WorldWideScience

Sample records for rapid cost improvement

  1. Rapid and sustained cost management

    International Nuclear Information System (INIS)

    Hanson, D.

    2009-01-01

    Accenture helps clients develop comprehensive, process-driven strategies for rapid and sustained cost management that leverage deep insights and analytics. This approach enables companies to gain operating cost advantages by rationalizing, simplifying and automating current operating capabilities. It drives structural cost advantages by optimizing business mix, capital structure, organizational structure and geographic presence. This paper discussed how successful companies achieve high performance during times of economic turmoil. It also discussed the value of the winner's strategy in terms of rapid and sustained cost management (RSCM). It discussed how Accenture operates and its leveraged capabilities, improved efficiency, margins and cash flow while maintaining customer service levels. Building structural advantage and the Accenture difference were also discussed. It was concluded that RSCM is one vital way that Accenture can help companies achieve success. 4 figs

  2. Rapid improvement teams.

    Science.gov (United States)

    Alemi, F; Moore, S; Headrick, L; Neuhauser, D; Hekelman, F; Kizys, N

    1998-03-01

    Suggestions, most of which are supported by empirical studies, are provided on how total quality management (TQM) teams can be used to bring about faster organizationwide improvements. Ideas are offered on how to identify the right problem, have rapid meetings, plan rapidly, collect data rapidly, and make rapid whole-system changes. Suggestions for identifying the right problem include (1) postpone benchmarking when problems are obvious, (2) define the problem in terms of customer experience so as not to blame employees nor embed a solution in the problem statement, (3) communicate with the rest of the organization from the start, (4) state the problem from different perspectives, and (5) break large problems into smaller units. Suggestions for having rapid meetings include (1) choose a nonparticipating facilitator to expedite meetings, (2) meet with each team member before the team meeting, (3) postpone evaluation of ideas, and (4) rethink conclusions of a meeting before acting on them. Suggestions for rapid planning include reducing time spent on flowcharting by focusing on the future, not the present. Suggestions for rapid data collection include (1) sample patients for surveys, (2) rely on numerical estimates by process owners, and (3) plan for rapid data collection. Suggestions for rapid organizationwide implementation include (1) change membership on cross-functional teams, (2) get outside perspectives, (3) use unfolding storyboards, and (4) go beyond self-interest to motivate lasting change in the organization. Additional empirical investigations of time saved as a consequence of the strategies provided are needed. If organizations solve their problems rapidly, fewer unresolved problems may remain.

  3. Cost Improvement Analysis

    Science.gov (United States)

    1986-06-01

    Cc) Ul y Cli U;ra ISO or.) . ............ t cc fl .9 it it ý I oli CC) I it cli L3 I HIM .......... 114 t4l t.r IM...Burroughz Cost AFIT/LSQ AV785-6280 Curve Programs Prof. Jeff Daneman Z-100 Cost Curve ASD/ACCR AV785- 8583 Programs Capt Arthur Mills * *- PROGRAMS CONCEPT

  4. A Systems Approach to Rapid School Improvement

    Science.gov (United States)

    McCauley, Carlas

    2018-01-01

    To support systemic thinking about school improvement, the Center on School Turnaround at WestEd developed a framework to assist states, districts, and schools in leading and managing rapid improvement efforts. The framework, which is presented in this article, has four domains that have proved central to rapid, significant improvement: (1)…

  5. 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.

  6. Lean-Six Sigma: tools for rapid cycle cost reduction.

    Science.gov (United States)

    Caldwell, Chip

    2006-10-01

    Organizational costs can be grouped as process cost, cost of quality, and cost of poor quality. Providers should train managers in the theory and application of Lean-Six Sigma, including the seven categories of waste and how to remove them. Healthcare financial executives should work with managers in eliminating waste to improve service and reduce costs.

  7. Improving hospital cost accounting with activity-based costing.

    Science.gov (United States)

    Chan, Y C

    1993-01-01

    In this article, activity-based costing, an approach that has proved to be an improvement over the conventional costing system in product costing, is introduced. By combining activity-based costing with standard costing, health care administrators can better plan and control the costs of health services provided while ensuring that the organization's bottom line is healthy.

  8. 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.

  9. 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.

  10. 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.

  11. Rapid, low-cost, image analysis through video processing

    International Nuclear Information System (INIS)

    Levinson, R.A.; Marrs, R.W.; Grantham, D.G.

    1976-01-01

    Remote Sensing now provides the data necessary to solve many resource problems. However, many of the complex image processing and analysis functions used in analysis of remotely-sensed data are accomplished using sophisticated image analysis equipment. High cost of this equipment places many of these techniques beyond the means of most users. A new, more economical, video system capable of performing complex image analysis has now been developed. This report describes the functions, components, and operation of that system. Processing capability of the new video image analysis system includes many of the tasks previously accomplished with optical projectors and digital computers. Video capabilities include: color separation, color addition/subtraction, contrast stretch, dark level adjustment, density analysis, edge enhancement, scale matching, image mixing (addition and subtraction), image ratioing, and construction of false-color composite images. Rapid input of non-digital image data, instantaneous processing and display, relatively low initial cost, and low operating cost gives the video system a competitive advantage over digital equipment. Complex pre-processing, pattern recognition, and statistical analyses must still be handled through digital computer systems. The video system at the University of Wyoming has undergone extensive testing, comparison to other systems, and has been used successfully in practical applications ranging from analysis of x-rays and thin sections to production of color composite ratios of multispectral imagery. Potential applications are discussed including uranium exploration, petroleum exploration, tectonic studies, geologic mapping, hydrology sedimentology and petrography, anthropology, and studies on vegetation and wildlife habitat

  12. Customer Dissatisfaction Index and its Improvement Costs

    Science.gov (United States)

    Lvovs, Aleksandrs; Mutule, Anna

    2010-01-01

    The paper gives description of customer dissatisfaction index (CDI) that can be used as reliability level characterizing factor. The factor is directly joined with customer satisfaction of power supply and can be used for control of reliability level of power supply for residential customers. CDI relations with other reliability indices are shown. Paper also gives a brief overview of legislation of Latvia in power industry that is the base for CDI introduction. Calculations of CDI improvement costs are performed in the paper too.

  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. Cost reduction through improved seismic design

    International Nuclear Information System (INIS)

    Severud, L.K.

    1984-01-01

    During the past decade, many significnt seismic technology developments have been accomplished by the United States Department of Energy (USDOE) programs. Both base technology and major projects, such as the Fast Flux Test Facility (FFTF) and the Clinch River Breeder Reactor (CRBR) plant, have contributed to seismic technology development and validation. Improvements have come in the areas of ground motion definitions, soil-structure interaction, and structural analysis methods and criteria for piping, equipment, components, reactor core, and vessels. Examples of some of these lessons learned and technology developments are provided. Then, the highest priority seismic technology needs, achievable through DOE actions and sponsorship are identified and discussed. Satisfaction of these needs are expected to make important contributions toward cost avoidances and reduced capital costs of future liquid metal nuclear plants. 23 references, 12 figures

  15. 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...

  16. 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

  17. The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

    Science.gov (United States)

    Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

    2014-09-01

    Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

  18. Cost benefit justification of nuclear plant reliability improvement

    International Nuclear Information System (INIS)

    El-Sayed, M.A.H.; Abdelmonem, N.M.

    1986-01-01

    Nuclear power costs are evaluated on the bases of general ground rules (a) vary from time to time (b) vary from country to another (c) even vary from one reactor type to another. The main objective of an electric utility is to provide the electric energy to the different consummers at the lowest possible cost with reasonable reliability level. Rapid increase of the construction costs and fuel prices in recent years have stimulated a great deal of interest in improving the reliability and productivity of new and existing power plants. One of the most important areas is the improvement of the secondary steam loop and the reactor cooling system. The method for evaluating the reliability of steam loop and cooling system utilizes the cut-set technique. The developed method can be easily used to show to what extent the overall reliability of the nuclear plant is affected by the possible failures in the steam and cooling subsystem. The cost reliability trade-off analysis is used to evaluate alternative schemes in the design with a view towards meeting a high reliability goal. Based on historical or estimated failure and repair rate, the reliability of the alternate scheme can be calculated

  19. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    Science.gov (United States)

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  20. 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.

  1. Cost benefit justification of nuclear plant reliability improvement

    International Nuclear Information System (INIS)

    El-Sayed, M.A.H.; Abdelmonem, N.M.

    1985-01-01

    The design of the secondary steam loop of the nuclear power plant has a significant effect on the reliability of the plant. Moreover, the necessity to cool a reactor safely has increased the reliability demanded from the system. The rapidly rising construction costs and fuel prices in recent years have stimulated a great deal in optimizing the productivity of a nuclear power plant through reliability improvement of the secondary steamloop and the reactor cooling system. A method for evaluating the reliability of steam loop and cooling system of a nuclear power plant is presented. The method utilizes the cut-set technique. The developed method can be easily used to show to what extent the overall reliability of the nuclear plant is affected by the possible failures in the steam and cooling subsystem. A model for calculating the increase in the nuclear plant productivity resulting from a proposed improvement in the two subsystems reliability is discussed. The model takes into account the capital cost of spare parts for several components, replacement energy, operating and maintenance costs

  2. Resummation improved rapidity spectrum for gluon fusion Higgs production

    International Nuclear Information System (INIS)

    Ebert, Markus A.; Tackmann, Frank J.; Michel, Johannes K.L.; Muenster Univ.

    2017-02-01

    Gluon-induced processes such as Higgs production typically exhibit large perturbative corrections. These partially arise from large virtual corrections to the gluon form factor, which at timelike momentum transfer contains Sudakov logarithms evaluated at negative arguments ln 2 (-1)=-π 2 . It has been observed that resumming these terms in the timelike form factor leads to a much improved perturbative convergence for the total cross section. We discuss how to consistently incorporate the resummed form factor into the perturbative predictions for generic cross sections differential in the Born kinematics, including in particular the Higgs rapidity spectrum. We verify that this indeed improves the perturbative convergence, leading to smaller and more reliable perturbative uncertainties, and that this is not affected by cancellations between resummed and unresummed contributions. Combining both fixed-order and resummation uncertainties, the perturbative uncertainty for the total cross section at N 3 LO+N 3 LL φ ' is about a factor of two smaller than at N 3 LO. The perturbative uncertainty of the rapidity spectrum at NNLO+NNLL φ ' is similarly reduced compared to NNLO. We also study the analogous resummation for quark-induced processes, namely Higgs production through bottom quark annihilation and the Drell-Yan rapidity spectrum. For the former the resummation leads to a small improvement, while for the latter it confirms the already small uncertainties of the fixed-order predictions.

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

    International Nuclear Information System (INIS)

    Anon.

    1978-01-01

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

  4. Model improves oil field operating cost estimates

    International Nuclear Information System (INIS)

    Glaeser, J.L.

    1996-01-01

    A detailed operating cost model that forecasts operating cost profiles toward the end of a field's life should be constructed for testing depletion strategies and plans for major oil fields. Developing a good understanding of future operating cost trends is important. Incorrectly forecasting the trend can result in bad decision making regarding investments and reservoir operating strategies. Recent projects show that significant operating expense reductions can be made in the latter stages o field depletion without significantly reducing the expected ultimate recoverable reserves. Predicting future operating cost trends is especially important for operators who are currently producing a field and must forecast the economic limit of the property. For reasons presented in this article, it is usually not correct to either assume that operating expense stays fixed in dollar terms throughout the lifetime of a field, nor is it correct to assume that operating costs stay fixed on a dollar per barrel basis

  5. 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.

  6. Improving clinicians' access to cost data.

    Science.gov (United States)

    Kenagy, John; Shah, Ben

    2014-08-01

    Bringing clinical and financial data together is critical to effectively running and operating service lines. Helping clinicians use cost data to make decisions requires a shared vision and a partnership between finance leaders and physicians. Hosting a "jam session" of technical, financial, and clinical experts can accelerate an organization's business intelligence strategy. Labor and supply costs represent the most actionable cost data for clinicians. Clinician buy-in hinges on education and support. It is important to focus on easy wins at the beginning of the project.

  7. Costs and Benefits of Software Process Improvement

    National Research Council Canada - National Science Library

    Prenger, Karen

    1997-01-01

    There are numerous problems in DoD software development projects. The ad hoc practices used in the military services and in industry have resulted in unpredictable costs and schedules and low-quality products...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  9. 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

  10. Online Classrooms: Powerful Tools for Rapid-Iteration Pedagogical Improvements

    Science.gov (United States)

    Horodyskyj, L.; Semken, S.; Anbar, A.; Buxner, S.

    2015-11-01

    Online education offers the opportunity to reach a variety of students including non-traditional and geographically diverse students. Research has shown that online courses modeled after traditional lecture-exam courses are ineffective. Over the past three years, Arizona State University developed and offered Habitable Worlds, an online-only astrobiology lab course featuring active learning tools. The course is offered in an intelligent tutoring system (ITS) that records a wealth of student data. In analyzing data from the Fall 2013 offering of the course, we were able to identify pre-post quiz results that were suboptimal and where in the lesson and how precisely students were missing concepts. The problem areas were redesigned, and the improved lessons were deployed a few months later. We saw significant improvements in our pre-post quiz results due to the implemented changes. This demonstrates the effectiveness of using robust ITS not only to present content online, but to provide instantaneous data for rapid iteration and improvement of existing content.

  11. 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...... characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m...

  12. Tune-control improvements on the rapid-cycling synchrotron

    International Nuclear Information System (INIS)

    Potts, C.; Faber, M.; Gunderson, G.; Knott, M.; Voss, D.

    1981-01-01

    The as-built lattice of the Rapid-Cycling Synchrotron (RCS) had two sets of correction sextupoles and two sets of quadrupoles energized by dc power supplies to control the tune and the tune tilt. With this method of powering these magnets, adjustment of tune conditions during the accelerating cycle as needed was not possible. A set of dynamically programmable power supplies has been built and operated to provide the required chromaticity adjustment. The short accelerating time (16.7 ms) of the RCS and the inductance of the magnets dictated large transistor amplifier power supplies. The required time resolution and waveform flexibility indicated the desirability of computer control. Both the amplifiers and controls are described, along with resulting improvements in the beam performance. A set of octupole magnets and programmable power supplies with similar dynamic qualities have been constructed and installed to control the anticipated high-intensity transverse instability. This system will be operational in the spring of 1981

  13. 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.

  14. Cost and operational acceptability improvements to gasifiers

    Energy Technology Data Exchange (ETDEWEB)

    Connor, A.

    2003-07-01

    This work reports on the operation of two gasifiers by Biomass Engineering Ltd. in Northern Ireland, and the simplification of their gas conditioning system. Details are given of the high tar destruction levels achieved, the locally available wood waste and pallet wood, and the use of a back-pulsable dry ceramic filtration system for removing trace organics and particulates from the resulting gas prior to gas cooling, final filtration and use in a gas engine. The results of a techno-economic assessment of the original scrubbing system and the new ceramic filtration system indicating cost savings are presented. Further work to optimise the parameters of the filters is planned.

  15. 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…

  16. HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years.

    Science.gov (United States)

    Knapp, Herschel; Chan, Kee

    2015-07-01

    To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients. A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation. At 5 years, a total of 2,620 tests were conducted with a quarterly mean of 131 ± 81. Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3.58 tests per quarter. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost(s) associated with the testing process. Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings. Copyright © 2015. Published by Elsevier Inc.

  17. Rapid, low-cost prototyping of centrifugal microfluidic devices for effective implementation of various microfluidic operations

    CSIR Research Space (South Africa)

    Hugo, S

    2013-10-01

    Full Text Available 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. ... stream_source_info Hugo_2015_ABSTRACT.pdf.txt stream_content_type text/plain stream_size 1281 Content-Encoding UTF-8 stream_name Hugo_2015_ABSTRACT.pdf.txt Content-Type text/plain; charset=UTF-8 Rapid Product Development...

  18. Improved management of radiotherapy departments through accurate cost data

    International Nuclear Information System (INIS)

    Kesteloot, K.; Lievens, Y.; Schueren, E. van der

    2000-01-01

    our model would then increase with 14-36%. We showed that cost information can be used to analyze the precise financial consequences of changes in routine clinical practice in radiotherapy. Comparing the cost data with the prevailing reimbursement may reveal inconsistencies and stimulate to develop improved financing systems. (author)

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

    National Research Council Canada - National Science Library

    Angelis, Diana I; Dillard, John; Franck, Raymond; Melese, Francois

    2007-01-01

    The purpose of this report is to explore the possibility of improving DoD cost estimation methods by including explanatory variables that capture the coordination and motivation problems associated with the program...

  20. Costing improvement of remanufacturing crankshaft by integrating Mahalanobis-Taguchi System and Activity based Costing

    Science.gov (United States)

    Abu, M. Y.; Nor, E. E. Mohd; Rahman, M. S. Abd

    2018-04-01

    Integration between quality and costing system is very crucial in order to achieve an accurate product cost and profit. Current practice by most of remanufacturers, there are still lacking on optimization during the remanufacturing process which contributed to incorrect variables consideration to the costing system. Meanwhile, traditional costing accounting being practice has distortion in the cost unit which lead to inaccurate cost of product. The aim of this work is to identify the critical and non-critical variables during remanufacturing process using Mahalanobis-Taguchi System and simultaneously estimate the cost using Activity Based Costing method. The orthogonal array was applied to indicate the contribution of variables in the factorial effect graph and the critical variables were considered with overhead costs that are actually demanding the activities. This work improved the quality inspection together with costing system to produce an accurate profitability information. As a result, the cost per unit of remanufactured crankshaft of MAN engine model with 5 critical crankpins is MYR609.50 while Detroit engine model with 4 critical crankpins is MYR1254.80. The significant of output demonstrated through promoting green by reducing re-melting process of damaged parts to ensure consistent benefit of return cores.

  1. Recent Improvements in IERS Rapid Service/Prediction Center Products

    National Research Council Canada - National Science Library

    Stamatakos, N; Luzum, B; Wooden, W

    2007-01-01

    ...) at USNO has made several improvements to its combination and pre- diction products. These improvements are due to the inclusion of new input data sources as well as modifications to the combination and prediction algorithms...

  2. 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.

  3. 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

    2018-06-01

    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.

  4. 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

  5. The importance of capital cost reduction in improving nuclear economics

    International Nuclear Information System (INIS)

    Langmo, A.; Braun, C.

    1996-01-01

    In the developed countries having existing nuclear programs, the situation necessitates lower total power generation cost. The restructuring of utility industry due to the deregulation causes to reorganize the ownership of some nuclear plants, and the overall economics of nuclear plants in relation to their local competition is reexamined. The reluctance to make any new long term capital cost commitment arises, and it makes new plant construction less likely in near future, and plant upgrading and improvement to be put to intense scrutiny. The capital cost recovery in existing nuclear plants in USA is discussed. It is important to recognize that there is very little that can be done to affect already expended capital, and only that can be done is to improve plant capacity factors, besides write-off. The roles of architects and engineers in improved plant economics are now evaluated by the various organizations which are interested in the participation in new nuclear industry reorganization and restructuring. The reduction of operation and maintenance costs and capital investment, and the improvement of capacity factor are reported. In new ALWR construction program, architects and engineers can significantly support the control of plant capital costs by the selection of the plant design and the sites, and the strategies of procurement and contract, construction schedule and others. (K.I.)

  6. Regional-employment impact of rapidly escalating energy costs. [Riverside-San Bernardino SMSA

    Energy Technology Data Exchange (ETDEWEB)

    Kolk, D X

    1983-04-01

    This paper presents a methodology for incorporating price-induced technological substitution into a regional input-output forecasting model. The model was used to determine the employment impacts of rapidly escalating energy costs on the Riverside-San Bernardino (California) SMSA. The results indicate that the substitution effect between energy and other goods was dominated by the income effect. A reallocation of consumer expenditures from labor-intensive to energy-intensive goods occurred, resulting in a two- to threefold increase in the unemployment rate among low-skilled individuals. 18 references, 5 tables.

  7. 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.

  8. Cost-effectiveness of improving pediatric hospital care in Nicaragua.

    Science.gov (United States)

    Broughton, Edward I; Gomez, Ivonne; Nuñez, Oscar; Wong, Yudy

    2011-11-01

    To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

  9. 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.

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

    African Journals Online (AJOL)

    The specific objectives of the study was an analysis of the costs and returns of improved and alternative technologies available in the study area by farmers and their level of adoption of the new technologies. Data were collected from a random sample of 250 farmers and 30 extension Staff in the three (3) agricultural zones ...

  11. 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

  12. ModGrasp: An open-source rapid-prototyping framework for designing low-cost sensorised modular hands

    OpenAIRE

    Sanfilippo, Filippo; Zhang, Houxiang; Pettersen, Kristin Ytterstad; Salvietti, G.; Prattichizzo, Domenico

    2014-01-01

    This paper introduces ModGrasp, an open-source virtual and physical rapid-prototyping framework that allows for the design, simulation and control of low-cost sensorised modular hands. By combining the rapid-prototyping approach with the modular concept, different manipulator configurations can be modelled. A real-time one-to-one correspondence between virtual and physical prototypes is established. Different control algorithms can be implemented for the models. By using a low-cost sensing ap...

  13. 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.

  14. 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.

  15. 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

  16. IMPROVING MANAGEMENT ACCOUNTING AND COST CALCULATION IN DAIRY INDUSTRY USING STANDARD COST METHOD

    Directory of Open Access Journals (Sweden)

    Bogdănoiu Cristiana-Luminiţa

    2013-04-01

    Full Text Available This paper aims to discuss issues related to the improvement of management accounting in the dairy industry by implementing standard cost method. The methods used today do not provide informational satisfaction to managers in order to conduct effectively production activities, which is why we attempted the standard cost method, it responding to the managers needs to obtain the efficiency of production, and all economic entities. The method allows an operative control of how they consume manpower and material resources by pursuing distinct, permanent and complete deviations during the activity and not at the end of the reporting period. Successful implementation of the standard method depends on the accuracy by which standards are developed and promotes consistently anticipated calculation of production costs as well as determination, tracking and controlling deviations from them, leads to increased practical value of accounting information and business improvement.

  17. 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.

  18. A Rapid and Cost-Effective Method for DNA Extraction from Archival Herbarium Specimens.

    Science.gov (United States)

    Krinitsina, A A; Sizova, T V; Zaika, M A; Speranskaya, A S; Sukhorukov, A P

    2015-11-01

    Here we report a rapid and cost-effective method for the extraction of total DNA from herbarium specimens up to 50-90-year-old. The method takes about 2 h, uses AMPure XP magnetic beads diluted by PEG-8000- containing buffer, and does not require use of traditional volatile components like chloroform, phenol, and liquid nitrogen. It yields up to 4 µg of total nucleic acid with high purity from about 30 mg of dry material. The quality of the extracted DNA was tested by PCR amplification of 5S rRNA and rbcL genes (nuclear and chloroplast DNA markers) and compared against the traditional chloroform/isoamyl alcohol method. Our results demonstrate that the use of the magnetic beads is crucial for extraction of DNA suitable for subsequent PCR from herbarium samples due to the decreasing inhibitor concentrations, reducing short fragments of degraded DNA, and increasing median DNA fragment sizes.

  19. 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.

  20. Rapid mapping using low-cost structure-from-motion photogrammetry expedites the lahar modeling process

    Science.gov (United States)

    Ratner, Jacqueline; Pyle, David; Mather, Tamsin

    2014-05-01

    Structure-from-motion (SfM) is a branch of photogrammetry that triangulates points in digital photos to produce a 3D model. When applied to topographical modeling, SfM presents a powerful tool for rapid terrain mapping. At little to no cost and on a timescale of hours, a metric-resolution digital terrain model (DTM) can be produced; the resultant DTM can be used for many types of hazard scenario modeling and is here applied to lahars and floods. This study demonstrates the robustness of the SfM method through two case studies. First, an SfM DTM of Boscastle, UK, is compared against LiDAR and SRTM DTMs in a flood simulation model. Resolution is found to be more robust than for satellite based DTMs, and though less precise than the most detailed LiDAR survey, still perfectly adequate for the purposes of modeling flows. Next, the same method is applied to a region of Ecuador lacking the regionally comprehensive LiDAR survey available in the UK. Compared against the only other topographical data available, (SRTM, ASTER, 1956 topographical map), the SfM DTM is shown to have a higher resolution and is a preferable alternative for modeling lahars. The advantages of this study for emergency management are to provide a cheap and rapid metric-resolution alternative to low resolution or costly topography data sets. In regions such as Ecuador where scientific resources are scarce, SfM assists in providing a thorough, but otherwise unattainable, understanding of potential disaster scenarios that is accessible to local authorities to be used in the disaster prevention and mitigation processes.

  1. Serine Protease Zymography: Low-Cost, Rapid, and Highly Sensitive RAMA Casein Zymography.

    Science.gov (United States)

    Yasumitsu, Hidetaro

    2017-01-01

    To detect serine protease activity by zymography, casein and CBB stain have been used as a substrate and a detection procedure, respectively. Casein zymography has been using substrate concentration at 1 mg/mL and employing conventional CBB stain. Although ordinary casein zymography provides reproducible results, it has several disadvantages including time-consuming and relative low sensitivity. Improved casein zymography, RAMA casein zymography, is rapid and highly sensitive. RAMA casein zymography completes the detection process within 1 h after incubation and increases the sensitivity at least by tenfold. In addition to serine protease, the method also detects metalloprotease 7 (MMP7, Matrilysin) with high sensitivity.

  2. Improving performance and reducing costs of cooling towers

    International Nuclear Information System (INIS)

    Bartz, J.A.

    1992-01-01

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

  3. Improving environmental impact and cost assessment for supplier evaluation

    Science.gov (United States)

    Beucker, Severin; Lang, Claus

    2004-02-01

    Improving a company"s environmental and financial performance necessitates the evaluation of environmental impacts deriving from the production and cost effects of corporate actions. These effects have to be made transparent and concrete targets have to be developed. Such an evaluation has to be done on a regular basis but with limited expenses. To achieve this, different instruments of environmental controlling such as LCA and environmental performance indicators have to be combined with methods from cost accounting. Within the research project CARE (Computer Aided Resource Efficiency Accounting for Medium-Sized Enterprises), the method Resource Efficiency Accounting (REA) is used to give the participating companies new insights into hidden costs and environmental effects of their production and products. The method combines process based cost accounting with environmental impact assessment methodology and offers results that can be integrated into a company"s environmental controlling system and business processes like cost accounting, supplier assessment, etc. Much of the data necessary for the combined assessment can be available within a company"s IT system and therefore can be efficiently used for the assessment process. The project CARE puts a strong focus on the use of company data and information systems for the described assessment process and offers a methodological background for the evaluation and the structuring of such data. Besides the general approach of the project CARE the paper will present results from a case study in which the described approach is used for the evaluation of suppliers.

  4. Reduced cost and improved figure of sapphire optical components

    Science.gov (United States)

    Walters, Mark; Bartlett, Kevin; Brophy, Matthew R.; DeGroote Nelson, Jessica; Medicus, Kate

    2015-10-01

    Sapphire presents many challenges to optical manufacturers due to its high hardness and anisotropic properties. Long lead times and high prices are the typical result of such challenges. The cost of even a simple 'grind and shine' process can be prohibitive. The high precision surfaces required by optical sensor applications further exacerbate the challenge of processing sapphire thereby increasing cost further. Optimax has demonstrated a production process for such windows that delivers over 50% time reduction as compared to traditional manufacturing processes for sapphire, while producing windows with less than 1/5 wave rms figure error. Optimax's sapphire production process achieves significant improvement in cost by implementation of a controlled grinding process to present the best possible surface to the polishing equipment. Following the grinding process is a polishing process taking advantage of chemical interactions between slurry and substrate to deliver excellent removal rates and surface finish. Through experiments, the mechanics of the polishing process were also optimized to produce excellent optical figure. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. Through specially developed polishing slurries, the peak-to-valley figure error of spherical sapphire parts is reduced by over 80%.

  5. 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.

  6. IMPROVING SEMI-GLOBAL MATCHING: COST AGGREGATION AND CONFIDENCE MEASURE

    Directory of Open Access Journals (Sweden)

    P. d’Angelo

    2016-06-01

    Full Text Available Digital elevation models are one of the basic products that can be generated from remotely sensed imagery. The Semi Global Matching (SGM algorithm is a robust and practical algorithm for dense image matching. The connection between SGM and Belief Propagation was recently developed, and based on that improvements such as correction of over-counting the data term, and a new confidence measure have been proposed. Later the MGM algorithm has been proposed, it aims at improving the regularization step of SGM, but has only been evaluated on the Middlebury stereo benchmark so far. This paper evaluates these proposed improvements on the ISPRS satellite stereo benchmark, using a Pleiades Triplet and a Cartosat-1 Stereo pair. The over-counting correction slightly improves matching density, at the expense of adding a few outliers. The MGM cost aggregation shows leads to a slight increase of accuracy.

  7. 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

  8. 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.

  9. IMPROVING BIOMASS LOGISTICS COST WITHIN AGRONOMIC SUSTAINABILITY CONSTRAINTS AND BIOMASS QUALITY TARGETS

    Energy Technology Data Exchange (ETDEWEB)

    J. Richard Hess; Kevin L. Kenney; Christopher T. Wright; David J. Muth; William Smith

    2012-10-01

    Equipment manufacturers have made rapid improvements in biomass harvesting and handling equipment. These improvements have increased transportation and handling efficiencies due to higher biomass densities and reduced losses. Improvements in grinder efficiencies and capacity have reduced biomass grinding costs. Biomass collection efficiencies (the ratio of biomass collected to the amount available in the field) as high as 75% for crop residues and greater than 90% for perennial energy crops have also been demonstrated. However, as collection rates increase, the fraction of entrained soil in the biomass increases, and high biomass residue removal rates can violate agronomic sustainability limits. Advancements in quantifying multi-factor sustainability limits to increase removal rate as guided by sustainable residue removal plans, and mitigating soil contamination through targeted removal rates based on soil type and residue type/fraction is allowing the use of new high efficiency harvesting equipment and methods. As another consideration, single pass harvesting and other technologies that improve harvesting costs cause biomass storage moisture management challenges, which challenges are further perturbed by annual variability in biomass moisture content. Monitoring, sampling, simulation, and analysis provide basis for moisture, time, and quality relationships in storage, which has allowed the development of moisture tolerant storage systems and best management processes that combine moisture content and time to accommodate baled storage of wet material based upon “shelf-life.” The key to improving biomass supply logistics costs has been developing the associated agronomic sustainability and biomass quality technologies and processes that allow the implementation of equipment engineering solutions.

  10. 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

  11. 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

  12. 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).

  13. The Data-to-Action Framework: A Rapid Program Improvement Process

    Science.gov (United States)

    Zakocs, Ronda; Hill, Jessica A.; Brown, Pamela; Wheaton, Jocelyn; Freire, Kimberley E.

    2015-01-01

    Although health education programs may benefit from quality improvement methods, scant resources exist to help practitioners apply these methods for program improvement. The purpose of this article is to describe the Data-to-Action framework, a process that guides practitioners through rapid-feedback cycles in order to generate actionable data to…

  14. Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT

    Directory of Open Access Journals (Sweden)

    Onwujekwe Obinna E

    2009-11-01

    Full Text Available Abstract Background The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria. However, although rapid diagnostic tests (RDTs have improved the ease of appropriate diagnosis of malaria diagnosis, the cost-effectiveness of RDTs in case management of malaria has not been evaluated in Nigeria. The study hence compares the cost-effectiveness of RDT versus syndromic diagnosis and microscopy. Methods A total of 638 patients with fever, clinically diagnosed as malaria (presumptive malaria by health workers, were selected for examination with both RDT and microscopy. Patients positive on RDT received artemisinin-based combination therapy (ACT and febrile patients negative on RDT received an antibiotic treatment. Using a decision tree model for a hypothetical cohort of 100,000 patients, the diagnostic alternatives considered were presumptive treatment (base strategy, RDT and microscopy. Costs were based on a consumer and provider perspective while the outcome measure was deaths averted. Information on costs and malaria epidemiology were locally generated, and along with available data on effectiveness of diagnostic tests, adherence level to drugs for treatment, and drug efficacy levels, cost-effectiveness estimates were computed using TreeAge programme. Results were reported based on costs and effects per strategy, and incremental cost-effectiveness ratios. Results The cost-effectiveness analysis at 43.1% prevalence level showed an incremental cost effectiveness ratio (ICER of 221 per deaths averted between RDT and presumptive treatment, while microscopy is dominated

  15. Treating Type 1 Diabetes Mellitus with a Rapid-Acting Analog Insulin Regimen vs. Regular Human Insulin in Germany: A Long-Term Cost-Effectiveness Evaluation.

    Science.gov (United States)

    Valentine, William J; Van Brunt, Kate; Boye, Kristina S; Pollock, Richard F

    2018-06-01

    The aim of the present study was to evaluate the cost effectiveness of rapid-acting analog insulin relative to regular human insulin in adults with type 1 diabetes mellitus in Germany. The PRIME Diabetes Model, a patient-level, discrete event simulation model, was used to project long-term clinical and cost outcomes for patients with type 1 diabetes from the perspective of a German healthcare payer. Simulated patients had a mean age of 21.5 years, duration of diabetes of 8.6 years, and baseline glycosylated hemoglobin of 7.39%. Regular human insulin and rapid-acting analog insulin regimens reduced glycosylated hemoglobin by 0.312 and 0.402%, respectively. Compared with human insulin, hypoglycemia rate ratios with rapid-acting analog insulin were 0.51 (non-severe nocturnal) and 0.80 (severe). No differences in non-severe diurnal hypoglycemia were modeled. Discount rates of 3% were applied to future costs and clinical benefits accrued over the 50-year time horizon. In the base-case analysis, rapid-acting analog insulin was associated with an improvement in quality-adjusted life expectancy of 1.01 quality-adjusted life-years per patient (12.54 vs. 11.53 quality-adjusted life-years). Rapid-acting analog insulin was also associated with an increase in direct costs of €4490, resulting in an incremental cost-effectiveness ratio of €4427 per quality-adjusted life-year gained vs. human insulin. Sensitivity analyses showed that the base case was driven predominantly by differences in hypoglycemia; abolishing these differences reduced incremental quality-adjusted life expectancy to 0.07 quality-adjusted life-years, yielding an incremental cost-effectiveness ratio of €74,622 per quality-adjusted life-year gained. Rapid-acting analog insulin is associated with beneficial outcomes in patients with type 1 diabetes and is likely to be considered cost effective in the German setting vs. regular human insulin.

  16. A low-cost approach for rapidly creating demonstration models for hands-on learning

    Science.gov (United States)

    Kinzli, Kristoph-Dietrich; Kunberger, Tanya; O'Neill, Robert; Badir, Ashraf

    2018-01-01

    Demonstration models allow students to readily grasp theory and relate difficult concepts and equations to real life. However drawbacks of using these demonstration models are that they are can be costly to purchase from vendors or take a significant amount of time to build. These two limiting factors can pose a significant obstacle for adding demonstrations to the curriculum. This article presents an assignment to overcome these obstacles, which has resulted in 36 demonstration models being added to the curriculum. The article also presents the results of student performance on course objectives as a result of the developed models being used in the classroom. Overall, significant improvement in student learning outcomes, due to the addition of demonstration models, has been observed.

  17. Noninvasive Hemoglobin Monitoring: A Rapid, Reliable, and Cost-Effective Method Following Total Joint Replacement.

    Science.gov (United States)

    Martin, J Ryan; Camp, Christopher L; Stitz, Amber; Young, Ernest Y; Abdel, Matthew P; Taunton, Michael J; Trousdale, Robert T

    2016-03-02

    Noninvasive hemoglobin (nHgb) monitoring was initially introduced in the intensive care setting as a means of rapidly assessing Hgb values without performing a blood draw. We conducted a prospective analysis to compare reliability, cost, and patient preference between nHgb monitoring and invasive Hgb (iHgb) monitoring performed via a traditional blood draw. We enrolled 100 consecutive patients undergoing primary or revision total hip or total knee arthroplasty. On postoperative day 1, nHgb and iHgb values were obtained within thirty minutes of one another. iHgb and nHgb values, cost, patient satisfaction, and the duration of time required to obtain each reading were recorded. The concordance correlation coefficient (CCC) was utilized to evaluate the agreement of the two Hgb measurement methods. Paired t tests and Wilcoxon signed-rank tests were utilized to compare mean Hgb values, time, and pain for all readings. The mean Hgb values did not differ significantly between the two measurement methods: the mean iHgb value (and standard deviation) was 11.3 ± 1.4 g/dL (range, 8.2 to 14.3 g/dL), and the mean nHgb value was 11.5 ± 1.8 g/dL (range, 7.0 to 16.0 g/dL) (p = 0.11). The CCC between the two Hgb methods was 0.69. One hundred percent of the patients with an nHgb value of ≥ 10.5 g/dL had an iHgb value of >8.0 g/dL. The mean time to obtain an Hgb value was 0.9 minute for the nHgb method and 51.1 minutes for the iHgb method (p measurement, resulting in a savings of $26 per Hgb assessment when the noninvasive method is used. Noninvasive Hgb monitoring was found to be more efficient, less expensive, and preferred by patients compared with iHgb monitoring. Providers could consider screening total joint arthroplasty patients with nHgb monitoring and only order iHgb measurement if the nHgb value is protocol had been applied to the first blood draw in our 100 patients, approximately $2000 would have been saved. Extrapolated to the U.S. total joint arthroplasty practice

  18. Integrating unmanned aerial systems and LSPIV for rapid, cost-effective stream gauging

    Science.gov (United States)

    Lewis, Quinn W.; Lindroth, Evan M.; Rhoads, Bruce L.

    2018-05-01

    Quantifying flow in rivers is fundamental to assessments of water supply, water quality, ecological conditions, hydrological responses to storm events, and geomorphological processes. Image-based surface velocity measurements have shown promise in extending the range of discharge conditions that can be measured in the field. The use of Unmanned Aerial Systems (UAS) in image-based measurements of surface velocities has the potential to expand applications of this method. Thus far, few investigations have assessed this potential by evaluating the accuracy and repeatability of discharge measurements using surface velocities obtained from UAS. This study uses large-scale particle image velocimetry (LSPIV) derived from videos captured by cameras on a UAS and a fixed tripod to obtain discharge measurements at ten different stream locations in Illinois, USA. Discharge values are compared to reference values measured by an acoustic Doppler current profiler, a propeller meter, and established stream gauges. The results demonstrate the effects of UAS flight height, camera steadiness and leveling accuracy, video sampling frequency, and LSPIV interrogation area size on surface velocities, and show that the mean difference between fixed and UAS cameras is less than 10%. Differences between LSPIV-derived and reference discharge values are generally less than 20%, not systematically low or high, and not related to site parameters like channel width or depth, indicating that results are relatively insensitive to camera setup and image processing parameters typically required of LSPIV. The results also show that standard velocity indices (between 0.85 and 0.9) recommended for converting surface velocities to depth-averaged velocities yield reasonable discharge estimates, but are best calibrated at specific sites. The study recommends a basic methodology for LSPIV discharge measurements using UAS that is rapid, cost-efficient, and does not require major preparatory work at a

  19. Minim typing--a rapid and low cost MLST based typing tool for Klebsiella pneumoniae.

    Science.gov (United States)

    Andersson, Patiyan; Tong, Steven Y C; Bell, Jan M; Turnidge, John D; Giffard, Philip M

    2012-01-01

    Here we report a single nucleotide polymorphism (SNP) based genotyping method for Klebsiella pneumoniae utilising high-resolution melting (HRM) analysis of fragments within the multilocus sequence typing (MLST) loci. The approach is termed mini-MLST or Minim typing and it has previously been applied to Streptococcus pyogenes, Staphylococcus aureus and Enterococcus faecium. Six SNPs were derived from concatenated MLST sequences on the basis of maximisation of the Simpsons Index of Diversity (D). DNA fragments incorporating these SNPs and predicted to be suitable for HRM analysis were designed. Using the assumption that HRM alleles are defined by G+C content, Minim typing using six fragments was predicted to provide a D = 0.979 against known STs. The method was tested against 202 K. pneumoniae using a blinded approach in which the MLST analyses were performed after the HRM analyses. The HRM-based alleles were indeed in accordance with G+C content, and the Minim typing identified known STs and flagged new STs. The tonB MLST locus was determined to be very diverse, and the two Minim fragments located herein contribute greatly to the resolving power. However these fragments are refractory to amplification in a minority of isolates. Therefore, we assessed the performance of two additional formats: one using only the four fragments located outside the tonB gene (D = 0.929), and the other using HRM data from these four fragments in conjunction with sequencing of the tonB MLST fragment (D = 0.995). The HRM assays were developed on the Rotorgene 6000, and the method was shown to also be robust on the LightCycler 480, allowing a 384-well high through-put format. The assay provides rapid, robust and low-cost typing with fully portable results that can directly be related to current MLST data. Minim typing in combination with molecular screening for antibiotic resistance markers can be a powerful surveillance tool kit.

  20. Minim typing--a rapid and low cost MLST based typing tool for Klebsiella pneumoniae.

    Directory of Open Access Journals (Sweden)

    Patiyan Andersson

    Full Text Available Here we report a single nucleotide polymorphism (SNP based genotyping method for Klebsiella pneumoniae utilising high-resolution melting (HRM analysis of fragments within the multilocus sequence typing (MLST loci. The approach is termed mini-MLST or Minim typing and it has previously been applied to Streptococcus pyogenes, Staphylococcus aureus and Enterococcus faecium. Six SNPs were derived from concatenated MLST sequences on the basis of maximisation of the Simpsons Index of Diversity (D. DNA fragments incorporating these SNPs and predicted to be suitable for HRM analysis were designed. Using the assumption that HRM alleles are defined by G+C content, Minim typing using six fragments was predicted to provide a D = 0.979 against known STs. The method was tested against 202 K. pneumoniae using a blinded approach in which the MLST analyses were performed after the HRM analyses. The HRM-based alleles were indeed in accordance with G+C content, and the Minim typing identified known STs and flagged new STs. The tonB MLST locus was determined to be very diverse, and the two Minim fragments located herein contribute greatly to the resolving power. However these fragments are refractory to amplification in a minority of isolates. Therefore, we assessed the performance of two additional formats: one using only the four fragments located outside the tonB gene (D = 0.929, and the other using HRM data from these four fragments in conjunction with sequencing of the tonB MLST fragment (D = 0.995. The HRM assays were developed on the Rotorgene 6000, and the method was shown to also be robust on the LightCycler 480, allowing a 384-well high through-put format. The assay provides rapid, robust and low-cost typing with fully portable results that can directly be related to current MLST data. Minim typing in combination with molecular screening for antibiotic resistance markers can be a powerful surveillance tool kit.

  1. Water quality audits can improve availability and reduce costs

    International Nuclear Information System (INIS)

    Dvorin, R.S.; Schlesinger, H.A.

    1984-01-01

    The Water Quality Audit (WQA) is an independent, detailed review and thorough analysis of an operating plant's water technology control systems and operator education (as distinguished from operator training). The need for such an audit and its role in improving the reliability and availability of both nuclear and fossil-fueled power plants is discussed. Instances of how the failure of either system hardware or operational control has caused injection of seawater, acid, caustic, or ion exchange resin into the condensate-feedwater system and steam generator are revealed. The systems to be audited are described, and the stage-wise nature of the audit explained. The potential savings of an audit are outlined and the timing and range of costs of a WQA are given

  2. 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.

  3. 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

  4. Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes.

    NARCIS (Netherlands)

    Schouten, L.M.T.; Niessen, L.W.; Pas, J.W. van der; Grol, R.P.T.M.; Hulscher, M.E.J.L.

    2010-01-01

    OBJECTIVE: To investigate the lifelong health effects, costs, and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting. STUDY DESIGN AND METHODS: Economic evaluation from a healthcare perspective with lifetime horizon

  5. Minim Typing – A Rapid and Low Cost MLST Based Typing Tool for Klebsiella pneumoniae

    Science.gov (United States)

    Andersson, Patiyan; Tong, Steven Y. C.; Bell, Jan M.; Turnidge, John D.; Giffard, Philip M.

    2012-01-01

    Here we report a single nucleotide polymorphism (SNP) based genotyping method for Klebsiella pneumoniae utilising high-resolution melting (HRM) analysis of fragments within the multilocus sequence typing (MLST) loci. The approach is termed mini-MLST or Minim typing and it has previously been applied to Streptococcus pyogenes, Staphylococcus aureus and Enterococcus faecium. Six SNPs were derived from concatenated MLST sequences on the basis of maximisation of the Simpsons Index of Diversity (D). DNA fragments incorporating these SNPs and predicted to be suitable for HRM analysis were designed. Using the assumption that HRM alleles are defined by G+C content, Minim typing using six fragments was predicted to provide a D = 0.979 against known STs. The method was tested against 202 K. pneumoniae using a blinded approach in which the MLST analyses were performed after the HRM analyses. The HRM-based alleles were indeed in accordance with G+C content, and the Minim typing identified known STs and flagged new STs. The tonB MLST locus was determined to be very diverse, and the two Minim fragments located herein contribute greatly to the resolving power. However these fragments are refractory to amplification in a minority of isolates. Therefore, we assessed the performance of two additional formats: one using only the four fragments located outside the tonB gene (D = 0.929), and the other using HRM data from these four fragments in conjunction with sequencing of the tonB MLST fragment (D = 0.995). The HRM assays were developed on the Rotorgene 6000, and the method was shown to also be robust on the LightCycler 480, allowing a 384-well high through-put format. The assay provides rapid, robust and low-cost typing with fully portable results that can directly be related to current MLST data. Minim typing in combination with molecular screening for antibiotic resistance markers can be a powerful surveillance tool kit. PMID:22428067

  6. 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

    2014-01-01

    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. PMID:24998993

  7. An improved set of standards for finding cost for cost-effectiveness analysis.

    Science.gov (United States)

    Barnett, Paul G

    2009-07-01

    Guidelines have helped standardize methods of cost-effectiveness analysis, allowing different interventions to be compared and enhancing the generalizability of study findings. There is agreement that all relevant services be valued from the societal perspective using a long-term time horizon and that more exact methods be used to cost services most affected by the study intervention. Guidelines are not specific enough with respect to costing methods, however. The literature was reviewed to identify the problems associated with the 4 principal methods of cost determination. Microcosting requires direct measurement and is ordinarily reserved to cost novel interventions. Analysts should include nonwage labor cost, person-level and institutional overhead, and the cost of development, set-up activities, supplies, space, and screening. Activity-based cost systems have promise of finding accurate costs of all services provided, but are not widely adopted. Quality must be evaluated and the generalizability of cost estimates to other settings must be considered. Administrative cost estimates, chiefly cost-adjusted charges, are widely used, but the analyst must consider items excluded from the available system. Gross costing methods determine quantity of services used and employ a unit cost. If the intervention will affect the characteristics of a service, the method should not assume that the service is homogeneous. Questions are posed for future reviews of the quality of costing methods. The analyst must avoid inappropriate assumptions, especially those that bias the analysis by exclusion of costs that are affected by the intervention under study.

  8. 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, ...

  9. 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.

  10. Use of rapid-scan EPR to improve detection sensitivity for spin-trapped radicals.

    Science.gov (United States)

    Mitchell, Deborah G; Rosen, Gerald M; Tseitlin, Mark; Symmes, Breanna; Eaton, Sandra S; Eaton, Gareth R

    2013-07-16

    The short lifetime of superoxide and the low rates of formation expected in vivo make detection by standard continuous wave (CW) electron paramagnetic resonance (EPR) challenging. The new rapid-scan EPR method offers improved sensitivity for these types of samples. In rapid-scan EPR, the magnetic field is scanned through resonance in a time that is short relative to electron spin relaxation times, and data are processed to obtain the absorption spectrum. To validate the application of rapid-scan EPR to spin trapping, superoxide was generated by the reaction of xanthine oxidase and hypoxanthine with rates of 0.1-6.0 μM/min and trapped with 5-tert-butoxycarbonyl-5-methyl-1-pyrroline-N-oxide (BMPO). Spin trapping with BMPO to form the BMPO-OOH adduct converts the very short-lived superoxide radical into a more stable spin adduct. There is good agreement between the hyperfine splitting parameters obtained for BMPO-OOH by CW and rapid-scan EPR. For the same signal acquisition time, the signal/noise ratio is >40 times higher for rapid-scan than for CW EPR. Rapid-scan EPR can detect superoxide produced by Enterococcus faecalis at rates that are too low for detection by CW EPR. Copyright © 2013 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  11. Using rapid scan EPR to improve the detection limit of quantitative EPR by more than one order of magnitude

    OpenAIRE

    Möser, J.; Lips, K.; Tseytlin, M.; Eaton, G.; Eaton, S.; Schnegg, A

    2017-01-01

    X band rapid scan EPR was implemented on a commercially available Bruker ELEXSYS E580 spectrometer. Room temperature rapid scan and continuous wave EPR spectra were recorded for amorphous silicon powder samples. By comparing the resulting signal intensities the feasibility of performing quantitative rapid scan EPR is demonstrated. For different hydrogenated amorphous silicon samples, rapid scan EPR results in signal to noise improvements by factors between 10 and 50. Rapid scan EPR is thus ca...

  12. 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

    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...

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

    KAUST Repository

    Fan, Yiqiang; Li, Huawei; Yi, Ying; Foulds, Ian G.

    2013-01-01

    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

  14. Cost effectiveness of FDG-PET: rapid evaluation in recurrent colorectal cancer

    International Nuclear Information System (INIS)

    Kelley, B.B.; Miles, K.A.; Keith, C.J.; Wong, D.C.; Griffiths, M.R.

    2002-01-01

    Full text: Intensive patient follow-up in assessments of the cost-effectiveness of a new imaging modality is associated with time-delays, ethical difficulties and increased costs. This study aims to evaluate the cost-effectiveness of FDG-PET in recurrent colorectal cancer using Australian data whilst avoiding intensive patient follow-up. The study population comprised patients with recurrent colorectal under consideration for resection of apparently isolated hepatic metastasis in whom demonstration of extra-hepatic tumour would preclude surgery. The results of FDG-PET in a consecutive series of 75 such patients referred to the Wesley PET centre were used to determine the range of possible values for disease prevalence and specificity, assuming the value for PET sensitivity as reported in the federal government's PET review. These values, along with the diagnostic accuracy of CT and Australian costs for procedures (PET = $ 1200), were entered into decision trees modelling a diagnostic strategy comprising CT only and an alternative strategy where patients without extra-hepatic tumour on CT also undergo FDG-PET. The cost per patient, accuracy and Incremental Cost-Accuracy Ratio (ICAR) were determined for each strategy. The PET strategy is cheaper for all possible values of disease prevalence and PET specificity ($306-328/patient) and is more cost-effective for values of disease prevalence above 0.18 or PET specificity above 0.86. At a typical disease prevalence of 0.3 (PET specificity 0.92), the ICAR for the PET strategy is $9700 versus $11,200 for CT. PET remains cost saving even if the best reported values for sensitivity of CT and worse values for PET are used, FDG-PET for recurrent colorectal cancer in Australia would be cost-saving and most probably cost-effective. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  15. 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.

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

    KAUST Repository

    Li, Huawei; Fan, Yiqiang; Foulds, Ian G.

    2011-01-01

    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.

  17. Rapid evaluation of the cost-effectiveness o FDG-PET in recurrent colorectal cancer

    International Nuclear Information System (INIS)

    Miles, K.A.; Keith, C.J.; Wong, D.C.; Griffiths, M.R.

    2002-01-01

    Full text: To evaluate the cost-effectiveness of FDG-PET in recurrent colorectal cancer using Australian data whilst avoiding the time delays, costs and ethical difficulties associated with intensive patient follow-up. A decision tree sensitivity analysis was used. The study population comprised patients with recurrent colorectal under consideration for resection of apparently isolated hepatic metastasis in whom demonstration of extra-hepatic tumour would preclude surgery.The results of FDG-PET in a consecutive series of 75 such patients referred to the Wesley PET centre were used to determine the range of possible values for disease prevalence and specificity, assuming the value for PET sensitivity as reported in the federal government's PET review. These values, along with the diagnostic accuracy of CT and Australian costs for procedures (PET = $1200), were entered into decision trees modelling a diagnostic strategy comprising CT only and an alternative strategy where patients without extrahepatic tumour on CT also undergo FDG-PET. The cost per patient, accuracy and Incremental Cost-Accuracy Ratio (ICAR) were determined for each strategy. The PET strategy is cheaper for all possible values of disease prevalence and PET specificity ($306-328 / patient) and is more cost-effective for values of disease prevalence above 0.18 or PET specificity above 0.86. At a typical disease prevalence of 0.3 (PET specificity 0.92), the ICAR for the PET strategy is $9700 versus $11,200 for CT. PET remains cost saving even if the best reported values for sensitivity of CT and worse values for PET are used. FDG-PET for recurrent colorectal cancer in Australia would be cost saving and most probably cost-effective. Copyright (2002) Blackwell Science Pty Ltd

  18. 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...

  19. Rapid Manufacturing of Durable, Cost-Effective Ceramic Matrix Composites for High Temperature Structures, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Hypersonic vehicles require durable and cost-effective hot structures that do not impose weight penalties such as those associated with the use of non-structural...

  20. Improved rapidly-quenched hydrogen-absorbing alloys for development of improved-capacity nickel metal hydride batteries

    Science.gov (United States)

    Ise, Tadashi; Hamamatsu, Takeo; Imoto, Teruhiko; Nogami, Mitsuzo; Nakahori, Shinsuke

    The effects of annealing a rapidly-quenched hydrogen-absorbing alloy with a stoichiometric ratio of 4.76 were investigated concerning its hydrogen-absorbing properties, crystal structure and electrochemical characteristics. Annealing at 1073 K homogenized the alloy microstructure and flattened its plateau slope in the P-C isotherms. However, annealing at 1273 K segregated a second phase rich in rare earth elements, increased the hydrogen-absorbing pressure and decreased the hydrogen-absorbing capacity. As the number of charge-discharge cycles increases, the particle size distribution of the rapidly-quenched alloy became broad due to partial pulverization. However, particle size distribution of the rapidly-quenched, annealed, alloy was sharp, since the annealing homogenized the microstructure, thereby improving the cycle characteristics. A high-capacity rectangular nickel metal hydride battery using a rapidly-quenched, annealed, surface-treated alloy for the negative electrode and an active material coated with cobalt compound containing sodium for the positive electrode was developed. The capacity of the resulting battery was 30% greater than that of a conventional battery.

  1. Integration of quality improvement and cost-efficiency through industrial improvement techniques

    Directory of Open Access Journals (Sweden)

    Vink JP

    2016-06-01

    Full Text Available Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

  2. 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 ...

  3. Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania.

    Directory of Open Access Journals (Sweden)

    Jacklin F Mosha

    Full Text Available BACKGROUND: Over diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: The magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a or=5 year age group in the lower transmission site (RR 14.0 95%CI 8.2-24.2. In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in <2 year old cohort compared to children seen at routine care system. (0.08% vs 28.2%; p<0.001. A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001. Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system. IMPLICATIONS: The introduction of RDTs is likely to lead to financial savings. However, improving diagnosis to one disease may lead to over diagnosis of another illness. Quality improvement is complex but introducing RDTs for the diagnosis of malaria is a good start.

  4. A high performance, high precision, low cost rapid prototyping and manufacturing technology

    OpenAIRE

    Viacheslav R. Shulunov

    2014-01-01

    A novel roll powder sintering (RPS) technology is proposed for processing real plastic, ceramic, metal and other 3-D objects 1m³ (or more) in volume directly from a CAD model within several hours. The breakthrough advantages of the technology are compared to the dominant rapid prototyping and manufacturing (RP&M) processes that are currently on the market.

  5. 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.

  6. Rapid Eye Movement Sleep Behavior Disorder in Paraneoplastic Cerebellar Degeneration: Improvement with Immunotherapy.

    Science.gov (United States)

    Vale, Thiago Cardoso; Fernandes do Prado, Lucila Bizari; do Prado, Gilmar Fernandes; Povoas Barsottini, Orlando Graziani; Pedroso, José Luiz

    2016-01-01

    To report two female patients with paraneoplastic cerebellar degeneration (PCD) related to breast cancer that presented with rapid eye movement-sleep behavior disorder (RBD) and improved sleep symptoms with immunotherapy. The two patients were evaluated through clinical scale and polysomnography before and after therapy with intravenous immunoglobulin. RBD was successfully treated with immunotherapy in both patients. Score on the RBD screening questionnaire dropped from 10 to 1 or 0, allied with the normalization of polysomnographic findings. A marked improvement in RBD after immunotherapy in PCD raises the hypothesis that secondary RBD may be an immune-mediated sleep disorder. © 2016 Associated Professional Sleep Societies, LLC.

  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 day readmissions, postoperative infections, operating time, or reoperations. This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument 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. 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.

  9. 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.

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

    African Journals Online (AJOL)

    user

    2011-02-21

    Feb 21, 2011 ... Available online at http://www.academicjournals.org/AJB ... α-casein, produces PCR ready DNA at a fraction of the cost of commercial DNA extraction kits. Key words: DNA .... This experiment was performed to evaluate the efficiency of the ..... Zoetendal EG, Ben-Amor K, Akkermans AD, Abee T, De Vos WM.

  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. Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project.

    Science.gov (United States)

    Bunch, Azalea Marie; Leasure, A Renee; Carithers, Cathrin; Burnette, Robert E; Berryman, Michael Scott

    2016-02-01

    The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90-min chest pain screening and evaluation protocol to a 120-min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home. The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study. There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group. Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety. ©2015 American Association of Nurse Practitioners.

  13. The Rapid Disaster Evaluation System (RaDES): A Plan to Improve Global Disaster Response by Privatizing the Assessment Component.

    Science.gov (United States)

    Iserson, Kenneth V

    2017-09-01

    Emergency medicine personnel frequently respond to major disasters. They expect to have an effective and efficient management system to elegantly allocate available resources. Despite claims to the contrary, experience demonstrates this rarely occurs. This article describes privatizing disaster assessment using a single-purposed, accountable, and well-trained organization. The goal is to achieve elegant disaster assessment, rather than repeatedly exhorting existing groups to do it. The Rapid Disaster Evaluation System (RaDES) would quickly and efficiently assess a postdisaster population's needs. It would use an accountable nongovernmental agency's teams with maximal training, mobility, and flexibility. Designed to augment the Inter-Agency Standing Committee's 2015 Emergency Response Preparedness Plan, RaDES would provide the initial information needed to avoid haphazard and overlapping disaster responses. Rapidly deployed teams would gather information from multiple sources and continually communicate those findings to their base, which would then disseminate them to disaster coordinators in a concise, coherent, and transparent way. The RaDES concept represents an elegant, minimally bureaucratic, and effective rapid response to major disasters. However, its implementation faces logistical, funding, and political obstacles. Developing and maintaining RaDES would require significant funding and political commitment to coordinate the numerous agencies that claim to be performing the same tasks. Although simulations can demonstrate efficacy and deficiencies, only field tests will demonstrate RaDES' power to improve interagency coordination and decrease the cost of major disaster response. At the least, the RaDES concept should serve as a model for discussing how to practicably improve our current chaotic disaster responses. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. ScreenCube: A 3D Printed System for Rapid and Cost-Effective Chemical Screening in Adult Zebrafish.

    Science.gov (United States)

    Monstad-Rios, Adrian T; Watson, Claire J; Kwon, Ronald Y

    2018-02-01

    Phenotype-based small molecule screens in zebrafish embryos and larvae have been successful in accelerating pathway and therapeutic discovery for diverse biological processes. Yet, the application of chemical screens to adult physiologies has been relatively limited due to additional demands on cost, space, and labor associated with screens in adult animals. In this study, we present a 3D printed system and methods for intermittent drug dosing that enable rapid and cost-effective chemical administration in adult zebrafish. Using prefilled screening plates, the system enables dosing of 96 fish in ∼3 min, with a 10-fold reduction in drug quantity compared to that used in previous chemical screens in adult zebrafish. We characterize water quality kinetics during immersion in the system and use these kinetics to rationally design intermittent dosing regimens that result in 100% fish survival. As a demonstration of system fidelity, we show the potential to identify two known chemical inhibitors of adult tail fin regeneration, cyclopamine and dorsomorphin. By developing methods for rapid and cost-effective chemical administration in adult zebrafish, this study expands the potential for small molecule discovery in postembryonic models of development, disease, and regeneration.

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    Marco A. Rendón-Medina

    2018-01-01

    Full Text Available Summary:. 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.

  17. Multiple strategies to improve sensitivity, speed and robustness of isothermal nucleic acid amplification for rapid pathogen detection

    Directory of Open Access Journals (Sweden)

    Lemieux Bertrand

    2011-05-01

    Full Text Available Abstract Background In the past decades the rapid growth of molecular diagnostics (based on either traditional PCR or isothermal amplification technologies meet the demand for fast and accurate testing. Although isothermal amplification technologies have the advantages of low cost requirements for instruments, the further improvement on sensitivity, speed and robustness is a prerequisite for the applications in rapid pathogen detection, especially at point-of-care diagnostics. Here, we describe and explore several strategies to improve one of the isothermal technologies, helicase-dependent amplification (HDA. Results Multiple strategies were approached to improve the overall performance of the isothermal amplification: the restriction endonuclease-mediated DNA helicase homing, macromolecular crowding agents, and the optimization of reaction enzyme mix. The effect of combing all strategies was compared with that of the individual strategy. With all of above methods, we are able to detect 50 copies of Neisseria gonorrhoeae DNA in just 20 minutes of amplification using a nearly instrument-free detection platform (BESt™ cassette. Conclusions The strategies addressed in this proof-of-concept study are independent of expensive equipments, and are not limited to particular primers, targets or detection format. However, they make a large difference in assay performance. Some of them can be adjusted and applied to other formats of nucleic acid amplification. Furthermore, the strategies to improve the in vitro assays by maximally simulating the nature conditions may be useful in the general field of developing molecular assays. A new fast molecular assay for Neisseria gonorrhoeae has also been developed which has great potential to be used at point-of-care diagnostics.

  18. 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

  19. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes.

    Science.gov (United States)

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  20. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

    Science.gov (United States)

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

  1. Low-Cost, Rapidly Responsive, Controllable, and Reversible Photochromic Hydrogel for Display and Storage.

    Science.gov (United States)

    Yang, Yongqi; Guan, Lin; Gao, Guanghui

    2018-04-25

    Traditional optoelectronic devices without stretchable performance could be limited for substrates with irregular shape. Therefore, it is urgent to explore a new generation of flexible, stretchable, and low-cost intelligent vehicles as visual display and storage devices, such as hydrogels. In the investigation, a novel photochromic hydrogel was developed by introducing the negatively charged ammonium molybdate as a photochromic unit into polyacrylamide via ionic and covalent cross-linking. The hydrogel exhibited excellent properties of low cost, easy preparation, stretchable deformation, fatigue resistance, high transparency, and second-order response to external signals. Moreover, the photochromic and fading process of hydrogels could be precisely controlled and repeated under the irradiation of UV light and exposure of oxygen at different time and temperature. The photochromic hydrogel could be considered applied for artificial intelligence system, wearable healthcare device, and flexible memory device. Therefore, the strategy for designing a soft photochromic material would open a new direction to manufacture flexible and stretchable devices.

  2. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

    Science.gov (United States)

    Savitz, Lucy A; Savitz, Samuel T

    2016-01-01

    Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

  3. A simple, rapid, cost-effective and sensitive method for detection of Salmonella in environmental and pecan samples.

    Science.gov (United States)

    Dobhal, S; Zhang, G; Rohla, C; Smith, M W; Ma, L M

    2014-10-01

    PCR is widely used in the routine detection of foodborne human pathogens; however, challenges remain in overcoming PCR inhibitors present in some sample matrices. The objective of this study was to develop a simple, sensitive, cost-effective and rapid method for processing large numbers of environmental and pecan samples for Salmonella detection. This study was also aimed at validation of a new protocol for the detection of Salmonella from in-shell pecans. Different DNA template preparation methods, including direct boiling, prespin, multiple washing and commercial DNA extraction kits, were evaluated with pure cultures of Salmonella Typhimurium and with enriched soil, cattle feces and in-shell pecan each spiked individually with Salmonella Typhimurium. PCR detection of Salmonella was conducted using invA and 16S rRNA gene (internal amplification control) specific primers. The effect of amplification facilitators, including bovine serum albumin (BSA), polyvinylpyrrolidone (PVP), polyethylene glycol (PEG) and gelatin on PCR sensitivity, was also evaluated. Conducting a prespin of sample matrices in combination with the addition of 0·4% (w/v) BSA and 1% (w/v) PVP in PCR mix was the simplest, most rapid, cost-effective and sensitive method for PCR detection of Salmonella, with up to 40 CFU Salmonella per reaction detectable in the presence of over 10(9 ) CFU ml(-1) of background micro-organisms from enriched feces soil or pecan samples. The developed method is rapid, cost-effective and sensitive for detection of Salmonella from different matrices. This study provides a method with broad applicability for PCR detection of Salmonella in complex sample matrices. This method has a potential for its application in different research arenas and diagnostic laboratories. © 2014 The Society for Applied Microbiology.

  4. Expedited Site Characterization: A rapid, cost-effective process for preremedial site characterization

    International Nuclear Information System (INIS)

    Burton, J.C.; Walker, J.L.; Jennings, T.V.; Aggarwal, P.K.; Hastings, B.; Meyer, W.T.; Rose, C.M.; Rosignolo, C.L.

    1993-01-01

    Argonne National Laboratory has developed a unique, cost- and time-effective, technically innovative process for preremedial site characterization, referred to as Expedited Site Characterization (ESC). The cost of the ESC field sampling process ranges from 1/10 to 1/5 of the cost of traditional site characterization. The time required for this ESC field activity is approximately 1/30 of that for current methods. Argonne's preremedial site investigations based on this approach have been accepted by the appropriate regulatory agencies. The ESC process is flexible and neither site nor contaminant dependent. The process has been successfully tested and applied in site investigations of multiple contaminated landfills in New Mexico (for the US Department of the Interior's Bureau of Land Management [BLM]) and at former grain storage facilities in Nebraska and Kansas, contaminated with carbon tetrachloride (for the Department of Agriculture's Commodity Credit Corporation [CCC/USDA]). A working demonstration of this process was sponsored by the US Department of Energy (DOE) Office of Technology Development as a model of the methodology needed to accelerate site characterizations at DOE facilities. This report describes the application of the process in New Mexico, Nebraska and Kansas

  5. Consolidating staff augmentation contracts improves teamwork and reduces costs

    International Nuclear Information System (INIS)

    Townsend, J.; Sibilla, L.; Gregovich, J.W.

    1991-01-01

    Nuclear power plants have traditionally used multiple contracting firms to provide temporary staff augmentation personnel primarily because of two perceptions: (1) managers believe they have greater access to a higher quality, readily available pool of applicants. (2) using multiple contractors inherently keeps costs down as a result of several competitors submitting resumes for the same position. This paper provides information, based on the experiences of a leading nuclear power plant, that disproves these perceptions. It explains why consolidating several contracts for professional and technical classifications (excluding craft labor and refueling personnel) and competitively bidding and awarding the contract to a single contracting firm promotes teamwork and reduces costs

  6. 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

  7. 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…

  8. 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

  9. A cost-effective device for the rapid transfer of gel-separated proteins onto membranes.

    Science.gov (United States)

    Tam, Hann W; Huang, Yu-Chen; Tam, Ming F

    2009-03-01

    We describe here the fabrication of a cost-effective semi-dry blotting apparatus for the transfer of proteins onto membranes. Graphite sheets were used as electrodes. Protein mixtures were separated on NuPAGE 4% to 12% polyacrylamide gradient gels. With a Tris-bicine buffer, we demonstrated that close to 80% of the proteins with apparent molecular mass of 80kDa or less were removed from the gels after 8min of blotting. The process is much faster than the techniques reported previously in the literature.

  10. Rapid detection of methicillin-resistant Staphylococcus aureus directly from clinical samples: methods, effectiveness and cost considerations

    Directory of Open Access Journals (Sweden)

    Stürenburg, Enno

    2009-07-01

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA isolates is a serious public health problem whose ever-increasing rate is commensurate with the pressure it is exerting on the healthcare system. At present, more than 20% of clinical S. aureus isolates in German hospitals are methicillin resistant. Strategies from low-prevalence countries show that this development is not necessarily inevitable. In the Scandinavian countries and the Netherlands, thanks to a rigorous prevention programme, MRSA prevalence has been kept at an acceptably low level (<1–3%. Central to these ‘search and destroy’ control strategies is an admission screening using several MRSA swabs taken from mucocutaneous colonisation sites of high-risk patients (‘MRSA surveillance’. It has also been reported that the speed with which MRSA carriage is detected has an important role to play, as it is a key component of any effective strategy to prevent the pathogen from spreading. Since MRSA culturing involves a 2–3 day delay before the final results are available, rapid detection techniques (commonly referred to as ‘MRSA rapid tests’ using PCR methods and, most recently, rapid culturing methods have been developed. The implementation of rapid tests reduces the time of detection of MRSA carriers from 48–72 to 2–5 h. Clinical evaluation data have shown that MRSA can thus be detected with very high sensitivity. Specificity however is sometimes impaired due to false-positive PCR signals occurring in mixed flora specimens. In order to rule out any false-positive PCR results, a culture screen must always be carried out simultaneously.The data provide preliminary evidence that a PCR assay can reduce nosocomial MRSA transmission in high-risk patients or high-risk areas, whereas an approach that screens all patients admitted to the hospital is probably not effective. Information concerning the cost-effectiveness of rapid MRSA tests is still sparse and thus the issue remains

  11. 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

    Experimental research in precision farming is a significant challenge due to the considerable resources required to perform field experiments. Simulating the field environment is a frequently used technique which is useful for functional software tests, but beyond that it is necessary to perform...... 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...... as outdoor driving in semi-rugged terrain such as grass fields and bare soil. This paper presents the FrobitPro robot and describes two use cases in current research projects, namely the Grassbots project which focuses on harvesting of grass on lowland areas for biofuel production and the SAFE project...

  12. A rapid and cost-effective fluorescence detection in tube (FDIT) method to analyze protein phosphorylation.

    Science.gov (United States)

    Jin, Xiao; Gou, Jin-Ying

    2016-01-01

    Protein phosphorylation is one of the most important post-translational modifications catalyzed by protein kinases in living organisms. The advance of genome sequencing provided the information of protein kinase families in many organisms, including both model and non-model plants. The development of proteomics technologies also enabled scientists to efficiently reveal a large number of protein phosphorylations of an organism. However, kinases and phosphorylation targets are still to be connected to illustrate the complicated network in life. Here we adapted Pro-Q ® Diamond (Pro-Q ® Diamond Phosphoprotein Gel Stain), a widely used phosphoprotein gel-staining fluorescence dye, to establish a rapid, economical and non-radioactive fluorescence detection in tube (FDIT) method to analyze phosphorylated proteins. Taking advantages of high sensitivity and specificity of Pro-Q ® diamond, the FDIT method is also demonstrated to be rapid and reliable, with a suitable linear range for in vitro protein phosphorylation. A significant and satisfactory protein kinase reaction was detected as fast as 15 min from Wheat Kinase START 1.1 (WKS1.1) on a thylakoid ascorbate peroxidase (tAPX), an established phosphorylation target in our earlier study. The FDIT method saves up to 95% of the dye consumed in a gel staining method. The FDIT method is remarkably quick, highly reproducible, unambiguous and capable to be scaled up to dozens of samples. The FDIT method could serve as a simple and sensitive alternative procedure to determine protein kinase reactions with zero radiation exposure, as a supplementation to other widely used radioactive and in-gel assays.

  13. A rapid and cost-effective fluorescence detection in tube (FDIT method to analyze protein phosphorylation

    Directory of Open Access Journals (Sweden)

    Xiao Jin

    2016-11-01

    Full Text Available Abstract Background Protein phosphorylation is one of the most important post-translational modifications catalyzed by protein kinases in living organisms. The advance of genome sequencing provided the information of protein kinase families in many organisms, including both model and non-model plants. The development of proteomics technologies also enabled scientists to efficiently reveal a large number of protein phosphorylations of an organism. However, kinases and phosphorylation targets are still to be connected to illustrate the complicated network in life. Results Here we adapted Pro-Q® Diamond (Pro-Q® Diamond Phosphoprotein Gel Stain, a widely used phosphoprotein gel-staining fluorescence dye, to establish a rapid, economical and non-radioactive fluorescence detection in tube (FDIT method to analyze phosphorylated proteins. Taking advantages of high sensitivity and specificity of Pro-Q® diamond, the FDIT method is also demonstrated to be rapid and reliable, with a suitable linear range for in vitro protein phosphorylation. A significant and satisfactory protein kinase reaction was detected as fast as 15 min from Wheat Kinase START 1.1 (WKS1.1 on a thylakoid ascorbate peroxidase (tAPX, an established phosphorylation target in our earlier study. Conclusion The FDIT method saves up to 95% of the dye consumed in a gel staining method. The FDIT method is remarkably quick, highly reproducible, unambiguous and capable to be scaled up to dozens of samples. The FDIT method could serve as a simple and sensitive alternative procedure to determine protein kinase reactions with zero radiation exposure, as a supplementation to other widely used radioactive and in-gel assays.

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

    Directory of Open Access Journals (Sweden)

    Sanjiv Sharma

    2017-04-01

    Full Text Available 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. Keywords: Microneedles, Minimally invasive sensors, Continuous glucose monitoring (CGM, Continuous lactate monitoring (CLM, Interstitial therapeutic drug monitoring (iTDM

  15. 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…

  16. In House HSV PCR, Process Improvement and Cost Effectiveness Analysis

    Science.gov (United States)

    2017-09-15

    TYPE 09/15/2017 Poster 4. TITLE AND SUBTITLE Cost-Analysis: In-hous(l HSV P(’R capabilities 6. AUTHOR(S) Ma.i Nich() las R CaJT 7. PERFORMING...ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMIT A TIC ".’ OF 18. NUMBER a. REPORT b. ABSTRACT c. THIS PAGE ABSTRACT OF PAGES 3

  17. Lean Six Sigma for reduced cycle costs and improved readiness

    OpenAIRE

    Apte, Uday; Kang, Keebom

    2006-01-01

    Sponsored Report (for Acquisition Research Program) In general, during the lifecycle of a weapon system a significantly larger amount of money gets spent in operating and maintaining the system than acquiring it. Hence, efficient logistics systems, including transportation, inventory management, modifications and maintenance activities, are critically important for containing the lifecycle costs of weapon systems and for maintaining the highest level of military readiness given the extant ...

  18. 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 rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... 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...

  19. 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

  20. Cost-effectiveness analysis of malaria rapid diagnostic test incentive schemes for informal private healthcare providers in Myanmar.

    Science.gov (United States)

    Chen, Ingrid T; Aung, Tin; Thant, Hnin Nwe Nwe; Sudhinaraset, May; Kahn, James G

    2015-02-05

    The emergence of artemisinin-resistant Plasmodium falciparum parasites in Southeast Asia threatens global malaria control efforts. One strategy to counter this problem is a subsidy of malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) within the informal private sector, where the majority of malaria care in Myanmar is provided. A study in Myanmar evaluated the effectiveness of financial incentives vs information, education and counselling (IEC) in driving the proper use of subsidized malaria RDTs among informal private providers. This cost-effectiveness analysis compares intervention options. A decision tree was constructed in a spreadsheet to estimate the incremental cost-effectiveness ratios (ICERs) among four strategies: no intervention, simple subsidy, subsidy with financial incentives, and subsidy with IEC. Model inputs included programmatic costs (in dollars), malaria epidemiology and observed study outcomes. Data sources included expenditure records, study data and scientific literature. Model outcomes included the proportion of properly and improperly treated individuals with and without P. falciparum malaria, and associated disability-adjusted life years (DALYs). Results are reported as ICERs in US dollars per DALY averted. One-way sensitivity analysis assessed how outcomes depend on uncertainty in inputs. ICERs from the least to most expensive intervention are: $1,169/DALY averted for simple subsidy vs no intervention, $185/DALY averted for subsidy with financial incentives vs simple subsidy, and $200/DALY averted for a subsidy with IEC vs subsidy with financial incentives. Due to decreasing ICERs, each strategy was also compared to no intervention. The subsidy with IEC was the most favourable, costing $639/DALY averted compared with no intervention. One-way sensitivity analysis shows that ICERs are most affected by programme costs, RDT uptake, treatment-seeking behaviour, and the prevalence and virulence of non

  1. Logistics costs evaluation as a way of company’s efficiency improvement

    OpenAIRE

    Galina VOLOSCENCO; Natalia SESTENCO-DIACEK

    2015-01-01

    In Logistic systems, besides the usual costs for work forces, material and supplies, there are specific costs which are not always identified with the term classic meaning. These are transaction costs which influence on financial indicators of the company and on its efficiency and competitiveness accordingly. These costs classification, factors influencing on their amount, allows to find ways for their reduction methods and so that to improve the efficiency of the company.

  2. An improved ternary vector system for Agrobacterium-mediated rapid maize transformation.

    Science.gov (United States)

    Anand, Ajith; Bass, Steven H; Wu, Emily; Wang, Ning; McBride, Kevin E; Annaluru, Narayana; Miller, Michael; Hua, Mo; Jones, Todd J

    2018-05-01

    A simple and versatile ternary vector system that utilizes improved accessory plasmids for rapid maize transformation is described. This system facilitates high-throughput vector construction and plant transformation. The super binary plasmid pSB1 is a mainstay of maize transformation. However, the large size of the base vector makes it challenging to clone, the process of co-integration is cumbersome and inefficient, and some Agrobacterium strains are known to give rise to spontaneous mutants resistant to tetracycline. These limitations present substantial barriers to high throughput vector construction. Here we describe a smaller, simpler and versatile ternary vector system for maize transformation that utilizes improved accessory plasmids requiring no co-integration step. In addition, the newly described accessory plasmids have restored virulence genes found to be defective in pSB1, as well as added virulence genes. Testing of different configurations of the accessory plasmids in combination with T-DNA binary vector as ternary vectors nearly doubles both the raw transformation frequency and the number of transformation events of usable quality in difficult-to-transform maize inbreds. The newly described ternary vectors enabled the development of a rapid maize transformation method for elite inbreds. This vector system facilitated screening different origins of replication on the accessory plasmid and T-DNA vector, and four combinations were identified that have high (86-103%) raw transformation frequency in an elite maize inbred.

  3. Using rapid-scan EPR to improve the detection limit of quantitative EPR by more than one order of magnitude.

    Science.gov (United States)

    Möser, J; Lips, K; Tseytlin, M; Eaton, G R; Eaton, S S; Schnegg, A

    2017-08-01

    X-band rapid-scan EPR was implemented on a commercially available Bruker ELEXSYS E580 spectrometer. Room temperature rapid-scan and continuous-wave EPR spectra were recorded for amorphous silicon powder samples. By comparing the resulting signal intensities the feasibility of performing quantitative rapid-scan EPR is demonstrated. For different hydrogenated amorphous silicon samples, rapid-scan EPR results in signal-to-noise improvements by factors between 10 and 50. Rapid-scan EPR is thus capable of improving the detection limit of quantitative EPR by at least one order of magnitude. In addition, we provide a recipe for setting up and calibrating a conventional pulsed and continuous-wave EPR spectrometer for rapid-scan EPR. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. A rapid, sensitive, and cost-efficient assay to estimate viability of potato cyst nematodes.

    Science.gov (United States)

    van den Elsen, Sven; Ave, Maaike; Schoenmakers, Niels; Landeweert, Renske; Bakker, Jaap; Helder, Johannes

    2012-02-01

    Potato cyst nematodes (PCNs) are quarantine organisms, and they belong to the economically most relevant pathogens of potato worldwide. Methodologies to assess the viability of their cysts, which can contain 200 to 500 eggs protected by the hardened cuticle of a dead female, are either time and labor intensive or lack robustness. We present a robust and cost-efficient viability assay based on loss of membrane integrity upon death. This assay uses trehalose, a disaccharide present at a high concentration in the perivitelline fluid of PCN eggs, as a viability marker. Although this assay can detect a single viable egg, the limit of detection for regular field samples was higher, ≈10 viable eggs, due to background signals produced by other soil components. On the basis of 30 nonviable PCN samples from The Netherlands, a threshold level was defined (ΔA(trehalose) = 0.0094) below which the presence of >10 viable eggs is highly unlikely (true for ≈99.7% of the observations). This assay can easily be combined with a subsequent DNA-based species determination. The presence of trehalose is a general phenomenon among cyst nematodes; therefore, this method can probably be used for (for example) soybean, sugar beet, and cereal cyst nematodes as well.

  5. Improved Process Used to Treat Aqueous Mixed Waste Results in Cost Savings and Improved Worker Safety

    International Nuclear Information System (INIS)

    Hodge, D.S.; Preuss, D.E.; Belcher, K.J.; Rock, C.M.; Bray, W.S.; Herman, J.P.

    2006-01-01

    This paper describes an improved process implemented at Argonne National Laboratory (ANL) to treat aqueous mixed waste. This waste is comprised of radioactively-contaminated corrosive liquids with heavy metals. The Aqueous Mixed Waste Treatment System (AMWTS) system components include a reaction tank and a post-treatment holding tank with ancillary piping and pumps; and a control panel with pumping/mixing controls; tank level, temperature and pH/Oxidation Reduction Potential (ORP) indicators. The process includes a neutralization step to remove the corrosive characteristic, a chromium reduction step to reduce hexavalent chromium to trivalent chromium, and a precipitation step to convert the toxic metals into an insoluble form. Once the toxic metals have precipitated, the resultant sludge is amenable to stabilization and can be reclassified as a low-level waste if the quantity of leachable toxic metals, as determined by the TCLP, is below Universal Treatment Standards (UTS). To date, six batches in eight have passed the UTS. The AMWTS is RCRA permitted and allows for the compliant treatment of mixed waste prior to final disposal at a Department of Energy (DOE) or commercial radioactive waste disposal facility. Mixed wastes eligible for treatment include corrosive liquids (pH 12.5) containing EPA-regulated toxic metals (As, Ba, Pb, Cd, Cr, Ag, Se, Hg) at concentrations greater than the RCRA Toxicity Characteristic Leaching Procedure (TCLP) limit. The system has also been used to treat corrosive wastes with small quantities of fissionable materials. The AMWTS is a significant engineered solution with many improvements over the more labor intensive on-site treatment method being performed within a ventilation hood used previously. The previously used treatment system allowed for batch sizes of only 15-20 gallons whereas the new AMWTS allows for the treatment of batches up to 75 gallons; thereby reducing batch labor and supply costs by 40-60% and reducing analytical

  6. Do rapid 'superbug' tests pay off? Balance the costs and benefits of leading-edge technology. Interview by Alan Joch.

    Science.gov (United States)

    Morgan, Margie Ann

    2009-02-01

    As hospitals become increasingly sensitive to the health and financial consequences of health care-associated infections (HAIs), a new generation of molecular-based testing technologies promises to significantly shorten the time required to identify "superbugs" and other bacterial infections. The leading-edge techniques promise to reduce costs by helping hospitals quickly determine which patients to isolate because they carry active methicillin-resistant Staphylococcus aureus (MRSA) infections, for example, or which ones to release from prophylactic isolation because they ultimately tested negative for a dangerous infection. But diagnostic speed comes at a price--the costs to perform molecular tests are significantly higher than conventional methods. This challenges hospitals to balance health care expenses with medical efficacy, says molecular testing veteran Margie Morgan, Ph.D., scientific director at Cedars-Sinai Medical Center, Los Angeles. "The rapid methods can be extreme time savers and possibly help a great deal with the isolation of patients. But some of the tests may cost five times what manual methods might be, so there is a price for seeing so much of a reduction in time," she says.

  7. Improving multi-GNSS ultra-rapid orbit determination for real-time precise point positioning

    Science.gov (United States)

    Li, Xingxing; Chen, Xinghan; Ge, Maorong; Schuh, Harald

    2018-03-01

    Currently, with the rapid development of multi-constellation Global Navigation Satellite Systems (GNSS), the real-time positioning and navigation are undergoing dramatic changes with potential for a better performance. To provide more precise and reliable ultra-rapid orbits is critical for multi-GNSS real-time positioning, especially for the three merging constellations Beidou, Galileo and QZSS which are still under construction. In this contribution, we present a five-system precise orbit determination (POD) strategy to fully exploit the GPS + GLONASS + BDS + Galileo + QZSS observations from CDDIS + IGN + BKG archives for the realization of hourly five-constellation ultra-rapid orbit update. After adopting the optimized 2-day POD solution (updated every hour), the predicted orbit accuracy can be obviously improved for all the five satellite systems in comparison to the conventional 1-day POD solution (updated every 3 h). The orbit accuracy for the BDS IGSO satellites can be improved by about 80, 45 and 50% in the radial, cross and along directions, respectively, while the corresponding accuracy improvement for the BDS MEO satellites reaches about 50, 20 and 50% in the three directions, respectively. Furthermore, the multi-GNSS real-time precise point positioning (PPP) ambiguity resolution has been performed by using the improved precise satellite orbits. Numerous results indicate that combined GPS + BDS + GLONASS + Galileo (GCRE) kinematic PPP ambiguity resolution (AR) solutions can achieve the shortest time to first fix (TTFF) and highest positioning accuracy in all coordinate components. With the addition of the BDS, GLONASS and Galileo observations to the GPS-only processing, the GCRE PPP AR solution achieves the shortest average TTFF of 11 min with 7{°} cutoff elevation, while the TTFF of GPS-only, GR, GE and GC PPP AR solution is 28, 15, 20 and 17 min, respectively. As the cutoff elevation increases, the reliability and accuracy of GPS-only PPP AR solutions

  8. 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

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

    KAUST Repository

    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

    2016-01-01

    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

  10. 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”.

  11. Revising history for cost-informed process improvement

    NARCIS (Netherlands)

    Low, W.Z.; vanden Broucke, S.K.L.M.; Wynn, M.T.; ter Hofstede, A.H.M.; De Weerdt, J.; van der Aalst, W.M.P.

    2016-01-01

    Organisations are constantly seeking new ways to improve operational efficiencies. This study investigates a novel way to identify potential efficiency gains in business operations by observing how they were carried out in the past and then exploring better ways of executing them by taking into

  12. Improving patient-level costing in the English and the German 'DRG' system.

    Science.gov (United States)

    Vogl, Matthias

    2013-03-01

    The purpose of this paper is to develop ways to improve patient-level cost apportioning (PLCA) in the English and German inpatient 'DRG' cost accounting systems, to support regulators in improving costing schemes, and to give clinicians and hospital management sophisticated tools to measure and link their management. The paper analyzes and evaluates the PLCA step in the cost accounting schemes of both countries according to the impact on the key aspects of DRG introduction: transparency and efficiency. The goal is to generate a best available PLCA standard with enhanced accuracy and managerial relevance, the main requirements of cost accounting. A best available PLCA standard in 'DRG' cost accounting uses: (1) the cost-matrix from the German system; (2) a third axis in this matrix, representing service-lines or clinical pathways; (3) a scoring system for key cost drivers with the long-term objective of time-driven activity-based costing and (4) a point of delivery separation. Both systems have elements that the other system can learn from. By combining their strengths, regulators are supported in enhancing PLCA systems, improving the accuracy of national reimbursement and the managerial relevance of inpatient cost accounting systems, in order to reduce costs in health care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  13. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    Science.gov (United States)

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.

  14. 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.

  15. 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

  16. An improved synthesis of pentacene: rapid access to a benchmark organic semiconductor.

    Science.gov (United States)

    Pramanik, Chandrani; Miller, Glen P

    2012-04-20

    Pentacene is an organic semiconductor used in a variety of thin-film organic electronic devices. Although at least six separate syntheses of pentacene are known (two from dihydropentacenes, two from 6,13-pentacenedione and two from 6,13-dihydro-6,13-dihydroxypentacene), none is ideal and several utilize elevated temperatures that may facilitate the oxidation of pentacene as it is produced. Here, we present a fast (-2 min of reaction time), simple, high-yielding (≥ 90%), low temperature synthesis of pentacene from readily available 6,13-dihydro-6,13-dihydroxypentacene. Further, we discuss the mechanism of this highly efficient reaction. With this improved synthesis, researchers gain rapid, affordable access to high purity pentacene in excellent yield and without the need for a time consuming sublimation.

  17. An Improved Synthesis of Pentacene: Rapid Access to a Benchmark Organic Semiconductor

    Directory of Open Access Journals (Sweden)

    Glen P. Miller

    2012-04-01

    Full Text Available Pentacene is an organic semiconductor used in a variety of thin-film organic electronic devices. Although at least six separate syntheses of pentacene are known (two from dihydropentacenes, two from 6,13-pentacenedione and two from 6,13-dihydro-6,13-dihydroxypentacene, none is ideal and several utilize elevated temperatures that may facilitate the oxidation of pentacene as it is produced. Here, we present a fast (~2 min of reaction time, simple, high-yielding (≥90%, low temperature synthesis of pentacene from readily available 6,13-dihydro-6,13-dihydroxypentacene. Further, we discuss the mechanism of this highly efficient reaction. With this improved synthesis, researchers gain rapid, affordable access to high purity pentacene in excellent yield and without the need for a time consuming sublimation.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. Improving Resident Performance Through a Simulated Rapid Response Team: A Pilot Study.

    Science.gov (United States)

    Burke, Peter A; Vest, Michael T; Kher, Hemant; Deutsch, Joseph; Daya, Sneha

    2015-07-01

    The Joint Commission requires hospitals to develop systems in which a team of clinicians can rapidly recognize and respond to changes in a patient's condition. The rapid response team (RRT) concept has been widely adopted as the solution to this mandate. The role of house staff in RRTs and the impact on resident education has been controversial. At Christiana Care Health System, eligible residents in their second through final years lead the RRTs. To evaluate the use of a team-based, interdisciplinary RRT training program for educating and training first-year residents in an effort to improve global RRT performance before residents start their second year. This pilot study was administered in 3 phases. Phase 1 provided residents with classroom-based didactic sessions using case-based RRT scenarios. Multiple choice examinations were administered, as well as a confidence survey based on a Likert scale before and after phase 1 of the program. Phase 2 involved experiential training in which residents engaged as mentored participants in actual RRT calls. A qualitative survey was used to measure perceived program effectiveness after phase 2. In phase 3, led by senior residents, simulated RRTs using medical mannequins were conducted. Participants were divided into 5 teams, in which each resident would rotate in the roles of leader, nurse, and respiratory therapist. This phase measured resident performance with regard to medical decision making, data gathering, and team behaviors during the simulated RRT scenarios. Performance was scored by an attending and a senior resident. A total of 18 residents were eligible (N=18) for participation. The average multiple choice test score improved by 20% after didactic training. The average confidence survey score before training was 3.44 out of 5 (69%) and after training was 4.13 (83%), indicating a 14% improvement. High-quality team behaviors correlated with medical decision making (0.92) more closely than did high-quality data

  3. Improvement of the cost-benefit analysis algorithm for high-rise construction projects

    Directory of Open Access Journals (Sweden)

    Gafurov Andrey

    2018-01-01

    Full Text Available The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the “Project analysis scenario” flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

  4. Improvement of the cost-benefit analysis algorithm for high-rise construction projects

    Science.gov (United States)

    Gafurov, Andrey; Skotarenko, Oksana; Plotnikov, Vladimir

    2018-03-01

    The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the "Project analysis scenario" flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

  5. 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.

  6. Programme level implementation of malaria rapid diagnostic tests (RDTs) use: outcomes and cost of training health workers at lower level health care facilities in Uganda.

    Science.gov (United States)

    Kyabayinze, Daniel J; Asiimwe, Caroline; Nakanjako, Damalie; Nabakooza, Jane; Bajabaite, Moses; Strachan, Clare; Tibenderana, James K; Van Geetruyden, Jean Pierre

    2012-04-20

    The training of health workers in the use of malaria rapid diagnostic tests (RDTs) is an important component of a wider strategy to improve parasite-based malaria diagnosis at lower level health care facilities (LLHFs) where microscopy is not readily available for all patients with suspected malaria. This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. Health workers from 21 health facilities in Uganda were given a one-day central training on the use of RDTs in malaria case management, including practical skills on how to perform read and interpret the test results. Successful trainees subsequently integrated the use of RDTs into their routine care for febrile patients at their LLHFs and transferred their acquired skills to colleagues (cascade training model). A cross-sectional evaluation of the health workers' competence in performing RDTs was conducted six weeks following the training, incorporating observation, in-depth interviews with health workers and the review of health facility records relating to tests offered and antimalarial drug (AMD) prescriptions pre and post training. The direct costs relating to the training processes were also documented. Overall, 135 health workers were trained including 63 (47%) nursing assistants, a group of care providers without formal medical training. All trainees passed the post-training concordance test with ≥ 80% except 12 that required re-training. Six weeks after the one-day training, 51/64 (80%) of the health workers accurately performed the critical steps in performing the RDT. The performance was similar among the 10 (16%) participants who were peer-trained by their trained colleagues. Only 9 (14%) did not draw the appropriate amount of blood using pipette. The average cost of the one-day training was US$ 101 (range $92-$112), with the main cost drivers being trainee travel and per

  7. Programme level implementation of malaria rapid diagnostic tests (RDTs use: outcomes and cost of training health workers at lower level health care facilities in Uganda

    Directory of Open Access Journals (Sweden)

    Kyabayinze Daniel J

    2012-04-01

    Full Text Available Abstract Background The training of health workers in the use of malaria rapid diagnostic tests (RDTs is an important component of a wider strategy to improve parasite-based malaria diagnosis at lower level health care facilities (LLHFs where microscopy is not readily available for all patients with suspected malaria. This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. Methods Health workers from 21 health facilities in Uganda were given a one-day central training on the use of RDTs in malaria case management, including practical skills on how to perform read and interpret the test results. Successful trainees subsequently integrated the use of RDTs into their routine care for febrile patients at their LLHFs and transferred their acquired skills to colleagues (cascade training model. A cross-sectional evaluation of the health workers’ competence in performing RDTs was conducted six weeks following the training, incorporating observation, in-depth interviews with health workers and the review of health facility records relating to tests offered and antimalarial drug (AMD prescriptions pre and post training. The direct costs relating to the training processes were also documented. Results Overall, 135 health workers were trained including 63 (47% nursing assistants, a group of care providers without formal medical training. All trainees passed the post-training concordance test with ≥ 80% except 12 that required re-training. Six weeks after the one-day training, 51/64 (80% of the health workers accurately performed the critical steps in performing the RDT. The performance was similar among the 10 (16% participants who were peer-trained by their trained colleagues. Only 9 (14% did not draw the appropriate amount of blood using pipette. The average cost of the one-day training was US$ 101 (range $92-$112, with the

  8. Low Cost, Lightweight Gravity Coring and Improved Epoxy Impregnation Applied to Laminated Maar Sediment in Vietnam

    Directory of Open Access Journals (Sweden)

    Jan P. Schimmelmann

    2018-05-01

    Full Text Available In response to the need for lightweight and affordable sediment coring and high-resolution structural documentation of unconsolidated sediment, we developed economical and fast methods for (i recovering short sediment cores with undisturbed topmost sediment, without the need for a firmly anchored coring platform, and (ii rapid epoxy-impregnation of crayon-shaped subcores in preparation for thin-sectioning, with minimal use of solvents and epoxy resin. The ‘Autonomous Gravity Corer’ (AGC can be carried to remote locations and deployed from an inflatable or makeshift raft. Its utility was tested on modern unconsolidated lacustrine sediment from a ~21 m deep maar lake in Vietnam’s Central Highlands near Pleiku. The sedimentary fabric fidelity of the epoxy-impregnation method was demonstrated for finely laminated artificial flume sediment. Our affordable AGC is attractive not only for work in developing countries, but lends itself broadly for coring in remote regions where challenging logistics prevent the use of heavy coring equipment. The improved epoxy-impregnation technique saves effort and costly chemical reagents, while at the same time preserving the texture of the sediment.

  9. 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

    2017-01-01

    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. PMID:28346363

  10. "It's the economy, stupid": strategies for improved cost containment in cancer treatment.

    Science.gov (United States)

    Sleijfer, S

    2014-04-01

    The advent of numerous novel antitumor compounds has improved the prognosis of many cancer patients but has also substantially increased the costs of cancer care and put more pressure on health-care budgets. This situation increasingly raises questions such as the extent to which these drugs offer value sufficient to justify their cost and how to accommodate the increasing costs of cancer care. Here I look at the various aspects that affect cancer care economics and offer potential solutions.

  11. 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

  12. The low cost of quality improvements in the electricity distribution sector of Brazil

    International Nuclear Information System (INIS)

    Corton, Maria Luisa; Zimmermann, Aneliese; Phillips, Michelle Andrea

    2016-01-01

    We analyze the impact of introducing output-based incentives in the price-cap regulatory regime of the Brazilian electricity distribution sector. We focus on the trade-off between operating costs and quality improvement, hypothesizing a positive relationship. Operating costs include maintenance and repair expenses. The regulator sets limits for service continuity and non-technical energy losses in each regulatory period. Service continuity refers to the average length of interruptions in electricity distribution. Non-technical losses refer to losses due to factors specific to the distribution segment. Quality incentives include peer-pressure and penalties/rewards for compliance with minimum quality standards. We model operating costs using a GMM framework to acknowledge endogeneity of variables. The model is dynamic given the inclusion of regulatory lags to recognize past cost behavior. Findings reveal a small trade-off between costs and quality. We conclude that quality improvements are not costly relative to the potential savings from complying with quality standards. We also find that the impact on operating costs is larger when energy losses increase compared to the cost effect due to increases in duration of outages. These findings suggest areas of attention in managerial decision making, and serve as valuable information to the regulator in tailoring quality incentives for this sector. - Highlights: • The article focuses on the impact of quality improvements on operating costs. • We find a very small tradeoff between quality improvements and operating costs. • We find the impact of a large share of electricity losses on costs larger compared to the impact of longer outages. • The results serve the regulator to adjust incentives for quality improvement. • The results serve the regulator in tailoring regulatory values for electricity losses and outages.

  13. Tracheostomy Complications as a Trigger for an Airway Rapid Response: Analysis and Quality Improvement Considerations.

    Science.gov (United States)

    Rassekh, Christopher H; Zhao, Jing; Martin, Niels D; Chalian, Ara A; Atkins, Joshua H

    2015-12-01

    To analyze the subset of airway rapid response (ARR) calls related to tracheostomy identified over a 46-month period from August 2011 to May 2015 to determine proximate cause, intervention, and outcome and to develop process improvement initiatives. Single-institution multidisciplinary retrospective cohort study. Tertiary care academic medical center in a large urban setting. Hospital inpatients with an in situ tracheostomy or laryngectomy who experienced an ARR. Detailed review of operator, hospital, and patient records related to ARR system activations over a 46-month period. ARR was activated for 28 patients with existing tracheostomy. The cohort included open tracheostomy (n = 14), percutaneous tracheostomy (n = 8), laryngectomy stoma (n = 3), and indeterminate technique (n = 3). The most frequent triggers for emergency airway intervention were decannulation (n = 16), followed by mucus plugging (n = 4). The mean body mass index of ARR patients was higher than that of a comparator tracheostomy cohort (32.9 vs 26.3, P 40 in 9 ARR patients. There was 1 mortality in the series. Tracheostomy is a major trigger for ARR with potential fatal outcome. Factors that may contribute to tracheostomy emergencies include high body mass index, surgical technique for open tracheostomy or percutaneous tracheostomy, tracheostomy tube size, and bedside tracheostomy management. Results have triggered a hospital-wide practice improvement plan focused on tracheostomy awareness and documentation, discrete process changes, and implementation of guidelines for emergency management. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  14. VA announces aggressive new approach to produce rapid improvements in VA medical centers

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-02-01

    Full Text Available No abstract available. Article truncated at 150 words. The U.S. Department of Veterans Affairs (VA announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1. VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2. Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1. Table 1. VA facilities with one-star ratings …

  15. Rapid improvement of respiratory quality in asthmatic children after "assisted drainage" therapy

    Directory of Open Access Journals (Sweden)

    Haryono Utomo

    2010-08-01

    Full Text Available Background  Whilst current asthma management is well-developed, there are still 5-10% uncontrolled asthma patients with unknown etiologies. However, its connection with oral focal infection is still uncertain. Therefore, a collaborated research for asthma management was conducted by pediatricians and dental practitioners. Within minutes after the "assisted drainage" therapy, a modification of healing root planning procedure, there is rapid improvement of respiratory function, ie., forced expiratory-volume one second (FEV1 in asthmatic children. This quick response usually achieved by oral inhalation. Objective To investigate the effectiveness of the assisted drainage therapy in the improvement of respiratory quality. Methods Fifteen asthmatic children were subjected to a longitudinal study for two weeks. In tbe first week they were instructed for al lergen avoidance only and the fOllowing one week was combined with tbe assisted drainage therapy, followed by  mental health education and dental plaque control therapy. Each s'ubject was af'sef'sed for respiratory quality with a computerized spirometer and blood sampling test. Paired t-test analysis was used for statistical analysis. Results Assisted drainage therapy was performed, within minutes FEV1 increased significantly (P= 0.001. Additionally, there were significant differences serum histamine (P= 0,001 pre and post treatment. Conclusions The assisted drainage therapy is effective as an adjuvant therapy for mild persistent asthma in children.

  16. SOEC efficiency and cost improvement Part 1 and 2

    International Nuclear Information System (INIS)

    Yildiz, B.; Chang, K.-C.; Meyers, D. J.; You, H.; Carter, J.D.; Elam, J.W.; Honegger, D.A.; Libera, J.A.; Pellin, M.J.

    2007-01-01

    Part I: Electrochemical and X-ray Characterization of Solid-Oxide Electrolysis Cell Oxygen Electrodes on Electrolyte Substrates--The governing reaction mechanisms, and the electrode and electrolyte material compositions and structures, that controls the efficiency and durability of the solid oxide electrolysis cells (SOEC) need to be identified and well-understood for a significant improvement in nuclear hydrogen production using high temperature steam electrolysis. ANL conducted experimental analysis of SOEC electrolyte and electrodes to progress in this objective. Our study on the oxygen electrode focused on specifically the effect of electrode crystal structure on its electrochemical performance, and the evolution of the electronic and structural properties of the electrodes while under electrochemical conditions and high temperature. We found through electrochemical impedance spectroscopy experiments that, while different crystal orientations in La 0.8 Sr 0.2 MnO 3+d (LSM) show different initial performance and different electrochemical activation under SOEC conditions, a good mixed ionic electronic conductor La 0.8 Sr 0.2 CoO 3+d (LSC) does not seem to exhibit similar variations. Our in-situ x-ray and electrochemical measurements at the Advanced Photon Source of ANL have identified the chemical states of the A-site elements of the doped lanthanum manganite electrodes. We found that the changes in the concentration and in the electronic state of the La and Sr (the A-site elements of the perovskite) occurring only at the top airelectrode film interface can be responsible from the electrochemical improvement of the SOEC anode under DC current. Our observation related to the La chemical state change is unexpected and probably unique to the electrochemical current-conditioning. Part II: Progress Towards the Atomic Layer Deposition of Lanthanum Strontium Manganate--Lanthanum strontium manganate (LSM) is the most commonly used cathode material for solid oxide fuel

  17. 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.

  18. Competitive investments in cost reducing process improvement : The role of managerial incentives and spillover learning

    NARCIS (Netherlands)

    Veldman, Jasper; Gaalman, Gerard J.c.

    2015-01-01

    We study the rivalry between two firms and consider the effect of spillovers when the firms' operations and technology managers are given bonuses for cost reduction. We model a game in which the firm owners independently offer their manager a bonus to stimulate cost reducing process improvement

  19. Uranium Mill Tailings Remedial Action Project: Cost Reduction and Productivity Improvement Program Project Plan

    International Nuclear Information System (INIS)

    1991-11-01

    The purpose of the Cost Reduction/Productivity Improvement Program Plan is to formalize and improve upon existing efforts to control costs which have been underway since project inception. This program plan has been coordinated with the Department of Energy (DOE) Office of Environmental Management (EM) and the DOE Field Office, Albuquerque (AL). It incorporates prior Uranium Mill Tallings Remedial Action (UMTRA) Project Office guidance issued on the subject. The opportunities for reducing cosh and improving productivity are endless. The CR/PIP has these primary objectives: Improve productivity and quality; heighten the general cost consciousness of project participants, at all levels of their organizations; identify and implement specific innovative employee ideas that extend beyond what is required through existing processes and procedures; emphasize efforts that create additional value for the money spent by maintaining the project Total Estimated Cost (TEC) at the lowest possible level

  20. Effect of improved glycemic control on health care costs and utilization.

    Science.gov (United States)

    Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C

    2001-01-10

    Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.

  1. Real-time patient survey data during routine clinical activities for rapid-cycle quality improvement.

    Science.gov (United States)

    Wofford, James Lucius; Campos, Claudia L; Jones, Robert E; Stevens, Sheila F

    2015-03-12

    Surveying patients is increasingly important for evaluating and improving health care delivery, but practical survey strategies during routine care activities have not been available. We examined the feasibility of conducting routine patient surveys in a primary care clinic using commercially available technology (Web-based survey creation, deployment on tablet computers, cloud-based management of survey data) to expedite and enhance several steps in data collection and management for rapid quality improvement cycles. We used a Web-based data management tool (survey creation, deployment on tablet computers, real-time data accumulation and display of survey results) to conduct four patient surveys during routine clinic sessions over a one-month period. Each survey consisted of three questions and focused on a specific patient care domain (dental care, waiting room experience, care access/continuity, Internet connectivity). Of the 727 available patients during clinic survey days, 316 patients (43.4%) attempted the survey, and 293 (40.3%) completed the survey. For the four 3-question surveys, the average time per survey was overall 40.4 seconds, with a range of 5.4 to 20.3 seconds for individual questions. Yes/No questions took less time than multiple choice questions (average 9.6 seconds versus 14.0). Average response time showed no clear pattern by order of questions or by proctor strategy, but monotonically increased with number of words in the question (30 words)-8.0, 11.8, 16.8, seconds, respectively. This technology-enabled data management system helped capture patient opinions, accelerate turnaround of survey data, with minimal impact on a busy primary care clinic. This new model of patient survey data management is feasible and sustainable in a busy office setting, supports and engages clinicians in the quality improvement process, and harmonizes with the vision of a learning health care system.

  2. Levee Setbacks: An Innovative, Cost Effective, and Sustainable Solution for Improved Flood Risk management

    Science.gov (United States)

    2017-06-30

    ER D C/ EL S R- 17 -3 Levee Setbacks: An Innovative , Cost-Effective, and Sustainable Solution for Improved Flood Risk Management En vi...EL SR-17-3 June 2017 Levee Setbacks: An Innovative , Cost-Effective, and Sustainable Solution for Improved Flood Risk Management David L. Smith...alternative view point is necessary. ERDC/EL SR-17-3 4 Levee setbacks are a relatively recent innovation in Corps flood risk management practice

  3. UMTRA Project-Level Cost Reduction/Productivity Improvement Program manual

    International Nuclear Information System (INIS)

    1995-06-01

    Mission of the Uranium Mill Tailings Remedial Action (UMTRA) Project Cost Reduction/Productivity Improvement Program (CR/PIP) is to contribute to the UMTRA Project's environmental restoration mission by providing the means to achieve and recognize continuous improvements and cost savings. This manual includes program definition, description of UMTRA project organizational responsibilities and interfaces with existing project functions, guidance to contractors, and definition of project-level functions

  4. A Low-Cost, Simplified Platform of Interchangeable, Ambient Ionization Sources for Rapid, Forensic Evidence Screening on Portable Mass Spectrometric Instrumentation

    Directory of Open Access Journals (Sweden)

    Patrick W. Fedick

    2018-03-01

    Full Text Available Portable mass spectrometers (MS are becoming more prevalent due to improved instrumentation, commercialization, and the robustness of new ionization methodologies. To increase utility towards diverse field-based applications, there is an inherent need for rugged ionization source platforms that are simple, yet robust towards analytical scenarios that may arise. Ambient ionization methodologies have evolved to target specific real-world problems and fulfill requirements of the analysis at hand. Ambient ionization techniques continue to advance towards higher performance, with specific sources showing variable proficiency depending on application area. To realize the full potential and applicability of ambient ionization methods, a selection of sources may be more prudent, showing a need for a low-cost, flexible ionization source platform. This manuscript describes a centralized system that was developed for portable MS systems that incorporates modular, rapidly-interchangeable ionization sources comprised of low-cost, commercially-available parts. Herein, design considerations are reported for a suite of ambient ionization sources that can be crafted with minimal machining or customization. Representative spectral data is included to demonstrate applicability towards field processing of forensic evidence. While this platform is demonstrated on portable instrumentation, retrofitting to lab-scale MS systems is anticipated.

  5. Low-dosage epoetin in maintenance haemodialysis: costs and quality-of-life improvement.

    Science.gov (United States)

    Harris, D C

    1994-01-01

    Decisions about epoetin (recombinant human erythropoetin) dosage and target haematocrit in dialysis patients have been determined largely by the high acquisition cost of epoetin, but are made with incomplete knowledge about which target haematocrit gives the optimum clinical benefit. Haematopoietic response to epoetin may be determined by pharmacodynamic factors such as rate and frequency of administration, as well as by individual patient characteristics such as ethnicity. Resistance to epoetin may be due to iron or vitamin deficiency, natural or exogenous inhibitors of erythropoiesis and bone marrow fibrosis. The high acquisition cost of epoetin must be considered along with a number of other factors that can influence the true cost of epoetin treatment. Hidden costs of epoetin treatment include administration costs, changes in other treatments, extra laboratory tests and adverse events. Administration costs and extra laboratory surveillance add little to overall cost. Depletion of iron stores, hypertension, increased blood coagulability and reduced dialyser efficiency resulting from epoetin treatment may all add a small additional component to the true cost. Severe complications with significant cost implications are rare. Amongst the various components of true cost, only the acquisition cost can definitely be reduced by low dosage treatment. Balanced against the true and potential costs of epoetin are a number of benefits which can result in potential savings. The need for blood transfusion is all but abolished, avoiding the cost of transfusion and its complications. Sensitisation against histocompatibility antigens is reduced by avoiding transfusion, and so the waiting time for cadaveric transplantation may be reduced. Rates of hospitalisation for all causes, especially those associated with anaemia, may be reduced by epoetin treatment. By improving well-being, epoetin may allow patients to be transferred to minimal-care units or home where dialysis can be

  6. 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.

  7. Supplier’s Joint Investments in Cost Reduction and Quality Improvement in a Decentralized Supply Chain

    Directory of Open Access Journals (Sweden)

    Hengyun Zhang

    2017-01-01

    Full Text Available We consider a decentralized supply chain with a downstream manufacturer and an upstream supplier. The upstream supplier sells a product to the manufacturer, who faces a quality and price sensitive demand. The supplier has a chance to invest in both cost reduction and quality improvement of its product. We derive the optimal investment and pricing decisions for the supply chain members. We do so in both the centralized and the decentralized supply chains. We show that the optimal investment and pricing decisions in the decentralized supply chain may deviate from that in the centralized supply chain. We develop a mechanism to coordinate the decentralized supply chain. The developed mechanism contains four policies: wholesale price, sharing of revenue, sharing of cost reduction investment cost, and sharing of quality improvement investment cost. We also show that the developed coordination mechanism can lead to Pareto improvement.

  8. 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.

  9. RAPID COMMUNICATION: Improving prediction accuracy of GPS satellite clocks with periodic variation behaviour

    Science.gov (United States)

    Heo, Youn Jeong; Cho, Jeongho; Heo, Moon Beom

    2010-07-01

    The broadcast ephemeris and IGS ultra-rapid predicted (IGU-P) products are primarily available for use in real-time GPS applications. The IGU orbit precision has been remarkably improved since late 2007, but its clock products have not shown acceptably high-quality prediction performance. One reason for this fact is that satellite atomic clocks in space can be easily influenced by various factors such as temperature and environment and this leads to complicated aspects like periodic variations, which are not sufficiently described by conventional models. A more reliable prediction model is thus proposed in this paper in order to be utilized particularly in describing the periodic variation behaviour satisfactorily. The proposed prediction model for satellite clocks adds cyclic terms to overcome the periodic effects and adopts delay coordinate embedding, which offers the possibility of accessing linear or nonlinear coupling characteristics like satellite behaviour. The simulation results have shown that the proposed prediction model outperforms the IGU-P solutions at least on a daily basis.

  10. 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

  11. 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.

  12. Artificial intelligence guides system's best practices, cutting costs and improving services.

    Science.gov (United States)

    1999-06-01

    One for the history books. Clinical care improvement initiatives guided by a sophisticated artificial intelligence program have helped a major Virginia integrated health system make dramatic improvements in the cost and quality of its health care services. Find out how the technological innovation has earned Sentara Health System a place in the permanent collection of the Smithsonian's National Museum of American History.

  13. 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.

  14. 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

  15. Learning to improve medical decision making from imbalanced data without a priori cost.

    Science.gov (United States)

    Wan, Xiang; Liu, Jiming; Cheung, William K; Tong, Tiejun

    2014-12-05

    In a medical data set, data are commonly composed of a minority (positive or abnormal) group and a majority (negative or normal) group and the cost of misclassifying a minority sample as a majority sample is highly expensive. This is the so-called imbalanced classification problem. The traditional classification functions can be seriously affected by the skewed class distribution in the data. To deal with this problem, people often use a priori cost to adjust the learning process in the pursuit of optimal classification function. However, this priori cost is often unknown and hard to estimate in medical decision making. In this paper, we propose a new learning method, named RankCost, to classify imbalanced medical data without using a priori cost. Instead of focusing on improving the class-prediction accuracy, RankCost is to maximize the difference between the minority class and the majority class by using a scoring function, which translates the imbalanced classification problem into a partial ranking problem. The scoring function is learned via a non-parametric boosting algorithm. We compare RankCost to several representative approaches on four medical data sets varying in size, imbalanced ratio, and dimension. The experimental results demonstrate that unlike the currently available methods that often perform unevenly with different priori costs, RankCost shows comparable performance in a consistent manner. It is a challenging task to learn an effective classification model based on imbalanced data in medical data analysis. The traditional approaches often use a priori cost to adjust the learning of the classification function. This work presents a novel approach, namely RankCost, for learning from medical imbalanced data sets without using a priori cost. The experimental results indicate that RankCost performs very well in imbalanced data classification and can be a useful method in real-world applications of medical decision making.

  16. 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.

  17. 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.

  18. The Healthcare Improvement Scotland evidence note rapid review process: providing timely, reliable evidence to inform imperative decisions on healthcare.

    Science.gov (United States)

    McIntosh, Heather M; Calvert, Julie; Macpherson, Karen J; Thompson, Lorna

    2016-06-01

    Rapid review has become widely adopted by health technology assessment agencies in response to demand for evidence-based information to support imperative decisions. Concern about the credibility of rapid reviews and the reliability of their findings has prompted a call for wider publication of their methods. In publishing this overview of the accredited rapid review process developed by Healthcare Improvement Scotland, we aim to raise awareness of our methods and advance the discourse on best practice. Healthcare Improvement Scotland produces rapid reviews called evidence notes using a process that has achieved external accreditation through the National Institute for Health and Care Excellence. Key components include a structured approach to topic selection, initial scoping, considered stakeholder involvement, streamlined systematic review, internal quality assurance, external peer review and updating. The process was introduced in 2010 and continues to be refined over time in response to user feedback and operational experience. Decision-makers value the responsiveness of the process and perceive it as being a credible source of unbiased evidence-based information supporting advice for NHSScotland. Many agencies undertaking rapid reviews are striving to balance efficiency with methodological rigour. We agree that there is a need for methodological guidance and that it should be informed by better understanding of current approaches and the consequences of different approaches to streamlining systematic review methods. Greater transparency in the reporting of rapid review methods is essential to enable that to happen.

  19. 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.

  20. 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.

  1. 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

  2. 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...... recovery. The annual energy cost and first cost of the HVAC system were calculat4ed using DOE 2.1E for different levels of air quality (10-50% dissatisfied). This was achieved by changing the outdoor air supply rate and the pollution loads. Previous studies have documented a 1.1% increase in office...

  3. 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

    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......, 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...

  4. 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.

  5. Cost and impact of a quality improvement programme in mental health services.

    Science.gov (United States)

    Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

    2010-04-01

    To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

  6. Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

    Science.gov (United States)

    Bowblis, John R; Roberts, Amy Restorick

    2018-06-01

    Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

  7. Improving nursing morale in a climate of cost containment. Part 1. Organizational assessment.

    Science.gov (United States)

    Haw, M A; Claus, E G; Durbin-Lafferty, E; Iversen, S M

    1984-10-01

    Faced with declining resources for health care and greater pressures to improve productivity of nursing staff, nursing administrators must act now to develop organizational responses to morale problems among nursing staff. As part of a two-part series for JONA, the authors describe low-cost organizational approaches that address nursing morale. Presented in Part 1 is a low-cost diagnostic process for assessing needs of staff and appraising organizational dimensions contributing to morale. Assessment findings provide clear direction for developing organizational approaches for improving morale.

  8. [Improving job morale of nurses despite insurance cost control. 1: Organization assessment].

    Science.gov (United States)

    Haw, Mary Ann; Claus, Eleanor G; Durbin-Lafferty, Ellen; Iversen, Sharon M

    2003-04-01

    Faced with declining resources for health care and greater pressures to improve productivity of nursing staff, nursing administrators must act now to develop organizational responses to morale problems among nursing staff. As part of a two-part series for JONA, the authors describe low-cost organizational approaches that address nursing morale. Presented in Part 1 is a low-cost diagnostic process for assessing needs of staff and appraising organizational dimensions contributing to morale. Assessment findings provide clear direction for developing organizational approaches for improving morale.

  9. 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

    current. Performing these changes takes an estimated 6647 hours a year in each ED. While the whiteboard is well-like and has improved the clinicians’ overview, our cost-of-overview estimation shows that it consumes substantial staff resources. This reflects the value the clinicians assign to having......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...... an overview but also reveals the amount of resources removed from other activities to maintain this overview....

  10. 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/.

  11. Estimation of cost per severe accident for improvement of accident protection and consequence mitigation strategies

    International Nuclear Information System (INIS)

    Silva, Kampanart; Ishiwatari, Yuki; Takahara, Shogo

    2013-01-01

    To assess the complex situations regarding the severe accidents such as what observed in Fukushima Accident, not only radiation protection aspects but also relevant aspects: health, environmental, economic and societal aspects; must be all included into the consequence assessment. In this study, the authors introduce the “cost per severe accident” as an index to analyze the consequences of severe accidents comprehensively. The cost per severe accident consists of various costs and consequences converted into monetary values. For the purpose of improvement of the accident protection and consequence mitigation strategies, the costs needed to introduce the protective actions, and health and psychological consequences are included in the present study. The evaluations of these costs and consequences were made based on the systematic consequence analysis using level 2 and 3 probabilistic safety assessment (PSA) codes. The accident sequences used in this analysis were taken from the results of level 2 seismic PSA of a virtual 1,100 MWe BWR-5. The doses to the public and the number of people affected were calculated using the level 3 PSA code OSCAAR of Japan Atomic Energy Agency (JAEA). The calculations have been made for 248 meteorological sequences, and the outputs are given as expectation values for various meteorological conditions. Using these outputs, the cost per severe accident is calculated based on the open documents on the Fukushima Accident regarding the cost of protective actions and compensations for psychological harms. Finally, optimized accident protection and consequence mitigation strategies are recommended taking into account the various aspects comprehensively using the cost per severe accident. The authors must emphasize that the aim is not to estimate the accident cost itself but to extend the scope of “risk-informed decision making” for continuous safety improvements of nuclear energy. (author)

  12. Rapid response systems.

    Science.gov (United States)

    Lyons, Patrick G; Edelson, Dana P; Churpek, Matthew M

    2018-07-01

    Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation. Articles written in English and published in PubMed. Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement. Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. Estimating the cost of improving quality in electricity distribution: A parametric distance function approach

    International Nuclear Information System (INIS)

    Coelli, Tim J.; Gautier, Axel; Perelman, Sergio; Saplacan-Pop, Roxana

    2013-01-01

    The quality of electricity distribution is being more and more scrutinized by regulatory authorities, with explicit reward and penalty schemes based on quality targets having been introduced in many countries. It is then of prime importance to know the cost of improving the quality for a distribution system operator. In this paper, we focus on one dimension of quality, the continuity of supply, and we estimated the cost of preventing power outages. For that, we make use of the parametric distance function approach, assuming that outages enter in the firm production set as an input, an imperfect substitute for maintenance activities and capital investment. This allows us to identify the sources of technical inefficiency and the underlying trade-off faced by operators between quality and other inputs and costs. For this purpose, we use panel data on 92 electricity distribution units operated by ERDF (Electricité de France - Réseau Distribution) in the 2003–2005 financial years. Assuming a multi-output multi-input translog technology, we estimate that the cost of preventing one interruption is equal to 10.7€ for an average DSO. Furthermore, as one would expect, marginal quality improvements tend to be more expensive as quality itself improves. - Highlights: ► We estimate the implicit cost of outages for the main distribution company in France. ► For this purpose, we make use of a parametric distance function approach. ► Marginal quality improvements tend to be more expensive as quality itself improves. ► The cost of preventing one interruption varies from 1.8 € to 69.2 € (2005 prices). ► We estimate that, in average, it lays 33% above the regulated price of quality.

  14. 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.

  15. 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.

  16. 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

    2018-03-15

    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.

  17. Predictive value and cost-effectiveness analysis of a rapid polymerase chain reaction for preoperative detection of nasal carriage of Staphylococcus aureus.

    Science.gov (United States)

    Shrestha, Nabin K; Shermock, Kenneth M; Gordon, Steven M; Tuohy, Marion J; Wilson, Deborah A; Cwynar, Roberta E; Banbury, Michael K; Longworth, David L; Isada, Carlos M; Mawhorter, Steven D; Procop, Gary W

    2003-05-01

    To determine the accuracy and cost-effectiveness of a polymerase chain reaction (PCR) for detecting nasal carriage of Staphylococcus aureus directly from clinical specimens. CROSS-SECTIONAL STUDY: This occurred in a tertiary-care hospital in Cleveland, Ohio, and included 239 consecutive patients who were scheduled for a cardiothoracic surgical procedure. Conventional cultures and a PCR for S. aureus from nasal swabs were used as measurements. COST-EFFECTIVENESS ANALYSIS: Data sources were market prices and Bureau of Labor Statistics. The time horizon was the maximum period for availability of culture results (3 days). Interventions included universal mupirocin therapy without testing; initial therapy, with termination if PCR negative (treat-PCR); initial therapy, with termination if culture negative (treat-culture); treat PCR-positive carriers (PCR-guided treatment); and treat culture-positive carriers (culture-guided treatment). The perspective was institutional and costs and the length of time to treatment were outcome measures. Sixty-seven (28%) of the 239 swabs grew S. aureus. Rapid PCR was 97.0% sensitive and 97.1% specific for the detection of S. aureus. For populations with prevalences of nasal S. aureus carriage of up to 50%, the PCR assay had negative predictive values of greater than 97%. PCR-guided treatment had the lowest incremental cost-effectiveness ratio (1.93 dollars per additional day compared with the culture strategy). Among immediate treatment strategies, treat-PCR was most cost-effective. The universal therapy strategy cost 38.19 dollars more per additional day gained with carrier identification compared with the PCR strategy. Rapid real-time PCR is an accurate, rapid, and cost-effective method for identifying S. aureus carriers for preoperative intervention.

  18. The potential for machine learning algorithms to improve and reduce the cost of 3-dimensional printing for surgical planning.

    Science.gov (United States)

    Huff, Trevor J; Ludwig, Parker E; Zuniga, Jorge M

    2018-05-01

    3D-printed anatomical models play an important role in medical and research settings. The recent successes of 3D anatomical models in healthcare have led many institutions to adopt the technology. However, there remain several issues that must be addressed before it can become more wide-spread. Of importance are the problems of cost and time of manufacturing. Machine learning (ML) could be utilized to solve these issues by streamlining the 3D modeling process through rapid medical image segmentation and improved patient selection and image acquisition. The current challenges, potential solutions, and future directions for ML and 3D anatomical modeling in healthcare are discussed. Areas covered: This review covers research articles in the field of machine learning as related to 3D anatomical modeling. Topics discussed include automated image segmentation, cost reduction, and related time constraints. Expert commentary: ML-based segmentation of medical images could potentially improve the process of 3D anatomical modeling. However, until more research is done to validate these technologies in clinical practice, their impact on patient outcomes will remain unknown. We have the necessary computational tools to tackle the problems discussed. The difficulty now lies in our ability to collect sufficient data.

  19. 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.

  20. Security of supply in electricity markets: Improving cost efficiency of supplying security and possible welfare gains

    DEFF Research Database (Denmark)

    Klinge Jacobsen, Henrik; Grenaa Jensen, Stine

    2012-01-01

    In liberalised markets the ability to maintain security of electricity supply is questioned because security is characterised as a public good. We discuss if this property can be modified with changing technology. Furthermore, we examine if construction of markets for security can be justified...... by possible welfare gains. From a welfare perspective it is possible that security levels are too high and obtained with too high costs. Adjusting the effort so that marginal cost for securing supply is at similar levels in generation capacity and in network maintenance could increase welfare even without...... the need to construct markets. Secondarily, a consumer defined average level of security might improve welfare. Finally, different willingness to pay among customers and construction of advanced markets might increase welfare further. We argue that several cost and welfare improvements can be achieved...

  1. 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.

  2. Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

    Science.gov (United States)

    Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

    2016-09-01

    The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Consequent use of IT tools as a driver for cost reduction and quality improvements

    Science.gov (United States)

    Hein, Stefan; Rapp, Roberto; Feustel, Andreas

    2013-10-01

    The semiconductor industry drives a lot of efforts in the field of cost reductions and quality improvements. The consequent use of IT tools is one possibility to support these goals. With the extensions of its 150mm Fab to 200mm Robert Bosch increased the systematic use of data analysis and Advanced Process Control (APC).

  4. Targeting Environmental Quality to Improve Population Health and Lower Healthcare Costs

    Science.gov (United States)

    Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Ye...

  5. A rapid, sensitive, reproducible and cost-effective method for mutation profiling of colon cancer and metastatic lymph nodes

    International Nuclear Information System (INIS)

    Fumagalli, Debora; Gavin, Patrick G; Taniyama, Yusuke; Kim, Seung-Il; Choi, Hyun-Joo; Paik, Soonmyung; Pogue-Geile, Katherine L

    2010-01-01

    An increasing number of studies show that genetic markers can aid in refining prognostic information and predicting the benefit from systemic therapy. Our goal was to develop a high throughput, cost-effective and simple methodology for the detection of clinically relevant hot spot mutations in colon cancer. The Maldi-Tof mass spectrometry platform and OncoCarta panel from Sequenom were used to profile 239 colon cancers and 39 metastatic lymph nodes from NSABP clinical trial C-07 utilizing routinely processed FFPET (formalin-fixed paraffin-embedded tissue). Among the 238 common hot-spot cancer mutations in 19 genes interrogated by the OncoCarta panel, mutations were detected in 7 different genes at 26 different nucleotide positions in our colon cancer samples. Twenty-four assays that detected mutations in more than 1% of the samples were reconfigured into a new multiplexed panel, termed here as ColoCarta. Mutation profiling was repeated on 32 mutant samples using ColoCarta and the results were identical to results with OncoCarta, demonstrating that this methodology was reproducible. Further evidence demonstrating the validity of the data was the fact that the mutation frequencies of the most common colon cancer mutations were similar to the COSMIC (Catalog of Somatic Mutations in Cancer) database. The frequencies were 43.5% for KRAS, 20.1% for PIK3CA, and 12.1% for BRAF. In addition, infrequent mutations in NRAS, AKT1, ABL1, and MET were detected. Mutation profiling of metastatic lymph nodes and their corresponding primary tumors showed that they were 89.7% concordant. All mutations found in the lymph nodes were also found in the corresponding primary tumors, but in 4 cases a mutation was present in the primary tumor only. This study describes a high throughput technology that can be used to interrogate DNAs isolated from routinely processed FFPET and identifies the specific mutations that are common to colon cancer. The development of this technology and the Colo

  6. Rapid Resumption of Interrupted Search Is Independent of Age-Related Improvements in Visual Search

    Science.gov (United States)

    Lleras, Alejandro; Porporino, Mafalda; Burack, Jacob A.; Enns, James T.

    2011-01-01

    In this study, 7-19-year-olds performed an interrupted visual search task in two experiments. Our question was whether the tendency to respond within 500 ms after a second glimpse of a display (the "rapid resumption" effect ["Psychological Science", 16 (2005) 684-688]) would increase with age in the same way as overall search efficiency. The…

  7. The determination of Sr-90 in environmental material using an improved rapid method

    International Nuclear Information System (INIS)

    Ghods, A.; Veselsky, J.C.; Zhu, S.; Mirna, A.; Schelenz, R.

    1989-01-01

    A short report on strontium 90, its occurrence in the biosphere and its rapid determination methods is given. Classification of determination methods suitable for various environmental and biological materials is established. Interference due to Y-91 and a method to eliminate the activity of Y-90 and Y-91 is discussed. Tabs

  8. Improved sensitivity of nucleic acid amplification for rapid diagnosis of tuberculous meningitis

    DEFF Research Database (Denmark)

    Johansen, Isik Somuncu; Lundgren, Bettina; Tabak, Fehmi

    2004-01-01

    was adjusted from the recommended value of 3,400 to 1,000, the sensitivity of the modified procedure increased to 84.7%, with unchanged specificity. Results were obtained in 3 to 4 h. The new pretreatment procedure with the ProbeTec assay described here provides a rapid, simple, and sensitive tool...

  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. 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.

  11. Impact of improvements in HYLIFE-II on safety, performance and cost

    International Nuclear Information System (INIS)

    Hoffman, M.A.; Lee, Y.T.

    1995-01-01

    The HYLIFE-II fusion power plant conceptual design has evolved and improved continually over the past four years to its present form. This paper describes the FY93 reference case H1-B (nominally 1 GW(e) net output) and the enhanced case HE-B (nominally 2 GW(e) net output), which take advantage of improvements in the tritium management system to eliminate the intermediate loop and the intermediate heat exchangers (IHXs). The improvements in the heat-transport system and the steam power plant are described and the resulting cost reductions are evaluated. The new estimated cost of electricity (in 1990 dollars) is 5.1 cents kWh -1 for reference case H1-B and 3.6 cents kWh -1 for the enhanced case HE-B. (orig.)

  12. Quality improvement in hospitals: how much does it reduce healthcare costs?

    Science.gov (United States)

    Jones, S B

    1995-01-01

    The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

  13. Evaluation of potential cost reductions from improved amine-based CO2 capture systems

    International Nuclear Information System (INIS)

    Rao, Anand B.; Rubin, Edward S.; Keith, David W.; Granger Morgan, M.

    2006-01-01

    Technological innovations in CO 2 capture and storage technologies are being pursued worldwide under a variety of private and government-sponsored R and D programs. While much of this R and D is directed at novel concepts and potential breakthrough technologies, there are also substantial efforts to improve CO 2 capture technologies already in use. In this paper, we focus on amine-based CO 2 capture systems for power plants and other combustion-based applications. The current performance and cost of such systems have been documented in several recent studies. In this paper we examine the potential for future cost reductions that may result from continued process development. We used the formal methods of expert elicitation to understand what experts in this field believe about possible improvements in some of the key underlying parameters that govern the performance and cost of this technology. A dozen leading experts from North America, Europe and Asia participated in this study, providing their probabilistic judgments via a detailed questionnaire coupled with individual interviews. Judgments about detailed technical parameters were then used in an integrated power plant modeling framework (IECM-CS) developed for USDOE to evaluate the performance and costs of alternative carbon capture and sequestration technologies for fossil-fueled power plants. The experts' responses have allowed us to build a picture of how the overall performance and cost of amine-based systems might improve over the next decade or two. Results show how much the cost of CO 2 capture could be reduced via targeted R and D in key areas

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

    International Nuclear Information System (INIS)

    Popoolaa, A.P.I.; Oluwasegun, K.M.; Olorunniwo, O.E.; Atanda, P.O.; Aigbodion, V.S.

    2016-01-01

    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.

  15. 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.

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

    OpenAIRE

    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 F...

  17. Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

    Science.gov (United States)

    Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

    2018-03-20

    No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

  18. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review.

    OpenAIRE

    Fitzpatrick-Lewis, D; Ganann, R; Krishnaratne, S; Ciliska, D; Kouyoumdjian, F; Hwang, SW

    2011-01-01

    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 databas...

  19. Comparative study of efficacy, rapidity of detection, and cost-effectiveness of potassium hydroxide, calcofluor white, and Chicago sky blue stains in the diagnosis of dermatophytoses.

    Science.gov (United States)

    Prakash, R; Prashanth, Hosakere Veerappa; Ragunatha, Shivanna; Kapoor, Meenakshi; Anitha, T K; Krishnamurthy, Veena

    2016-04-01

    The diagnosis of superficial mycosis such as dermatophytosis is often done clinically. However, in difficult cases, a rapid test with high sensitivity and specificity helps in the immediate confirmation and administration of treatment. The efficacy, rapidity of detection, and cost-effectiveness of KOH preparation, calcofluor white (CW) stain, and Chicago sky blue (CSB) stain in the identification of fungal elements were assessed in patients with dermatophytoses attending the dermatology clinic of a tertiary care hospital. All three tests were performed on each sample collected from 73 patients according to standard procedure. The slides were examined after 5 and 30 minutes in × 10 and × 40 magnifications. The sensitivity and specificity of CW and CSB at 5 and 30 minutes were calculated using KOH preparation as the standard test. CSB stain showed highest positivity (94.5%) within 5 minutes when compared to KOH (75.3%) and CW (83.5%). After 30 minutes, positivity increased in KOH (84.9%) and CW stains (89%), but it remained the same in CSB stain. Both CW and CSB stains when compared to 10% KOH are equally sensitive (100%), but CW was more specific (72.7%), particularly at 30 minutes. When cost of performing tests on 100 specimens is considered, KOH, CW, and CSB stains cost Rs 5, 100, and 15, respectively. CSB stain is a better stain for rapid diagnosis of dermatophytoses because of ease of performance, rapidity of detection, better appreciation of morphology of fungal elements, and cost effectiveness. © 2016 The International Society of Dermatology.

  20. Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients.

    Science.gov (United States)

    Giulieri, Stefano G; Chapuis-Taillard, Caroline; Manuel, Oriol; Hugli, Olivier; Pinget, Christophe; Wasserfallen, Jean-Blaise; Sahli, Roland; Jaton, Katia; Marchetti, Oscar; Meylan, Pascal

    2015-01-01

    Enterovirus (EV) is the most frequent cause of aseptic meningitis (AM). Lack of microbiological documentation results in unnecessary antimicrobial therapy and hospitalization. To assess the impact of rapid EV detection in cerebrospinal fluid (CSF) by a fully-automated PCR (GeneXpert EV assay, GXEA) on the management of AM. Observational study in adult patients with AM. Three groups were analyzed according to EV documentation in CSF: group A = no PCR or negative PCR (n=17), group B = positive real-time PCR (n = 20), and group C = positive GXEA (n = 22). Clinical, laboratory and health-care costs data were compared. Clinical characteristics were similar in the 3 groups. Median turn-around time of EV PCR decreased from 60 h (IQR (interquartile range) 44-87) in group B to 5h (IQR 4-11) in group C (p<0.0001). Median duration of antibiotics was 1 (IQR 0-6), 1 (0-1.9), and 0.5 days (single dose) in groups A, B, and C, respectively (p < 0.001). Median length of hospitalization was 4 days (2.5-7.5), 2 (1-3.7), and 0.5 (0.3-0.7), respectively (p < 0.001). Median hospitalization costs were $5458 (2676-6274) in group A, $2796 (2062-5726) in group B, and $921 (765-1230) in group C (p < 0.0001). Rapid EV detection in CSF by a fully-automated PCR improves management of AM by significantly reducing antibiotic use, hospitalization length and costs. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Rapid assessment of Schistosoma mansoni: the validity, applicability and cost-effectiveness of the Lot Quality Assurance Sampling method in Uganda.

    Science.gov (United States)

    Brooker, Simon; Kabatereine, Narcis B; Myatt, Mark; Russell Stothard, J; Fenwick, Alan

    2005-07-01

    Rapid and accurate identification of communities at highest risk of morbidity from schistosomiasis is key for sustainable control. Although school questionnaires can effectively and inexpensively identify communities with a high prevalence of Schistosoma haematobium, parasitological screening remains the preferred option for S. mansoni. To help reduce screening costs, we investigated the validity of Lot Quality Assurance Sampling (LQAS) in classifying schools according to categories of S. mansoni prevalence in Uganda, and explored its applicability and cost-effectiveness. First, we evaluated several sampling plans using computer simulation and then field tested one sampling plan in 34 schools in Uganda. Finally, cost-effectiveness of different screening and control strategies (including mass treatment without prior screening) was determined, and sensitivity analysis undertaken to assess the effect of infection levels and treatment costs. In identifying schools with prevalences > or =50%, computer simulations showed that LQAS had high levels of sensitivity and specificity (>90%) at sample sizes LQAS where 15 children were sampled had excellent diagnostic performance (sensitivity: 100%, specificity: 96.4%, positive predictive value: 85.7% and negative predictive value: 92.3%). Screening using LQAS was more cost-effective than mass treating all schools (US$218 vs. US$482/high prevalence school treated). Threshold analysis indicated that parasitological screening and mass treatment would become equivalent for settings where prevalence > or =50% in 75% of schools and for treatment costs of US$0.19 per schoolchild. We conclude that, in Uganda, LQAS provides a rapid, valid and cost-effective method for guiding decision makers in allocating finite resources for the control of schistosomiasis.

  2. Factoring economic costs into conservation planning may not improve agreement over priorities for protection.

    Science.gov (United States)

    Armsworth, Paul R; Jackson, Heather B; Cho, Seong-Hoon; Clark, Melissa; Fargione, Joseph E; Iacona, Gwenllian D; Kim, Taeyoung; Larson, Eric R; Minney, Thomas; Sutton, Nathan A

    2017-12-21

    Conservation organizations must redouble efforts to protect habitat given continuing biodiversity declines. Prioritization of future areas for protection is hampered by disagreements over what the ecological targets of conservation should be. Here we test the claim that such disagreements will become less important as conservation moves away from prioritizing areas for protection based only on ecological considerations and accounts for varying costs of protection using return-on-investment (ROI) methods. We combine a simulation approach with a case study of forests in the eastern United States, paying particular attention to how covariation between ecological benefits and economic costs influences agreement levels. For many conservation goals, agreement over spatial priorities improves with ROI methods. However, we also show that a reliance on ROI-based prioritization can sometimes exacerbate disagreements over priorities. As such, accounting for costs in conservation planning does not enable society to sidestep careful consideration of the ecological goals of conservation.

  3. Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

    Directory of Open Access Journals (Sweden)

    Edward Broughton

    2014-01-01

    Full Text Available Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers’ perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%–34% and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29–$249. The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

  4. 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.

  5. 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.

  6. 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

  7. Cost/worth assessment of reliability improvement in distribution networks by means of artificial intelligence

    Energy Technology Data Exchange (ETDEWEB)

    Bouhouras, Aggelos S.; Labridis, Dimitris P.; Bakirtzis, Anastasios G. [Power Systems Laboratory, Aristotle University of Thessaloniki, Dept. of Electrical and Computer Engineering, 54124 Thessaloniki (Greece)

    2010-06-15

    A major challenge for the power utilities today is to ensure a high level of reliability of supply to customers. Two main factors determine the feasibility of a project that improves the reliability of supply: the project cost (investment and operational) and the benefits that result from the implementation of the project. This paper examines the implementation of an Artificial Intelligence System in an urban distribution network, capable to locate and isolate short circuit faults in the feeder, thus accomplishing immediate restoration of electric supply to the customers. The paper describes the benefits of the project, which are supply reliability improvement and distribution network loss reduction through network reconfigurations. By comparison of the project benefits and costs the economic feasibility of such a project for an underground distribution feeder in Greece is demonstrated. (author)

  8. Precision oncology in advanced cancer patients improves overall survival with lower weekly healthcare costs

    Science.gov (United States)

    Haslem, Derrick S.; Chakravarty, Ingo; Fulde, Gail; Gilbert, Heather; Tudor, Brian P.; Lin, Karen; Ford, James M.; Nadauld, Lincoln D.

    2018-01-01

    The impact of precision oncology on guiding treatment decisions of late-stage cancer patients was previously studied in a retrospective analysis. However, the overall survival and costs were not previously evaluated. We report the overall survival and healthcare costs associated with precision oncology in these patients with advanced cancer. Building on a matched cohort study of 44 patients with metastatic cancer who received all of their care within a single institution, we evaluated the overall survival and healthcare costs for each patient. We analyzed the outcomes of 22 patients who received genomic testing and targeted therapy (precision oncology) between July 1, 2013 and January 31, 2015, and compared to 22 historically controlled patients (control) who received standard chemotherapy (N = 17) or best supportive care (N = 5). The median overall survival was 51.7 weeks for the targeted treatment group and 25.8 weeks for the control group (P = 0.008) when matching on age, gender, histological diagnosis and previous treatment lines. Average costs over the entire period were $2,720 per week for the targeted treatment group and $3,453 per week for the control group, (P = 0.036). A separate analysis of 1,814 patients with late-stage cancer diagnoses found that those who received a targeted cancer treatment (N = 93) had 6.9% lower costs in the last 3 months of life compared with those who did not. These findings suggest that precision oncology may improve overall survival for refractory cancer patients while lowering average per-week healthcare costs, resource utilization and end-of-life costs. PMID:29552312

  9. Supply chain cost improvement opportunities through streamlining cross-border operations

    Directory of Open Access Journals (Sweden)

    Jan Hendrik Havenga

    2013-09-01

    Full Text Available The Cross-Border Road Transport Agency (CBRTA in South Africa aims to encourage and facilitate trade between South Africa and its neighbouring countries. The CBRTA sponsored a study by Stellenbosch University (SU to determine the logistics cost impact of cross-border delays between South Africa and its major neighbouring trading partners, and prioritise opportunities for improvement. SU is the proprietor of both a comprehensive freight demand model and a logistics cost model for South Africa, which enable extractions and extensions of freight flows and related costs for specific purposes. Through the application of these models, the following information is identified and presented in this paper: South Africa’s most important border posts (based on traffic flows; a product profile for imports and exports through these border posts; the modal split (road and rail; the annual logistics costs incurred on the corridors feeding the border posts, as well as the additional costs incurred due to border delays. The research has proved that the streamlining of border-post operations that take a total supply chain view (i.e. of both border operations and those that could be moved from the border is beneficial.

  10. 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.

  11. Initiating antiretroviral therapy for HIV at a patient's first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial.

    Science.gov (United States)

    Long, Lawrence C; Maskew, Mhairi; Brennan, Alana T; Mongwenyana, Constance; Nyoni, Cynthia; Malete, Given; Sanne, Ian; Fox, Matthew P; Rosen, Sydney

    2017-07-17

    Determine the cost and cost-effectiveness of single-visit (same-day) antiretroviral treatment (ART) initiation compared to standard of care initiation. Cost-effectiveness analysis of individually randomized (1 : 1) pragmatic trial of single-visit initiation, which increased viral suppression at 10 months by 26% [relative risk (95% confidence interval) 1.26 (1.05-1.50)]. Primary health clinic in Johannesburg, South Africa. HIV positive, adult, nonpregnant patients not yet on ART or known to be eligible who presented at the clinic 8 May 2013 to 29 August 2014. Same-day ART initiation using point-of-care laboratory instruments and accelerated clinic procedures to allow treatment-eligible patients to receive antiretroviral medications at the same visit as testing HIV positive or having an eligible CD4 cell count. Comparison was to standard of care ART initiation, which typically required three to five additional clinic visits. Average cost per patient enrolled and per patient achieving the primary outcome of initiated 90 days or less and suppressed 10 months or less, and production cost per patient achieving primary outcome (all costs per primary outcome patients). The average cost per patient enrolled, per patient achieving the primary outcome, and production cost were $319, $487, and $738 in the standard arm and $451, $505, and $707 in the rapid arm. Same-day treatment initiation was more effective than standard initiation, more expensive per patient enrolled, and less expensive to produce a patient achieving the primary outcome. Omitting point-of-care laboratory tests at initiation and focusing on high-volume clinics have the potential to reduce costs substantially and should be evaluated in routine settings.

  12. The admissible portfolio selection problem with transaction costs and an improved PSO algorithm

    Science.gov (United States)

    Chen, Wei; Zhang, Wei-Guo

    2010-05-01

    In this paper, we discuss the portfolio selection problem with transaction costs under the assumption that there exist admissible errors on expected returns and risks of assets. We propose a new admissible efficient portfolio selection model and design an improved particle swarm optimization (PSO) algorithm because traditional optimization algorithms fail to work efficiently for our proposed problem. Finally, we offer a numerical example to illustrate the proposed effective approaches and compare the admissible portfolio efficient frontiers under different constraints.

  13. Cost-effectiveness of measures to improve biodiversity in Swedish forests

    OpenAIRE

    Ekvall, Hans

    2014-01-01

    The main objective of this thesis is to analyse the cost-effectiveness of measures, which improve biodiversity among life forms dependent on coarse woody debris (CWD). The amount of CWD in forest land has decreased due to modern forest management. The wood of the trees is an important source of income for the forest owner and there is an undeniable conflict between increasing the amount of CWD and the economics of silviculture. To gain acceptance among forest owners of an increased re...

  14. Improvement of safety by analysis of costs and benefits of the system

    OpenAIRE

    T. Karkoszka; M. Andraczke

    2011-01-01

    Purpose: of the paper has been the assessment of the dependence between improvement of the implemented occupational health and safety management system and both minimization of costs connected with occupational health and safety assurance and optimization of real work conditions.Design/methodology/approach: used for the analysis has included definition of the occupational health and safety system with regard to the rules and tool allowing for occupational safety assurance in the organisationa...

  15. Impact of improvements in HYLIFE-II on safety, performance and cost

    International Nuclear Information System (INIS)

    Hoffman, M.A.; Lee, Y.T.

    1994-01-01

    The HYLIFE-II conceptual design has evolved and improved continually over the past four years to its present form. This paper describes the latest FY93 versions, Reference Case H1-B (nominally 1 GWe output) and the Enhanced Case H2-B (nominally 2 GWe net output), which take advantage of improvements in the tritium management system to eliminate the intermediate loops and the intermediate heat exchangers (IHX's). The improvements in the heat transport system and the steam power plant are described and the resulting cost reductions are evaluated. The new estimated cost of electricity (in 1990 dollars) is 5.1 cents/kWh for Reference Case H1-B and 3.6 cents/kWh for the Enhanced Case H2-B. In order to make a more equitable comparison of HYLIFE-II with two recent IFE (inertial fusion energy) studies sponsored by the DOE, namely OSIRIS and PROMETHEUS, the authors have revised their design concept in many important ways. The overall reactor concept and an overview of the latest design is given by Moir, et al. This paper will focus on those changes which have impacted the heat transport and power conversion systems and the overall cost of electricity

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

    NARCIS (Netherlands)

    Worrell, E.; Kermeli, Katerina; 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

  17. 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.

  18. Validation and application of an improved method for the rapid determination of proline in grape berries.

    Science.gov (United States)

    Rienth, Markus; Romieu, Charles; Gregan, Rebecca; Walsh, Caroline; Torregrosa, Laurent; Kelly, Mary T

    2014-04-16

    A rapid and sensitive method is presented for the determination of proline in grape berries. Following acidification with formic acid, proline is derivatized by heating at 100 °C for 15 min with 3% ninhydrin in dimethyl sulfoxide, and the absorbance, which is stable for at least 60 min, is read at 520 nm. The method was statistically validated in the concentration range from 2.5 to 15 mg/L, giving a repeatability and intermediate precision of generally amino acid analyzer. In terms of sample preparation, a simple dilution (5-20-fold) is required, and sugars, primary amino acids, and anthocyanins were demonstrated not to interfere, as the latter are bleached by ninhydrin under the experimental conditions. The method was applied to the study of proline accumulation in the fruits of microvines grown in phytotrons, and it was established that proline accumulation and concentrations closely resemble those of field-grown macrovines.

  19. A Rapid and Improved Method to Generate Recombinant Dengue Virus Vaccine Candidates.

    Science.gov (United States)

    Govindarajan, Dhanasekaran; Guan, Liming; Meschino, Steven; Fridman, Arthur; Bagchi, Ansu; Pak, Irene; ter Meulen, Jan; Casimiro, Danilo R; Bett, Andrew J

    2016-01-01

    Dengue is one of the most important mosquito-borne infections accounting for severe morbidity and mortality worldwide. Recently, the tetravalent chimeric live attenuated Dengue vaccine Dengvaxia® was approved for use in several dengue endemic countries. In general, live attenuated vaccines (LAV) are very efficacious and offer long-lasting immunity against virus-induced disease. Rationally designed LAVs can be generated through reverse genetics technology, a method of generating infectious recombinant viruses from full length cDNA contained in bacterial plasmids. In vitro transcribed (IVT) viral RNA from these infectious clones is transfected into susceptible cells to generate recombinant virus. However, the generation of full-length dengue virus cDNA clones can be difficult due to the genetic instability of viral sequences in bacterial plasmids. To circumvent the need for a single plasmid containing a full length cDNA, in vitro ligation of two or three cDNA fragments contained in separate plasmids can be used to generate a full-length dengue viral cDNA template. However, in vitro ligation of multiple fragments often yields low quality template for IVT reactions, resulting in inconsistent low yield RNA. These technical difficulties make recombinant virus recovery less efficient. In this study, we describe a simple, rapid and efficient method of using LONG-PCR to recover recombinant chimeric Yellow fever dengue (CYD) viruses as potential dengue vaccine candidates. Using this method, we were able to efficiently generate several viable recombinant viruses without introducing any artificial mutations into the viral genomes. We believe that the techniques reported here will enable rapid and efficient recovery of recombinant flaviviruses for evaluation as vaccine candidates and, be applicable to the recovery of other RNA viruses.

  20. A Rapid and Improved Method to Generate Recombinant Dengue Virus Vaccine Candidates.

    Directory of Open Access Journals (Sweden)

    Dhanasekaran Govindarajan

    Full Text Available Dengue is one of the most important mosquito-borne infections accounting for severe morbidity and mortality worldwide. Recently, the tetravalent chimeric live attenuated Dengue vaccine Dengvaxia® was approved for use in several dengue endemic countries. In general, live attenuated vaccines (LAV are very efficacious and offer long-lasting immunity against virus-induced disease. Rationally designed LAVs can be generated through reverse genetics technology, a method of generating infectious recombinant viruses from full length cDNA contained in bacterial plasmids. In vitro transcribed (IVT viral RNA from these infectious clones is transfected into susceptible cells to generate recombinant virus. However, the generation of full-length dengue virus cDNA clones can be difficult due to the genetic instability of viral sequences in bacterial plasmids. To circumvent the need for a single plasmid containing a full length cDNA, in vitro ligation of two or three cDNA fragments contained in separate plasmids can be used to generate a full-length dengue viral cDNA template. However, in vitro ligation of multiple fragments often yields low quality template for IVT reactions, resulting in inconsistent low yield RNA. These technical difficulties make recombinant virus recovery less efficient. In this study, we describe a simple, rapid and efficient method of using LONG-PCR to recover recombinant chimeric Yellow fever dengue (CYD viruses as potential dengue vaccine candidates. Using this method, we were able to efficiently generate several viable recombinant viruses without introducing any artificial mutations into the viral genomes. We believe that the techniques reported here will enable rapid and efficient recovery of recombinant flaviviruses for evaluation as vaccine candidates and, be applicable to the recovery of other RNA viruses.

  1. 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.

  2. [Thin layer agar represents a cost-effective alternative for the rapid diagnosis of multi-drug resistant tuberculosis].

    Science.gov (United States)

    Hernández-Sarmiento, José M; Martínez-Negrete, Milton A; Castrillón-Velilla, Diana M; Mejía-Espinosa, Sergio A; Mejía-Mesa, Gloria I; Zapata-Fernández, Elsa M; Rojas-Jiménez, Sara; Marín-Castro, Andrés E; Robledo-Restrepo, Jaime A

    2014-01-01

    Using cost-benefit analysis for comparing the thin-layer agar culture method to the standard multiple proportion method used in diagnosing multidrug-resistant tuberculosis (MDR TB). A cost-benefit evaluation of two diagnostic tests was made at the Corporación para Investigaciones Biológicas (CIB) in Medellín, Colombia. 100 patients were evaluated; 10.8% rifampicin resistance and 14.3% isoniazid resistance were found. A computer-based decision tree model was used for cost-effectiveness analysis (Treeage Pro); the thin-layer agar culture method was most cost-effective, having 100% sensitivity, specificity and predictive values for detecting rifampicin and isoniazid resistance. The multiple proportion method value was calculated as being US$ 71 having an average 49 day report time compared to US$ 18 and 14 days for the thin-layer agar culture method. New technologies have been developed for diagnosing tuberculosis which are apparently faster and more effective; their operating characteristics must be evaluated as must their effectiveness in terms of cost-benefit. The present study established that using thin-layer agar culture was cheaper, equally effective and could provide results more quickly than the traditional method. This implies that a patient could receive MDR TB treatment more quickly.

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

    International Nuclear Information System (INIS)

    Usami, Kenji; Ishijima, Tatsuo; Toyoda, Hirotaka

    2012-01-01

    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 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 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.

  4. Improving cost-effectiveness and facilitating participation of developing countries in international emissions trading

    International Nuclear Information System (INIS)

    Bohm, P.

    2003-01-01

    Cost-effectiveness is a crucial requirement for meaningful agreements on international climate change policy. This is also borne out in the wording of the Framework Convention of Climate Change and, in particular, the Kyoto Protocol (KP), see UNFCCC (1992) and UN (1997). However, the KP - as it stands after COP7 in Marrakech - is not fully cost-effective, although it may eventually turn out to be the only politically feasible, 'most cost-effective', first step in international climate change policy. The successor to the COP7 version of the KP may be a renegotiated protocol, if the COP7 version fails to be ratified by enough countries to enter into force, or it may be the treaty to be designed for a second commitment period. Four dimensions in which cost-effectiveness may be improved in a treaty that succeeds the KP are discussed here. They all relate to international emissions trading (IET) which is likely to be the most significant instrument for attaining cost-effective reductions in aggregate greenhouse gas (GHG) emissions. It is important for a climate treaty to be able to attract as many developing countries to IET as possible and achieve this as soon as possible. This would have to occur at essentially no cost to them. Only with developing countries onboard can the world community get full access to their low-cost options for emission reductions. A first aspect to be discussed here is related to identifying a cost-effective approach to attain that goal (Section 1). Another aspect concerns the role of the Clean Development Mechanism (CDM) in this context (Section 2). A third issue is to evaluate the consequences for cost-effectiveness of introducing a Commitment Period Reserve to limit 'overselling' (Section 3). A final one deals with the increase in flexibility that would follow from allowing not only banking but also borrowing of Assigned Amount Units (AAUs) (Section 4). While the first two issues refer directly to developing countries, the last two will be

  5. A discrete event simulation to model the cost-utility of fingolimod and natalizumab in rapidly evolving severe relapsing-remitting multiple sclerosis in the UK.

    Science.gov (United States)

    Montgomery, Stephen M; Maruszczak, Maciej J; Slater, David; Kusel, Jeanette; Nicholas, Richard; Adlard, Nicholas

    2017-05-01

    Two disease-modifying therapies are licensed in the EU for use in rapidly-evolving severe (RES) relapsing-remitting multiple sclerosis (RRMS), fingolimod and natalizumab. Here a discrete event simulation (DES) model to analyze the cost-effectiveness of natalizumab and fingolimod in the RES population, from the perspective of the National Health Service (NHS) in the UK, is reported. A DES model was developed to track individual RES patients, based on Expanded Disability Status Scale scores. Individual patient characteristics were taken from the RES sub-groups of the pivotal trials for fingolimod. Utility data were in line with previous models. Published costs were inflated to NHS cost year 2015. Owing to the confidential patient access scheme (PAS) discount applied to fingolimod in the UK, a range of discount levels were applied to the fingolimod list price, to capture the likelihood of natalizumab being cost-effective in a real-world setting. At the lower National Institute of Health and Care Excellence (NICE) threshold of £20,000/quality-adjusted life year (QALY), fingolimod only required a discount greater than 0.8% of list price to be cost-effective. At the upper threshold of £30,000/QALY employed by the NICE, fingolimod was cost-effective if the confidential discount is greater than 2.5%. Sensitivity analyses conducted using fingolimod list-price showed the model to be most sensitive to changes in the cost of each drug, particularly fingolimod. The DES model shows that only a modest discount to the UK fingolimod list-price is required to make fingolimod a more cost-effective option than natalizumab in RES RRMS.

  6. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.

    Science.gov (United States)

    Bernard, Stephen A; Nguyen, Vina; Cameron, Peter; Masci, Kevin; Fitzgerald, Mark; Cooper, David J; Walker, Tony; Std, B Paramed; Myles, Paul; Murray, Lynne; David; Taylor; Smith, Karen; Patrick, Ian; Edington, John; Bacon, Andrew; Rosenfeld, Jeffrey V; Judson, Rodney

    2010-12-01

    To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes. In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge. A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge. In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.

  7. 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...

  8. Cost-effectiveness of using a molecular diagnostic test to improve preoperative diagnosis of thyroid cancer.

    Science.gov (United States)

    Najafzadeh, Mehdi; Marra, Carlo A; Lynd, Larry D; Wiseman, Sam M

    2012-12-01

    Fine-needle aspiration biopsy (FNAB) is a safe and inexpensive diagnostic procedure for evaluating thyroid nodules.Up to 25% of the results from an FNAB, however, may not be diagnostic or may be indeterminate, leading to a subsequent diagnostic thyroid surgery. A new molecularly based diagnostic test could potentially reduce indeterminate cytological results and, with high accuracy, provide a definitive diagnosis for cancer in thyroid nodules. The aim of the study was to estimate the cost-effectiveness of utilizing a molecular diagnostic (DX) test as an adjunct to FNAB, compared with NoDX, to improve the preoperative diagnosis of thyroid nodules. We constructed a patient-level simulation model to estimate the clinical and economic outcomes of using a DX test compared with current practice (NoDX) for the diagnosis of thyroid nodules. By using a cost-effectiveness framework, we measured incremental clinical benefits in terms of quality-adjusted life-years and incremental costs over a 10-year time horizon. Assuming 95% sensitivity and specificity of the Dx test when used as an adjunct to FNAB, the utilization of the DX test resulted in a gain of 0.046 quality-adjusted life-years (95% confidence interval 0.019-0.078) and a saving of $1087 (95% confidence interval $691-$1533) in direct costs per patient. If the cost of the Dx test is less than $1087 per test, we expect to save quality-adjusted life-years and reduce costs when it is utilized. Sensitivity of the DX test, compared with specificity, had a larger influence on the overall outcomes. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. Improved silicon surface passivation of APCVD Al2O3 by rapid thermal annealing

    NARCIS (Netherlands)

    Black, L.E.; Allen, T.; McIntosh, K.R.; Cuévas, A.

    2016-01-01

    Short-duration post-deposition thermal treatments at temperatures above those normally used for annealing activation have the potential to further improve the already excellent passivation of crystalline silicon (c-Si) achieved by Al2O3, but have so far received little attention. In this work we

  10. 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 ...

  11. 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.

  12. PCR-Restriction Fragment Length Polymorphism for Rapid, Low-Cost Identification of Isoniazid-Resistant Mycobacterium tuberculosis▿

    Science.gov (United States)

    Caws, Maxine; Tho, Dau Quang; Duy, Phan Minh; Lan, Nguyen Thi Ngoc; Hoa, Dai Viet; Torok, Mili Estee; Chau, Tran Thi Hong; Van Vinh Chau, Nguyen; Chinh, Nguyen Tran; Farrar, Jeremy

    2007-01-01

    PCR-restriction fragment length poymorphism (PCR-RFLP) is a simple, robust technique for the rapid identification of isoniazid-resistant Mycobacterium tuberculosis. One hundred consecutive isolates from a Vietnamese tuberculosis hospital were tested by MspA1I PCR-RFLP for the detection of isoniazid-resistant katG_315 mutants. The test had a sensitivity of 80% and a specificity of 100% against conventional phenotypic drug susceptibility testing. The positive and negative predictive values were 1 and 0.86, respectively. None of the discrepant isolates had mutant katG_315 codons by sequencing. The test is cheap (less than $1.50 per test), specific, and suitable for the rapid identification of isoniazid resistance in regions with a high prevalence of katG_315 mutants among isoniazid-resistant M. tuberculosis isolates. PMID:17428939

  13. Advancements in valve technology and industry lessons lead to improved plant reliability and cost savings

    International Nuclear Information System (INIS)

    Sharma, V.; Kalsi, M.S.

    2005-01-01

    Plant reliability and safety hinges on the proper functioning of several valves. Recent advancements in valve technology have resulted in new analytical and test methods for evaluating and improving valve and actuator reliability. This is especially significant in critical service applications in which the economic impact of a valve failure on production, outage schedules and consequential damages far surpasses the initial equipment purchase price. This paper presents an overview of recent advances in valve technology driven by reliability concerns and cost savings objectives without comprising safety in the Nuclear Power Industry. This overview is based on over 27 years of experience in supporting US and International nuclear power utilities, and contributing to EPRI, and NSSS Owners' Groups in developing generic models/methodologies to address industry wide issues; performing design basis reviews; and implementing plant-wide valve reliability improvement programs. Various analytical prediction software and hardware solutions and training seminars are now available to implement valve programs covering power plants' lifecycle from the construction phase through life extension and power up rate. These tools and methodologies can enhance valve-engineering activities including the selection, sizing, proper application, condition monitoring, failure analysis, and condition based maintenance optimization with a focus on potential bad actors. This paper offers two such examples, the Kalsi Valve and Actuator Program (KVAP) and Check Valve Analysis and Prioritization (CVAP) [1-3, 8, 9, 11-13]. The advanced, validated torque prediction models incorporated into KVAP software for AOVs and MOVs have improved reliability of margin predictions and enabled cost savings through elimination of unwarranted equipment modifications. CVAP models provides a basis to prioritize the population of valves recommended for preventive maintenance, inspection and/or modification, allowing

  14. RAPID MAPPING FOR BUILT HERITAGE AT RISK USING LOW-COST AND COTS SENSORS. A TEST IN THE DUOMO VECCHIO OF SAN SEVERINO MARCHE

    Directory of Open Access Journals (Sweden)

    A. Calantropio

    2017-11-01

    Full Text Available 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.

  15. 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.

  16. Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department.

    Science.gov (United States)

    White, Benjamin A; Brown, David F M; Sinclair, Julia; Chang, Yuchiao; Carignan, Sarah; McIntyre, Joyce; Biddinger, Paul D

    2012-03-01

    Emergency Department (ED) crowding is well recognized, and multiple studies have demonstrated its negative effect on patient care. This study aimed to assess the effect of an intervention, Supplemented Triage and Rapid Treatment (START), on standard ED performance measures. The START program complemented standard ED triage with a team of clinicians who initiated the diagnostic work-up and selectively accelerated disposition in a subset of patients. This retrospective before-after study compared performance measures over two 3-month periods (September-November 2007 and 2008) in an urban, academic tertiary care ED. Data from an electronic patient tracking system were queried over 12,936 patients pre-intervention, and 14,220 patients post-intervention. Primary outcomes included: 1) overall length of stay (LOS), 2) LOS for discharged and admitted patients, and 3) the percentage of patients who left without complete assessment (LWCA). In the post-intervention period, patient volume increased 9% and boarder hours decreased by 1.3%. Median overall ED LOS decreased by 29 min (8%, 361 min pre-intervention, 332 min post-intervention; p < 0.001). Median LOS for discharged patients decreased by 23 min (7%, 318 min pre-intervention, 295 min post-intervention; p < 0.001), and by 31 min (7%, 431 min pre-intervention, 400 min post-intervention) for admitted patients. LWCA was decreased by 1.7% (4.1% pre-intervention, 2.4% post-intervention; p < 0.001). In this study, a comprehensive screening and clinical care program was associated with a significant decrease in overall ED LOS, LOS for discharged and admitted patients, and rate of LWCA, despite an increase in ED patient volume. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Can Economic Model Transparency Improve Provider Interpretation of Cost-effectiveness Analysis? Evaluating Tradeoffs Presented by the Second Panel on Cost-effectiveness in Health and Medicine.

    Science.gov (United States)

    Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

    2017-11-01

    The Second Panel on Cost-Effectiveness in Health and Medicine convened on December 7, 2016 at the National Academy of Medicine to disseminate their recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses (CEAs). Following its summary, panel proceedings included lengthy discussions including the field's struggle to disseminate findings efficiently through peer-reviewed literature to target audiences. With editors of several medical and outcomes research journals in attendance, there was consensus that findings of cost-effectiveness analyses do not effectively reach other researchers or health care providers. The audience members suggested several solutions including providing additional training to clinicians in cost-effectiveness research and requiring that cost-effectiveness models are made publicly available. However, there remains the questions of whether making economic modelers' work open-access through journals is fair under the defense that these models remain one's own intellectual property, or whether journals can properly manage the peer-review process specifically for cost-effectiveness analyses. In this article, we elaborate on these issues and provide some suggested solutions that may increase the dissemination and application of cost-effectiveness literature to reach its intended audiences and ultimately benefit the patient. Ultimately, it is our combined view as economic modelers and clinicians that cost-effectiveness results need to reach the clinician to improve the efficiency of medical practice, but that open-access models do not improve clinician access or interpretation of the economics of medicine.

  18. Advanced launch system (ALS) - Electrical actuation and power systems improve operability and cost picture

    Science.gov (United States)

    Sundberg, Gale R.

    1990-01-01

    To obtain the Advanced Launch System (ALS) primary goals of reduced costs and improved operability, there must be significant reductions in the launch operations and servicing requirements relative to current vehicle designs and practices. One of the primary methods for achieving these goals is by using vehicle electrrical power system and controls for all aviation and avionics requirements. A brief status review of the ALS and its associated Advanced Development Program is presented to demonstrate maturation of those technologies that will help meet the overall operability and cost goals. The electric power and actuation systems are highlighted as a sdpecific technology ready not only to meet the stringent ALS goals (cryogenic field valves and thrust vector controls with peak power demands to 75 hp), but also those of other launch vehicles, military ans civilian aircraft, lunar/Martian vehicles, and a multitude of comercial applications.

  19. Advanced Launch System (ALS): Electrical actuation and power systems improve operability and cost picture

    Science.gov (United States)

    Sundberg, Gale R.

    1990-01-01

    To obtain the Advanced Launch System (ALS) primary goals of reduced costs and improved operability, there must be significant reductions in the launch operations and servicing requirements relative to current vehicle designs and practices. One of the primary methods for achieving these goals is by using vehicle electrical power system and controls for all actuation and avionics requirements. A brief status review of the ALS and its associated Advanced Development Program is presented to demonstrate maturation of those technologies that will help meet the overall operability and cost goals. The electric power and actuation systems are highlighted as a specific technology ready not only to meet the stringent ALS goals (cryogenic field valves and thrust vector controls with peak power demands to 75 hp), but also those of other launch vehicles, military and civilian aircraft, lunar/Martian vehicles, and a multitude of commercial applications.

  20. Improving the delivery of care and reducing healthcare costs with the digitization of information.

    Science.gov (United States)

    Noffsinger, R; Chin, S

    2000-01-01

    In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

  1. An improved out-cell to in-cell rapid transfer system at the HFEF-south

    International Nuclear Information System (INIS)

    Bacca, J.P.; Sherman, E.K.

    1990-01-01

    The Argonne National Laboratory (ANL) Hot Fuel Examination Facility-South (HFEF-S), located at the ANL-West site of the Idaho National Engineering Laboratory, is currently undergoing extensive refurbishment and modifications in preparation for its use, beginning in 1991, in demonstrating remote recycling of fast reactor, metal-alloy fuel as part of the US Department of Energy liquid-metal reactor, Integral Fast Reactor (IFR) program. Included in these improvements to HFEF-S is a new, small-item, rapid transfer system (RTS). When installed, this system will enable the rapid transfer of small items from the hot-cell exterior into the argon cell (argon-gas atmosphere) of the facility without necessitating the use of time-consuming and laborious procedures. The new RTS will also provide another important function associated with HFEF-S hot-cell operation in the IFR Fuel Recycle Program; namely, the rapid insertion of clean, radioactive contamination-measuring smear paper specimens into the hot cells for area surveys, and the expedited removal of these contaminated (including alpha as well as beta/gamma contamination) smears from the argon cell for transfer to an adjacent health physics field laboratory in the facility for nuclear contamination/radiation counting

  2. 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

  3. Improvements to Rapfish: a rapid evaluation technique for fisheries integrating ecological and human dimensions.

    Science.gov (United States)

    Pitcher, T J; Lam, M E; Ainsworth, C; Martindale, A; Nakamura, K; Perry, R I; Ward, T

    2013-10-01

    This paper reports recent developments in Rapfish, a normative, scalable and flexible rapid appraisal technique that integrates both ecological and human dimensions to evaluate the status of fisheries in reference to a norm or goal. Appraisal status targets may be sustainability, compliance with a standard (such as the UN code of conduct for responsible fisheries) or the degree of progress in meeting some other goal or target. The method combines semi-quantitative (e.g. ecological) and qualitative (e.g. social) data via multiple evaluation fields, each of which is assessed through scores assigned to six to 12 attributes or indicators: the scoring method allows user flexibility to adopt a wide range of utility relationships. For assessing sustainability, six evaluation fields have been developed: ecological, technological, economic, social, ethical and institutional. Each field can be assessed directly with a set of scored attributes, or several of the fields can be dealt with in greater detail using nested subfields that themselves comprise multidimensional Rapfish assessments (e.g. the hierarchical institutional field encompasses both governance and management, including a detailed analysis of legality). The user has the choice of including all or only some of the available sustainability fields. For the attributes themselves, there will rarely be quantitative data, but scoring allows these items to be estimated. Indeed, within a normative framework, one important advantage with Rapfish is transparency of the rigour, quality and replicability of the scores. The Rapfish technique employs a constrained multidimensional ordination that is scaled to situate data points within evaluation space. Within each evaluation field, results may be presented as a two-dimensional plot or in a one-dimensional rank order. Uncertainty is expressed through the probability distribution of Monte-Carlo simulations that use the C.L. on each original observation. Overall results of the

  4. Shifting the Paradigm for Long Term Monitoring at Legacy Sites to Improve Performance while Reducing Cost

    International Nuclear Information System (INIS)

    Eddy-Dilek, Carol A.; Looney, Brian B.; Seaman, John; Kmetz, Thomas

    2013-01-01

    A major issue facing many government and private industry sites that were previously contaminated with radioactive and chemical wastes is that often the sites cannot be cleaned up enough to permit unrestricted human access. These sites will require long-term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality in a cost effective manner. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site (SRS), the larger DOE complex, and many large federal and private sites. Currently, most monitoring strategies are focused on laboratory measurements of contaminants measured in groundwater samples collected from wells. This approach is expensive, and provides limited and lagging information about the effectiveness of cleanup activities and the behavior of the residual contamination. Over the last twenty years, DOE and other federal agencies have made significant investments in the development of various types of sensors and strategies that would allow for remote analysis of contaminants in groundwater, but these approaches do not promise significant reductions in risk or cost. Scientists at SRS have developed a new paradigm to simultaneously improve the performance of long term monitoring systems while lowering the overall cost of monitoring. This alternative approach incorporates traditional point measurements of contaminant concentration with measurements of controlling variables including boundary conditions, master variables, and traditional plume/contaminant variables. Boundary conditions are the overall driving forces that control plume movement and therefore provide leading indication to changes in plume stability. These variables include metrics associated with meteorology, hydrology, hydrogeology, and land use. Master variables are the key variables that control the chemistry of the

  5. The rapid growth of domestic oil consumption in Saudi Arabia and the opportunity cost of oil exports foregone

    International Nuclear Information System (INIS)

    Gately, Dermot; Al-Yousef, Nourah; Al-Sheikh, Hamad M.H.

    2012-01-01

    We analyze the rapid growth of Saudi Arabia's domestic oil consumption, a nine-fold increase in 40 years, to nearly 3 million barrels per day, about one-fourth of production. Such rapid growth in consumption – 5.7% annually, which is 37% faster than its income growth of 4.2% – will challenge Saudi Arabia's ability to increase its oil exports, which are relied upon in long-term world oil projections by the International Energy Agency (IEA), US Department of Energy (DOE) and British Petroleum (BP). However, these institutions assume unprecedented slowdowns in Saudi oil consumption – from 5.7% annual growth historically to less than 2% in the future – allowing them to project increases in Saudi oil exports. Using 1971–2010 data, we estimate that the income responsiveness (elasticity) of oil consumption is at least 1.5—using both Ordinary Least Squares regression and Cointegration methods. We believe that continued high growth rates for domestic oil consumption are more likely than the dramatic slowdowns projected by IEA, DOE and BP. This will have major implications for Saudi production and export levels. - Highlights: ► We analyze the rapid growth of Saudi Arabia's domestic oil consumption, now one-fourth of production. ► Estimated income elasticity of oil demand at least 1.5, using OLS and Co-integration. ► Yet IEA, DOE and BP project unprecedented slowdowns, from 5.7% historically to below 2%, half the rate of income growth. ► Continued high growth rates are more likely, with major implications for Saudi production and export levels.

  6. 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...

  7. 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.

  8. 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

  9. Addition of Kinesio Taping of the orbicularis oris muscles to speech therapy rapidly improves drooling in children with neurological disorders.

    Science.gov (United States)

    Mikami, Denise Lica Yoshimura; Furia, Cristina Lemos Barbosa; Welker, Alexis Fonseca

    2017-09-21

    To evaluate the effects of Kinesio Taping (KT) of the orbicularis oris muscles as an adjunct to standard therapy for drooling. Fifteen children with neurological disorders and drooling received speech therapy and twice-weekly KT of the orbicularis muscles over a 30-day period. Drooling was assessed by six parameters: impact on the life of the child and caregiver; severity of drooling; frequency of drooling; drooling volume (estimated by number of bibs used); salivary leak; and interlabial gap. Seven markers of oral motor skills were also assessed. KT of the orbicularis oris region reduced the interlabial gap. All oral motor skills and almost all markers of drooling improved after 15 days of treatment. In this sample of children with neurological disorders, adding KT of the orbicularis oris muscles to speech therapy caused rapid improvement in oral motor skills and drooling.

  10. 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

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

    International Nuclear Information System (INIS)

    Li, Wei; Xie, Yuanbo; Hao, Fanghua

    2014-01-01

    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

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

    Science.gov (United States)

    2016-10-01

    quality of life , and cognitive function. This design will allow us to assess the efficacy of IQ as a customizable balance treatment in TBI, and to...VANJHCS.  As  such,  we  have   explored  additional  avenues  and  are   working  closely  with  the  dedicated...AWARD NUMBER: W81XWH-14-2-0150 TITLE: Improving Balance in TBI Using a Low-Cost Customized Virtual Reality Rehabilitation Tool PRINCIPAL

  13. 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.

  14. Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR.

    Science.gov (United States)

    Huynh, Lynn; Totev, Todor; Vekeman, Francis; Neary, Maureen P; Duh, Mei S; Benson, Al B

    2017-09-01

    To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor's perspective. Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p = .03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p = .01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p = .02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients

  15. 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 P<0.05. This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service 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

  16. Examination of rapid phase change in copper wires to improve material models and understanding of burst

    Science.gov (United States)

    Olles, Joseph; Garasi, Christopher; Ball, J. Patrick

    2017-11-01

    Electrically-pulsed wires undergo multiple phase changes including a postulated metastable phase resulting in explosive wire growth. Simulations using the MHD approximation attempt to account for the governing physics, but lack the material properties (equations-of-state and electrical conductivity) to accurately predict the phase evolution of the exploding (bursting) wire. To explore the dynamics of an exploding copper wire (in water), we employ a digital micro-Schlieren streak photography technique. This imaging quantifies wire expansion and shock waves emitted from the wire during phase changes. Using differential voltage probes, a Rogowski coil, and timing fiducials, the phase change of the wire is aligned with electrical power and energy deposition. Time-correlated electrical diagnostics and imaging allow for detailed validation of MHD simulations, comparing observed phases with phase change details found in the material property descriptions. In addition to streak imaging, a long exposure image is taken to capture axial striations along the length of the wire. These images are used to compare with results from 3D MHD simulations which propose that these perturbations impact the rate of wire expansion and temporal change in phases. If successful, the experimental data will identify areas for improvement in the material property models, and modeling results will provide insight into the details of phase change in the wire with correlation to variations in the electrical signals.

  17. Rapid Improvement in Visual Selective Attention Related to Action Video Gaming Experience

    Directory of Open Access Journals (Sweden)

    Nan Qiu

    2018-02-01

    Full Text Available A central issue in cognitive science is understanding how learning induces cognitive and neural plasticity, which helps illuminate the biological basis of learning. Research in the past few decades showed that action video gaming (AVG offered new, important perspectives on learning-related cognitive and neural plasticity. However, it is still unclear whether cognitive and neural plasticity is observable after a brief AVG session. Using behavioral and electrophysiological measures, this study examined the plasticity of visual selective attention (VSA associated with a 1 h AVG session. Both AVG experts and non-experts participated in this study. Their VSA was assessed prior to and after the AVG session. Within-group comparisons on the participants' performance before and after the AVG session showed improvements in response time in both groups and modulations of electrophysiological measures in the non-experts. Furthermore, between-group comparisons showed that the experts had superior VSA, relative to the non-experts, prior to the AVG session. These findings suggested an association between the plasticity of VSA and AVG. Most importantly, this study showed that the plasticity of VSA was observable after even a 1 h AVG session.

  18. Rapid Improvement in Visual Selective Attention Related to Action Video Gaming Experience.

    Science.gov (United States)

    Qiu, Nan; Ma, Weiyi; Fan, Xin; Zhang, Youjin; Li, Yi; Yan, Yuening; Zhou, Zhongliang; Li, Fali; Gong, Diankun; Yao, Dezhong

    2018-01-01

    A central issue in cognitive science is understanding how learning induces cognitive and neural plasticity, which helps illuminate the biological basis of learning. Research in the past few decades showed that action video gaming (AVG) offered new, important perspectives on learning-related cognitive and neural plasticity. However, it is still unclear whether cognitive and neural plasticity is observable after a brief AVG session. Using behavioral and electrophysiological measures, this study examined the plasticity of visual selective attention (VSA) associated with a 1 h AVG session. Both AVG experts and non-experts participated in this study. Their VSA was assessed prior to and after the AVG session. Within-group comparisons on the participants' performance before and after the AVG session showed improvements in response time in both groups and modulations of electrophysiological measures in the non-experts. Furthermore, between-group comparisons showed that the experts had superior VSA, relative to the non-experts, prior to the AVG session. These findings suggested an association between the plasticity of VSA and AVG. Most importantly, this study showed that the plasticity of VSA was observable after even a 1 h AVG session.

  19. Leptin rapidly improves glucose homeostasis in obese mice by increasing hypothalamic insulin sensitivity.

    Science.gov (United States)

    Koch, Christiane; Augustine, Rachael A; Steger, Juliane; Ganjam, Goutham K; Benzler, Jonas; Pracht, Corinna; Lowe, Chrishanthi; Schwartz, Michael W; Shepherd, Peter R; Anderson, Greg M; Grattan, David R; Tups, Alexander

    2010-12-01

    Obesity is associated with resistance to the actions of both leptin and insulin via mechanisms that remain incompletely understood. To investigate whether leptin resistance per se contributes to insulin resistance and impaired glucose homeostasis, we investigated the effect of acute leptin administration on glucose homeostasis in normal as well as leptin- or leptin receptor-deficient mice. In hyperglycemic, leptin-deficient Lep(ob/ob) mice, leptin acutely and potently improved glucose metabolism, before any change of body fat mass, via a mechanism involving the p110α and β isoforms of phosphatidylinositol-3-kinase (PI3K). Unlike insulin, however, the anti-diabetic effect of leptin occurred independently of phospho-AKT, a major downstream target of PI3K, and instead involved enhanced sensitivity of the hypothalamus to insulin action upstream of PI3K, through modulation of IRS1 (insulin receptor substrate 1) phosphorylation. These data suggest that leptin resistance, as occurs in obesity, reduces the hypothalamic response to insulin and thereby impairs peripheral glucose homeostasis, contributing to the development of type 2 diabetes.

  20. Do low-cost ceramic water filters improve water security in rural South Africa?

    Science.gov (United States)

    Lange, Jens; Materne, Tineke; Grüner, Jörg

    2016-10-01

    This study examined the performance of a low-cost ceramic candle filter system (CCFS) for point of use (POU) drinking water treatment in the village of Hobeni, Eastern Cape Province, South Africa. CCFSs were distributed in Hobeni and a survey was carried out among their users. The performance of 51 CCFSs was evaluated by dip slides and related to human factors. Already after two-thirds of their specified lifetime, none of the distributed CCFSs produced water without distinct contamination, and more than one-third even deteriorated in hygienic water quality. Besides the water source (springs were preferable compared to river or rain water), a high water throughput was the dominant reason for poor CCFS performance. A stepwise laboratory test documented the negative effects of repeated loading and ambient field temperatures. These findings suggest that not every CCFS type per se guarantees improved drinking water security and that the efficiency of low-cost systems should continuously be monitored. For this purpose, dip slides were found to be a cost-efficient alternative to standard laboratory tests. They consistently underestimated microbial counts but can be used by laypersons and hence by the users themselves to assess critical contamination of their filter systems.

  1. 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.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    K.I. Samchuk

    2017-03-01

    Full Text Available Awareness of human life and health as the highest value is a sign of a civilized society. The economic activity of enterprises accompanied the influence of dangerous and harmful factors. An urgent need for society development and European integration is to create an effective mechanism by which the whole complex will be implemented measures to create conditions that meet the health care workers. The article highlighted media mouthpieces and performers interests of occupational safety, responsibilities entities regarding safety, the place and importance of your support in the management 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.

  4. Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal

    Directory of Open Access Journals (Sweden)

    Trape Jean-François

    2010-06-01

    Full Text Available Abstract Background In 2006, the Senegalese National Malaria Control Programme (NMCP has recommended artemisinin-based combination therapy (ACT as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck®. Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i to study the accuracy of Paracheck® compared to the thick blood smear (TBS in two areas with different levels of malaria endemicity and ii analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP. Methods A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT. Results A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700€ per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes

  5. Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal.

    Science.gov (United States)

    Ly, Alioune Badara; Tall, Adama; Perry, Robert; Baril, Laurence; Badiane, Abdoulaye; Faye, Joseph; Rogier, Christophe; Touré, Aissatou; Sokhna, Cheikh; Trape, Jean-François; Michel, Rémy

    2010-06-04

    In 2006, the Senegalese National Malaria Control Programme (NMCP) has recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck). Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i) to study the accuracy of Paracheck compared to the thick blood smear (TBS) in two areas with different levels of malaria endemicity and ii) analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP. A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal) nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT. A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700 euros per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes of illness. The present study also demonstrated

  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. 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

  8. 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.

  9. 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.

  10. Convert a low-cost sensor to a colorimeter using an improved regression method

    Science.gov (United States)

    Wu, Yifeng

    2008-01-01

    Closed loop color calibration is a process to maintain consistent color reproduction for color printers. To perform closed loop color calibration, a pre-designed color target should be printed, and automatically measured by a color measuring instrument. A low cost sensor has been embedded to the printer to perform the color measurement. A series of sensor calibration and color conversion methods have been developed. The purpose is to get accurate colorimetric measurement from the data measured by the low cost sensor. In order to get high accuracy colorimetric measurement, we need carefully calibrate the sensor, and minimize all possible errors during the color conversion. After comparing several classical color conversion methods, a regression based color conversion method has been selected. The regression is a powerful method to estimate the color conversion functions. But the main difficulty to use this method is to find an appropriate function to describe the relationship between the input and the output data. In this paper, we propose to use 1D pre-linearization tables to improve the linearity between the input sensor measuring data and the output colorimetric data. Using this method, we can increase the accuracy of the regression method, so as to improve the accuracy of the color conversion.

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

    Science.gov (United States)

    Dubey, Manish K; Zehra, Andleeb; Aamir, Mohd; Meena, Mukesh; Ahirwal, Laxmi; Singh, Siddhartha; Shukla, Shruti; Upadhyay, Ram S; Bueno-Mari, Ruben; Bajpai, Vivek K

    2017-01-01

    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.

  12. 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.

  13. 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.

  14. Improved normal tissue sparing in head and neck radiotherapy using biological cost function based-IMRT.

    Science.gov (United States)

    Anderson, N; Lawford, C; Khoo, V; Rolfo, M; Joon, D L; Wada, M

    2011-12-01

    Intensity-modulated radiotherapy (IMRT) has reduced the impact of acute and late toxicities associated with head and neck radiotherapy. Treatment planning system (TPS) advances in biological cost function based optimization (BBO) and improved segmentation techniques have increased organ at risk (OAR) sparing compared to conventional dose-based optimization (DBO). A planning study was undertaken to compare OAR avoidance in DBO and BBO treatment planning. Simultaneous integrated boost treatment plans were produced for 10 head and neck patients using both planning systems. Plans were compared for tar get coverage and OAR avoidance. Comparisons were made using the BBO TPS Monte Carlo dose engine to eliminate differences due to inherent algorithms. Target coverage (V95%) was maintained for both solutions. BBO produced lower OAR doses, with statistically significant improvement to left (12.3%, p = 0.005) and right parotid mean dose (16.9%, p = 0.004), larynx V50_Gy (71.0%, p = 0.005), spinal cord (21.9%, p < 0.001) and brain stem dose maximums (31.5%, p = 0.002). This study observed improved OAR avoidance with BBO planning. Further investigations will be undertaken to review any clinical benefit of this improved planned dosimetry.

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

    Science.gov (United States)

    Garbarino, Sergio; Lanteri, Paola; Durando, Paolo; Magnavita, Nicola; Sannita, Walter G

    2016-08-18

    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.

  16. 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.

  17. Benefits and costs of ecological restoration: Rapid assessment of changing ecosystem service values at a U.K. wetland.

    Science.gov (United States)

    Peh, Kelvin S-H; Balmford, Andrew; Field, Rob H; Lamb, Anthony; Birch, Jennifer C; Bradbury, Richard B; Brown, Claire; Butchart, Stuart H M; Lester, Martin; Morrison, Ross; Sedgwick, Isabel; Soans, Chris; Stattersfield, Alison J; Stroh, Peter A; Swetnam, Ruth D; Thomas, David H L; Walpole, Matt; Warrington, Stuart; Hughes, Francine M R

    2014-10-01

    Restoration of degraded land is recognized by the international community as an important way of enhancing both biodiversity and ecosystem services, but more information is needed about its costs and benefits. In Cambridgeshire, U.K., a long-term initiative to convert drained, intensively farmed arable land to a wetland habitat mosaic is driven by a desire both to prevent biodiversity loss from the nationally important Wicken Fen National Nature Reserve (Wicken Fen NNR) and to increase the provision of ecosystem services. We evaluated the changes in ecosystem service delivery resulting from this land conversion, using a new Toolkit for Ecosystem Service Site-based Assessment (TESSA) to estimate biophysical and monetary values of ecosystem services provided by the restored wetland mosaic compared with the former arable land. Overall results suggest that restoration is associated with a net gain to society as a whole of $199 ha(-1)y(-1), for a one-off investment in restoration of $2320 ha(-1). Restoration has led to an estimated loss of arable production of $2040 ha(-1)y(-1), but estimated gains of $671 ha(-1)y(-1) in nature-based recreation, $120 ha(-1)y(-1) from grazing, $48 ha(-1)y(-1) from flood protection, and a reduction in greenhouse gas (GHG) emissions worth an estimated $72 ha(-1)y(-1). Management costs have also declined by an estimated $1325 ha(-1)y(-1). Despite uncertainties associated with all measured values and the conservative assumptions used, we conclude that there was a substantial gain to society as a whole from this land-use conversion. The beneficiaries also changed from local arable farmers under arable production to graziers, countryside users from towns and villages, and the global community, under restoration. We emphasize that the values reported here are not necessarily transferable to other sites.

  18. 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.

  19. 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.

  20. 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 mm 2 . 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 × 10 5 to 1.4 × 10 6 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.

  1. 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.

  2. Combining polyamine depletion with radiation therapy for rapidly dividing head and neck tumors: Strategies for improved locoregional control

    International Nuclear Information System (INIS)

    Petereit, D.G.; Harari, P.M.; Contreras, L.; Pickart, M.A.; Verma, A.K.; Kinsella, T.J.; Gerner, E.W.

    1994-01-01

    Locoregional control is adversely affected as clonogens from rapidly proliferating tumors repopulate during a course of radiation therapy. The cytostatic agent α-difluoromethylornithine (DFMO) was investigated for its capacity to slow proliferation kinetics in human squamous cell carcinomas (SSC) of the head and neck (H ampersand N), with the ultimate objective of improving locoregional control in rapidly dividing tumors treated with radiation therapy. Three human SSC cell lines established from primary H ampersand N tumors were evaluated in vitro (cell culture) and in vivo (SSC tumor xenografts in athymic mice) for the capacity of DFMO to induce growth inhibition. Flow cytometry analysis of SCC tumor growth kinetics and quantitative assessment of polyamine biosynthesis inhibition was performed to verify DFMO activity. DFMO effects on in vitro SSC radiosensitivity using clonogenic survival were also studied. A noncytotoxic exposure to DFMO (5mM x 72 hours) induced pronounced growth inhibition in all three SSC cell lines (70-90% at 7 days), and induced a 2-3 fold delay in volume doubling time for SCC tumor xenografts when administered orally in the drinking water (1.5%) to athymic mice. Kinetic analysis via flow cytometry confirmed that DFMO produced a lengthening of SCC cell cycle times, but did not alter in vitro radiosensitivity. Inhibition of ornithine decarboxylase (ODC) activity and depletion of endogenous polyamines (putrescine and spermidine), were confirmed in normal tissue (mouse skin) and in human SSC tumor xenografts of athymic mice receiving continuous oral DFMO. These data indicate that antiproliferative agents, such as DFMO, are capable of altering human SSC growth kinetics without altering intrinsic radiosensitivity. Such kinetic modulation may therefore provide a strategy to reduce the adverse impact of tumor cell proliferation during a radiotherapy treatment course for rapidly dividing tumors such as those in the H ampersand N. 33 refs., 5 figs

  3. 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.

  4. Cost-Effectiveness and Validity Assessment of Cyscope Microscope, Quantitative Buffy Coat Microscope, and Rapid Diagnostic Kit for Malaria Diagnosis among Clinic Attendees in Ibadan, Nigeria

    Directory of Open Access Journals (Sweden)

    Abiodun Ogunniyi

    2016-01-01

    Full Text Available Background. Unavailability of accurate, rapid, reliable, and cost-effective malaria diagnostic instruments constitutes major a challenge to malaria elimination. We validated alternative malaria diagnostic instruments and assessed their comparative cost-effectiveness. Method. Using a cross-sectional study design, 502 patients with malaria symptoms at selected health facilities in Ibadan between January and April 2014 were recruited consecutively. We examined malaria parasites using Cyscope®, QBC, and CareStart™ and results were compared to light microscopy (LM. Validity was determined by assessing sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV. Costs per hour of use for instruments and turnaround time were determined. Result. Sensitivity of the instruments was 76.0% (CareStart, 95.0% (Cyscope, and 98.1% (QBC. Specificity was 96.0% (CareStart, 87.3% (Cyscope, and 85.5% (QBC. PPV were 65.2%, 67.5%, and 84.7%, while NPV were 93.6%, 98.6%, and 99.4% for CareStart, Cyscope, and QBC with Kappa values of 0.75 (CI = 0.68–0.82 for CareStart, 0.72 (CI = 0.65–0.78 for Cyscope, and 0.71 (CI = 0.64–0.77 for QBC. Average cost per hour of use was the lowest ($2.04 with the Cyscope. Turnaround time was the fastest with Cyscope (5 minutes. Conclusion. Cyscope fluorescent microscope had the shortest turnaround time and is the most cost-effective of all the malaria diagnostic instruments evaluated.

  5. The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

    OpenAIRE

    Bishai, David; LeFevre, Amnesty; Theuss, Marc; Boxshall, Matt; Hetherington, John D; Zaw, Min; Montagu, Dominic

    2013-01-01

    Abstract Introduction This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009. Methods The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were g...

  6. A biodegradable colorimetric film for rapid low-cost field determination of formaldehyde contamination by digital image colorimetry.

    Science.gov (United States)

    Wongniramaikul, Worawit; Limsakul, Wadcharawadee; Choodum, Aree

    2018-05-30

    A biodegradable colorimetric film was fabricated on the lid of portable tube for in-tube formaldehyde detection. Based on the entrapment of colorimetric reagents within a thin film of tapioca starch, the yellow reaction product was observed with formaldehyde. Intensity of the blue channel from the digital image of yellow product showed a linear relationship in the range of 0-25 mg L -1 with low detection limit of 0.7 ± 0.1 mg L -1 . Inter-day precision of 0.61-3.10%RSD were obtained with less than 4.2% relative error from control samples. The developed method was applied for various food samples in Phuket and formaldehyde concentration range was non-detectable to 1.413 mg kg -1 . The quantified concentrations of formaldehyde in fish and squid samples provided relative errors of -7.7% and +10.8% compared to spectrophotometry. This low cost sensor (∼0.04 USD/test) with digital image colorimetry was thus an effective alternative for formaldehyde detection in food sample. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. 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.

  8. The Effect of Rapid Antigen Detection Test on Antibiotic Prescription Decision of Clinicians and Reducing Antibiotic Costs in Children with Acute Pharyngitis.

    Science.gov (United States)

    Kose, Engin; Sirin Kose, Seda; Akca, Deniz; Yildiz, Kerem; Elmas, Cengizhan; Baris, Mustafa; Anil, Murat

    2016-08-01

    We aimed to investigate the effect of rapid antigen detection test (RADT) in the diagnosis of streptococcal pharyngitis, its impact on antibiotic prescription decision of pediatricians and influence on reduction of antibiotic treatment costs in children with pharyngitis. The study group consisted of 223 patients who were diagnosed with pharyngitis by pediatricians. The sensitivity and specificity of RADT were 92.1% (95% Cl: 78.6-98.3%) and 97.3% (95% Cl: 93.8-99.1%), respectively. In the first assessment, before performing RADT, pediatricians decided to prescribe antibiotics for 178 (79.8%) patients with pharyngitis. After learning RADT results, pediatricians finally decided to prescribe antibiotics for 83 (37.2%) patients with pharyngitis, and antibiotic prescription decreased by 42.6%. Antibiotic costs in non-Group A streptococcus pharyngitis, Group A streptococcus pharyngitis and all subjects groups decreased by 80.8%, 48%, and 76.4%, respectively. Performing RADT in children with pharyngitis has an important impact on treatment decision of clinicians, reduction of unnecessary antibiotic prescriptions and antibiotic costs. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Selectivity improvement of positive photoionization ion mobility spectrometry for rapid detection of organophosphorus pesticides by switching dopant concentration.

    Science.gov (United States)

    Zhou, Qinghua; Li, Jia; Wang, Bin; Wang, Shuang; Li, Haiyang; Chen, Jinyuan

    2018-01-01

    Ion mobility spectrometry (IMS) opened a potential avenue for the rapid detection of organophosphorus pesticides (OPPs), though an improved selectivity of stand-alone IMS was still in high demand. In this study, a stand-alone positive photoionization ion mobility spectrometry (PP-IMS) apparatus was constructed for the rapid detection of OPPs with acetone as dopant. The photoionization of acetone molecules was induced by the ultraviolet irradiation to produce the reactant ions (Ac) 2 H + , which were employed to ionize the OPPs including fenthion, imidan, phosphamidon, dursban, dimethoate and isocarbophos via the proton transfer reaction. Due to the difference in proton affinity, the tested OPPs exhibited the different dopant-dependent manners. Based on this observation, the switching of dopant concentration was implemented to improve the selectivity of PP-IMS for OPPs detection. For instance, a mixture of fenthion, dursban and dimethoate was tested. By switching the concentration of doped acetone from 0.07 to 2.33 to 19.94mgL -1 , the ion peaks of fenthion and dursban were inhibited in succession, achieving the selective detection of dimethoate at last. In addition, another mixture of imidan and phosphamidon was initially detected by PP-IMS with a dose of 0.07mgL -1 acetone, indicating that their ion peaks were severely overlapped; when the concentration of doped acetone was switched to 19.94mgL -1 , the inhibition of imidan signals promised the accurate identification of phosphamidon in mixture. Finally, the PP-IMS in combination of switching dopant concentration was applied to detect the mixed fenthion, dursban and dimethoate in Chinese cabbage, demonstrating the applicability of proposed method to real samples. Copyright © 2017. Published by Elsevier B.V.

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

    Directory of Open Access Journals (Sweden)

    Li Cong

    2015-03-01

    Full Text Available 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.

  11. 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

  12. The effect of availability improvement of a nuclear power plant on the cost of generating electricity

    International Nuclear Information System (INIS)

    Nejat, S.M.R.

    1980-01-01

    The objective of this investigation is to study the economic benefits in operating a nuclear power plant as a result of improving the availabilitty of the secondary (steam) loop of the plant. A new method has been developed to obtain availability, frequency of failure, probability and frequency of operation, cycle time, and uptime for different capacity states of a parallel-series system having components with failure and repair rates distributed exponentially. The method has been applied to different subsystems, systems, and the seconary loop as a whole. The effect of having spare parts for several components, as measured by savings in the generation of electricity, is also studied. The Kettelle algorithm was applied to determine optimal spare part allocation in order to achieve maximum availability or minimum cost of electricity, subject to a fixed spare parts budget. It has been shown that the optimum spare parts allocation and the budget level which gives optimum availability, do not necessarily give minimum electricity cost. The savings per year for optimal spare parts allocation and different spare parts budgets were obtained. The results show that the utilty will save its customers a large amount of money if spare parts are purchased, especially at the beginning of the plant operation, and are allocated judiciously

  13. 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.

  14. German diabetes management programs improve quality of care and curb costs.

    Science.gov (United States)

    Stock, Stephanie; Drabik, Anna; Büscher, Guido; Graf, Christian; Ullrich, Walter; Gerber, Andreas; Lauterbach, Karl W; Lüngen, Markus

    2010-12-01

    This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.

  15. 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.

  16. Y-12 product improvements expected to reduce metal production costs and decrease fabrication losses

    International Nuclear Information System (INIS)

    Hassler, Morris E.

    2005-01-01

    The Y-12 National Security Complex (Y-12) supplies uranium metal and uranium oxide feed material for fabrication into fuel for research reactors around the world. Over the past few years, Y-12 has continued to improve its Low Enriched Uranium (LEU) product. The LEU is produced by taking U.S. surplus Highly Enriched Uranium (HEU) and blending it with depleted or natural uranium. The surplus HEU comes from dismantled U.S. weapons parts. Those research reactors that use LEU from Y-12 are making important contributions to international nuclear nonproliferation by using LEU rather than HEU, and helping to disposition former U.S. weapons material. It is clearly understood that the research reactor community must keep fuel costs as low as possible and Y-12 is making every effort to improve efficiencies in producing the uranium through standardizing the chemical specifications as well as the product mass and dimensional qualities. These production cost reductions allows for the U.S. to keep the LEU product price low even with the dramatic increase in the uranium enrichment and feed component market prices in the last few years. This paper will discuss a new standard specification that has been proposed to existing LEU metal customers and fuel fabricators. It will also cover Y-12's progress on a new mold-design that will result in a more uniform, higher quality product and eliminates two steps of the production process. This new product is expected to decrease fabrication losses by 5-10%, depending on the fabricator's process. The paper will include planned activities and the schedule associated with implementation of the new specification and product form. (author)

  17. An improved charging/discharging strategy of lithium batteries considering depreciation cost in day-ahead microgrid scheduling

    International Nuclear Information System (INIS)

    Zhang, Zhong; Wang, Jianxue; Wang, Xiuli

    2015-01-01

    Highlights: • A quantitative depreciation cost model is put forward for lithium batteries. • A practical charging/discharging strategy is applied to battery management. • The depth of discharge of the battery storage is scheduled more rationally. • The proposed strategy improves the cost efficiency of lithium batteries in MGs. - Abstract: An energy storage system is critical for the safe and stable operation of a microgrid (MG) and has a promising prospect in future power system. Economical and safe operation of storage system is of great significance to MGs. This paper presents an improved management strategy for lithium battery storage by establishing a battery depreciation cost model and employing a practical charging/discharging strategy. Firstly, experimental data of lithium battery cycle lives, which are functions of the depth of discharge, are investigated and synthesized. A quantitative depreciation cost model is put forward for lithium batteries from the perspective of cycle life. Secondly, a practical charging/discharging strategy is applied to the lithium battery management in MGs. Then, an optimal scheduling model is developed to minimize MG operational cost including battery depreciation cost. Finally, numerical tests are conducted on a typical grid-connected MG. Results show that the depth of discharge of storage is scheduled more rationally, and operational cost is simultaneously saved for MG under the proposed management strategy. This study helps to improve the cost efficiency and alleviate the aging process for lithium batteries.

  18. 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

    scenario in Europe would have substantial benefits on health through improvements in air pollution. Health effects and societal cost savings may significantly counterbalance investment costs and should be taken into account when evaluating strategies for mitigation of global warming....... 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...... 78678 LY in Europe. A total of 7173 cases of persistent chronic bronchitis could be avoided annually. Several other health outcomes improved similarly. The saved societal costs totaled 6.64 billion € annually. Conclusions: In addition to carbon emission reductions, an improved building insulation...

  19. 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.

  20. Improving the first-line treatment of febrile illnesses in Ghana: willingness to pay for malaria rapid diagnostic tests at licensed chemical shops in the Kintampo area.

    Science.gov (United States)

    Tawiah, Theresa; Malam, Keziah; Kwarteng, Anthony; Bart-Plange, Constance; Febir, Lawrence; Aubyn, Vivian; Obermann, Konrad; Owusu-Agyei, Seth; Asante, Kwaku Poku

    2018-01-01

    Use of malaria rapid diagnostic test (mRDT) enhances patient management and reduces costs associated with the inappropriate use of antimalarials. Despite its proven clinical effectiveness, mRDT is not readily available at licensed chemical shops in Ghana. Therefore, in order to improve the use of mRDT, there is the need to understand the willingness to pay for and sell mRDT. This study assessed patients' willingness to pay and licensed chemical operators' (LCS) willingness to sell mRDTs. The study was a cross-sectional survey conducted in Kintampo North Municipality and Kintampo South District of Ghana. Contingent valuation method using the dichotomous approach was applied to explore patient's willingness to pay. In-depth interviews (IDIs) were used to obtain information from licensed chemical operators' willingness to sell. Majority 161 (97%) of the customers were willing to pay for mRDT while 100% of licensed chemical operators were also willing to sell mRDT. The average lowest amount respondents were willing to pay was Ghana cedis (GH¢) 1.1 (US$ 0.26) and an average highest amount of GH¢ 2.1 (US$ 0.49). LCS operators were willing to sell the test kit at an average lowest price of GH¢1 (US$ 0.23) and average highest price of GH¢2 (US$ 0.47). Community members were willing to pay for mRDT and LCS operators are willing to sell mRDTs. However, the high cost of the mRDT is likely to prevent the widespread use of mRDT. There is a clear need to find system-compatible ways to subsidize the use of mRDT via National Health Insurance scheme.

  1. 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,...

  2. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review

    Science.gov (United States)

    2011-01-01

    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. Conclusions These studies

  3. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review.

    Science.gov (United States)

    Fitzpatrick-Lewis, Donna; Ganann, Rebecca; Krishnaratne, Shari; Ciliska, Donna; Kouyoumdjian, Fiona; Hwang, Stephen W

    2011-08-10

    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. 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. 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. These studies provide important new evidence regarding

  4. 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

  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. Patient engagement: four case studies that highlight the potential for improved health outcomes and reduced costs.

    Science.gov (United States)

    Laurance, Jeremy; Henderson, Sarah; Howitt, Peter J; Matar, Mariam; Al Kuwari, Hanan; Edgman-Levitan, Susan; Darzi, Ara

    2014-09-01

    The energy of patients and members of the public worldwide who care about improving health is a huge, but still largely unrecognized and untapped, resource. The aim of patient engagement is to shift the clinical paradigm from determining "what is the matter?" to discovering "what matters to you?" This article presents four case studies from around the world that highlight the proven and potential abilities of increased patient engagement to improve health outcomes and reduce costs, while extending the reach of treatment and diagnostic programs into the community. The cases are an online mental health community in the United Kingdom, a genetic screening program in the United Arab Emirates, a World Health Organization checklist for new mothers, and a hospital-based patient engagement initiative in the United States. Evidence from these and similar endeavors suggests that closer collaboration on the part of patients, families, health care providers, health care systems, and policy makers at multiple levels could help diverse nations provide more effective and population-appropriate health care with fewer resources. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Rapid Fishery Assessment by Market Survey (RFAMS--an improved rapid-assessment approach to characterising fish landings in developing countries.

    Directory of Open Access Journals (Sweden)

    William T White

    Full Text Available The complex multi-gear, multi-species tropical fisheries in developing countries are poorly understood and characterising the landings from these fisheries is often impossible using conventional approaches. A rapid assessment method for characterising landings at fish markets, using an index of abundance and estimated weight within taxonomic groups, is described. This approach was developed for contexts where there are no detailed data collection protocols, and where consistent data collection across a wide range of fisheries types and geographic areas is required, regardless of the size of the site and scale of the landings. This methodology, which was demonstrated at seven fish landing sites/fish markets in southern Indonesia between July 2008 and January 2011, provides a rapid assessment of the abundance and diversity in the wild catch over a wide variety of taxonomic groups. The approach has wider application for species-rich fisheries in developing countries where there is an urgent need for better data collection protocols, monitoring future changes in market demographics, and evaluating health of fisheries.

  8. 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

  9. 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

  10. Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care.

    Science.gov (United States)

    Paton, Fiona; Wright, Kath; Ayre, Nigel; Dare, Ceri; Johnson, Sonia; Lloyd-Evans, Brynmor; Simpson, Alan; Webber, Martin; Meader, Nick

    2016-01-01

    Crisis Concordat was established to improve outcomes for people experiencing a mental health crisis. The Crisis Concordat sets out four stages of the crisis care pathway: (1) access to support before crisis point; (2) urgent and emergency access to crisis care; (3) quality treatment and care in crisis; and (4) promoting recovery. To evaluate the clinical effectiveness and cost-effectiveness of the models of care for improving outcomes at each stage of the care pathway. Electronic databases were searched for guidelines, reviews and, where necessary, primary studies. The searches were performed on 25 and 26 June 2014 for NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, and the Health Technology Assessment (HTA) and PROSPERO databases, and on 11 November 2014 for MEDLINE, PsycINFO and the Criminal Justice Abstracts databases. Relevant reports and reference lists of retrieved articles were scanned to identify additional studies. When guidelines covered a topic comprehensively, further literature was not assessed; however, where there were gaps, systematic reviews and then primary studies were assessed in order of priority. Systematic reviews were critically appraised using the Risk Of Bias In Systematic reviews assessment tool, trials were assessed using the Cochrane risk-of-bias tool, studies without a control group were assessed using the National Institute for Health and Care Excellence (NICE) prognostic studies tool and qualitative studies were assessed using the Critical Appraisal Skills Programme quality assessment tool. A narrative synthesis was conducted for each stage of the care pathway structured according to the type of care model assessed. The type and range of evidence identified precluded the use of meta-analysis. One review of reviews, six systematic reviews, nine guidelines and 15 primary studies were included. There was very limited evidence for access to support

  11. Navigating an ocean of information: how Community Care of North Carolina uses data to improve care and control costs.

    Science.gov (United States)

    Barrington, Randy

    2014-01-01

    Community Care of North Carolina's 14 networks use data analysis to provide relevant solutions that are responsive to unique regional environments. This article describes some of the ways that these networks use data to improve patient self-management, to meet providers' needs, to improve quality of care, and to control costs.

  12. 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.

  13. Cost-benefit comparisons of investments in improved water supply and cholera vaccination programs.

    Science.gov (United States)

    Jeuland, Marc; Whittington, Dale

    2009-05-18

    This paper presents the first cost-benefit comparison of improved water supply investments and cholera vaccination programs. Specifically, we compare two water supply interventions -- deep wells with public hand pumps and biosand filters (an in-house, point-of-use water treatment technology) -- with two types of cholera immunization programs with new-generation vaccines -- general community-based and targeted and school-based programs. In addition to these four stand-alone investments, we also analyze five combinations of water and vaccine interventions: (1) borehole+hand pump and community-based cholera vaccination, (2) borehole+hand pump and school-based cholera vaccination, (3) biosand filter and community-based cholera vaccination, (4) biosand filter and school-based cholera vaccination, and (5) biosand filter and borehole+hand pump. Using recent data applicable to developing country locations for parameters such as disease incidence, the effectiveness of vaccine and water supply interventions against diarrheal diseases, and the value of a statistical life, we construct cost-benefit models for evaluating these interventions. We then employ probabilistic sensitivity analysis to estimate a frequency distribution of benefit-cost ratios for all four interventions, given a wide variety of possible parameter combinations. Our results demonstrate that there are many plausible conditions in developing countries under which these interventions will be attractive, but that the two improved water supply interventions and the targeted cholera vaccination program are much more likely to yield attractive cost-benefit outcomes than a community-based vaccination program. We show that implementing community-based cholera vaccination programs after borehole+hand pump or biosand filters have already been installed will rarely be justified. This is especially true when the biosand filters are already in place, because these achieve substantial cholera risk reductions on their own

  14. Directional plasticity rapidly improves 3D vestibulo-ocular reflex alignment in monkeys using a multichannel vestibular prosthesis.

    Science.gov (United States)

    Dai, Chenkai; Fridman, Gene Y; Chiang, Bryce; Rahman, Mehdi A; Ahn, Joong Ho; Davidovics, Natan S; Della Santina, Charles C

    2013-12-01

    Bilateral loss of vestibular sensation can be disabling. We have shown that a multichannel vestibular prosthesis (MVP) can partly restore vestibular sensation as evidenced by improvements in the 3-dimensional angular vestibulo-ocular reflex (3D VOR). However, a key challenge is to minimize misalignment between the axes of eye and head rotation, which is apparently caused by current spread beyond each electrode's targeted nerve branch. We recently reported that rodents wearing a MVP markedly improve 3D VOR alignment during the first week after MVP activation, probably through the same central nervous system adaptive mechanisms that mediate cross-axis adaptation over time in normal individuals wearing prisms that cause visual scene movement about an axis different than the axis of head rotation. We hypothesized that rhesus monkeys would exhibit similar improvements with continuous prosthetic stimulation over time. We created bilateral vestibular deficiency in four rhesus monkeys via intratympanic injection of gentamicin. A MVP was mounted to the cranium, and eye movements in response to whole-body passive rotation in darkness were measured repeatedly over 1 week of continuous head motion-modulated prosthetic electrical stimulation. 3D VOR responses to whole-body rotations about each semicircular canal axis were measured on days 1, 3, and 7 of chronic stimulation. Horizontal VOR gain during 1 Hz, 50 °/s peak whole-body rotations before the prosthesis was turned on was prosthetic stimulation under normal diurnal lighting. Similar improvements were noted for all animals, all three axes of rotation tested, for all sinusoidal frequencies tested (0.05-5 Hz), and for high-acceleration transient rotations. VOR asymmetry changes did not reach statistical significance, although they did trend toward slight improvement over time. Prior studies had already shown that directional plasticity reduces misalignment when a subject with normal labyrinths views abnormal visual scene

  15. 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.

  16. Highway Safety Data : costs, quality, and strategies for improvement : research report

    Science.gov (United States)

    1998-01-01

    The goal of this project was to analyze the collection and management of highway safety data by identifying issues and costs, and proposing means of resolving those issues and reducing the costs. Initial emphasis addressed known elements of the highw...

  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. 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

  19. Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso

    Directory of Open Access Journals (Sweden)

    Tinto Halidou

    2011-08-01

    Full Text Available Abstract Background Malaria rapid diagnostic tests (RDTs have generally been found reliable and cost-effective. In Burkina Faso, the adherence of prescribers to the negative test result was found to be poor. Moreover, the test accuracy for malaria-attributable fever (MAF is not the same as for malaria infection. This paper aims at determining the costs and benefits of two competing strategies for the management of MAF: presumptive treatment for all or use of RDTs. Methods A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT recruiting 852 febrile patients during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis. Results and discussion At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525 € for a death averted, the total cost of managing 1,000 febrile children was 1,747 vs. 1,862 € in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the RDT would be the winning strategy for adults in both seasons and for children in the dry season. At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in patients with false positive RDT results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For children the presumptive strategy remains the best choice for a wide range of scenarios. Conclusions For RDTs to be preferred, a positive result

  20. Cost-Benefit Study of a Project to Lower Cost and Improve Fleet Readiness through Integrating the Management of Technical Information

    OpenAIRE

    Levine, Dan

    2010-01-01

    Proceedings Paper (for Acquisition Research Program) Approved for public release; distribution unlimited. This paper describes a cost-benefit analysis by the Institute for Defense Analyses of the ''Bridge Project'' that ADL (Advanced Distributed Learning) is conducting for the Office of Secretary of Defense for Acquisition, Technology and Logistics (OSD(AT&L) to improve the management of Integrated Logistics Support (ILS). The Project is part of the OSD RTOC program (Reduction in Total ...

  1. 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

  2. Nitrogen can improve the rapid response of photosynthesis to changing irradiance in rice (Oryza sativa L.) plants.

    Science.gov (United States)

    Sun, Jiali; Ye, Miao; Peng, Shaobing; Li, Yong

    2016-08-10

    To identify the effect of nitrogen (N) nutrition on the dynamic photosynthesis of rice plants, a pot experiment was conducted under two N conditions. The leaf N and chlorophyll levels, as well as steady-state photosynthesis, were significantly increased under high N. After the transition from saturating to low light levels, decreases in the induction state (IS%) of leaf photosynthesis (A) and stomatal conductance (gs) were more severe under low than under high N supply. After the transition from low to flecked irradiance, the times to 90% of maximum A (T90%A) were significantly longer under low than under high N supply. Under flecked irradiance, the maximum A under saturating light (Amax-fleck) and the steady-state A under low light (Amin-fleck) were both lower than those under uniform irradiance (Asat and Ainitial). Under high N supply, Amax-fleck was 14.12% lower than Asat, while it was 22.80% lower under low N supply. The higher IS%, shorter T90%A, and the lower depression of Amax-fleck from Asat under high N supply led to a less carbon loss compared with under a low N supply. Therefore, we concluded that N can improve the rapid response of photosynthesis to changing irradiance.

  3. Rapid activation of catalase followed by citrate efflux effectively improves aluminum tolerance in the roots of chick pea (Cicer arietinum).

    Science.gov (United States)

    Sharma, Manorma; Sharma, Vinay; Tripathi, Bhumi Nath

    2016-05-01

    The present study demonstrates the comparative response of two contrasting genotypes (aluminum (Al) tolerant and Al sensitive) of chick pea (Cicer arietinum) against Al stress. The Al-tolerant genotype (RSG 974) showed lesser inhibition of root growth as well as lower oxidative damages, measured in terms of the accumulation of H2O2 and lipid peroxidation compared to the Al-sensitive genotype (RSG 945). The accumulation of Al by roots of both genotypes was almost equal at 96 and 144 h after Al treatment; however, it was higher in Al-tolerant than Al-sensitive genotype at 48 h after Al treatment. Further, the Al-mediated induction of superoxide dismutase (SOD) activity was significantly higher in Al-tolerant than Al-sensitive genotype. Ascorbate peroxidase (APX) activity was almost similar in both genotypes. Al treatment promptly activated catalase activity in Al-tolerant genotype, and it was remarkably higher than that of Al-sensitive genotype. As another important Al detoxification mechanism, citrate efflux was almost equal in both genotypes except at 1000 μM Al treatment for 96 and 144 h. Further, citrate carrier and anion channel inhibitor experiment confirmed the contribution of citrate efflux in conferring Al tolerance in Al-tolerant genotype. Based on the available data, the present study concludes that rapid activation of catalase (also SOD) activity followed by citrate efflux effectively improves Al tolerance in chick pea.

  4. Caffeine ingestion after rapid weight loss in judo athletes reduces perceived effort and increases plasma lactate concentration without improving performance.

    Science.gov (United States)

    Lopes-Silva, Joao P; Felippe, Leandro J C; Silva-Cavalcante, Marcos D; Bertuzzi, Romulo; Lima-Silva, Adriano E

    2014-07-22

    The objective of this study was to examine the effect of caffeine on judo performance, perceived exertion, and plasma lactate response when ingested during recovery from a 5-day weight loss period. Six judokas performed two cycles of a 5-day rapid weight loss procedure to reduce their body weight by ~5%. After weigh-in, subjects re-fed and rehydrated over a 4-h recovery period. In the third hour of this "loading period", subjects ingested a capsule containing either caffeine (6 mg·kg-1) or placebo. One hour later, participants performed three bouts of a judo fitness test with 5-min recovery periods. Perceived exertion and plasma lactate were measured before and immediately after each test bout. Body weight was reduced in both caffeine and placebo conditions after the weight loss period (-3.9% ± 1.6% and -4.0% ± 2.3% from control, respectively, p caffeine or placebo groups. However, plasma lactate was systemically higher and perceived exertion lower in the subjects who ingested caffeine compared to either the control or placebo subjects (p caffeine did not improve performance during the judo fitness test after a 5-day weight loss period, but reduced perceived exertion and increased plasma lactate.

  5. A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food.

    Science.gov (United States)

    Abubakar, I; Irvine, L; Aldus, C F; Wyatt, G M; Fordham, R; Schelenz, S; Shepstone, L; Howe, A; Peck, M; Hunter, P R

    2007-09-01

    To determine the diagnostic accuracy of tests for the rapid diagnosis of bacterial food poisoning in clinical and public health practice and to estimate the cost-effectiveness of these assays in a hypothetical population in order to inform policy on the use of these tests. Studies evaluating diagnostic accuracy of rapid tests were retrieved using electronic databases and handsearching reference lists and key journals. Hospital laboratories and test manufacturers were contacted for cost data, and clinicians involved in the care of patients with food poisoning were invited to discuss the conclusions of this review using the nominal group technique. A systematic review of the current medical literature on assays used for the rapid diagnosis of bacterial food poisoning was carried out. Specific organisms under review were Salmonella, Campylobacter, Escherichia coli O157, Staphylococcus aureus, Clostridium perfringens and Bacillus cereus. Data extraction was undertaken using standardised data extraction forms. Where a sufficient number of studies evaluating comparable tests were identified, meta-analysis was performed. A decision analytic model was developed, using effectiveness data from the review and cost data from hospitals and manufacturers, which contributed to an assessment of the cost-effectiveness of rapid tests in a hypothetical UK population. Finally, diagnostic accuracy and cost-effectiveness results were presented to a focus group of GPs, microbiologists and consultants in communicable disease control, to assess professional opinion on the use of rapid tests in the diagnosis of food poisoning. Good test performance levels were observed with rapid test methods, especially for polymerase chain reaction (PCR) assays. The estimated levels of diagnostic accuracy using the area under the curve of the summary receiver operating characteristic curve was very high. Indeed, although traditional culture is the natural reference test to use for comparative statistical

  6. 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.

  7. Application of improved Vogel’s approximation method in minimization of rice distribution costs of Perum BULOG

    Science.gov (United States)

    Nahar, J.; Rusyaman, E.; Putri, S. D. V. E.

    2018-03-01

    This research was conducted at Perum BULOG Sub-Divre Medan which is the implementing institution of Raskin program for several regencies and cities in North Sumatera. Raskin is a program of distributing rice to the poor. In order to minimize rice distribution costs then rice should be allocated optimally. The method used in this study consists of the Improved Vogel Approximation Method (IVAM) to analyse the initial feasible solution, and Modified Distribution (MODI) to test the optimum solution. This study aims to determine whether the IVAM method can provide savings or cost efficiency of rice distribution. From the calculation with IVAM obtained the optimum cost is lower than the company's calculation of Rp945.241.715,5 while the cost of the company's calculation of Rp958.073.750,40. Thus, the use of IVAM can save rice distribution costs of Rp12.832.034,9.

  8. Measuring Values Of Environmental Quality Improvement And Leisure Time Through Combining Contingent Valuation and Travel Cost Data

    OpenAIRE

    Young Sook Eom; Douglas M. Larson

    2004-01-01

    This paper demonstrates a utility-theoretic empirical framework for estimating values of environmental quality improvement by combining travel cost and contingent valuation data in a two-constraint (time and money) budget framework. Recgninzing the role of time "prices" and time budget, the recreation demand and willingness to pay (WTP) functiuons are specified with full price and full budget arguments, with the opportunity cost of time being a fraction of wage rate. When applied to the case ...

  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. Y-12 product improvements expected to reduce metal production costs and decrease fabrication losses

    International Nuclear Information System (INIS)

    Parker, Elaine; Hassler, Morris

    2004-01-01

    Full text: The Y-12 National Security Complex supplies uranium metal and uranium oxide feed material that is then fabricated into fuel for research reactors around the world. Over the past two to three years, Y-12 has learned a great deal about its Low Enriched Uranium (LEU) product. The LEU is produced by taking U.S. surplus Highly Enriched Uranium (HEU) and blending it with depleted or natural uranium. The surplus HEU comes from dismantled U.S. weapons parts that have been declared as surplus. Those research reactors that use LEU from Y-12 are making important contributions to international nuclear non-proliferation by using LEU rather than HEU, and by helping to disposition former weapons material. We clearly understand that our customers want to keep fuel costs as low as possible. We at Y-12 are making every effort to improve efficiencies in producing the uranium through standardizing the chemical specifications as well as the product mass and dimensional qualities. This paper will discuss the new standard specification that we have proposed to existing LEU metal customers and fuel fabricators. It will also cover Y-12's progress on a new mold-design that will result in a more uniform, higher quality product that is less expensive to produce. This new product is expected to decrease overall fabrication losses by 5-10%, depending on the fabricator's process. The paper will include planned activities and the schedule associated with implementation of the new specification and product form. (author)

  11. The effect of plant reliability improvement in the cost of generating electricity

    International Nuclear Information System (INIS)

    Nejat, S.; Sanders, R.C.; Tsoulfanidis, N.

    1982-01-01

    The objective of this investigation is to study the economic benefits in operating a nuclear power plant, as a result of improving the availability of the secondary (steam) loop of the plant. A new method has been developed to obtain availability, frequency of failure, probability and frequency of operation, cycle time, and uptime for different capacity states of a parallel series system having components with failure and repair rates distributed exponentially in time. The method has been applied to different subsystems, systems, and the secondary loop of a plant as a whole. The effect of having spare parts for several components, as measured by savings in the generation of electricity, is also studied. The Kettelle algorithm was applied to determine optimal allocation of spare parts to achieve maximum availability or minimum cost of electricity, subject to a fixed spare parts budget. The savings per year for optimal spare parts allocation and different spare parts budgets were obtained. The results show that the utility will save its customers a large amount of money if spare parts are purchased, especially at the beginning of the plant operation, and are allocated judiciously

  12. 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.

  13. 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

  14. 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.

  15. 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

  16. Rapid road repair vehicle

    Science.gov (United States)

    Mara, Leo M.

    1998-01-01

    Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find an the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was was heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past.

  17. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study.

    Science.gov (United States)

    Lokkerbol, Joran; Adema, Dirk; Cuijpers, Pim; Reynolds, Charles F; Schulz, Richard; Weehuizen, Rifka; Smit, Filip

    2014-03-01

    Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI). In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant. For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

    Science.gov (United States)

    Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

    2016-09-01

    Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with

  19. A low cost, safe, disposable, rapid and self-sustainable paper-based platform for diagnostic testing: lab-on-paper

    International Nuclear Information System (INIS)

    Costa, M N; Veigas, B; Jacob, J M; Santos, D S; Martins, R; Fortunato, E; Gomes, J; Inácio, J; Baptista, P V

    2014-01-01

    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

  20. 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

  1. Rapid tryptophan depletion improves decision-making cognition in healthy humans without affecting reversal learning or set shifting.

    Science.gov (United States)

    Talbot, Peter S; Watson, David R; Barrett, Suzanne L; Cooper, Stephen J

    2006-07-01

    Rapid tryptophan (Trp) depletion (RTD) has been reported to cause deterioration in the quality of decision making and impaired reversal learning, while leaving attentional set shifting relatively unimpaired. These findings have been attributed to a more powerful neuromodulatory effect of reduced 5-HT on ventral prefrontal cortex (PFC) than on dorsolateral PFC. In view of the limited number of reports, the aim of this study was to independently replicate these findings using the same test paradigms. Healthy human subjects without a personal or family history of affective disorder were assessed using a computerized decision making/gambling task and the CANTAB ID/ED attentional set-shifting task under Trp-depleted (n=17; nine males and eight females) or control (n=15; seven males and eight females) conditions, in a double-blind, randomized, parallel-group design. There was no significant effect of RTD on set shifting, reversal learning, risk taking, impulsivity, or subjective mood. However, RTD significantly altered decision making such that depleted subjects chose the more likely of two possible outcomes significantly more often than controls. This is in direct contrast to the previous report that subjects chose the more likely outcome significantly less often following RTD. In the terminology of that report, our result may be interpreted as improvement in the quality of decision making following RTD. This contrast between studies highlights the variability in the cognitive effects of RTD between apparently similar groups of healthy subjects, and suggests the need for future RTD studies to control for a range of personality, family history, and genetic factors that may be associated with 5-HT function.

  2. Technical note: Rapid image-based field methods improve the quantification of termite mound structures and greenhouse-gas fluxes

    Directory of Open Access Journals (Sweden)

    P. A. Nauer

    2018-06-01

    Full Text Available Termite mounds (TMs mediate biogeochemical processes with global relevance, such as turnover of the important greenhouse gas methane (CH4. However, the complex internal and external morphology of TMs impede an accurate quantitative description. Here we present two novel field methods, photogrammetry (PG and cross-sectional image analysis, to quantify TM external and internal mound structure of 29 TMs of three termite species. Photogrammetry was used to measure epigeal volume (VE, surface area (AE and mound basal area (AB by reconstructing 3-D models from digital photographs, and compared against a water-displacement method and the conventional approach of approximating TMs by simple geometric shapes. To describe TM internal structure, we introduce TM macro- and micro-porosity (θM and θμ, the volume fractions of macroscopic chambers, and microscopic pores in the wall material, respectively. Macro-porosity was estimated using image analysis of single TM cross sections, and compared against full X-ray computer tomography (CT scans of 17 TMs. For these TMs we present complete pore fractions to assess species-specific differences in internal structure. The PG method yielded VE nearly identical to a water-displacement method, while approximation of TMs by simple geometric shapes led to errors of 4–200 %. Likewise, using PG substantially improved the accuracy of CH4 emission estimates by 10–50 %. Comprehensive CT scanning revealed that investigated TMs have species-specific ranges of θM and θμ, but similar total porosity. Image analysis of single TM cross sections produced good estimates of θM for species with thick walls and evenly distributed chambers. The new image-based methods allow rapid and accurate quantitative characterisation of TMs to answer ecological, physiological and biogeochemical questions. The PG method should be applied when measuring greenhouse-gas emissions from TMs to avoid large errors from inadequate shape

  3. Caffeine Ingestion after Rapid Weight Loss in Judo Athletes Reduces Perceived Effort and Increases Plasma Lactate Concentration without Improving Performance

    Directory of Open Access Journals (Sweden)

    Joao P. Lopes-Silva

    2014-07-01

    Full Text Available The objective of this study was to examine the effect of caffeine on judo performance, perceived exertion, and plasma lactate response when ingested during recovery from a 5-day weight loss period. Six judokas performed two cycles of a 5-day rapid weight loss procedure to reduce their body weight by ~5%. After weigh-in, subjects re-fed and rehydrated over a 4-h recovery period. In the third hour of this “loading period”, subjects ingested a capsule containing either caffeine (6 mg·kg−1 or placebo. One hour later, participants performed three bouts of a judo fitness test with 5-min recovery periods. Perceived exertion and plasma lactate were measured before and immediately after each test bout. Body weight was reduced in both caffeine and placebo conditions after the weight loss period (−3.9% ± 1.6% and −4.0% ± 2.3% from control, respectively, p < 0.05. At three hours after weigh-in, body weight had increased with both treatments but remained below the control (−3.0% ± 1.3% and −2.7% ± 2.2%. There were no significant differences in the number of throws between the control, caffeine or placebo groups. However, plasma lactate was systemically higher and perceived exertion lower in the subjects who ingested caffeine compared to either the control or placebo subjects (p < 0.05. In conclusion, caffeine did not improve performance during the judo fitness test after a 5-day weight loss period, but reduced perceived exertion and increased plasma lactate.

  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. 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.

  6. Costs and efficacy of management measures to improve udder health on Dutch dairy farms

    NARCIS (Netherlands)

    Huijps, K.; Hogeveen, H.; Lam, T.J.G.M.; Oude Lansink, A.G.J.M.

    2010-01-01

    Many different management measures are available to control mastitis, a very costly disease in the dairy sector. The objective of this paper was to evaluate the costs and efficacies of 18 of these management measures, for contagious and environmental pathogens, and their effect on bulk tank somatic

  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. 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....

  9. Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh.

    Science.gov (United States)

    Hayford, K; Uddin, M J; Koehlmoos, T P; Bishai, D M

    2014-04-25

    To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention. Cost data and stakeholder perspectives were collected January-February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs. The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable. Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results. Copyright © 2014. Published by Elsevier Ltd.

  10. 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.

  11. 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 cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

  12. Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis.

    Science.gov (United States)

    Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Sullivan, Patrick W

    2011-04-01

    In October 2008, Centers for Medicare and Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers (HAPUs), thus placing stress on hospitals to prevent incidence of this costly condition. To evaluate whether prevention methods are cost-effective compared with standard care in the management of HAPUs. A semi-Markov model simulated the admission of patients to an acute care hospital from the time of admission through 1 year using the societal perspective. The model simulated health states that could potentially lead to an HAPU through either the practice of "prevention" or "standard care." Univariate sensitivity analyses, threshold analyses, and Bayesian multivariate probabilistic sensitivity analysis using 10,000 Monte Carlo simulations were conducted. Cost per quality-adjusted life-years (QALYs) gained for the prevention of HAPUs. Prevention was cost saving and resulted in greater expected effectiveness compared with the standard care approach per hospitalization. The expected cost of prevention was $7276.35, and the expected effectiveness was 11.241 QALYs. The expected cost for standard care was $10,053.95, and the expected effectiveness was 9.342 QALYs. The multivariate probabilistic sensitivity analysis showed that prevention resulted in cost savings in 99.99% of the simulations. The threshold cost of prevention was $821.53 per day per person, whereas the cost of prevention was estimated to be $54.66 per day per person. This study suggests that it is more cost effective to pay for prevention of HAPUs compared with standard care. Continuous preventive care of HAPUs in acutely ill patients could potentially reduce incidence and prevalence, as well as lead to lower expenditures.

  13. Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana.

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    Full Text Available This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS in the identification of maternal complications in Ghana.A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out.Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC in the intervention health centres (before-intervention = 9 /1,000 ANC attendance; after-intervention = 12/1,000 ANC attendance; P-value = 0.010. In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention = 96/1,000 labour clients; P-value = 0.305. Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio decreased from US$17,017.58 (before-intervention to US$15,207.5 (after-intervention. Incremental cost -effectiveness ratio (ICER was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS, cost per pregnancy complication detected was US$285.Computer -assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth

  14. 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.

  15. Constraining Forest Certificate's Market to Improve Cost-Effectiveness of Biodiversity Conservation in São Paulo State, Brazil.

    Science.gov (United States)

    Bernasconi, Paula; Blumentrath, Stefan; Barton, David N; Rusch, Graciela M; Romeiro, Ademar R

    2016-01-01

    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.

  16. 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.

  17. Anchorage onto deciduous teeth: effectiveness of early rapid maxillary expansion in increasing dental arch dimension and improving anterior crowding

    OpenAIRE

    Mutinelli, Sabrina; Manfredi, Mario; Guiducci, Antonio; Denotti, Gloria; Cozzani, Mauro

    2015-01-01

    Background Anchorage onto permanent dentition is a common procedure in rapid maxillary expansion. However, replacing first permanent molars with the second deciduous molars seems to be an option to reduce some negative side effects during orthodontic treatment. The purpose of this study was to evaluate the dental effect of rapid maxillary expansion with anchorage exclusively onto deciduous teeth performed in the first period of transition. Methods Twenty patients with a lateral cross-bite tre...

  18. Dietary nitrate does not reduce oxygen cost of exercise or improve muscle mitochondrial function in patients with mitochondrial myopathy

    NARCIS (Netherlands)

    Nabben, M.; Schmitz, J.P.J.; Ciapaite, J.; le Clercq, C.M.P.; van Riel, N.A.; Haak, H.R.; Nicolay, K.; de Coo, I.F.M.; Smeets, H.; Praet, S.F.; van Loon, L.J.; Prompers, J.J.

    2017-01-01

    Muscle weakness and exercise intol erance 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

  19. Improving the quantum cost of reversible Boolean functions using reorder algorithm

    Science.gov (United States)

    Ahmed, Taghreed; Younes, Ahmed; Elsayed, Ashraf

    2018-05-01

    This paper introduces a novel algorithm to synthesize a low-cost reversible circuits for any Boolean function with n inputs represented as a Positive Polarity Reed-Muller expansion. The proposed algorithm applies a predefined rules to reorder the terms in the function to minimize the multi-calculation of common parts of the Boolean function to decrease the quantum cost of the reversible circuit. The paper achieves a decrease in the quantum cost and/or the circuit length, on average, when compared with relevant work in the literature.

  20. Integration of palliative care in the context of rapid response: a report from the Improving Palliative Care in the ICU advisory board.

    Science.gov (United States)

    Nelson, Judith E; Mathews, Kusum S; Weissman, David E; Brasel, Karen J; Campbell, Margaret; Curtis, J Randall; Frontera, Jennifer A; Gabriel, Michelle; Hays, Ross M; Mosenthal, Anne C; Mulkerin, Colleen; Puntillo, Kathleen A; Ray, Daniel E; Weiss, Stefanie P; Bassett, Rick; Boss, Renee D; Lustbader, Dana R

    2015-02-01

    Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.

  1. 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.

  2. 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.

  3. 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.

  4. Rapid MR imaging

    International Nuclear Information System (INIS)

    Edelman, R.R.; Buxton, R.B.; Brady, T.J.

    1988-01-01

    Conventional magnetic resonance (MR) imaging methods typically require several minutes to produce an image, but the periods of respiration, cardiac motion and peristalsis are on the order of seconds or less. The need to reduce motion artifact, as well as the need to reduce imaging time for patient comfort and efficiency, have provided a strong impetus for the development of rapid imaging methods. For abdominal imaging, motion artifacts due to respiration can be significantly reduced by collecting the entire image during one breath hold. For other applications, such as following the kinetics of administered contrast agents, rapid imaging is essential to achieve adequate time resolution. A shorter imaging time entails a cost in image signal/noise (S/N), but improvements in recent years in magnet homogeneity, gradient and radiofrequency coil design have led to steady improvements in S/N and consequently in image quality. For many chemical applications the available S/N is greater than needed, and a trade-off of lower S/N for a shorter imaging time is acceptable. In this chapter, the authors consider the underlying principles of rapid imaging as well as clinical applications of these methods. The bulk of this review concentrates on short TR imaging, but methods that provide for a more modest decrease in imaging time as well as or those that dramatically shorten the imaging time to tens of milliseconds are also discussed

  5. 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.

  6. One Improvement Method of Reducing Duration Directly to Solve Time-Cost Tradeoff Problem

    Science.gov (United States)

    Jian-xun, Qi; Dedong, Sun

    Time and cost are two of the most important factors for project plan and schedule management, and specially, time-cost tradeoff problem is one classical problem in project scheduling, which is also a difficult problem. Methods of solving the problem mainly contain method of network flow and method of mending the minimal cost. Thereinto, for the method of mending the minimal cost is intuitionistic, convenient and lesser computation, these advantages make the method being used widely in practice. But disadvantage of the method is that the result of each step is optimal but the terminal result maybe not optimal. In this paper, firstly, method of confirming the maximal effective quantity of reducing duration is designed; secondly, on the basis of above method and the method of mending the minimal cost, the main method of reducing duration directly is designed to solve time-cost tradeoff problem, and by analyzing validity of the method, the method could obtain more optimal result for the problem.

  7. 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.

  8. 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 forme pour l

  9. Benefits and costs of improved cookstoves: assessing the implications of variability in health, forest and climate impacts.

    Directory of Open Access Journals (Sweden)

    Marc A Jeuland

    Full Text Available Current attention to improved cook stoves (ICS focuses on the "triple benefits" they provide, in improved health and time savings for households, in preservation of forests and associated ecosystem services, and in reducing emissions that contribute to global climate change. Despite the purported economic benefits of such technologies, however, progress in achieving large-scale adoption and use has been remarkably slow. This paper uses Monte Carlo simulation analysis to evaluate the claim that households will always reap positive and large benefits from the use of such technologies. Our analysis allows for better understanding of the variability in economic costs and benefits of ICS use in developing countries, which depend on unknown combinations of numerous uncertain parameters. The model results suggest that the private net benefits of ICS will sometimes be negative, and in many instances highly so. Moreover, carbon financing and social subsidies may help enhance incentives to adopt, but will not always be appropriate. The costs and benefits of these technologies are most affected by their relative fuel costs, time and fuel use efficiencies, the incidence and cost-of-illness of acute respiratory illness, and the cost of household cooking time. Combining these results with the fact that households often find these technologies to be inconvenient or culturally inappropriate leads us to understand why uptake has been disappointing. Given the current attention to the scale up of ICS, this analysis is timely and important for highlighting some of the challenges for global efforts to promote ICS.

  10. 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.

  11. 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.

  12. Improved HYLIFE-II heat transport system and steam power plant: Impact on performance and cost of electricity

    International Nuclear Information System (INIS)

    Hoffman, M.A.; Lee, Ying T.

    1992-12-01

    The HYLIFE-II conceptual design has evolved and improved continually over the past four years to its present form. This paper describes the latest FY92 versions, Reference Case H1 (nominally 1 GWe net output) and the Enhanced Case HE (nominally 2 GWe net output), which take advantage of improvements in the tritium management system to eliminate the intermediate loop and the intermediate heat exchangers (IHX's). The improvements in the heat transport system and the steam power plant are described and the resulting cost reductions are evaluated. The new estimated cost of electricity (in 1990 dollars) is 6.6 cents/kWh for Reference Case H1 and 4.7 cents/kWh for the Enhanced Case

  13. Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation.

    Science.gov (United States)

    Turner-Stokes, Lynne; Poppleton, Rob; Williams, Heather; Schoewenaars, Katie; Badwan, Derar

    2012-01-01

    A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a "real-life" application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.

  14. Optimisation modelling to assess cost of dietary improvement in remote Aboriginal Australia.

    Directory of Open Access Journals (Sweden)

    Julie Brimblecombe

    Full Text Available The cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations.We used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods.A twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet.Simultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B met all nutrient targets except sodium (146.2% and 148.9% of the respective target and saturated fat (12.0% and 11.7% of energy. Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (-90% and refined cereals (-90% and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals.This modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure.

  15. Optimisation modelling to assess cost of dietary improvement in remote Aboriginal Australia.

    Science.gov (United States)

    Brimblecombe, Julie; Ferguson, Megan; Liberato, Selma C; O'Dea, Kerin; Riley, Malcolm

    2013-01-01

    The cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations. We used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods. A twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet. Simultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B) met all nutrient targets except sodium (146.2% and 148.9% of the respective target) and saturated fat (12.0% and 11.7% of energy). Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day) and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (-90%) and refined cereals (-90%) and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals. This modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure.

  16. 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

    2015-07-01

    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

  17. Opportunities for cost reduction and improved environmental impact in the lead and lead/acid battery industries

    Science.gov (United States)

    Lewis, N.

    The opportunities for cost reduction through improved environmental performance exist in many companies, but often are not realized. This paper describes the efforts of a typical firm — Calder Industrial Materials (CIM) — that is experiencing ever-tighter environmental controls and profit erosion through the effects of new environmental legislation. At the same time, however, CIM sees opportunities to reduce its environmental burden and cut costs. As the story unfolds, readers may well discover many parallels with their own companies. It may even spur some into action, for remember, every £1000 saved requires ten times the turnover to generate the same profit.

  18. Multiplex pyrosequencing assay using AdvISER-MH-PYRO algorithm: a case for rapid and cost-effective genotyping analysis of prostate cancer risk-associated SNPs.

    Science.gov (United States)

    Ambroise, Jérôme; Butoescu, Valentina; Robert, Annie; Tombal, Bertrand; Gala, Jean-Luc

    2015-06-25

    Single Nucleotide Polymorphisms (SNPs) identified in Genome Wide Association Studies (GWAS) have generally moderate association with related complex diseases. Accordingly, Multilocus Genetic Risk Scores (MGRSs) have been computed in previous studies in order to assess the cumulative association of multiple SNPs. When several SNPs have to be genotyped for each patient, using successive uniplex pyrosequencing reactions increases analytical reagent expenses and Turnaround Time (TAT). While a set of several pyrosequencing primers could theoretically be used to analyze multiplex amplicons, this would generate overlapping primer-specific pyro-signals that are visually uninterpretable. In the current study, two multiplex assays were developed consisting of a quadruplex (n=4) and a quintuplex (n=5) polymerase chain reaction (PCR) each followed by multiplex pyrosequencing analysis. The aim was to reliably but rapidly genotype a set of prostate cancer-related SNPs (n=9). The nucleotide dispensation order was selected using SENATOR software. Multiplex pyro-signals were analyzed using the new AdvISER-MH-PYRO software based on a sparse representation of the signal. Using uniplex assays as gold standard, the concordance between multiplex and uniplex assays was assessed on DNA extracted from patient blood samples (n = 10). All genotypes (n=90) generated with the quadruplex and the quintuplex pyroquencing assays were perfectly (100 %) concordant with uniplex pyrosequencing. Using multiplex genotyping approach for analyzing a set of 90 patients allowed reducing TAT by approximately 75 % (i.e., from 2025 to 470 min) while reducing reagent consumption and cost by approximately 70 % (i.e., from ~229 US$ /patient to ~64 US$ /patient). This combination of quadruplex and quintuplex pyrosequencing and PCR assays enabled to reduce the amount of DNA required for multi-SNP analysis, and to lower the global TAT and costs of SNP genotyping while providing results as reliable as uniplex

  19. 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.

  20. Near Zero Energy House (NZEH) Design Optimization to Improve Life Cycle Cost Performance Using Genetic Algorithm

    Science.gov (United States)

    Latief, Y.; Berawi, M. A.; Koesalamwardi, A. B.; Supriadi, L. S. R.

    2018-03-01

    Near Zero Energy House (NZEH) is a housing building that provides energy efficiency by using renewable energy technologies and passive house design. Currently, the costs for NZEH are quite expensive due to the high costs of the equipment and materials for solar panel, insulation, fenestration and other renewable energy technology. Therefore, a study to obtain the optimum design of a NZEH is necessary. The aim of the optimum design is achieving an economical life cycle cost performance of the NZEH. One of the optimization methods that could be utilized is Genetic Algorithm. It provides the method to obtain the optimum design based on the combinations of NZEH variable designs. This paper discusses the study to identify the optimum design of a NZEH that provides an optimum life cycle cost performance using Genetic Algorithm. In this study, an experiment through extensive design simulations of a one-level house model was conducted. As a result, the study provide the optimum design from combinations of NZEH variable designs, which are building orientation, window to wall ratio, and glazing types that would maximize the energy generated by photovoltaic panel. Hence, the design would support an optimum life cycle cost performance of the house.

  1. A novel approach for rapidly and cost-effectively assessing toxicity of toxic metals in acidic water using an acidophilic iron-oxidizing biosensor.

    Science.gov (United States)

    Yang, Shih-Hung; Cheng, Kuo-Chih; Liao, Vivian Hsiu-Chuan

    2017-11-01

    Contamination by heavy metals and metalloids is a serious environmental and health concern. Acidic wastewaters are often associated with toxic metals which may enter and spread into agricultural soils. Several biological assays have been developed to detect toxic metals; however, most of them can only detect toxic metals in a neutral pH, not in an acidic environment. In this study, an acidophilic iron-oxidizing bacterium (IOB) Strain Y10 was isolated, characterized, and used to detect toxic metals toxicity in acidic water at pH 2.5. The colorimetric acidophilic IOB biosensor was based on the inhibition of the iron oxidizing ability of Strain Y10, an acidophilic iron-oxidizing bacterium, by metals toxicity. Our results showed that Strain Y10 is acidophilic iron-oxidizing bacterium. Thiobacillus caldus medium (TCM) (pH 2.5) supplied with both S 4 O 6 2- and glucose was the optimum growth medium for Strain Y10. The optimum temperature and pH for the growth of Strain Y10 was 45 °C and pH 2.5, respectively. Our study demonstrates that the color-based acidophilic IOB biosensor can be semi-quantitatively observed by eye or quantitatively measured by spectrometer to detect toxicity from multiple toxic metals at pH 2.5 within 45 min. Our study shows that monitoring toxic metals in acidic water is possible by using the acidophilic IOB biosensor. Our study thus provides a novel approach for rapid and cost-effective detection of toxic metals in acidic conditions that can otherwise compromise current methods of chemical analysis. This method also allows for increased efficiency when screening large numbers of environmental samples. Copyright © 2017 Elsevier Ltd. All rights reserved.

  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. Cost reduction improvement for power generation system integrating WECS using harmony search algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Ngonkham, S. [Khonkaen Univ., Amphur Muang (Thailand). Dept. of Electrical Engineering; Buasri, P. [Khonkaen Univ., Amphur Muang (Thailand). Embed System Research Group

    2009-03-11

    A harmony search (HS) algorithm was used to optimize economic dispatch (ED) in a wind energy conversion system (WECS) for power system integration. The HS algorithm was based on a stochastic random search method. System costs for the WECS system were estimated in relation to average wind speeds. The HS algorithm was implemented to optimize the ED with a simple programming procedure. The study showed that the initial parameters must be carefully selected to ensure the accuracy of the HS algorithm. The algorithm demonstrated that total costs of the WECS system were higher than costs associated with energy efficiency procedures that reduced the same amount of greenhouse gas (GHG) emissions. 7 refs,. 10 tabs., 16 figs.

  4. 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.

  5. 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

  6. 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...

  7. 76 FR 65769 - Airport Improvement Program: Modifications to Benefit Cost Analysis (BCA) Threshold

    Science.gov (United States)

    2011-10-24

    ... have risen faster than the general rate of inflation. Since we were unable to locate construction cost... enables us to best respond. B. Modifications to Policy The previous AIP grant policy, issued June 24, 1997... established a docket and invited airport sponsors and other interested parties to comment on the BCA...

  8. 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…

  9. 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...

  10. Improving the problem analysis in cost-benefit analysis for transport projects : An explorative study

    NARCIS (Netherlands)

    Annema, J.A.; Mouter, N.

    2013-01-01

    Key actors (consultants, scientists and policy makers) in the Netherlands transport policy cost-benefit analysis (CBA) practice consider ‘problem analysis’ to be one of the important CBA substantive problems. Their idea is that a good-quality problem analysis can help to identify proper solutions,

  11. 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

  12. Prospective Health: Duke's Approach to Improving Employee Health and Managing Health Care Costs

    Science.gov (United States)

    Davidson, H. Clint, Jr.

    2004-01-01

    If developing a healthy workforce is critical to reining in the skyrocketing cost of health care, then why have so many attempts at preventive health or disease management fallen short? How can employers connect with employees to engage them in changing unhealthy habits or lifestyles? Duke University has launched an innovative new approach called…

  13. 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.

  14. 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

  15. 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

  16. 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.

  17. Army Corps of Engineers: Cost Increases in Flood Control Projects and Improving Communication with Nonfederal Sponsors

    Science.gov (United States)

    2013-12-01

    such poor condition that it had to have major rehabilitation work performed. Work to fix the deteriorated tunnel cost $10 million more than had...originally been estimated.19 Corps officials on the Little Calumet project said during construction they encountered a former landfill along one portion

  18. An Efficiency Improved Active Power Decoupling Circuit with Minimized Implementation Cost

    DEFF Research Database (Denmark)

    Tang, Yi; Blaabjerg, Frede

    2014-01-01

    topology does not require additional passive component, e.g. inductors or film capacitors for ripple energy storage because this task can be accomplished by the dc-link capacitors themselves, and therefore its implementation cost can be minimized. Another unique feature of the proposed topology...

  19. 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

  20. 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…

  1. Thermal cooling using low-temperature waste heat. A cost-effective way for industrial companies to improve energy efficiency?

    Energy Technology Data Exchange (ETDEWEB)

    Schall, D.; Hirzel, S. [Fraunhofer Institute for Systems and Innovation Research ISI, Breslauer Strasse 48, 76139 Karlsruhe (Germany)

    2012-11-15

    As a typical cross-cutting technology, cooling and refrigeration equipment is used for a variety of industrial applications. While cooling is often provided by electric compression cooling systems, thermal cooling systems powered by low-temperature waste heat could improve energy efficiency and promise a technical saving potential corresponding to 0.5 % of the total electricity demand in the German industry. In this paper, we investigate the current and future cost-effectiveness of thermal cooling systems for industrial companies. Our focus is on single-stage, closed absorption and adsorption cooling systems with cooling powers between 40 and 100 kW, which use low-temperature waste heat at temperature levels between 70C and 85C. We analyse the current and future cost-effectiveness of these alternative cooling systems using annual cooling costs (annuities) and payback times. For a forecast until 2015, we apply the concept of experience curves, identifying learning rates of 14 % (absorption machines) and 17 % (adsorption machines) by an expert survey of the German market. The results indicate that thermal cooling systems are currently only cost-effective under optimistic assumptions (full-time operation, high electricity prices) when compared to electric compression cooling systems. Nevertheless, the cost and efficiency improvements expected for this still young technology mean that thermal cooling systems could be more cost-effective in the future. However, depending on future electricity prices, a high number of operating hours is still crucial to achieve payback times substantially below 4 years which are usually required for energy efficiency measures to be widely adopted in the industry.

  2. Rapid and cost-effective identification and antimicrobial susceptibility testing in patients with Gram-negative bacteremia directly from blood-culture fluid.

    Science.gov (United States)

    Sakarikou, Christina; Altieri, Anna; Bossa, Maria Cristina; Minelli, Silvia; Dolfa, Camilla; Piperno, Micol; Favalli, Cartesio

    2018-03-01

    Rapid pathogen identification (ID) and antimicrobial susceptibility testing (AST) in bacteremia cases or sepsis could improve patient prognosis. Thus, it is important to provide timely reports, which make it possible for clinicians to set up appropriate antibiotic therapy during the early stages of bloodstream infection (BSI). This study evaluates an in-house microbiological protocol for early ID as well as AST on Gram negative bacteria directly from positive monomicrobial and polymicrobial blood cultures (BCs). A total of 102 non-duplicated positive BCs from patients with Gram-negative bacteremia were tested. Both IDs and ASTs were performed from bacterial pellets extracted directly from BCs using our protocol, which was applied through the combined use of a MALDI-TOF MS and Vitek2 automated system. The results of our study showed a 100% agreement in bacterial ID and 98.25% categorical agreement in AST when compared to those obtained by routine conventional methods. We recorded only a 0.76% minor error (mE), 0.76% major error (ME) and a 0.20% very major error (VME). Moreover, the turnaround time (TAT) regarding the final AST report was significantly shortened (ΔTAT = 8-20 h, p patient management, by early and appropriate antimicrobial treatment and could potentially optimize antimicrobial stewardship programs. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Case-mix tool, costs and effectiveness in improving primary care mental health and substance abuse services.

    Science.gov (United States)

    Riihimäki, Kirsi; Heiska-Johansson, Ainomaija; Ketola, Eeva

    2018-02-01

    Despite its importance in improving care and developing services, high-quality data evaluating cost-effectiveness and services in different case-mix populations is scarce in primary care. The objective was to investigate the service use of those mental health and substance abuse patients, who use lots of services. Primary health care diagnosis-related groups (pDRG) is a tool to evaluate service provider system and improve efficiency, productivity and quality. We viewed all pDRG results available from the year 2015 concerning municipal mental health and substance abuse services. In primary care mental health and substance abuse services, the most common ICD-10-codes were depression and substance abuse. One-fifth of patients produced 57% of costs. Their medium of appointments was 16 per year versus 6 per year of all patients. Only 54% of their diagnoses were recorded in the electronic health records versus 75% of all patients. They made 5.7 different pDRG episodes, including 1.8 episodes of depression, per patient. The average episode cost for this patient group was 301€. pDRG makes health care production transparent also in mental health and substance abuse services. It is easy to identify patients, who use a lot of services and thus induce the majority of costs, and focus on their needs in managing and developing services.

  4. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    Science.gov (United States)

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Using fuzzy logic to improve the project time and cost estimation based on Project Evaluation and Review Technique (PERT

    Directory of Open Access Journals (Sweden)

    Farhad Habibi

    2018-09-01

    Full Text Available Among different factors, correct scheduling is one of the vital elements for project management success. There are several ways to schedule projects including the Critical Path Method (CPM and Program Evaluation and Review Technique (PERT. Due to problems in estimating dura-tions of activities, these methods cannot accurately and completely model actual projects. The use of fuzzy theory is a basic way to improve scheduling and deal with such problems. Fuzzy theory approximates project scheduling models to reality by taking into account uncertainties in decision parameters and expert experience and mental models. This paper provides a step-by-step approach for accurate estimation of time and cost of projects using the Project Evaluation and Review Technique (PERT and expert views as fuzzy numbers. The proposed method included several steps. In the first step, the necessary information for project time and cost is estimated using the Critical Path Method (CPM and the Project Evaluation and Review Technique (PERT. The second step considers the duration and cost of the project activities as the trapezoidal fuzzy numbers, and then, the time and cost of the project are recalculated. The duration and cost of activities are estimated using the questionnaires as well as weighing the expert opinions, averaging and defuzzification based on a step-by-step algorithm. The calculating procedures for evaluating these methods are applied in a real project; and the obtained results are explained.

  6. Drycon dry ash conveyor: dry bottom ash handling system with reduced operating costs and improved plant efficiency

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-07-01

    The Drycon dry bottom ash extraction system is designed to remove bottom ash beneath the furnace, cooling it without any need of water. Fresh air in countercurrent flow to the ash is used for the ash cooling. Data presented show how savings of time and costs can be achieved with this system and how a boiler efficiency can be increased using this technology. Considerable advantages in the reliability of operation with new improvements of the design are described. 7 figs.

  7. 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.

  8. 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.

  9. Rapid Detection of Human Immunodeficiency Virus Types 1 and 2 by Use of an Improved Piezoelectric Biosensor

    Science.gov (United States)

    Severns, Virginia; Branch, Darren W.; Edwards, Thayne L.; Larson, Richard S.

    2013-01-01

    Disasters can create situations in which blood donations can save lives. However, in emergency situations and when resources are depleted, on-site blood donations require the rapid and accurate detection of blood-borne pathogens, including human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2). Techniques such as PCR and antibody capture by an enzyme-linked immunosorbent assay (ELISA) for HIV-1 and HIV-2 are precise but time-consuming and require sophisticated equipment that is not compatible with emergency point-of-care requirements. We describe here a prototype biosensor based on piezoelectric materials functionalized with specific antibodies against HIV-1 and HIV-2. We show the rapid and accurate detection of HIV-1 and HIV-2 in both simple and complex solutions, including human serum, and in the presence of a cross-confounding virus. We report detection limits of 12 50% tissue culture infective doses (TCID50s) for HIV-1 and 87 TCID50s for HIV-2. The accuracy, precision of measurements, and operation of the prototype biosensor compared favorably to those for nucleic acid amplification. We conclude that the biosensor has significant promise as a successful point-of-care diagnostic device for use in emergency field applications requiring rapid and reliable testing for blood-borne pathogens. PMID:23515541

  10. 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

    .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 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...... 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...

  11. Reducing transport costs and improving sustainability simultaneously through horizontal logistics collaboration: a case study

    OpenAIRE

    Van Lier, Tom; Macharis, Cathy; Caris, An; Vrenken, Huub

    2010-01-01

    In this paper the potential of a more systematic bundling of the outbound freight flows out of three neighboring distribution centers (DCs) of the same company, each specialized in a specific product category and each using a separate planning system, is investigated. Most of the outbound flows are currently still transported by truck, so one way to simultaneously achieve lower transport costs and more sustainable logistics is through supply chain collaboration in outbound logistics. This pap...

  12. Improvement of the assessment of the external costs of severe nuclear accidents

    International Nuclear Information System (INIS)

    Markandya, A.; Dale, N.; Schneider, T.

    1998-12-01

    The first part of this document presents a bibliographic study on the accidents costs. The second part is devoted to an empirical study realized in Spain, concerning the risk assessment by experts. The third part proposes an approach in terms of hope of utility for the aversion calculation facing the major risks. The last part presents the probabilities transformations taking into account the human perception of the risk. (A.L.B.)

  13. Army Corps of Engineers: Actions Needed to Improve Cost Sharing for Dam Safety Repairs

    Science.gov (United States)

    2015-12-01

    agreements with the Corps, their history of being a sponsor, the financial impacts of cost sharing for dam safety repair projects, and the Corps...1240 (2007)) and Beaver Lake dam, AR (Pub. L. No. 102-377, 106 Stat. 1315, 1318 (1992), Pub. L. No. 102-580, § 209(f), 106 Stat. 4797, 4830 (1992...inaction in setting a clear policy for a provision under which sponsors face significant financial impacts has contributed to conditions under

  14. 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.

  15. Improving the Parametric Method of Cost Estimating Relationships of Naval Ships

    Science.gov (United States)

    2014-06-01

    tool since the total cost of the ship is broken down into smaller parts as defined by the WBS. The Navy currently uses the Expanded Ship Work Breakdown...Includes boilers , reactors, turbines, gears, shafting, propellers, steam piping, lube oil piping, and radiation 300 Electric Plant Includes ship...spaces, ladders, storerooms, laundry, and workshops 700 Armament Includes guns, missile launchers, ammunition handling and stowage, torpedo tubes , depth

  16. Accounting for health and health care: approaches to measuring the sources and costs of their improvement

    National Research Council Canada - National Science Library

    Panel to Advance a Research Program on the Design of National Health Accounts

    .... Accounting for Health and Health Care addresses both these issues. The government agencies responsible for measuring unit prices for medical services have taken steps in recent years that have greatly improved the accuracy of those measures. Nonetheless, this book has several recommendations aimed at further improving the price indices.

  17. A Kalman Filter Implementation for Precision Improvement in Low-Cost GPS Positioning of Tractors

    Science.gov (United States)

    Gomez-Gil, Jaime; Ruiz-Gonzalez, Ruben; Alonso-Garcia, Sergio; Gomez-Gil, Francisco Javier

    2013-01-01

    Low-cost GPS receivers provide geodetic positioning information using the NMEA protocol, usually with eight digits for latitude and nine digits for longitude. When these geodetic coordinates are converted into Cartesian coordinates, the positions fit in a quantization grid of some decimeters in size, the dimensions of which vary depending on the point of the terrestrial surface. The aim of this study is to reduce the quantization errors of some low-cost GPS receivers by using a Kalman filter. Kinematic tractor model equations were employed to particularize the filter, which was tuned by applying Monte Carlo techniques to eighteen straight trajectories, to select the covariance matrices that produced the lowest Root Mean Square Error in these trajectories. Filter performance was tested by using straight tractor paths, which were either simulated or real trajectories acquired by a GPS receiver. The results show that the filter can reduce the quantization error in distance by around 43%. Moreover, it reduces the standard deviation of the heading by 75%. Data suggest that the proposed filter can satisfactorily preprocess the low-cost GPS receiver data when used in an assistance guidance GPS system for tractors. It could also be useful to smooth tractor GPS trajectories that are sharpened when the tractor moves over rough terrain. PMID:24217355

  18. The German energy audit program for firms. A cost-effective way to improve energy efficiency?

    Energy Technology Data Exchange (ETDEWEB)

    Fleiter, T.; Eichhammer, W. [Fraunhofer Institute for Systems and Innovation Research ISI, Breslauer Str. 48, 76139, Karlsruhe (Germany); Gruber, E. [Institute for Resource Efficiency and Energy Strategies IREES GmbH, Schoenfeldstr. 8, 76131, Karlsruhe (Germany); Worrell, E. [Copernicus Institute of Sustainable Development, Utrecht University, Heidelberglaan 2, 3584, Utrecht (Netherlands)

    2012-11-15

    In 2008, a program was established in Germany to provide grants for energy audits in small- and medium-sized enterprises. It aims to overcome barriers to energy efficiency, like the lack of information or a lack of capacity, and is intended to increase the adoption of energy efficiency measures. We evaluate the program's impact in terms of energy savings, CO2 mitigation, and cost-effectiveness. We find that firms adopt 1.7-2.9 energy efficiency measures, which they would not have adopted without the program. Taking a firm's perspective, the program shows a net present value ranging from -0.4 to 6 euro/MWh saved, which very likely implies a net benefit. For the government, each ton of CO2 mitigated costs between 1.8 and 4.1 euro. Each euro of public expenditure on audit grants led to 17-33 euro of private investment. The cost-effectiveness of the program for firms and the low share of public expenditure underline its value for the German energy efficiency policy mix and suggest that it should be expanded in Germany. Further, the good experiences with the program in Germany should encourage countries which have not yet established an audit program to do so.

  19. A program for thai rubber tappers to improve the cost of occupational health and safety.

    Science.gov (United States)

    Arphorn, Sara; Chaonasuan, Porntip; Pruktharathikul, Vichai; Singhakajen, Vajira; Chaikittiporn, Chalermchai

    2010-01-01

    The purposes of this research were to determine the cost of occupational health and safety and work-related health problems, accidents, injuries and illnesses in rubber tappers by implementing a program in which rubber tappers were provided training on self-care in order to reduce and prevent work-related accidents, injuries and illnesses. Data on costs for healthcare, the prevention and the treatment of work-related accidents, injuries and illnesses were collected by interview using a questionnaire. The findings revealed that there was no relationship between what was spent on healthcare and the prevention of work-related accidents, injuries and illnesses and that spent on the treatment of work-related accidents, injuries and illnesses. The proportion of the injured subjects after the program implementation was significantly less than that before the program implementation (p<0.001). The level of pain after the program implementation was significantly less than that before the program implementation (p<0.05). The treatment costs incurred after the program implementation were significantly less than those incurred before the program implementation (p<0.001). It was demonstrated that this program raised the health awareness of rubber tappers. It strongly empowered the leadership in health promotion for the community.

  20. Waste Minimization Improvements Achieved Through Six Sigma Analysis Result In Significant Cost Savings

    International Nuclear Information System (INIS)

    Mousseau, Jeffrey D.; Jansen, John R.; Janke, David H.; Plowman, Catherine M.

    2003-01-01

    Improved waste minimization practices at the Department of Energy's (DOE) Idaho National Engineering and Environmental Laboratory (INEEL) are leading to a 15% reduction in the generation of hazardous and radioactive waste. Bechtel, BWXT Idaho, LLC (BBWI), the prime management and operations contractor at the INEEL, applied the Six Sigma improvement process to the INEEL Waste Minimization Program to review existing processes and define opportunities for improvement. Our Six Sigma analysis team: composed of an executive champion, process owner, a black belt and yellow belt, and technical and business team members used this statistical based process approach to analyze work processes and produced ten recommendations for improvement. Recommendations ranged from waste generator financial accountability for newly generated waste to enhanced employee recognition programs for waste minimization efforts. These improvements have now been implemented to reduce waste generation rates and are producing positive results

  1. 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.

  2. Efficacy of Corrected Rapid Turnover Protein Increment Index (CRII) for Early Detection of Improvement of Nutrition Status in Patients with Malnutrition

    OpenAIRE

    Suyama, Yohji; Adachi, Kyoichi; Notsu, Yoshitomo; Satoh, Emi; Nariai, Yukiko; Hashimoto, Yohko; Sumi, Asako; Kawaguchi, Mikiko; Ishimura, Norihisa

    2009-01-01

    Serum prealbumin level is useful for assessment of changes in nutritional status but it is markedly affected by the inflammation. In this study, we examined the efficacy of the corrected rapid turnover protein increment index (CRII) for prealbumin, which is calculated as [prealbumin level/C-reactive protein (CRP) level on the assessment day]/[prealbumin level/CRP level on the day of starting nutritional care], for prediction of improvement of nutritional status in patients with malnutrition. ...

  3. Quality Improvement Processes in Obesity Surgery Lead to Higher Quality and Value, Lower Costs.

    Science.gov (United States)

    Brousseau, Holli; Pohl, Dieter

    2017-03-01

    In the era of changes in the evaluation of medical services and performance, the Centers for Medicare and Medicaid Services (CMS) has determined that the key components are quality, value, and clinical practice improvement (MACRA). Weight Loss Surgery, also called Bariatric or Obesity Surgery, has been at the forefront of quality improvement and quality reporting through the Center of Excellence Program since 2005. As a result, weight loss surgery is now as safe as gallbladder surgery.1 Even within this culture of quality and safety, improvements are still possible, as described in this article. [Full article available at http://rimed.org/rimedicaljournal-2017-03.asp].

  4. 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.

  5. A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals.

    Science.gov (United States)

    van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A

    2016-10-01

    Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  6. Maize feedstocks with improved digestibility reduce the costs and environmental impacts of biomass pretreatment and saccharification

    NARCIS (Netherlands)

    Torres Salvador, A.F.; Slegers, Ellen; Noordam-Boot, C.M.M.; Dolstra, O.; Vlaswinkel, L.; Boxtel, van A.J.B.; Visser, R.G.F.; Trindade, L.M.

    2016-01-01

    Background - Despite the recognition that feedstock composition influences biomass conversion efficiency, limited information exists as to how bioenergy crops with reduced recalcitrance can improve the economics and sustainability of cellulosic fuel conversion platforms. We have compared the

  7. Low cost corrosion and oxidation resistant coatings for improved system reliability, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — In order to improve high-temperature oxidation and corrosion resistance of critical superalloy components in turbine engines innovative processing methods must be...

  8. Structural Changes in Stx1 Engineering Monoclonal Antibody Improves Its Functionality as Diagnostic Tool for a Rapid Latex Agglutination Test

    Directory of Open Access Journals (Sweden)

    Daniela Luz

    2018-02-01

    Full Text Available Stx1 toxin is one of the AB5 toxins of Shiga toxin-producing Escherichia coli (STEC responsible for foodborne intoxication during outbreaks. The single-chain variable fragment (scFv is the most common recombinant antibody format; it consists of both variable chains connected by a peptide linker with conserved specificity and affinity for antigen. The drawbacks of scFv production in bacteria are the heterologous expression, conformation and stability of the molecule, which could change the affinity for the antigen. In this work, we obtained a stable and functional scFv-Stx1 in bacteria, starting from IgG produced by hybridoma cells. After structural modifications, i.e., change in protein orientation, vector and linker, its solubility for expression in bacteria was increased as well as the affinity for its antigen, demonstrated by a scFv dissociation constant (KD of 2.26 × 10−7 M. Also, it was able to recognize purified Stx1 and cross-reacted with Stx2 toxin by ELISA (Enzyme-Linked Immunosorbent Assay, and detected 88% of Stx1-producing strains using a rapid latex agglutination test. Thus, the scFv fragment obtained in the present work is a bacteria-produced tool for use in a rapid diagnosis test, providing an alternative for STEC diagnosis.

  9. An improved out-cell to in-cell rapid transfer system at the HFEF/South

    International Nuclear Information System (INIS)

    Bacca, J.P.; Sherman, E.K.

    1991-01-01

    This paper reports on Argonne National Laboratory's Fuel Cycle Facility (FCF) (formerly named Hot Fuel Examination Facility-South) (HFEF/South) which is currently being refurbished and upgraded in preparation for demonstrating remote, fast reactor metal-fuel reprocessing and refabrication, as part of the Integral Fast Reactor (IFR) Program. Among the FCF hot-cell system upgrades being provided is a newly fabricated, direct, out-of-cell to in-cell, small-item transfer system for the FCF argon cell. This system will enable the rapid transfer of selected small items from the hot cell exterior into the argon cell (argon-gas atmosphere) of the facility, without necessitating the use of formerly employed, very time-consuming, and quite laborious procedures. The new system will be especially valuable for the rapid insertion of IFR fuel processing makeup materials and small tools into the argon cell, and for use in argon cell and overall FCF radioactive contamination-control activities

  10. 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.

  11. 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.

  12. Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.

    Science.gov (United States)

    McGrath, Susan P; Blike, George T

    2015-10-01

    A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants' feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

  13. A Novel Training Program for Police Officers that Improves Interactions with Mentally Ill Individuals and is Cost-Effective

    Science.gov (United States)

    Krameddine, Yasmeen I.; DeMarco, David; Hassel, Robert; Silverstone, Peter H.

    2013-01-01

    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 toward 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 behaviors (n = 142) as well as in indirect measurements of behavior 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 1-day training course significantly changed behavior 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. PMID

  14. Material flow cost accounting as a tool for improved resource efficiency in the hotel sector: A case of emerging market

    Directory of Open Access Journals (Sweden)

    Celani John Nyide

    2016-12-01

    Full Text Available Material Flow Cost Accounting (MFCA is one of the Environmental Management Accounting (EMA tools that has been developed to enable environmentally and economically efficient material usage and thus improve resource efficiency. However, the use of this tool to improve resource efficiency in the South African hotel sector remains unknown. An exploratory study, qualitative in nature, was conducted using a single case study with embedded units approach. A Hotel Management Group that met the selection criteria formed part of this study. In-depth interviews were conducted with 10 participants and additional documents were analysed. The investigated hotels have developed technologies that provide an environmental account in both physical and monetary units which constitute the use of MFCA to improve resource efficiencies. However, the study established a number of factors that affect the implementation of MFCA by the hotel sector in a South African context

  15. Formosa Plastics Corporation: Plant-Wide Assessment of Texas Plant Identifies Opportunities for Improving Process Efficiency and Reducing Energy Costs

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-01-01

    At Formosa Plastics Corporation's plant in Point Comfort, Texas, a plant-wide assessment team analyzed process energy requirements, reviewed new technologies for applicability, and found ways to improve the plant's energy efficiency. The assessment team identified the energy requirements of each process and compared actual energy consumption with theoretical process requirements. The team estimated that total annual energy savings would be about 115,000 MBtu for natural gas and nearly 14 million kWh for electricity if the plant makes several improvements, which include upgrading the gas compressor impeller, improving the vent blower system, and recovering steam condensate for reuse. Total annual cost savings could be $1.5 million. The U.S. Department of Energy's Industrial Technologies Program cosponsored this assessment.

  16. Atrial overexpression of angiotensin-converting enzyme 2 improves the canine rapid atrial pacing-induced structural and electrical remodeling. Fan, ACE2 improves atrial substrate remodeling.

    Science.gov (United States)

    Fan, Jinqi; Zou, Lili; Cui, Kun; Woo, Kamsang; Du, Huaan; Chen, Shaojie; Ling, Zhiyu; Zhang, Quanjun; Zhang, Bo; Lan, Xianbin; Su, Li; Zrenner, Bernhard; Yin, Yuehui

    2015-01-01

    The purpose of this study was to investigate whether atrial overexpression of angiotensin-converting enzyme 2 (ACE2) by homogeneous transmural atrial gene transfer can reverse atrial remodeling and its mechanisms in a canine atrial-pacing model. Twenty-eight mongrel dogs were randomly divided into four groups: Sham-operated, AF-control, gene therapy with adenovirus-enhanced green fluorescent protein (Ad-EGFP) and gene therapy with Ad-ACE2 (Ad-ACE2) (n = 7 per subgroup). AF was induced in all dogs except the Sham-operated group by rapid atrial pacing at 450 beats/min for 2 weeks. Ad-EGFP and Ad-ACE2 group then received epicardial gene painting. Three weeks after gene transfer, all animals except the Sham group underwent rapid atrial pacing for another 3 weeks and then invasive electrophysiological, histological and molecular studies. The Ad-ACE2 group showed an increased ACE2 and Angiotensin-(1-7) expression, and decreased Angiotensin II expression in comparison with Ad-EGFP and AF-control group. ACE2 overexpression attenuated rapid atrial pacing-induced increase in activated extracellular signal-regulated kinases and mitogen-activated protein kinases (MAPKs) levels, and decrease in MAPK phosphatase 1(MKP-1) level, resulting in attenuation of atrial fibrosis collagen protein markers and transforming growth factor-β1. Additionally, ACE2 overexpression also modulated the tachypacing-induced up-regulation of connexin 40, down-regulation of connexin 43 and Kv4.2, and significantly decreased the inducibility and duration of AF. ACE2 overexpression could shift the renin-angiotensin system balance towards the protective axis, attenuate cardiac fibrosis remodeling associated with up-regulation of MKP-1 and reduction of MAPKs activities, modulate tachypacing-induced ion channels and connexin remodeling, and subsequently reduce the inducibility and duration of AF.

  17. An empirical study of costs and advantages of improved corporate environmental management performance

    DEFF Research Database (Denmark)

    Ulhøi, John Parm

    2000-01-01

    Achieving a less unsustainable development or improving the overall quality of life requires the support of the business community at large. In response to this recognition, industry has undertaken various initiatives, such as new integrated environmental management systems, social...... 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...

  18. Simple, low-cost ways to dramatically improve the security of tags and seals

    International Nuclear Information System (INIS)

    Johnston, R.G.; Garcia, A.R.E.

    1999-01-01

    The Vulnerability Assessment Team at Los Alamos National Laboratory has analyzed over 100 different tags and security seals (tamper-indicating devices). We have demonstrated how all these security products can be defeated quickly, easily, and inexpensively using low-tech methods. In our view, most of these security devices can be significantly improved with minor changes in their design and/or in how they are used. In this paper, we present some generic suggestions for improving the security and reliability of tags and seals. (author)

  19. 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

  20. Low polymer hydraulic fracturing applications in Reconcavo basin wells can reduce cost and improve conductivity

    International Nuclear Information System (INIS)

    Suzart, Joao Walter Pereira; Araujo, Paulo Fernando de

    2000-01-01

    Gels used for hydraulic-fracturing treatments generally contain high concentrations of polymer. The polymer helps the fracturing fluid achieve the level of viscosity necessary for transporting proppant through the rock matrix. However, high-polymer gels leave greater amounts of residue in the formation and can therefore cause formation damage. This paper describes how low polymer (L P) gels can be used for hydraulic-fracturing operations to reduce job costs and increase conductivity by reducing formation damage while maintaining the characteristics of a high-polymer gel. The L P fluid system has a low p H and contains an appropriate breaker concentration. Operators have achieved positive results with this system, which allows them to measure robust gel breaks and reduces the necessity for well cleaning. Consequently, formation damage can be significantly reduced. (author)

  1. AREVA: Operating performance shows distinct improvement; Results heavily impacted by the cost of remedial measures

    International Nuclear Information System (INIS)

    2016-01-01

    The 2015 results illustrate the progress AREVA made in 2015 and open up favorable prospects for 2016 and the following years in view of its fundamentals. The group's competitiveness plan had a very positive impact on its costs and cash, despite the heavy net loss situation which continues and in a market environment that remained difficult in 2015. Half of this loss of 2 billion Euro is due to additional provisions for OL3 and half to provisions for restructuring and impairment related to market conditions. Concerning the group's liquidity, 2016 is funded and the capital increase which will be launched in the coming months will enable AREVA to gradually regain the group's positive profile. A new phase awaits the Group in 2016 with clarity and confidence in the implementation of the restructuring announced in 2015 and in particular the autonomy of AREVA NP and the creation of New AREVA

  2. 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 e