the first year of enrolment into the programme. Our findings suggest that home-based paediatric palliative care brings improved resource utilization and cost-savings for both patients and healthcare providers. More importantly, the lives of patients and their caregivers have improved, with terminally ill children and their caregivers being able to spend more quality time at home at the final stretch of the disease. The benefits of a community paediatric palliative care programme have been validated. Study findings can become key drivers when