Davila, D G; Parikh, N; Frelich, M J; Goldblatt, M I
Over 300,000 ventral hernia repairs (VHRs) are performed each year in the US. We sought to assess the economic burden related to ventral hernia recurrences with a focused comparison of those with the initial open versus laparoscopic surgery. The Premier Alliance database from 2009 to 2014 was utilized to obtain patient demographics and comorbid indices, including the Charlson comorbidity index (CCI). Total hospital cost and resource expenses during index laparoscopic and open VHRs and subsequent recurrent repairs were also obtained. The sample was separated into laparoscopic and open repair groups from the initial operation. Adjusted and propensity score matched cost outcome data were then compared amongst groups. One thousand and seventy-seven patients were used for the analysis with a recurrence rate of 3.78 %. For the combined sample, costs were significantly higher during recurrent hernia repair hospitalization ($21,726 versus $19,484, p cost and department level costs were similar during the index and the recurrent visit. The costs and resource utilization did not go up due to recurrence, even though these patients had greater severity during the recurrent visit (CCI score 0.92 versus 1.06; p = 0.0092). Using a matched sample, the total hospital recurrence cost was higher for the initial open group compared to laparoscopic group ($14,520 versus $12,649; p = 0.0454). Based on our analysis, need for recurrent VHR adds substantially to total hospital costs and resource utilization. Following initial laparoscopic repair, however, the total cost of recurrent repair is not significantly increased, as it is following initial open repair. When comparing the initial laparoscopic repair versus open, the cost of recurrence was higher for the prior open repair group.
Jul 3, 2006 ... 1Department of Medicinal Chemistry and Quality Control, National Institute for Pharmaceutical Research and Development, Abuja,. Nigeria. ... A rapid and cost effective method for the analysis of metronidazole in biological samples was ... effective HPLC method of assaying metronidazole both in.
Marchal, P.; Horwood, J.
of fishing effort towards the agreed long-term target, a decrease in short-term yields, and an increase in long-term yields. When the weight attached to (iii) is non-zero, the optimization of the cost function provides a non-oscillatory, convergent, and near-linear control. When the weight attached to (iii......This study proposes a dynamic control of fisheries by fishing effort, calculated so as to optimize a novel cost function, over a long period of management, based upon an example of the exploitation of the Celtic Sea cod. This cost function is a flexible weighed compromise between: (i) minimizing...... the variability in fishing effort; (ii) minimizing the variability in yields; (iii) achieving an agreed fishing effort target; and (iv) achieving an agreed yield target. Increasing the weight on the criteria (ii) and (iii), and decreasing the weight on the criteria (i) and (iv), results in a more rapid movement...
Larjavaara, Markku; Kanninen, Markku; Gordillo, Harold; Koskinen, Joni; Kukkonen, Markus; Käyhkö, Niina; Larson, Anne M.; Wunder, Sven
Slowing the reduction, or increasing the accumulation, of organic carbon stored in biomass and soils has been suggested as a potentially rapid and cost-effective method to reduce the rate of atmospheric carbon increase1. The costs of mitigating climate change by increasing ecosystem carbon relative to the baseline or business-as-usual scenario has been quantified in numerous studies, but results have been contradictory, as both methodological issues and substance differences cause variability2. Here we show, based on 77 standardized face-to-face interviews of local experts with the best possible knowledge of local land-use economics and sociopolitical context in ten landscapes around the globe, that the estimated cost of increasing ecosystem carbon varied vastly and was perceived to be 16-27 times cheaper in two Indonesian landscapes dominated by peatlands compared with the average of the eight other landscapes. Hence, if reducing emissions from deforestation and forest degradation (REDD+) and other land-use mitigation efforts are to be distributed evenly across forested countries, for example, for the sake of international equity, their overall effectiveness would be dramatically lower than for a cost-minimizing distribution.
Underwood, B. Shane; Guido, Zack; Gudipudi, Padmini; Feinberg, Yarden
Roadway design aims to maximize functionality, safety, and longevity. The materials used for construction, however, are often selected on the assumption of a stationary climate. Anthropogenic climate change may therefore result in rapid infrastructure failure and, consequently, increased maintenance costs, particularly for paved roads where temperature is a key determinant for material selection. Here, we examine the economic costs of projected temperature changes on asphalt roads across the contiguous United States using an ensemble of 19 global climate models forced with RCP 4.5 and 8.5 scenarios. Over the past 20 years, stationary assumptions have resulted in incorrect material selection for 35% of 799 observed locations. With warming temperatures, maintaining the standard practice for material selection is estimated to add approximately US$13.6, US$19.0 and US$21.8 billion to pavement costs by 2010, 2040 and 2070 under RCP4.5, respectively, increasing to US$14.5, US$26.3 and US$35.8 for RCP8.5. These costs will disproportionately affect local municipalities that have fewer resources to mitigate impacts. Failing to update engineering standards of practice in light of climate change therefore significantly threatens pavement infrastructure in the United States.
To sort out the best combinations of technologies for a crewed mission to Mars, NASA Headquarters awarded grants to MIT's Department of Aeronautics and Astronautics to develop an algorithm-based software tool that highlights the most reliable and cost-effective options. Utilizing the software, Professor Edward Crawley founded Cambridge, Massachussetts-based Ekotrope, which helps homebuilders choose cost- and energy-efficient floor plans and materials.
Peterson, Craig E.; Cutts, James; Balint, Tibor; Hall, James B.
This slide presentation reviews the development of a rapid cost assessment models for evaluation of exploration missions through the application of complexity based cost indices. In Fall of 2004, NASA began developing 13 documents, known as "strategic roadmaps," intended to outline a strategy for space exploration over the next 30 years. The Third Strategic Roadmap, The Strategic Roadmap for Solar System Exploration, focused on strategy for robotic exploration of the Solar System. Development of the Strategic Roadmap for Solar System Exploration led to the investigation of a large variety of missions. However, the necessity of planning around scientific inquiry and budgetary constraints made it necessary for the roadmap development team to evaluate potential missions not only for scientific return but also cost. Performing detailed cost studies for each of the large number of missions was impractical given the time constraints involved and lack of detailed mission studies; so a method of rapid cost assessment was developed by us to allow preliminary analysis. It has been noted that there is a strong correlation between complexity and cost and schedule of planetary missions. While these correlations were made after missions had been built and flown (successfully or otherwise), it seemed likely that a similar approach could provide at least some relative cost ranking. Cost estimation relationships (CERs) have been developed based on subsystem design choices. These CERs required more detailed information than available, forcing the team to adopt a more high level approach. Costing by analogy has been developed for small satellites, however, planetary exploration missions provide such varying spacecraft requirements that there is a lack of adequately comparable missions that can be used for analogy.
Petersburg, R. K.
The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.
DeMarco, Deborah M; Forster, Richard; Gakis, Thomas; Finberg, Robert W
Academic health centers are facing a potential reduction in Medicare financing for graduate medical education (GME). Both the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform (Deficit Commission) have suggested cutting approximately half the funding that teaching hospitals receive for indirect medical education. Because of the effort that goes into teaching trainees, who are only transient employees, hospital executives often see teaching programs as a drain on resources. In light of the possibility of a Medicare cut to GME programs, we undertook an analysis to assess the financial risk of training programs to our institution and the possibility of saving money by reducing resident positions. The chief administrative officer, in collaboration with the hospital chief financial officer, performed a financial analysis to examine the possibility of decreasing costs by reducing residency programs at the University of Massachusetts Memorial Medical Center. Despite the real costs of our training programs, the analysis demonstrated that GME programs have a positive impact on hospital finances. Reducing or eliminating GME programs would have a negative impact on our hospital's bottom line.
Increase in healthcare facilities and rapid environmental degradation: A technological paradox in. Nigeria's urban centres. Akinwale Coker1* and Mynepalli K. C. Sridhar2. 1Department of Civil Engineering, Faculty of Technology, University of Ibadan, Oyo State, Nigeria. 2Division of Environmental Health, Department of ...
Nykvist, Björn; Nilsson, Måns
To properly evaluate the prospects for commercially competitive battery electric vehicles (BEV) one must have accurate information on current and predicted cost of battery packs. The literature reveals that costs are coming down, but with large uncertainties on past, current and future costs of the dominating Li-ion technology. This paper presents an original systematic review, analysing over 80 different estimates reported 2007-2014 to systematically trace the costs of Li-ion battery packs for BEV manufacturers. We show that industry-wide cost estimates declined by approximately 14% annually between 2007 and 2014, from above US$1,000 per kWh to around US$410 per kWh, and that the cost of battery packs used by market-leading BEV manufacturers are even lower, at US$300 per kWh, and has declined by 8% annually. Learning rate, the cost reduction following a cumulative doubling of production, is found to be between 6 and 9%, in line with earlier studies on vehicle battery technology. We reveal that the costs of Li-ion battery packs continue to decline and that the costs among market leaders are much lower than previously reported. This has significant implications for the assumptions used when modelling future energy and transport systems and permits an optimistic outlook for BEVs contributing to low-carbon transport.
In unselected eczema patients subjected to routine patch testing, the number with positive reactions to Kathon CG 100 ppm increased from none in 1983 to 0.7% in January-August 1985, and to 4.6% in September 1985 to March 1986. Repeated open application tests (ROAT) with creams containing 7-15 ppm of the isothiazolinones were positive in 12 of 24 patients tested. 2 of the ROAT-positive cases had negative patch tests to 100 ppm Kathon CG, but 1 was positive with 200 ppm. Atopic dermatitis, chronic hand dermatitis and lower leg dermatitis were the most common disorders in the positive patients. The cause of the rapid increase of Kathon CG allergy in Finland during the winter of 1985-1986 was the use of a popular moisturizing cream containing first 19 ppm, then 7 ppm of a mixture of 2 isothiazolinones (Euxyl K 100).
Rolland, Estelle; Checchi, Francesco; Pinoges, Loretxu; Balkan, Suna; Guthmann, Jean-Paul; Guerin, Philippe J
To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if
Verstraeten, Willem W.; Neu, Jessica L.; Williams, Jason E.; Bowman, Kevin W.; Worden, John R.; Boersma, K. Folkert
Rapid population growth and industrialization have driven substantial increases in Asian ozone precursor emissions over the past decade, with highly uncertain impacts on regional and global tropospheric ozone levels. According to ozonesonde measurements, tropospheric ozone concentrations at two Asian sites have increased by 1 to 3% per year since 2000, an increase thought to contribute to positive trends in the ozone levels observed at North America’s West Coast. However, model estimates of the Asian contribution to North American ozone levels are not well-constrained by observations. Here we interpret Aura satellite measurements of tropospheric concentrations of ozone and its precursor NO2, along with its largest natural source, stratospheric ozone, using the TM5 global chemistry-transport model. We show that tropospheric ozone concentrations over China have increased by about 7% between 2005 and 2010 in response to two factors: a rise in Chinese emissions by about 21% and increased downward transport of stratospheric ozone. Furthermore, we find that transport from China of ozone and its precursors has offset about 43% of the 0.42 DU reduction in free-tropospheric ozone over the western United States that was expected between 2005 and 2010 as a result of emissions reductions associated with federal, state and local air quality policies. We conclude that global efforts may be required to address regional air quality and climate change.
E-learning now accounts for a substantial proportion of medical education provision. This progress has required significant investment and this investment has in turn come under increasing scrutiny so that the costs of e-learning may be controlled and its returns maximised. There are multiple methods by which the costs of e-learning can be controlled and its returns maximised. This short paper reviews some of those methods that are likely to be most effective and that are likely to save costs without compromising quality. Methods might include accessing free or low-cost resources from elsewhere; create short learning resources that will work on multiple devices; using open source platforms to host content; using in-house faculty to create content; sharing resources between institutions; and promoting resources to ensure high usage. Whatever methods are used to control costs or increase value, it is most important to evaluate the impact of these methods.
Toelch, U.; Bruce, M.J.; Meeus, M.T.H.; Reader, S.M.
Conformist social learning, the tendency to acquire the most common trait in a group, allows individuals to rapidly acquire established beneficial traits from a multitude of options. However, conformist strategies hinder acquisition of novel advantageous behavior patterns, because such innovations
Sevick, Laura K; Ghali, Sarah; Hill, Michael D; Danthurebandara, Vishva; Lorenzetti, Diane L; Noseworthy, Tom; Spackman, Eldon; Clement, Fiona
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.
Schackman, Bruce R; Metsch, Lisa R; Colfax, Grant N; Leff, Jared A; Wong, Angela; Scott, Callie A; Feaster, Daniel J; Gooden, Lauren; Matheson, Tim; Haynes, Louise F; Paltiel, A David; Walensky, Rochelle P
The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit. A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V
To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center. The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated. A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs. Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.
Haase, Frerk; Kouchaki, Alireza; Nymand, Morten
In this paper the design and development of a low cost rapid prototype platform for a Three Phase PFC rectifier application is presented. The active rectifier consists of a SiC-MOSFET based PWM converter and a low cost rapid prototype platform for simulating and implementing the digital control...... is then performed using automatic code generation for embedded targets, which provided a close link between simulation and implementation of the PFC controller. The paper shows how this rapid prototype platform developed and how it was used for the design and implementation of the controller for a high efficient Si...
Andò, Bruno; Baglio, Salvatore; Bulsara, Adi R.; Emery, Teresa; Marletta, Vincenzo; Pistorio, Antonio
Recently, there has been an upsurge in efforts dedicated to developing low-cost flexible electronics by exploiting innovative materials and direct printing technologies. This interest is motivated by the need for low-cost mass-production, shapeable, and disposable devices, and the rapid prototyping of electronics and sensors. This review, following a short overview of main printing processes, reports examples of the development of flexible transducers through low-cost inkjet printing technology. PMID:28368318
Rolland, E; Checchi, F; Pinoges, L.; Balkan, S; Guthmann, J P; Guerin, P. J.
OBJECTIVE: To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). METHODS: We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effect...
Andò, Bruno; Baglio, Salvatore; Bulsara, Adi R; Emery, Teresa; Marletta, Vincenzo; Pistorio, Antonio
Recently, there has been an upsurge in efforts dedicated to developing low-cost flexible electronics by exploiting innovative materials and direct printing technologies. This interest is motivated by the need for low-cost mass-production, shapeable, and disposable devices, and the rapid prototyping of electronics and sensors. This review, following a short overview of main printing processes, reports examples of the development of flexible transducers through low-cost inkjet printing technology.
Installation and utilization of residential distribution transformers has not changed substantially over a long period of time. Utilities typically size their transformers based on a formula that takes into account broadly what types and how many dwellings will be connected. Most new residential dwellings feature 200 Amp service per household with an anticipated energy demand of under 20,000 kWh per year. Average electrical energy consumption varies from state to state but averages to 11,280 kWh per year. Energy demand is expected to fall into a typical residential load curve that shows increased demand early in the morning, then decreasing during the day and another peak early to late evening. Distribution transformers are sized at the limit of the combined evening peak with the assumption that the transformer has enough thermal mass to absorb short overloads that may occur when concurrent loading situations among multiple dwellings arise. The assumption that concurrent loading is of short duration and the transformer can cool off during the night time has been validated over the years and has become standard practice. This has worked well when dwelling loads follow an averaging scheme and low level of coincidence. With the arrival of electric vehicles (EV's) this assumption has to be reevaluated. The acquisition of an electric vehicle in a household can drive up energy demand by over 4000 kWh per year. Potentially problematic is the increased capacity of battery packs and the resulting proliferation of Level 2 chargers. The additional load of a single Level 2 charger concurring with the combined evening peak load will push even conservatively sized distribution transformers over their nameplate rating for a substantial amount of time. Additionally, unlike common household appliances of similar power requirements such as ovens or water heaters, a Level 2 battery charger will run at peak power consumption for several hours, and the current drawn by the EVs has very
Cohen, Seth M; Kim, Jaewhan; Roy, Nelson; Courey, Mark
Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, controversy surrounds its timing. This study sought to determine how increased time from first primary care to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders. Retrospective analysis of a large, national administrative claims database was performed. Patients had an International Classification of Diseases, 9(th) Revision-coded diagnosis of a laryngeal/voice disorder; initially saw a primary care physician and, subsequently, an otolaryngologist as outpatients; and provided 6 months of follow-up data after the first otolaryngology evaluation. The outpatient health care costs accrued from the first primary care outpatient visit through the 6 months after the first otolaryngology outpatient visit were determined. There were 260,095 unique patients who saw a primary care physician as an outpatient for a laryngeal/voice disorder, with 8999 (3.5%) subsequently seeing an otolaryngologist and with 6 months postotolaryngology follow-up data. A generalized linear regression model revealed that, compared with patients who saw an otolaryngologist ≤1 month after the first primary care visit, patients in the >1-month and ≤3-months and >3-months time periods had relative mean cost increases of $271.34 (95% confidence interval $115.95-$426.73) and $711.38 (95% confidence interval $428.43-$993.34), respectively. Increased time from first primary care to first otolaryngology evaluation is associated with increased outpatient health care costs. Earlier otolaryngology examination may reduce health care expenditures in the evaluation and management of patients with laryngeal/voice disorders. Copyright © 2015 Elsevier Inc. All rights reserved.
O’Connor, Shawn M.; Xu, Henry Z.; Kuo, Arthur D.
Step-by-step variations occur during normal human walking, induced in part by imperfect sensorimotor control and naturally occurring random perturbations. These effects might increase energy expenditure during walking, because they differ from the nominal preferred gait, which is typically the most economical, and because of the cost of making active feedback adjustments to maintain gait stability. We tested this hypothesis by artificially inducing greater step variability through visual pert...
Lyly-Yrjänäinen, Jouni; Suomala, Petri; Israelsen, Poul
Component commonality (Labro 2004, Zhou & Gruppström 2004) can be defined as the use of the same version of a component across multiple products. It is usually seen as a means to manage costs without sacrificing product variety. However, when managing costs with component commonality, the managers...... should be able to identify rather rapidly which group of components would enable the most significant cost reductions. Unfortunately, the existing literature lacks profound discussion of how to identify the right components for increased component commonality. The objective of the paper is to discuss how...... constructions was identified as the most important bottleneck for the delivery process causing many indirect costs, especially with respect to project-management-related activities. Interestingly, by eliminating the need for mechanical engineering, the context starts to approach assembly-to-order context, also...
O'Connor, Shawn M; Xu, Henry Z; Kuo, Arthur D
Step-by-step variations occur during normal human walking, induced in part by imperfect sensorimotor control and naturally occurring random perturbations. These effects might increase energy expenditure during walking, because they differ from the nominal preferred gait, which is typically the most economical, and because of the cost of making active feedback adjustments to maintain gait stability. We tested this hypothesis by artificially inducing greater step variability through visual perturbations from a virtual reality display, and measuring the effect on energy expenditure. Young healthy adult subjects (N=11) walked on a treadmill while viewing a virtual hallway, to which virtual perturbations were applied in fore-aft or medio-lateral directions. The greatest effect on gait was achieved with medio-lateral visual perturbations, which resulted in a 65% increase in step width variability and a 5.9% increase (both Pstep width and (to a lesser degree) step length, and also induced slightly wider and (to a lesser degree) shorter mean steps. Each of these measures was found to correlate significantly with each other, regardless of perturbation direction and magnitude. They also correlated with metabolic rate (Pmeasure), despite explaining only a modest proportion of overall energetic variations (R(2)Step variability increases with some gait disorders and with increasing age. Our results suggest that imperfect sensorimotor control may contribute to the increased metabolic cost of walking observed with such conditions. Copyright © 2012 Elsevier B.V. All rights reserved.
Chan, Kamfai; Wong, Pui-Yan; Yu, Peter; Hardick, Justin; Wong, Kah-Yat; Wilson, Scott A; Wu, Tiffany; Hui, Zoe; Gaydos, Charlotte; Wong, Season S
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.
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.
Amruta V. Kulkarni
Full Text Available In this paper, power loss and cost models of power electronic converters based on converter ratings and datasheet information are presented. These models aid in creating rapid prototypes which facilitate the component selection process. Through rapid prototyping, users can estimate power loss and cost which are essential in design decisions. The proposed approach treats main power electronic components of a converter as building blocks that can be arranged to obtain multiple topologies to facilitate rapid prototyping. In order to get system-level power loss and cost models, two processes are implemented. The first process automatically provides minimum power loss or cost estimates and identifies components for specific applications and ratings; the second process estimates power losses and costs of each component of interest as well as the whole system. Two examples are used to illustrate the proposed approaches—boost and buck converters in continuous conduction mode. Achieved cost and loss estimates are over 93% accurate when compared to measured losses and real cost data. This research presents derivations of the proposed models, experimental validation of the models and demonstration of a user friendly interface that integrates all the models. Tools presented in this paper are expected to be very useful for practicing engineers, designers, and researchers, and are flexible and adaptable with changing or new technologies and varying component prices.
Bruce R Schackman
Full Text Available New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled-up prenatal testing to prevent mother-to-child HIV transmission in Haiti.A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance (rural standard of care, rapid plasma reagin test with results and treatment at 1-wk follow-up (urban standard of care, and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization-Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years (DALYs of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost-effectiveness ratios are in US dollars/DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost-effectiveness ratio of $6.83/DALY in rural settings and $9.95/DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow-up visits. Integrating rapid syphilis testing into a scaled-up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $525,000.In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost-effective. A similar approach may be beneficial in other resource
Schackman, Bruce R; Neukermans, Christopher P; Fontain, Sandy N Nerette; Nolte, Claudine; Joseph, Patrice; Pape, Jean W; Fitzgerald, Daniel W
New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant women using a rapid syphilis test as part of scaled-up prenatal testing to prevent mother-to-child HIV transmission in Haiti. A decision analytic model simulated health outcomes and costs separately for pregnant women in rural and urban areas. We compared syphilis syndromic surveillance (rural standard of care), rapid plasma reagin test with results and treatment at 1-wk follow-up (urban standard of care), and a new rapid test with immediate results and treatment. Test performance data were from a World Health Organization-Special Programme for Research and Training in Tropical Diseases field trial conducted at the GHESKIO Center Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince. Health outcomes were projected using historical data on prenatal syphilis treatment efficacy and included disability-adjusted life years (DALYs) of newborns, congenital syphilis cases, neonatal deaths, and stillbirths. Cost-effectiveness ratios are in US dollars/DALY from a societal perspective; annual costs are in US dollars from a payer perspective. Rapid testing with immediate treatment has a cost-effectiveness ratio of $6.83/DALY in rural settings and $9.95/DALY in urban settings. Results are sensitive to regional syphilis prevalence, rapid test sensitivity, and the return rate for follow-up visits. Integrating rapid syphilis testing into a scaled-up national HIV testing and prenatal care program would prevent 1,125 congenital syphilis cases and 1,223 stillbirths or neonatal deaths annually at a cost of $525,000. In Haiti, integrating a new rapid syphilis test into prenatal care and HIV testing would prevent congenital syphilis cases and stillbirths, and is cost-effective. A similar approach may be beneficial in other resource-poor countries
Full Text Available A centrifugal microfluidic platform to develop various microfluidic operations – the first of its kind in South Africa – is presented. Rapid and low-cost prototyping of centrifugal microfluidic disc devices, as well as a set-up to test the devices using centrifugal forces, is described. Preliminary results show that various microfluidic operations such as fluidic valving, transportation, and microfluidic droplet generation can be achieved. This work provides a complete centrifugal microfluidic platform and the building blocks on which to develop a variety of microfluidic applications and potential products rapidly and at a low cost.
Bolhuis, P. A.; Zwart, R.; Bär, P. R.; de Visser, M.; van der Helm, H. J.
After ischemic exercise tests, performed to detect glycogenoses or myoadenylate deaminase (EC 22.214.171.124) deficiency, the increases in serum lactate and ammonia usually are measured. Determination of hypoxanthine instead of ammonia can also be used to show myoadenylate deaminase deficiency, but HPLC of
Wu, Yan; Yu, Hongbo; Shen, Bo; Yu, Rongjun; Zhou, Zhiheng; Zhang, Guoping; Jiang, Yushi; Zhou, Xiaolin
Humans are willing to punish norm violations even at a substantial personal cost. Using fMRI and a variant of the ultimatum game and functional magnetic resonance imaging, we investigated how the brain differentially responds to fairness in loss and gain domains. Participants (responders) received offers from anonymous partners indicating a division of an amount of monetary gain or loss. If they accept, both get their shares according to the division; if they reject, both get nothing or lose the entire stake. We used a computational model to derive perceived fairness of offers and participant-specific inequity aversion. Behaviorally, participants were more likely to reject unfair offers in the loss (vs gain) domain. Neurally, the positive correlation between fairness and activation in ventral striatum was reduced, whereas the negative correlations between fairness and activations in dorsolateral prefrontal cortex were enhanced in the loss domain. Moreover, rejection-related dorsal striatum activation was higher in the loss domain. Furthermore, the gain-loss domain modulates costly punishment only when unfair behavior was directed toward the participants and not when it was directed toward others. These findings provide neural and computational accounts of increased costly norm enforcement under adversity and advanced our understanding of the context-dependent nature of fairness preference. © The Author (2014). Published by Oxford University Press. For Permissions, please email: firstname.lastname@example.org.
Alas, Alexandriah; Sajadi, Kamran P; Goldman, Howard B; Anger, Jennifer T
We assessed the availability and quality of urinary incontinence and pelvic organ prolapse information in social medias and the growth of such information in the past 13 months. We focused on the most popular social medias (Facebook, Twitter, and YouTube) to evaluate the key words "urogynecology," "pelvic organ prolapse," "stress incontinence," "urge incontinence," and "incontinence." Initial evaluation included top 30 search results for key word "incontinence" to compare with our study in 2010, followed by a secondary search using the top 100 items. Results were classified as useful or not useful and then further categorized by health care providers, others, commercial, or humorous in intent. Results with the intent of providing information were presumed to be informative. Comparative search over a 13-month period showed a stable amount of useful information, 40% to 39%, but an increase in the number of health professionals (22% vs 13%). However, of the 817 search results, 406 (50%) were medically useful. Only 28% were written by health professionals, but of the informative results, 56% were written by health professionals. Finally, specific search terms provided the highest relevant and useful information, but also limited the number of search items found. Over 13 months, there was an increase in useful information presented from health professionals. These changes may reflect the medical community's growing awareness of the usefulness of social media. If these trends continue, we predict the use of these medias for medical purposes will continue to increase among medical professionals.
Jehle, Charles Christopher; Nazir, Niaman; Bhavsar, Dhaval
The use of cannabis is currently increasing according to U.S. Department of Health and Human Services (HHS). Surprisingly, cannabis use among burn patients is poorly reported in literature. In this study, rates of cannabis use in burn patients are compared with general population. Data from the National Burn Repository (NBR) were used to investigate incidence, demographics, and outcomes in relation to use of cannabis as evidenced by urine drug screen (UDS). Thousands of patients from the NBR from 2002 to 2011 were included in this retrospective study. Inclusion criteria were patients older than 12 years of age who received a drug screen. Data points analyzed were patients' age, sex, UDS status, mechanism of burn injury, total body surface area, length of stay, ICU days, and insurance characteristics. Incidence of cannabis use in burn patients from the NBR was compared against national general population rates (gathered by Health and Human Services) using chi-square tests. Additionally, the burn patient population was analyzed using bivariate analysis and t-tests to find differences in the characteristics of these patients as well as differences in outcomes. Seventeen thousand eighty out of over 112,000 patients from NBR had information available for UDS. The incidence of cannabis use is increasing among the general population, but the rate is increasing more quickly among patients in the burn patient population (P = .0022). In 2002, 6.0% of patients in burn units had cannabis+ UDS, which was comparable with national incidence of 6.2%. By 2011, 27.0% of burn patients tested cannabis+ while national incidence of cannabis use was 7.0%. Patients who test cannabis+ are generally men (80.1%, P 60% of injuries, followed by scalds that are >15%. In comparing cannabis+/- patients, cannabis+ patients are more likely to be uninsured (25.2% vs 17.26%, P burns (TBSA% of 12.94 vs 10.98, P burn units is growing quickly. These patients are younger and are less likely to be insured
Lee, Ashley; Rakoczy, John; Heather, Daniel; Sanders, Devon
Over the past few years interest in the development and use of small satellites has rapidly gained momentum with universities, commercial, and government organizations. In a few years we may see networked clusters of dozens or even hundreds of small, cheap, easily replaceable satellites working together in place of the large, expensive and difficult-to-replace satellites now in orbit. Standards based satellite buses and deployment mechanisms, such as the CubeSat and Poly Pico-satellite Orbital Deployer (P-POD), have stimulated growth in this area. The use of small satellites is also proving to be a cost effective capability in many areas traditionally dominated by large satellites, though many challenges remain. Currently many of these small satellites undergo very little testing prior to flight. As these small satellites move from technology demonstration and student projects toward more complex operational assets, it is expected that the standards for verification and validation will increase.
Carsten Riis Olesen
Full Text Available In 1962 and 1965, 27 (13 and 14 muskox yearlings were translocated from East Greenland (71°N to the Angujaartorfiup Nunaa range in West Greenland (67°N. Angujaartorfiup Nunaa is a 6600 km2 icefree, continental area where caribou are indigenous. The climate is strictly continental with a minimum of precipitation but with abundant vegetation. Aerial surveys in 1990 documented that the muskox population has increased to 2600 heads despite quota-based harvesting since 1988. The annual quota was 200, 300 and 400 for 1988, 1989 and 1990, respectively. Distribution of muskoxen shows a significant preference for low altitude habitats southeast of Kangerlussuaq Airport and around Arnangarnup Qoorua (Paradise valley. Annual population increment averages 30% and the calf crop is around 24% of the population. Yearling recruitment in the population reveals that calf mortality during winter is very limited. About half of the 1-year-old females are served and they eventually give birth to their first calf when they turn 2 years old. With half of the 2-year-old females reproducing, the calf/cow ration ranges between 0.9 and 1.0.
Dowdy, D. W.; van't Hoog, A.; Shah, M.; Cobelens, F.
Drug susceptibility testing (DST) against second-line tuberculosis drugs (SLDs) is essential for improving outcomes among multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) cases. To evaluate the potential cost-effectiveness of rapid DST for SLDs. We constructed a
Yuen, Po Ki; Goral, Vasiliy N.
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…
Aspects of LHC construction. The CERN Council, where the representatives of the 20 Member States of the Organization decide on scientific programmes and financial resources, held its 120th session on 14 December under the chairmanship of Prof. Maurice Bourquin (CH). CERN adjusts to the LHC Director-General, Luciano Maiani, stressed that CERN was now fully engaged in the LHC and outlined the first moves to react to the increased cost to completion of the LHC. The new accelerator is an extremely complex, high-tech project which CERN is building under very severe conditions. However, the technical challenges are solved and industrial production of accelerator elements, and installation are starting. Professor Maiani said that 2001 had been a very hard but decisive year for CERN. An important milestone had been passed during this meeting with the approval of the LHC dipole magnets contract, the last major contract for the accelerator. The new costs to completion of the LHC project are now clear. A first propos...
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
Joseph, Jacob R; Smith, Brandon W; Williamson, Craig A; Park, Paul
Nontraumatic subdural hematoma (NTSDH) is a common neurosurgical disease process, with mortality reported as high as 13%. Seizure has a known association with NTSDH, although patient outcomes have not previously been well studied in this population. The purpose of this study was to examine the relationship between in-hospital seizure and inpatient outcomes in NTSDH. Using the University HealthSystem Consortium (UHC) database, we performed a retrospective cohort study of adults with a principal diagnosis of NTSDH (International Classification of Diseases, Ninth Revision code 43.21) between 2011 and 2015. Patients with in-hospital seizure (International Classification of Diseases, Ninth Revision codes 34500-34591, 78033, 78039) were compared with those without. Patients with a history of seizure before arrival were excluded. Patient demographics, hospital length of stay (LOS), intensive care unit stay, in-hospital mortality, and direct costs were recorded. A total 16,928 patients with NTSDH were identified. Mean age was 69.2 years, and 64.7% were male. In-hospital seizure was documented in 744 (4.40%) patients. Hospital LOS was 17.64 days in patients with seizure and 6.26 days in those without (P stay increased from 3.36 days without seizure to 9.36 days with seizure. In-hospital mortality was 9.19% in patients without seizure and 16.13% in those with seizure (P < 0.0001). Direct costs were $12,781 in patients without seizure and $38,110 in those with seizure (P < 0.0001). Seizure in patients with NTSDH correlates with significantly increased total LOS and increased mortality. Direct costs are similarly increased. Further studies accounting for effects of illness severity are necessary to validate these results. Copyright © 2016 Elsevier Inc. All rights reserved.
Jansen, Mieke; Stoks, Robby; Coors, Anja; van Doorslaer, Wendy; de Meester, Luc
Although natural populations may evolve resistance to anthropogenic stressors such as pollutants, this evolved resistance may carry costs. Using an experimental evolution approach, we exposed different Daphnia magna populations in outdoor containers to the carbamate pesticide carbaryl and control conditions, and assessed the resulting populations for both their resistance to carbaryl as well as their susceptibility to infection by the widespread bacterial microparasite Pasteuria ramosa. Our results show that carbaryl selection led to rapid evolution of carbaryl resistance with seemingly no cost when assessed in a benign environment. However, carbaryl-resistant populations were more susceptible to parasite infection than control populations. Exposure to both stressors reveals a synergistic effect on sterilization rate by P. ramosa, but this synergism did not evolve under pesticide selection. Assessing costs of rapid adaptive evolution to anthropogenic stress in a semi-natural context may be crucial to avoid too optimistic predictions for the fitness of the evolving populations. © 2011 The Author(s).
Heather M Bolton
Full Text Available We investigated the impact of temporary food restriction on a set shifting task requiring participants to judge clusters of pictures against a frequently changing rule. 60 healthy female participants underwent two testing sessions: once after fasting for 16 hours and once in a satiated state. Participants also completed a battery of questionnaires (Hospital Anxiety and Depression Scale [HADS]; Persistence, Perseveration and Perfectionism Questionnaire [PPPQ-22]; and Eating Disorders Examination Questionnaire [EDE-Q6]. Set shifting costs were significantly increased after fasting; this effect was independent of self-reported mood and perseveration. Furthermore, higher levels of weight concern predicted a general performance decrement under conditions of fasting. We conclude that relatively short periods of fasting can lead to set shifting impairments. This finding may have relevance to studies of development, individual differences, and the interpretation of psychometric tests. It also could have implications for understanding the etiology and maintenance of eating disorders, in which impaired set shifting has been implicated.
Peterson, Craig; Cutts, James; Balint, Tibor; Hall, James B.
In 2005, the Solar System Exploration Strategic Roadmap Conmrittee (chartered by NASA to develop the roadmap for Solar System Exploration Missions for the coming decades) found itself posed with the difficult problem of sorting through several mission concepts and determining their relative costs. While detailed mission studies are the normal approach to costing, neither the budget nor schedule allotted to the conmrittee could support such studies. Members of the Jet Propulsion Laboratory (JPL) supporting the conmrittee were given the challenge of developing a semi-quantitative approach that could provide the relative costs of these missions, without requiring an in depth study of the missions. In response to this challenge, a rapid cost assessment methodology based on a set of mission cost/complexity indexes was developed. This methodology also underwent two separate validations, one comparing its results when applied to historical missions, and another comparing its estimates against those of veteran space mission managers. Remarkably good agreement was achieved, suggesting that this approach provides an effective early indication of space mission costs.
Rakoczy, John; Heater, Daniel; Lee, Ashley
Marshall Space Flight Center's (MSFC) Small Projects Rapid Integration and Test Environment (SPRITE) is a Hardware-In-The-Loop (HWIL) facility that provides rapid development, integration, and testing capabilities for small projects (CubeSats, payloads, spacecraft, and launch vehicles). This facility environment focuses on efficient processes and modular design to support rapid prototyping, integration, testing and verification of small projects at an affordable cost, especially compared to larger type HWIL facilities. SPRITE (Figure 1) consists of a "core" capability or "plant" simulation platform utilizing a graphical programming environment capable of being rapidly re-configured for any potential test article's space environments, as well as a standard set of interfaces (i.e. Mil-Std 1553, Serial, Analog, Digital, etc.). SPRITE also allows this level of interface testing of components and subsystems very early in a program, thereby reducing program risk.
Musca, Gavril; Mihalache, Andrei; Tabacaru, Lucian
The advantage of the technological assisted design consists in easy modification of the machining technologies for obtaining machine alternation, tool changing, working parameters variation or the modification of loads to which the tools are subjected. By determining tool movement inside machining and by using tool related moving speeds needed for both positioning and manufacturing we are able to compute the required machining time for each component of the machining operation in progress. The present study describes a cost optimization model for machining operations which uses the following components: machine and its operator related cost, set-up and adjustment, unproductive costs (idle state), direct and indirect costs. By using manufacturing technologies assisted design procedures we may obtain various variants for the technological model by modifying the machining strategy, tooling, working regimes or the machine-tool that are used. Simulating those variants allows us to compare and establish the optimal manufacturing variant as well as the most productive one.
Construction cost inflation is affecting many state highway agencies including the Texas Department of : Transportation While some of this increase can be attributed to factors such as soaring cost of energy, : reports of large variations in cost of ...
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.
Stephen D Shafran
Full Text Available Significant attention has been focused on the perceived increase in the cost of antiviral treatment for hepatitis C genotype 1 infection since the approval of the first direct-acting antiviral agents in 2011. Using Canadian list prices, the present analysis points out a paradox: while the cost per antiviral regimen is increasing, the cost per cure is decreasing, especially with interferon-free therapy. In a publicly funded health care system, the lowest cost per cure is a more valuable measure of value for public money than the cost per regimen.
Foxcroft, D R; Milne, R
The aim of this study is to clarify the potential benefits, disbenefits and costs of Orlistat for the treatment of obesity. The method was a search for relevant systematic reviews and randomized controlled trials, in Medline, Pre-Medline, Embase and the Cochrane Library, using Orlistat and its synonyms. Identified trials were appraised using a standard appraisal checklist and trial data were extracted for use in cost-effectiveness modelling. Three large multicentre, randomized placebo controlled trials were included in the rapid review. On average, Orlistat results in obese people losing an additional 3-4% of their initial body weight over diet alone during a 2 year period. There was no strong evidence that this short-term weight loss would have a longer-term impact on morbidity and mortality. The cost utility of Orlistat treatment was estimated at around 46,000 Pounds per Quality Adjusted Life Year gained (extreme values sensitivity analysis 14,000 Pounds to 132,000 Pounds). This rapid review raises some important questions about the potential value of Orlistat in the treatment of obesity. Further research is needed, not only to clarify the longer-term impact of Orlistat treatment, but also to uncover the longer-term impact on mortality and morbidity from short-term weight loss.
Soriano-Heras, Enrique; Blaya-Haro, Fernando; Molino, Carlos; de Agustín Del Burgo, José María
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.
Rosenberg, Michael I.; Hart, Philip R.; Athalye, Rahul A.; Zhang, Jian; Cohan, David F.
An important question for commercial energy code compliance is: “How much energy cost savings can better compliance achieve?” This question is in sharp contrast to prior efforts that used a checklist of code requirements, each of which was graded pass or fail. Percent compliance for any given building was simply the percent of individual requirements that passed. A field investigation method is being developed that goes beyond the binary approach to determine how much energy cost savings is not realized. Prototype building simulations were used to estimate the energy cost impact of varying levels of non-compliance for newly constructed office buildings in climate zone 4C. Field data collected from actual buildings on specific conditions relative to code requirements was then applied to the simulation results to find the potential lost energy savings for a single building or for a sample of buildings. This new methodology was tested on nine office buildings in climate zone 4C. The amount of additional energy cost savings they could have achieved had they complied fully with the 2012 International Energy Conservation Code is determined. This paper will present the results of the test, lessons learned, describe follow-on research that is needed to verify that the methodology is both accurate and practical, and discuss the benefits that might accrue if the method were widely adopted.
STEPHEN C. NEWBOLD; CHARLES GRIFFITHS; CHRIS MOORE; ANN WOLVERTON; ELIZABETH KOPITS
The "social cost of carbon" (SCC) is the present value of the stream of future damages from one additional unit of carbon emissions in a particular year. This paper develops a rapid assessment model for the SCC. The model includes the essential ingredients for calculating the SCC at the global scale and is designed to be transparent and easy to use and modify. Our goal is to provide a tool to help analysts and decision-makers quickly explore the implications of various modeling assumptions fo...
Schultz, Christopher J.; Carey, Lawrence D.; Schultz, Elise V.; Blakeslee, Richard J.; Goodman, Steven J.
Rapid increases in total lightning (also termed "lightning jumps") have been observed for many decades. Lightning jumps have been well correlated to severe and hazardous weather occurrence. The main focus of lightning jump work has been on the development of lightning algorithms to be used in real-time assessment of storm intensity. However, in these studies it is typically assumed that the updraft "increases" without direct measurements of the vertical motion, or specification of which updraft characteristic actually increases (e.g., average speed, maximum speed, or convective updraft volume). Therefore, an end-to-end physical and dynamical basis for coupling rapid increases in total flash rate to increases in updraft speed and volume must be understood in order to ultimately relate lightning occurrence to severe storm metrics. Herein, we use polarimetric, multi-Doppler, and lightning mapping array measurements to provide physical context as to why rapid increases in total lightning are closely tied to severe and hazardous weather.
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.
Ghaderinezhad, Fariba; Amin, Reza; Temirel, Mikail; Yenilmez, Bekir; Wentworth, Adam; Tasoglu, Savas
Paper-based micro analytical devices offer significant advantages compared to the conventional microfluidic chips including cost-effectiveness, ease of fabrication, and ease of use while preserving critical features including strong capillary action and biological compatibility. In this work, we demonstrate an inexpensive, rapid method for high-throughput fabrication of paper-based microfluidics by patterning hydrophobic barriers using a desktop pen plotter integrated with a custom-made, low-cost paper feeder. We tested various types of commercial permanent markers and compared their water-resistant capabilities for creating hydrophobic barriers. Additionally, we studied the performance of markers with different types of paper, plotting speeds, and pattern dimensions. To verify the effectiveness of the presented fabrication method, colorimetric analysis was performed on the results of a glucose assay.
Sewell, Bernadette; Rees, Eugene; Thomas, Ian; Ch'ng, Chin Lye; Isaac, Mike; Berry, Nidhika
A study was performed to assess the cost of a rapid molecular assay (PCR) for diagnosis of Clostridium difficile infection (CDI) and the impact of its routine use on patient length of stay (LOS) in comparison with cell culture cytotoxin neutralization assay (CCNA). From March 2011 to September 2011, Xpert(®) C. difficile (Cepheid, Sunnyvale, CA, USA) PCR was used on patients with suspicion of CDI in two acute care hospitals in Abertawe Bro Morgannwg University Health Board, Swansea, Wales, UK. Test results were used for patient management. LOS and time to reportable result were compared for negative and positive prospective patients tested by PCR and historic control patients tested by CCNA during March 2010 to September 2010. Tests were priced using micro-costing and a cost comparison analysis was undertaken. In total, 506 patients were included. Time to reportable result for PCR samples was 1.53 h compared to 46.54 h for CCNA negatives and 22.45 h for CCNA positives. Patients tested by CCNA stayed 4.88 days longer in hospital compared to PCR patients if they tested positive and 7.03 days if tests were negative. The mean reduction in LOS observed in our study has the potential to generate cost savings of up to £2,292.62 for every patient with suspected CDI, if samples were to be tested routinely with PCR instead of CCNA. A rapid molecular test for C. difficile in an acute hospital setting produced quick results that led to a decrease in LOS compared to historic CCNA control patients. This could result in considerable savings through reduced excess inpatient days.
Suárez-Rodríguez, Monserrat; Montero-Montoya, Regina D.; Macías Garcia, Constantino
Even in socially monogamous species, sexual conflict is one reason that often promotes differences in the roles of sexes during reproduction, which may lead to one sex making a disproportionate contribution, and thus incurring disproportionate costs, at particular moments of the breeding process. In Mexico City, a number of songbird species line their nests with fibers from discarded cigarette butts, which reduce ectoparasite load but are genotoxic. As male Passer domesticus make substantial ...
... 25 Indians 1 2010-04-01 2010-04-01 false What if the tribal redesign plan leads to increased costs? 20.208 Section 20.208 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES... leads to increased costs? The tribe must meet any increase in cost to the General Assistance program...
Wolfe, Marlene K; Dentz, Holly N; Achando, Beryl; Mureithi, MaryAnne; Wolfe, Tim; Null, Clair; Pickering, Amy J
Diarrhea is a leading cause of death among children under 5 years of age worldwide. Flies are important vectors of diarrheal pathogens in settings lacking networked sanitation services. There is no standardized method for measuring fly density in households; many methods are cumbersome and unvalidated. We adapted a rapid, low-cost fly enumeration technique previously developed for industrial settings, the Scudder fly grill, for field use in household settings. We evaluated its performance in comparison to a sticky tape fly trapping method at latrine and food preparation areas among households in rural Kenya. The grill method was more sensitive; it detected the presence of any flies at 80% (433/543) of sampling locations versus 64% (348/543) of locations by the sticky tape. We found poor concordance between the two methods, suggesting that standardizing protocols is important for comparison of fly densities between studies. Fly species identification was feasible with both methods; however, the sticky tape trap allowed for more nuanced identification. Both methods detected a greater presence of bottle flies near latrines compared with food preparation areas (P < 0.01). The grill method detected more flies at the food preparation area compared with near the latrine (P = 0.014) while the sticky tape method detected no difference. We recommend the Scudder grill as a sensitive fly enumeration tool that is rapid and low cost to implement. © The American Society of Tropical Medicine and Hygiene.
Environmental impact can be difficult to assess, especially at the ecosystem level. Any impact assessment methodology that can give cost effective and timely results is highly desirable. Rapid bioassessment (RBA) is cost effective and produces timely results. Several types of RBA have been used at the Savannah River Site (SRS) to assess stream conditions, including the Index of Biotic Integrity (IBI) based on fish community characteristics, and various techniques using aquatic macroinvertebrate species diversity and abundance. In an attempt to broaden the applicability of the RBA concept, we have also begun to develop RBA techniques for seep-fed wetlands and terrestrial habitats. These techniques will focus on vertebrate and macroinvertebrate assemblages for seep-fed wetlands and arthropod assemblages for terrestrial habitats. In situ bioassay is another technique that could be used for rapid and economical assessment of the effects of anthropogenic disturbance. We propose the development of two methods of in situ bioassay that can address bioavailability of constituents of concern. The use of caged bioassay organisms can be applied to terrestrial systems such as capped or existing waste sites using the common house cricket. Another proposed bioassay could use a resident species, such as the imported red fire ant, which is found in disturbed habitats and open areas such as waste sites. Combining in situ techniques with RBA methodologies has the potential to provide a comprehensive assessment of chemical and physical impacts to a wide range of ecosystem types.
Chatburn, L. T.; Kirkup, B. C.; Polz, M. F.
Most culture-based microbiology tasks utilize a petri plate during processing, but rarely do the scientists capture the full information available from the plate. In particular, visual analysis of plates is an under-developed rich source of data that can be rapid and non-invasive. However, collecting this data has been limited by the difficulties of standardizing and quantifying human observations, by the limits of a scientists' fatigue, and by the cost of automating the process. The availability of specialized counting equipment and intelligent camera systems has not changed this - they are prohibitively expensive for many laboratories, only process a limited number of plate types, are often destructive to the sample, and have limited accuracy. This paper describes an automated visual inspection solution, VAPI, that employs inexpensive consumer computing hardware and digital cameras along with custom cross-platform open-source software written in C++, combining Trolltech's Qt GUI toolkit with Intel's OpenCV computer vision library. The system is more accurate than common commercial systems costing many times as much, while being flexible in use and offering comparable responsiveness. VAPI not only counts colonies but also sorts and enumerates colonies by morphology, tracks colony growth by time series analysis, and provides other analytical resources. Output to XML files or directly to a database provides data that can be easily maintained and manipulated by the end user, offering ready access for system enhancement, interaction with other software systems, and rapid development of advanced analysis applications.
Jenkins, David [EdgeBio
David Jenkins on "Ion Torrent semiconductor sequencing allows rapid, low-cost sequencing of the human exome" at the 2012 Sequencing, Finishing, Analysis in the Future Meeting held June 5-7, 2012 in Santa Fe, New Mexico.
Sun, Han; Liu, Zhengzhi; Hu, Chong; Ren, Kangning
Antimicrobial resistance (AMR) is a rapidly increasing threat to the effective treatment of infectious diseases worldwide. The two major remedies include: (1) using narrow-spectrum antibiotics based on rapid diagnosis; and (2) developing new antibiotics. A key part of both remedies is the antimicrobial susceptibility test (AST). However, the current standard ASTs that monitor colony formation are costly and time-consuming and the new strategies proposed are not yet practical to be implemented. Herein, we report a strategy to fabricate whole-hydrogel microfluidic chips using alginate-doped agar. This agar-based microfabrication makes it possible to prepare inexpensive hydrogel devices, and allows a seamless link between microfluidics and conventional agar-based cell culture. Different from common microfluidic systems, in our system the cells are cultured on top of the device, similar to normal agar plate culture; on the other hand, the microfluidic channels inside the hydrogel allow precise generation of linear gradient of drugs, thus giving a better performance than the conventional disk diffusion method. Cells in this system are not exposed to any shear flow, which allows the reliable tracking of individual cells and AST results to be obtained within 2-3 hours. Furthermore, our system could test the synergistic effect of drugs through two-dimensional gradient generation. Finally, the platform could be directly implemented to new drug discovery and other applications wherein a fast, cost-efficient method for studying the response of microorganisms upon drug administration is desirable.
Barthel, Erik R; Pierce, James R; Speer, Allison L; Levin, Daniel E; Goodhue, Catherine J; Ford, Henri R; Grikscheit, Tracy C; Upperman, Jeffrey S
Disasters occur randomly and can severely tax the health care delivery system of affected and surrounding regions. A significant proportion of disaster survivors are children, who have unique medical, psychosocial, and logistical needs after a mass casualty event. Children are often transported to specialty centers after disasters for a higher level of pediatric care, but this can also lead to separation of these survivors from their families. In a recent theoretical article, we showed that the availability of a pediatric trauma center after a mass casualty event would decrease the time needed to definitively treat the pediatric survivor cohort and decrease pediatric mortality. However, we also found that if the pediatric center was too slow in admitting and discharging patients, these benefits were at risk of being lost as children became "trapped" in the slow center. We hypothesized that this effect could result in further increased mortality and greater costs. Here, we expand on these ideas to test this hypothesis via mathematical simulation. We examine how a delay in discharge of part of the pediatric cohort is predicted to affect mortality and the cost of inpatient care in the setting of our model. We find that mortality would increase slightly (from 14.2%-16.1%), and the cost of inpatient care increases dramatically (by a factor of 21) if children are discharged at rates consistent with reported delays to reunification after a disaster from the literature. Our results argue for the ongoing improvement of identification technology and logistics for rapid reunification of pediatric survivors with their families after mass casualty events. Copyright © 2013 Elsevier Inc. All rights reserved.
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
Oliver, E.D.; Moll, A.J.
Not the least of the problems delaying the development and commercialization of synthetic fuel processes has been the extraordinary escalation of cost estimates by factors of up to ten in the past eight years. This study identifies and analyzes some of the most important contributing factors that have converged in the last few years. These factors include overoptimism and ill-defined project scope in the early stages, tightening environmental controls, difficulties in obtaining raw materials and fuels, general inflationary trends, ''hyperinflation'' of the costs of critical equipment, local labor shortages, and increased times required for procurement and construction. Cost increases have been particularly dramatic for ''offsites,'' liberally defined as nonprocess related parts of projects. Case histories of oil shale and tar sand developments are analyzed. Learning curves of costs during development and commercial use are studied. The analysis suggests that the worst of the extraordinary increases (above general inflationary trends) are probably over. Criteria to judge the state of development of processes are given, and some procedures to avoid future pitfalls are suggested.
Mosa, Kareem A.; El-Keblawy, Ali; Najar, Atyat
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
L.G.A. Bonneux (Luc); J.J.M. Barendregt (Jan); W.J. Nusselder (Wilma); P.J. van der Maas (Paul)
textabstractOBJECTIVES: To examine whether elimination of fatal diseases will increase healthcare costs. DESIGN: Mortality data from vital statistics combined with healthcare spending in a cause elimination life table. Costs were allocated to specific diseases through
Zhu, Hongying; Sencan, Ikbal; Wong, Justin; Dimitrov, Stoyan; Tseng, Derek; Nagashima, Keita; Ozcan, Aydogan
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.
Jiao, Xiaoqiang; Lyu, Yang; Wu, Xiaobin; Li, Haigang; Cheng, Lingyun; Zhang, Chaochun; Yuan, Lixing; Jiang, Rongfeng; Jiang, Baiwen; Rengel, Zed; Zhang, Fusuo; Davies, William J; Shen, Jianbo
Over the past five decades, Chinese grain production has increased 4-fold, from 110 Mt in 1961 to 557 Mt in 2014, with less than 9% of the world's arable land feeding 22% of the world's population, indicating a substantial contribution to global food security. However, compared with developed economies, such as the USA and the European Union, more than half of the increased crop production in China can be attributed to a rapid increase in the consumption of chemicals, particularly fertilizers. Excessive fertilization has caused low nutrient use efficiency and high environmental costs in grain production. We analysed the key requirements underpinning increased sustainability of crop production in China, as follows: (i) enhance nutrient use efficiency and reduce nutrient losses by fertilizing roots not soil to maximize root/rhizosphere efficiency with innovative root zone nutrient management; (ii) improve crop productivity and resource use efficiency by matching the best agronomic management practices with crop improvement; and (iii) promote technology transfer of the root zone nutrient management to achieve the target of high yields and high efficiency with low environmental risks on a broad scale. Coordinating grain production and environmental protection by increasing the sustainability of nutrient use will be a key step in achieving sustainable crop production in Chinese agriculture. © The Author 2016. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: email@example.com.
Liu, I-Chen; Chen, Pin-Chuan; Chau, Lai-Kwan; Chang, Guo-En
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.
Full Text Available Microfluidic devices are electrical/mechanical systems that offer the ability to work with minimal sample volumes, short reactions times, and have the possibility to perform massive parallel operations. An important application of microfluidics is blood rheology in microdevices, which has played a key role in recent developments of lab-on-chip devices for blood sampling and analysis. The most popular and traditional method to fabricate these types of devices is the polydimethylsiloxane (PDMS soft lithography technique, which requires molds, usually produced by photolithography. Although the research results are extremely encouraging, the high costs and time involved in the production of molds by photolithography is currently slowing down the development cycle of these types of devices. Here we present a simple, rapid, and low-cost nonlithographic technique to create microfluidic systems for biomedical applications. The results demonstrate the ability of the proposed method to perform cell free layer (CFL measurements and the formation of microbubbles in continuous blood flow.
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.
Aghion, E; Jan, L; Meshi, L; Goldman, J
Magnesium (Mg) and Mg-alloys are being considered as implantable biometals. Despite their excellent biocompatibility and good mechanical properties, their rapid corrosion is a major impediment precluding their widespread acceptance as implantable biomaterials. Here, we investigate the potential for rapid solidification to increase the corrosion resistance of Mg alloys. To this end, the effect of rapid solidification on the environmental and stress corrosion behavior of the AZ80 Mg alloy vs. its conventionally cast counterpart was evaluated in simulated physiological electrolytes. The microstructural characteristics were examined by optical microscopy, SEM, TEM, and X-ray diffraction analysis. The corrosion behavior was evaluated by immersion, salt spraying, and potentiodynamic polarization. Stress corrosion resistance was assessed by Slow Strain Rate Testing. The results indicate that the corrosion resistance of rapidly solidified ribbons is significantly improved relative to the conventional cast alloy due to the increased Al content dissolved in the α-Mg matrix and the correspondingly reduced presence of the β-phase (Mg17 Al12 ). Unfortunately, extrusion consolidated solidified ribbons exhibited a substantial reduction in the environmental performance and stress corrosion resistance. This was mainly attributed to the detrimental effect of the extrusion process, which enriched the iron impurities and increased the internal stresses by imposing a higher dislocation density. In terms of immersion tests, the average corrosion rate of the rapidly solidified ribbons was <0.4 mm/year compared with ∼2 mm/year for the conventionally cast alloy and 26 mm/year for the rapidly solidified extruded ribbons. © 2014 Wiley Periodicals, Inc.
Rasmussen, Susanne R; Thomsen, Janus Laust; Kilsmark, Janni
were given fixed appointments for health consultations. The follow-up period was six years. Analysis was carried out on the "intention to treat" principle. Outcome parameters were life years gained, and direct and total health costs (including productivity costs), discounted by 3% annually. Costs were......AIMS: The intention was to investigate whether preventive health checks and health discussions are cost effective. METHODS: In a randomized trial the authors compared two intervention groups (A and B) and one control group. In 1991 2,000 30- to 49-year-old persons were invited and those who...... based on register data. Univariate sensitivity analysis was carried out. RESULTS: Both intervention groups have significantly better life expectancy than the control group (no intervention). Group B and (A) significantly gain 0.14 (0.08) life years more than the control group. There were no differences...
Full Text Available We suggest that marketers actively participate in reducing unit costs during new product development, consistent with the theme of integrated marketing and manufacturing. Most marketing managers misjudge the impact on gross profit of reducing variable unit manufacturing costs, mistakenly believing that such cost reductions yield decreasing or linear returns while they actually generate increasing returns.
Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline
To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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.
Letitia-Maria Rof; Sorinel Capusneanu
This article highlights the increasing performances as result of implementation stages of the ActivityBased Costing in the companies operating in the energy sector in Romania. There are presented some aspects of the usefulness of applying the Activity-Based Costing in the energy sector and the advantages it offers compared to traditional costing. There are also outlined the steps for applying the Activity-Based Costing and its implementation in the largest hydropower producer in Romania. The ...
Anna V Glyakina
Full Text Available Here we present a systematic analysis of accessible surface areas and hydrogen bonds of 2554 globular proteins from four structural classes (all-α, all-β, α/β and α+β proteins that is aimed to learn in which structural class the accessible surface area increases with increasing protein molecular mass more rapidly than in other classes, and what structural peculiarities are responsible for this effect. The beta structural class of proteins was found to be the leader, with the following possible explanations of this fact. First, in beta structural proteins, the fraction of residues not included in the regular secondary structure is the largest, and second, the accessible surface area of packaged elements of the beta-structure increases more rapidly with increasing molecular mass in comparison with the alpha-structure. Moreover, in the beta structure, the probability of formation of backbone hydrogen bonds is higher than that in the alpha helix for all residues of α+β proteins (the average probability is 0.73±0.01 for the beta-structure and 0.60±0.01 for the alpha-structure without proline and α/β proteins, except for asparagine, aspartic acid, glycine, threonine, and serine (0.70±0.01 for the beta-structure and 0.60±0.01 for the alpha-structure without the proline residue. There is a linear relationship between the number of hydrogen bonds and the number of amino acid residues in the protein (Number of hydrogen bonds=0.678·number of residues-3.350.
Full Text Available In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR is low (9.1% in 2014, despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%.A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza.Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY, while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective.Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.
Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan
In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.
AJRH Managing Editor
This paper examines the rapid increase in Nigeria's sex ratio at birth from 1.03 boys born for every 1 girl born in each year from. 1996-2008 to 1.06 in each year from 2009-2014, second only to Tunisia in Africa at 1.07. The average sex ratio at birth in the world in 2014 was 1.07. In most Black African nations or Black majority ...
Hemmilä, Samu; Cauich-Rodríguez, Juan V.; Kreutzer, Joose; Kallio, Pasi
This paper describes rapid, simple, and cost-effective treatments for producing biocompatible and long-term hydrophilic polydimethylsiloxane (PDMS) surfaces identified in an experimental study investigating 39 treatments in all. The wetting of the surfaces was monitored during six months. Changes in surface morphology and chemical composition were also analyzed. Some of the treatments are presented here for the first time, while for earlier presented treatments the selection of investigated parameters was wider and the observation period for the surface wetting longer. The PDMS surfaces were modified by surface activation, physisorption, and synthesis of both “grafting to” and “grafting from” polymer brushes. In surface activation, the PDMS sample was exposed to oxygen plasma, with several combinations of exposure time and RF power. In the physisorption and synthesis of polymer brushes, three commercially available and biocompatible chemicals were used: 2-hydroxyethyl methacrylate (HEMA), polyethylene glycol (PEG), and polyvinylpyrrolidone (PVP). Thirty-three of the 39 treatments rendered the PDMS hydrophilic, and in 12 cases the hydrophilicity lasted at least six months. Seven of these long-term hydrophilic coatings supported a contact angle of 30° or less. Three of the long-lasting hydrophilic coatings required only minutes to prepare.
Chung, Angela I.; Cochran, Elizabeth S.; Kaiser, Anna E.; Christensen, Carl M.; Yildirim, Battalgazi; Lawrence, Jesse F.
Immediately following the Mw 7.2 Darfield, New Zealand, earthquake, over 180 Quake‐Catcher Network (QCN) low‐cost micro‐electro‐mechanical systems accelerometers were deployed in the Canterbury region. Using data recorded by this dense network from 2010 to 2013, we significantly improved the QCN rapid magnitude estimation relationship. The previous scaling relationship (Lawrence et al., 2014) did not accurately estimate the magnitudes of nearby (estimates earthquake magnitudes within 1 magnitude unit of the GNS Science GeoNet earthquake catalog magnitudes for 99% of the events tested, within 0.5 magnitude units for 90% of the events, and within 0.25 magnitude units for 57% of the events. These magnitudes are reliably estimated within 3 s of the initial trigger recorded on at least seven stations. In this report, we present the methods used to calculate a new scaling relationship and demonstrate the accuracy of the revised magnitude estimates using a program that is able to retrospectively estimate event magnitudes using archived data.
Stjern, Camilla Weum; Samset, Bjørn Hallvard; Myhre, Gunnar; Forster, Piers M.; Hodnebrog, Øivind; Andrews, Timothy; Boucher, Olivier; Faluvegi, Gregory; Iversen, Trond; Kasoar, Matthew; Kharin, Viatcheslav; Kirkevâg, Alf; Lamarque, Jean-François; Olivié, Dirk; Richardson, Thomas; Shawki, Dilshad; Shindell, Drew; Smith, Christopher J.; Takemura, Toshihiko; Voulgarakis, Apostolos
We investigate the climate response to increased concentrations of black carbon (BC), as part of the Precipitation Driver Response Model Intercomparison Project (PDRMIP). A tenfold increase in BC is simulated by nine global coupled-climate models, producing a model median effective radiative forcing of 0.82 (ranging from 0.41 to 2.91) W m-2, and a warming of 0.67 (0.16 to 1.66) K globally and 1.24 (0.26 to 4.31) K in the Arctic. A strong positive instantaneous radiative forcing (median of 2.10 W m-2 based on five of the models) is countered by negative rapid adjustments (-0.64 W m-2 for the same five models), which dampen the total surface temperature signal. Unlike other drivers of climate change, the response of temperature and cloud profiles to the BC forcing is dominated by rapid adjustments. Low-level cloud amounts increase for all models, while higher-level clouds are diminished. The rapid temperature response is particularly strong above 400 hPa, where increased atmospheric stabilization and reduced cloud cover contrast the response pattern of the other drivers. In conclusion, we find that this substantial increase in BC concentrations does have considerable impacts on important aspects of the climate system. However, some of these effects tend to offset one another, leaving a relatively small median global warming of 0.47 K per W m-2—about 20% lower than the response to a doubling of CO2. Translating the tenfold increase in BC to the present-day impact of anthropogenic BC (given the emissions used in this work) would leave a warming of merely 0.07 K.
... RAILROAD RETIREMENT ACT COMPUTING EMPLOYEE, SPOUSE, AND DIVORCED SPOUSE ANNUITIES Computing an Employee... increase is based on the cost-of-living increases in social security benefits during the period from...
Jennifer L Williams
Full Text Available Fitness costs of resistance to Bacillus thuringiensis (Bt crops occur in the absence of Bt toxins, when individuals with resistance alleles are less fit than individuals without resistance alleles. As costs of Bt resistance are common, refuges of non-Bt host plants can delay resistance not only by providing susceptible individuals to mate with resistant individuals, but also by selecting against resistance. Because costs typically vary across host plants, refuges with host plants that magnify costs or make them less recessive could enhance resistance management. Limited understanding of the physiological mechanisms causing fitness costs, however, hampers attempts to increase costs. In several major cotton pests including pink bollworm (Pectinophora gossypiella, resistance to Cry1Ac cotton is associated with mutations altering cadherin proteins that bind this toxin in susceptible larvae. Here we report that the concentration of gossypol, a cotton defensive chemical, was higher in pink bollworm larvae with cadherin resistance alleles than in larvae lacking such alleles. Adding gossypol to the larval diet decreased larval weight and survival, and increased the fitness cost affecting larval growth, but not survival. Across cadherin genotypes, the cost affecting larval growth increased as the gossypol concentration of larvae increased. These results suggest that increased accumulation of plant defensive chemicals may contribute to fitness costs associated with resistance to Bt toxins.
Full Text Available Abstract Background The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD. Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG-reimbursement. Method Cost data of 20 LVAD implantations (VentrAssist™ from 2005-2009 (period 1 were analyzed together with costs from nine patients using another LVAD (HeartWare™ from 2009-June 2011 (period 2. For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. Results The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299, and the corresponding DRG- reimbursement (2009 was $ 143, 192 . The mean LOS was 54 days (range 12- 127. For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664 and the corresponding DRG- reimbursement (2010 was $ 136, 963. The mean LOS was 49 days (range 31- 93. The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14
Mishra, Vinod; Fiane, Arnt E; Geiran, Odd; Sørensen, Gro; Khushi, Ishtiaq; Hagen, Terje P
The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD). Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG)-reimbursement. Cost data of 20 LVAD implantations (VentrAssist™) from 2005-2009 (period 1) were analyzed together with costs from nine patients using another LVAD (HeartWare™) from 2009-June 2011 (period 2). For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299), and the corresponding DRG- reimbursement (2009) was $ 143, 192 . The mean LOS was 54 days (range 12- 127). For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664) and the corresponding DRG- reimbursement (2010) was $ 136, 963. The mean LOS was 49 days (range 31- 93).The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14, 096 US$ (CI -3, 842 to -24, 349, p < 0
Petropoulos, G. P.; Knorr, W.; Scholze, M.; Boschetti, L.; Karantounias, G.
Remote sensing is increasingly being used as a cost-effective and practical solution for the rapid evaluation of impacts from wildland fires. The present study investigates the use of the support vector machine (SVM) classification method with multispectral data from the Advanced Spectral Emission and Reflection Radiometer (ASTER) for obtaining a rapid and cost effective post-fire assessment in a Mediterranean setting. A further objective is to perform a detailed intercomparison of available ...
Voleti, Bhavya; Navarria, Andrea; Liu, Rong-Jian; Banasr, Mounira; Li, Nanxin; Terwilliger, Rose; Sanacora, Gerard; Eid, Tore; Aghajanian, George; Duman, Ronald S
Clinical studies report that scopolamine, an acetylcholine muscarinic receptor antagonist, produces rapid antidepressant effects in depressed patients, but the mechanisms underlying the therapeutic response have not been determined. The present study examines the role of the mammalian target of rapamycin complex 1 (mTORC1) and synaptogenesis, which have been implicated in the rapid actions of N-methyl-D-aspartate receptor antagonists. The influence of scopolamine on mTORC1 signaling was determined by analysis of the phosphorylated and activated forms of mTORC1 signaling proteins in the prefrontal cortex (PFC). The numbers and function of spine synapses were analyzed by whole cell patch clamp recording and two-photon image analysis of PFC neurons. The actions of scopolamine were examined in the forced swim test in the absence or presence of selective mTORC1 and glutamate receptor inhibitors. The results demonstrate that a single, low dose of scopolamine rapidly increases mTORC1 signaling and the number and function of spine synapses in layer V pyramidal neurons in the PFC. Scopolamine administration also produces an antidepressant response in the forced swim test that is blocked by pretreatment with the mTORC1 inhibitor or by a glutamate alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor antagonist. Taken together, the results demonstrate that the antidepressant actions of scopolamine require mTORC1 signaling and are associated with increased glutamate transmission, and synaptogenesis, similar to N-methyl-D-aspartate receptor antagonists. These findings provide novel targets for safer and more efficacious rapid-acting antidepressant agents. © 2013 Society of Biological Psychiatry.
Kamandulis, Sigitas; Snieckus, Audrius; Venckunas, Tomas
a program involving a rapid stepwise increase in the number of jumps, drop height, and squat depth, and the addition of weight. Concentric, isometric maximal voluntary contraction (MVC), and stimulated knee extension torque were measured before and 10 min after each session. Muscle soreness and plasma...... creatine kinase activity were assessed after each session. Steep increments in stretch-shortening exercise load in sessions 4 and 7 amplified the postexercise decrease in stimulated muscle torque and slightly increased muscle soreness but had a minimal effect on the recovery of MVC and stimulated torque......The aim of the present study was to monitor the changes in indirect markers of muscle damage during 3 weeks (nine training sessions) of stretch-shortening (drop jump) exercise with constant load alternated with steep increases in load. Physically active men (n = 9, mean age 19.1 years) performed...
A methodology is developed for relating cost to ride quality in elevated guideway : system design, based upon directly relating guideway structural properties and : construction tolerances to both cost and ride quality. It is illustrated in detail : ...
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
Esch, T.E.M. van; Brabers, A.E.M.; Dijk, C.E. van; Gusdorf, L.; Groenewegen, P.P.; Jong, J.D. de
The compulsory deductible, a form of patient cost-sharing in the Netherlands, has more than doubled during the past years. There are indications that as a result, refraining from medical care has increased. We studied the relation between patient cost-sharing and refraining from medical care by
Saywell, Robert M; Champion, Victoria L; Skinner, Celette Sugg; Menon, Usha; Daggy, Joanne
Mammography is the primary method used for breast cancer screening. However, adherence to recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of three combinations of tailored telephone and mailed intervention strategies for increasing adherence to mammography. There were 1044 participants who were randomly assigned to one of four groups. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences, and a ratio of cost/improvement in mammogram adherence evaluated the cost-effectiveness. All three of the interventions (tailored telephone, tailored mail, and tailored telephone and mail) had significantly better adherence rates compared with the control group (usual care). However, when also considering costs, one emerged as the superior strategy. The cost-effectiveness ratios for the three interventions show that the tailored mail (letter) was the most cost-effective strategy, achieving 43.3% mammography adherence at a marginal cost of dollar 0.39 per 1% increase in women screened. The tailored mail plus telephone achieved greater adherence (49.4%), but at a higher cost (dollar 0.56 per 1% increase in women screened). A tailored mail reminder is an effective and economical intervention to increase mammography adherence. Future research should confirm this finding and address its applicability to practice in other settings.
Hupp, Jerry W.; Ward, David H.; Whalen, Mary E.; Pearce, John M.
Through the Changing Arctic Ecosystems (CAE) initiative, the U.S. Geological Survey (USGS) informs key resource management decisions for Arctic Alaska by providing scientific information on current and future ecosystem response to a warming climate. The Arctic Coastal Plain (ACP) of northern Alaska is a key study area within the USGS CAE initiative. This region has experienced a warming trend over the past decades, leading to decreased sea ice, permafrost thaw, and an advancement of spring phenology. The number of birds on the ACP also is changing, marked by increased populations of the four species of geese that nest in the region. The Snow Goose (Chen caerulescens) is the most rapidly increasing of these species. USGS CAE research is quantifying these changes and their implications for management agencies.
Todd C Atwood
Full Text Available In the Arctic Ocean's southern Beaufort Sea (SB, the length of the sea ice melt season (i.e., period between the onset of sea ice break-up in summer and freeze-up in fall has increased substantially since the late 1990s. Historically, polar bears (Ursus maritimus of the SB have mostly remained on the sea ice year-round (except for those that came ashore to den, but recent changes in the extent and phenology of sea ice habitat have coincided with evidence that use of terrestrial habitat is increasing. We characterized the spatial behavior of polar bears spending summer and fall on land along Alaska's north coast to better understand the nexus between rapid environmental change and increased use of terrestrial habitat. We found that the percentage of radiocollared adult females from the SB subpopulation coming ashore has tripled over 15 years. Moreover, we detected trends of earlier arrival on shore, increased length of stay, and later departure back to sea ice, all of which were related to declines in the availability of sea ice habitat over the continental shelf and changes to sea ice phenology. Since the late 1990s, the mean duration of the open-water season in the SB increased by 36 days, and the mean length of stay on shore increased by 31 days. While on shore, the distribution of polar bears was influenced by the availability of scavenge subsidies in the form of subsistence-harvested bowhead whale (Balaena mysticetus remains aggregated at sites along the coast. The declining spatio-temporal availability of sea ice habitat and increased availability of human-provisioned resources are likely to result in increased use of land. Increased residency on land is cause for concern given that, while there, bears may be exposed to a greater array of risk factors including those associated with increased human activities.
Chung, Philip; Heller, J Alex; Etemadi, Mozziyar; Ottoson, Paige E; Liu, Jonathan A; Rand, Larry; Roy, Shuvo
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.
Yu, Seong-Jin; Wu, Kou-Jen; Bae, Eun K; Hsu, Man-Jung; Richie, Christopher T; Harvey, Brandon K; Wang, Yun
In this study, methamphetamine (Meth)- and glutamate (Glu)-mediated intracellular Ca(++) (Ca(++) i) signals were examined in real time in primary cortical neurons overexpressing an intracellular Ca(++) probe, GCaMP5, by adeno-associated viral (AAV) serotype 1. Binding of Ca(++) to GCaMP increased green fluorescence intensity in cells. Both Meth and Glu induced a rapid increase in Ca(++) i, which was blocked by MK801, suggesting that Meth enhanced Ca(++) i through Glu receptor in neurons. The Meth-mediated Ca(++) signal was also blocked by Mg(++) , low Ca(++) or the L-type Ca(++) channel inhibitor nifedipine. The ryanodine receptor inhibitor dantrolene did not alter the initial Ca(++) influx but partially reduced the peak of Ca(++) i. These data suggest that Meth enhanced Ca(++) influx through membrane Ca(++) channels, which then triggered the release of Ca(++) from the endoplasmic reticulum in the cytosol. AAV-GCaMP5 was also injected to the parietal cortex of adult rats. Administration of Meth enhanced fluorescence in the ipsilateral cortex. Using immunohistochemistry, Meth-induced green fluorescence was found in the NeuN-containing cells in the cortex, suggesting that Meth increased Ca(++) in neurons in vivo. In conclusion, we have used in vitro and in vivo techniques to demonstrate a rapid increase of Ca(++) i by Meth in cortical neurons through overexpression of GCaMP5. As Meth induces behavioral responses and neurotoxicity through Ca(++) i, modulation of Ca(++) i may be useful to reduce Meth-related reactions. © 2014 Society for the Study of Addiction.
Hjort, Anne Mette; Gottrup, F
To demonstrate that changes in demography, life expectancy and incidence of background diseases (including type 2 diabetes mellitus) during the period 2009-2020 will significantly increase the costs of wound care in Denmark.......To demonstrate that changes in demography, life expectancy and incidence of background diseases (including type 2 diabetes mellitus) during the period 2009-2020 will significantly increase the costs of wound care in Denmark....
Buchman, Aron S; Wilson, Robert S; Yu, Lei; James, Bryan D; Boyle, Patricia A; Bennett, David A
Longitudinal studies of objectively measured physical activity are lacking in older adults. We tested whether objective measures of total daily activity decline more rapidly in older adults. This prospective, observational cohort study included 519 community-dwelling older persons from across metropolitan Chicago participating in the Rush Memory and Aging Project. Repeated total daily activity measures (leisure and non-leisure physical activity) were derived from actigraphic recordings for up to 10 days. Generalized estimating equation models which controlled for demographics measures were employed. At baseline, age was inversely related with the level of total daily activity (estimate, -0.014, S.E. 0.002, pdaily activity declined by about 0.070 × 10(5) activity counts/day/yr (estimate -0.065, S.E. 0.005, pdaily activity declined 3% more rapidly for each additional year of age at baseline (estimate -0.002, S.E. 0.001, p=0.027). Thus, total daily activity declined almost twice as fast in an individual 91 years old at baseline versus an individual 71 years old. A higher level of education was associated with a slower rate of decline (estimate 0.004, S.E. 0.002, pdaily activity were unchanged when controlling for baseline level of motor and cognitive function, other late-life activities and chronic health conditions. These data suggest that total daily activity in very old adults declines more rapidly with increasing age. Thus, physical inactivity is likely to become a larger problem in our aging population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Pollock, R F; Valentine, W J; Pilgaard, T; Nishimura, H
The Nippon Ultra-Rapid Insulin and Diabetic Complication Evaluation Study (NICE Study) (NCT00575172) was a 5-year, open-label, randomised controlled trial which compared cardiovascular outcomes in Japanese type 2 diabetes patients intensively treated with regular human insulin or insulin aspart (NovoRapid; Novo Nordisk A/S, Bagsvaerd, Denmark), a rapid-acting insulin analogue. The aim of the present analysis was to evaluate the cost effectiveness of insulin aspart versus regular human insulin from the perspective of a Japanese third-party healthcare payer. A discrete event-simulation model was developed in Microsoft Excel to assess the within-trial cost effectiveness and make longer-term clinical projections in patients treated with regular human insulin or insulin aspart. In addition to severe hypoglycaemia, the model captured myocardial and cerebral infarction events and percutaneous coronary intervention and coronary artery bypass graft procedures. Within-trial mortality, incidence of severe hypoglycaemia and cardiovascular event probabilities were derived from the annual rates observed during the trial period, while post-trial outcomes were calculated using the event rates from the trial, adjusted for increasing patient age. Event costs were accounted from the healthcare payer perspective and expressed in 2008 Japanese yen (JPY), while health-related quality of life (HRQoL) was captured using event and state utilities. Future costs and clinical benefits were discounted at 3% annually. Life expectancy, quality-adjusted life expectancy, cardiovascular event rates and costs were evaluated over 5- and 10-year time horizons and sensitivity analyses were performed to assess variability in model outcomes. Over 5 years of treatment, insulin aspart dominated human insulin both in incremental life expectancy and in incremental quality-adjusted life-years (QALYS). Insulin aspart was associated with a small improvement in discounted life expectancy of 0.005 years (4.688 vs
Rajsic, Jason; Wilson, Daryl E; Pratt, Jay
In visual search, there is a confirmation bias such that attention is biased towards stimuli that match a target template, which has been attributed to covert costs of updating the templates that guide search [Rajsic, Wilson, & Pratt, 2015. Confirmation bias in visual search. Journal of Experimental Psychology: Human Perception and Performance. Advance online publication. doi: 10.1037/xhp0000090 ]. In order to provide direct evidence for this speculation, the present study increased the cost of inspections in search by using gaze- and mouse-contingent searches, which restrict the manner in which information in search displays can be accrued, and incur additional motor costs (in the case of mouse-contingent searches). In a fourth experiment, we rhythmically mask elements in the search display to induce temporal inspection costs. Our results indicated that confirmation bias is indeed attenuated when inspection costs are increased. We conclude that confirmation bias results from the low-cost strategy of matching information to a single, concrete visual template, and that more sophisticated guidance strategies will be used when sufficiently beneficial. This demonstrates that search guidance itself comes at a cost, and that the form of guidance adopted in a given search depends on a comparison between guidance costs and the expected benefits of their implementation.
Simmons, Katharine B.; Bertolli, Jeanne; Rivera-Garcia, Brenda; Cox, Shanna; Romero, Lisa; Koonin, Lisa M.; Valencia-Prado, Miguel; Bracero, Nabal; Jamieson, Denise J.; Barfield, Wanda; Moore, Cynthia A.; Mai, Cara T.; Korhonen, Lauren C.; Frey, Meghan T.; Perez-Padilla, Janice; Torres-Muñoz, Ricardo; Grosse, Scott D.
We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus–related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus–associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs. PMID:27805547
Haastrup, Peter; Jarbøl, Dorte Ejg; Hansen, Jane Møller
a change in indications for use of PPIs in the same time range. Use of ulcerogenic drugs among the elderly has stagnated. Reimbursement modifications do not seem to have had a substantial influence on the steadily increasing use of PPIs. Conclusions: Use of PPIs has increased substantially the past decade......Background: Antisecretory drugs (ADs) are often prescribed in primary care for upper gastrointestinal symptoms. Reimbursement modifications have been made in Denmark to minimize costs related to use of ADs. However knowledge about development in use of ADs over the past decade and the impacts...... of the reimbursement modifications is sparse. Research questions: How has use of ADs developed in Denmark 2001-2011? Which impacts have the reimbursement modifications had on the use of ADs? Methods: The Register of Medicinal Product Statistics includes all sales and redeemed prescriptions nationwide covering...
DuVall, Jacquelyn A; Cabaniss, Scott T; Angotti, Morgan L; Moore, John H; Abhyankar, Mayuresh; Shukla, Nishant; Mills, Daniel L; Kessel, Bryan G; Garner, Gavin T; Swami, Nathan S; Landers, James P
Pathogen detection has traditionally been accomplished by utilizing methods such as cell culture, immunoassays, and nucleic acid amplification tests; however, these methods are not easily implemented in resource-limited settings because special equipment for detection and thermal cycling is often required. In this study, we present a magnetic bead aggregation assay coupled to an inexpensive microfluidic fabrication technique that allows for cell phone detection and analysis of a notable pathogen in less than one hour. Detection is achieved through the use of a custom-built system that allows for fluid flow control via centrifugal force, as well as manipulation of magnetic beads with an adjustable rotating magnetic field. Cell phone image capture and analysis is housed in a 3D-printed case with LED backlighting and a lid-mounted Android phone. A custom-written application (app.) is employed to interrogate images for the extent of aggregation present following loop-mediated isothermal amplification (LAMP) coupled to product-inhibited bead aggregation (PiBA) for detection of target sequences. Clostridium difficile is a pathogen of increasing interest due to its causative role in intestinal infections following antibiotic treatment, and was therefore chosen as the pathogen of interest in the present study to demonstrate the rapid, cost-effective, and sequence-specific detection capabilities of the microfluidic platform described herein.
Tabet, Anthony; Gardner, Matthew; Swanson, Sebastian; Crump, Sydney; McMeekin, Austin; Gong, Diana; Tabet, Rebecca; Hacker, Benjamin; Nestrasil, Igor
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.
Saywell, R M; Champion, V L; Skinner, C S; McQuillen, D; Martin, D; Maraj, M
Mammography is the primary method used for breast cancer screening. However, compliance with recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography. There were 808 participants who were randomly assigned to one of six groups. A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness. Three of the interventions (in-person, telephone plus letter, and in-person plus letter) had significantly better compliance rates compared with the control, physician letter, or telephone alone. However, when considering costs, only one emerged as the superior strategy. The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy, achieving a 35.6% mammography compliance at a marginal cost of $0.78 per 1% increase in women screened. A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography. Future research should confirm this finding and address its applicability to practice. Copyright 1999 American Health Foundation and Academic Press.
Inverso, Gino; Lappi, Michael D; Flath-Sporn, Susan J; Heald, Ronald; Kim, David C; Meara, John G
Process management within a health care setting is poorly understood and often leads to an incomplete understanding of the true costs of patient care. Using time-driven activity-based costing methods, we evaluated the high-volume, low-complexity diagnosis of plagiocephaly to increase value within our clinic. A total of 59 plagiocephaly patients were evaluated in phase 1 (n = 31) and phase 2 (n = 28) of this study. During phase 1, a process map was created, encompassing each of the 5 clinicians and administrative personnel delivering 23 unique activities. After analysis of the phase 1 process maps, average times as well as costs of these activities were evaluated for potential modifications in workflow. These modifications were implemented in phase 2 to determine overall impact on visit-time and costs of care. Improvements in patient education, workflow coordination, and examination room allocation were implemented during phase 2, resulting in a reduced patient visit-time of 13:25 (19.9% improvement) and an increased cost of $8.22 per patient (7.7% increase) due to changes in physician process times. However, this increased cost was directly offset by the availability of 2 additional appointments per day, potentially generating $7904 of additional annual revenue. Quantifying the impact of a 19.9% reduction in patient visit-time at an increased cost of 7.7% resulted in an increased value ratio of 1.113. This pilot study effectively demonstrates the novel use of time-driven activity-based costing in combination with the value equation as a metric for continuous process improvement programs within the health care setting.
Morgan, M. G.; Vaishnav, P.; Azevedo, I. L.; Dowlatabadi, H.
An interagency working group in the U.S. government has used three integrated assessment models of climate change to estimate "the social cost of carbon" and U.S. Federal Agencies and many others are using these figures as the benchmark for sound public policy. We argue that assessing the cost of emissions of CO2 on the margin is inappropriate for at least four reasons: 1) Greenhouse gas concentrations are cumulative and their radiative forcing is a non-linear function of the atmospheric concentration of many radiatively active gases. A marginal approach ignores these interactions and dependence of net forcing on concentrations of other greenhouse gases in the atmosphere. 2) Geologic evidence points to three quasi-equilibrium climate states. We know that the response of the climate system to changes in radiative forcing is non-linear. We also know that the feedbacks that have blessed us with a stable "climate optimum" for the past 10,000 years are uncertain in magnitude and operate over limited perturbations. Beyond that perturbation, it is likely that climate system dynamics will tip to a very different climate state. The probability and consequences of such climate transitions cannot be treated using a marginal approach. 3) Climate change and its impacts will vary by location, ecosystem and socio-economic context. The responses of social, economic and ecological systems are also likely to be non-linear, display hysteresis, and "tipping" or bifurcation. 4) We neither know how to characterize such impacts nor how they will be valued across different cultures and societies. Indeed, monetizing and discounting these heterogeneous and contextual impacts as a single global metric displays a hubris that has been roundly condemned by ethicists and decision-analysts. After outlining these limitations, we describe several strategies that could be used to inform climate policy to achieving deep decarbonization.
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.
Moore, Justin B; Heboyan, Vahé; Oniffrey, Theresa M; Brinkley, Jason; Andrews, Sara M; Kolbe, Mary Bea
American youth are insufficiently active, and minigrant programs have been developed to facilitate implementation of evidence-based interventions in communities. However, little is known about the cost-effectiveness of targeted minigrant programs for the implementation of physical activity (PA) promoting strategies for youth. To determine the cost-effectiveness of a minigrant program to increase PA among youth. Twenty community grantees were pair-matched and randomized to receive funding at the beginning of year 1 (2010-2011) or year 2 (2011-2012) to implement interventions to increase PA in youth. Costs were calculated by examining financial reports provided by the granting organization and grantees. Twenty counties in North Carolina. A random sample of approximately 800 fourth- to eighth-grade youth (per year) from the approximately 6100 youth served by the 20 community-based interventions. Cost-effectiveness ratios (CERs) were calculated at the county and project levels to determine the cost per child-minute of moderate-to-vigorous PA (MVPA) increased by wave. Analyses were conducted utilizing cost data from 20 community grantees and accelerometer-derived PA from the participating youth. Of the 20 participating counties, 18 counties displayed increased youth MVPA between at least 2 waves of observation. Of those 18 counties, the CER (US dollars/MVPA minutes per day) ranged from $0.02 to $1.86 (n = 13) in intervention year 1, $0.02 to $6.19 (n = 15) in intervention year 2, and $0.02 to $0.58 (n = 17) across both years. If utilized to implement effectual behavior change strategies, minigrants can be a cost-effective means of increasing children's MVPA, with a low monetary cost per minute of MVPA.
Karničar, Katarina; Drobnak, Igor; Petek, Marko; Magdevska, Vasilka; Horvat, Jaka; Vidmar, Robert; Baebler, Špela; Rotter, Ana; Jamnik, Polona; Fujs, Štefan; Turk, Boris; Fonovič, Marko; Gruden, Kristina; Kosec, Gregor; Petković, Hrvoje
Omics approaches have significantly increased our understanding of biological systems. However, they have had limited success in explaining the dramatically increased productivity of commercially important natural products by industrial high-producing strains, such as the erythromycin-producing actinomycete Saccharopolyspora erythraea. Further yield increase is of great importance but requires a better understanding of the underlying physiological processes. To reveal the mechanisms related to erythromycin yield increase, we have undertaken an integrated study of the genomic, transcriptomic, and proteomic differences between the wild type strain NRRL2338 (WT) and the industrial high-producing strain ABE1441 (HP) of S. erythraea at multiple time points of a simulated industrial bioprocess. 165 observed mutations lead to differences in gene expression profiles and protein abundance between the two strains, which were most prominent in the initial stages of erythromycin production. Enzymes involved in erythromycin biosynthesis, metabolism of branched chain amino acids and proteolysis were most strongly upregulated in the HP strain. Interestingly, genes related to TCA cycle and DNA-repair were downregulated. Additionally, comprehensive data analysis uncovered significant correlations in expression profiles of the erythromycin-biosynthetic genes, other biosynthetic gene clusters and previously unidentified putative regulatory genes. Based on this information, we demonstrated that overexpression of several genes involved in amino acid metabolism can contribute to increased yield of erythromycin, confirming the validity of our systems biology approach. Our comprehensive omics approach, carried out in industrially relevant conditions, enabled the identification of key pathways affecting erythromycin yield and suggests strategies for rapid increase in the production of secondary metabolites in industrial environment.
Trindade-Suedam, Ivy Kiemle; Castilho, Ricardo Leão; Sampaio-Teixeira, Ana Claudia Martins; Araújo, Bruna Mara Adorno Marmotel; Fukushiro, Ana Paula; Campos, Letícia Dominguez; Trindade, Inge Elly Kiemle
The transverse maxillary deficiency frequently observed in patients with cleft lip and palate (CLP) is usually treated by rapid maxillary expansion (RME). Considering that RME causes a significant increase of the internal nasal dimensions in children with unilateral CLP (UCLP), this study aimed to characterize the internal nasal geometry of children with bilateral CLP (BCLP) and transverse maxillary deficiency using acoustic rhinometry. The study also aimed to analyze changes caused by RME. Cross-sectional prospective study. Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. Fifteen children with repaired BCLP of both genders, aged 8 to 15 years, referred for RME, were prospectively analyzed. Subjects underwent acoustic rhinometry before the expander installation and after the active phase of expansion. Cross-sectional areas (CSA) and volumes (V) of the nasal valve regions (CSA1 and V1) and turbinates (CSA2, CSA3, and V2), were measured after nasal decongestion. In the majority of the subjects, an increase of internal nasal dimensions was observed. Percent changes of CSA1, CSA2, CSA3, V1, and V2 were: +25%, +11%, +9%, 20%, and +12%, respectively. Differences were significant for all variables studied, except CSA3 (P < .05). RME promotes an increase in the internal nasal dimensions of children with BCLP, suggesting that RME is capable of substantially improving nasal patency in this population.
Chowdhury, Golam M.I.; Zhang, Jie; Thomas, Monique; Banasr, Mounira; Ma, Xiaoxian; Pittman, Brian; Bristow, Linda; Schaeffer, Eric; Duman, Ronald; Rothman, Douglas; Behar, Kevin; Sanacora, Gerard
Several drugs have recently been reported to induce rapid antidepressant effects in clinical trials and rodent models. Although the cellular mechanisms involved remain unclear, reports suggest that increased glutamate transmission contributes to these effects. Here, we demonstrate that the antidepressant-like efficacy of three unique drugs, with reported rapid onset antidepressant properties, is coupled with a rapid transient rise in glutamate cycling in medial prefronal cortex (mPFC) of awak...
Sue Anne Zollinger
Full Text Available Bird song is a widely used model in the study of animal communication and sexual selection, and several song features have been shown to reflect the quality of the singer. Recent studies have demonstrated that song amplitude may be an honest signal of current condition in males and that females prefer high amplitude songs. In addition, birds raise the amplitude of their songs to communicate in noisy environments. Although it is generally assumed that louder song should be more costly to produce, there has been little empirical evidence to support this assumption. We tested the assumption by measuring oxygen consumption and respiratory patterns in adult male zebra finches (Taeniopygia guttata singing at different amplitudes in different background noise conditions. As background noise levels increased, birds significantly increased the sound pressure level of their songs. We found that louder songs required significantly greater subsyringeal air sac pressure than quieter songs. Though increased pressure is probably achieved by increasing respiratory muscle activity, these increases did not correlate with measurable increases in oxygen consumption. In addition, we found that oxygen consumption increased in higher background noise, independent of singing behaviour. This observation supports previous research in mammals showing that high levels of environmental noise can induce physiological stress responses. While our study did not find that increasing vocal amplitude increased metabolic costs, further research is needed to determine whether there are other non-metabolic costs of singing louder or costs associated with chronic noise exposure.
Hyder, Joseph A; Thomson, Cynthia A; Natarajan, Loki; Madlensky, Lisa; Pu, Minya; Emond, Jennifer; Kealey, Sheila; Rock, Cheryl L; Flatt, Shirley W; Pierce, John P
To assess the cost of adopting a plant-based diet. Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs. At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/ person/week (multivariate model, P=0.027). A major change to a plant-based diet was associated with a minimal increase in grocery costs.
Hyder, Joseph A.; Thomson, Cynthia A.; Natarajan, Loki; Madlensky, Lisa; Pu, Minya; Emond, Jennifer; Kealey, Sheila; Rock, Cheryl L.; Flatt, Shirley W.; Pierce, John P.
Objective To assess the cost of adopting a plant-based diet. Methods Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs. Results At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit:6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/person/week (multivariate model, p=0.027). Conclusions A major change to a plant-based diet was associated with a minimal increase in grocery costs. PMID:19296743
Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role
О. С. Кленов
Full Text Available The basic conditions to reduce the cost of processing technology and improve productivity through the use of modern cutting tools produced by leading foreign firms producing tools have been appraised from theory in the work. Theoretically, it has been found that an increase in the cost of processing varies according to extremum dependence, passing the minimum point. It is possible to reduce the minimum processing cost due to the increase of productivity using cutting edge tools, characterized by a high capacity for work in high cutting temperatures. The criterion showing the technological price cost minimum is the ratio of the expenditures on workers’ wages to the expenditures on the cutting tools, it being quite specific for various processing conditions. To analyze the possibilities of practical use of the proposed criterion, a complex of experimental researches of the technological prime cost and productivity of the processing with hard alloy cutting tools with wear-resistant coatings produced by the company «Iscar» has been carried out. It has been established that their use makes it possible by more than one half to reduce the labour consumption and overall costs as compared to the hard alloy cutting tools traditionally used in home industry. It has been shown that this effect is achieved by increasing the cutting speed and feed due to increased wear resistance and heat resistance of the «Iscar» company tools. It was established that it is much more possible to achieve low processing cost at milling than at turning. It was stated with regard to all major expenditures including the workers' wages, the cost of the cutting tools, equipment and other costs, allowing more correctly estimate the cost-effectiveness of mechanical processing. Experiments confirmed that the main condition for reducing the processing cost to its minimum value is to increase the processing performance through the use of a heat-resistant and wear-resistant cutting
ELEONORA IONELA FOCȘAN
Full Text Available Over time, mankind has tried to find different ways of costs reduction. This subject which we are facing more often nowadays, has been detailed studied, without reaching a general model, and also efficient, regarding the costs reduction. Costs reduction entails a number of benefits over the entity, the most important being: increase revenue and default to the profit, increase productivity, a higher level of services / products offered to clients, and last but not least, the risk mitigation of the economic deficit. Therefore, each entity search different modes to obtain most benefits, for the company to succeed in a competitive market. This article supports the companies, trying to make known a new way of minimizing the total cost of acquisitions, by presenting some hypotheses about the increasing variable demand, proving them, and development of formulas for reducing the costs. The hypotheses presented in the model described below, can be maximally exploited to obtain new models of reducing the total cost, according to the modes of the purchase of entities which approach it.
Williams, Gordon J; Sheikh, Bahman; Holden, Robert B; Kouretas, Tom J; Nelson, Kara L
The impact of loading rate on tertiary filtration of wastewater was studied using a pilot-scale, dual-media, rapid depth filtration system. Loading rates of 12.2, 15.3, 18.3, 21.4, and 24.4m/h were tested on parallel filter columns treating the same coagulated secondary wastewater to determine the impact on removal of turbidity, particles (2-15 microm), total coliform bacteria, Escherichia coli, and MS2 bacteriophage, as well as on the particle deposition profile in the filter bed. Increasing the loading rate from 12.2 to 24.4m/h decreased the removal efficiencies for all metrics. The observed impact of loading rate on particle removal was similar to that predicted by a clean-bed filtration model, although the model significantly underestimated the removal efficiencies of the smaller particles. For two loading rates, 12.2 and 18.3m/h, the effect of coagulant dose was also studied; the negative impact of loading rate on removal efficiency was eliminated by increasing the coagulant dose for the higher loading rate, which also resulted in removal of particles deeper in the filter bed. For all conditions studied, loading rate had no observable impact on the ability to disinfect filter effluents with chloramines. The results of this research indicate that loading rates higher than those typically used in tertiary filtration can produce acceptable effluent quality, and support a regulatory approach based on filter effluent turbidity.
Mohammed Saad Dwiddar
Full Text Available A methodology of evaluating the economics of the front-end nuclear fuel cycle with a price change sensitivity analysis for a VVER-1000 reactor core as a case study is presented. The effect of increasing the fuel enrichment and its corresponding reactor cycle length on the energy cost is investigated. The enrichment component was found to represent the highly expenses dynamic component affecting the economics of the front-end fuel cycle. Nevertheless, the increase of the fuel enrichment will increase the reactor cycle length, which will have a positive feedback on the electricity generation cost (cent/KWh. A long reactor operation time with a cheaper energy cost set the nuclear energy as a competitive alternative when compared with other energy sources.
Busby, Colin [W. L. Gore & Associates Inc., Newark, DE (United States)
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
Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian Schultz
at rural operational primary care centres. METHODS: Three health centres (HCs) were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis) in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients...... departments were enrolled from March 2010 to February 2011. Of these, a random sample of 1,627 was selected to measure additional socio-economic characteristics. Costing was performed following the standard step-down cost allocation and the ingredients approach. Effectiveness was measured as the number...
Anne C Spaulding
Full Text Available Emergency departments and jails provide medical services to persons at risk for HIV infection and are recommended venues for HIV screening. Our main objective in this study was to analyze the cost per new HIV diagnosis associated with the HIV screening program in these two venues. The emergency department's parallel testing program was conducted at Grady Memorial Hospital in Atlanta, Georgia starting in 2008; the jail's integrated testing program began at the Fulton County (GA Jail in 2011. The two sites, four miles apart from one another, employed the same rapid HIV test. Ascertainment that cases were new differed by site; only the jail systematically checked identities against health department HIV registries. The program in the emergency department used dedicated HIV test counselors and made 242 diagnoses over a 40-month period at a cost of $2,981 per diagnosis. The jail program used staff nurses, and found 41 new HIV cases over 10.5 months at a cost of $6,688 per new diagnosis. Differences in methods for ascertainment of new diagnoses, previously undiagnosed HIV sero-positivity, and methodologies used for assessing program costs prevent concluding that one program was more economical than the other. Nonetheless, our findings show that testing in both venues yielded many new diagnoses, with the costs within the range reported in the literature.
Ho, Phuong T; Reddy, Vijay S
The recent technological advances in electron microscopes, detectors, as well as image processing and reconstruction software have brought single particle cryo-electron microscopy (cryo-EM) into prominence for determining structures of bio-molecules at near atomic resolution. This has been particularly true for virus capsids, ribosomes, and other large assemblies, which have been the ideal specimens for structural studies by cryo-EM approaches. An analysis of time series metadata of virus structures on the methods of structure determination, resolution of the structures, and size of the virus particles revealed a rapid increase in the virus structures determined by cryo-EM at near atomic resolution since 2010. In addition, the data highlight the median resolution (∼3.0 Å) and size (∼310.0 Å in diameter) of the virus particles determined by X-ray crystallography while no such limits exist for cryo-EM structures, which have a median diameter of 508 Å. Notably, cryo-EM virus structures in the last four years have a median resolution of 3.9 Å. Taken together with minimal sample requirements, not needing diffraction quality crystals, and being able to achieve similar resolutions of the crystal structures makes cryo-EM the method of choice for current and future virus capsid structure determinations. Copyright © 2017 Elsevier Inc. All rights reserved.
Arnold, Suzanne N; Steneck, Robert S
Free space is necessary for larval recruitment in all marine benthic communities. Settling corals, with limited energy to invest in competitive interactions, are particularly vulnerable during settlement into well-developed coral reef communities. This situation may be exacerbated for corals settling into coral-depauperate reefs where succession in nursery microhabitats moves rapidly toward heterotrophic organisms inhospitable to settling corals. To study effects of benthic organisms (at millimeter to centimeter scales) on newly settled corals and their survivorship we deployed terra-cotta coral settlement plates at 10 m depth on the Mesoamerican Barrier Reef in Belize and monitored them for 38 mo. During the second and third years, annual recruitment rates declined by over 50% from the previous year. Invertebrate crusts (primarily sponges) were absent at the start of the experiment but increased in abundance annually from 39, 60, to 73% of the plate undersides by year three. Subsequently, substrates hospitable to coral recruitment, including crustose coralline algae, biofilmed terra-cotta and polychaete tubes, declined. With succession, substrates upon which spat settled shifted toward organisms inimical to survivorship. Over 50% of spat mortality was due to overgrowth by sponges alone. This result suggests that when a disturbance creates primary substrate a "recruitment window" for settling corals exists from approximately 9 to 14 mo following the disturbance. During the window, early-succession, facilitating species are most abundant. The window closes as organisms hostile to coral settlement and survivorship overgrow nursery microhabitats.
Suzanne N Arnold
Full Text Available Free space is necessary for larval recruitment in all marine benthic communities. Settling corals, with limited energy to invest in competitive interactions, are particularly vulnerable during settlement into well-developed coral reef communities. This situation may be exacerbated for corals settling into coral-depauperate reefs where succession in nursery microhabitats moves rapidly toward heterotrophic organisms inhospitable to settling corals. To study effects of benthic organisms (at millimeter to centimeter scales on newly settled corals and their survivorship we deployed terra-cotta coral settlement plates at 10 m depth on the Mesoamerican Barrier Reef in Belize and monitored them for 38 mo. During the second and third years, annual recruitment rates declined by over 50% from the previous year. Invertebrate crusts (primarily sponges were absent at the start of the experiment but increased in abundance annually from 39, 60, to 73% of the plate undersides by year three. Subsequently, substrates hospitable to coral recruitment, including crustose coralline algae, biofilmed terra-cotta and polychaete tubes, declined. With succession, substrates upon which spat settled shifted toward organisms inimical to survivorship. Over 50% of spat mortality was due to overgrowth by sponges alone. This result suggests that when a disturbance creates primary substrate a "recruitment window" for settling corals exists from approximately 9 to 14 mo following the disturbance. During the window, early-succession, facilitating species are most abundant. The window closes as organisms hostile to coral settlement and survivorship overgrow nursery microhabitats.
Dreesen, Imke A J; Lüchinger, Norman A; Stark, Wendelin J; Fussenegger, Martin
Adenoviral, adeno-associated viral, and retroviral particles are chosen as gene delivery shuttles in more than 50% of all gene therapy clinical trials. Bulk availability of clinical-grade viral particles and their efficiency to transduce the therapeutic cargo into specific target cells remain the most critical bottlenecks in gene therapy applications to date. Capitalizing on the flame-spray technology for the reproducible economic large-scale production of amorphous tricalcium phosphate nanoparticulate powders (ATCP), we designed a scalable ready-to-use gravity-flow column set-up for the straightforward concentration and purification of transgenic adenoviral, adeno-associated viral, and lentiviral particles. Specific elution buffers enabled rapid release of viral particles from the ATCP matrix of the column and provided high-titer virus preparations in an unsurpassed period of time. The interaction of ATCP with adenoviral, adeno-associated viral, and lentiviral particles in solution increased the transduction kinetics of several mammalian cell lines in culture. The nanoparticles were also able to modify the tropism of murine leukemia virus (MLV) towards transduction of human cells. Based on these findings, we believe that the use of flame-spray tricalcium phosphate nanoparticles will lead to important progress in the development of future gene therapy initiatives.
Kwok, Veronica; Niu, Zhendong; Kay, Paul; Zhou, Ke; Mo, Lei; Jin, Zhen; So, Kwok-Fai; Tan, Li Hai
The human brain has been shown to exhibit changes in the volume and density of gray matter as a result of training over periods of several weeks or longer. We show that these changes can be induced much faster by using a training method that is claimed to simulate the rapid learning of word meanings by children. Using whole-brain magnetic resonance imaging (MRI) we show that learning newly defined and named subcategories of the universal categories green and blue in a period of 2 h increases the volume of gray matter in V2/3 of the left visual cortex, a region known to mediate color vision. This pattern of findings demonstrates that the anatomical structure of the adult human brain can change very quickly, specifically during the acquisition of new, named categories. Also, prior behavioral and neuroimaging research has shown that differences between languages in the boundaries of named color categories influence the categorical perception of color, as assessed by judgments of relative similarity, by response time in alternative forced-choice tasks, and by visual search. Moreover, further behavioral studies (visual search) and brain imaging studies have suggested strongly that the categorical effect of language on color processing is left-lateralized, i.e., mediated by activity in the left cerebral hemisphere in adults (hence "lateralized Whorfian" effects). The present results appear to provide a structural basis in the brain for the behavioral and neurophysiologically observed indices of these Whorfian effects on color processing.
Komar, J; Leprêtre, P M; Alberty, M; Vantorre, J; Fernandes, R J; Hellard, P; Chollet, D; Seifert, L
The purpose of this study was to analyze the changes in stroke parameters, motor organization and swimming efficiency with increasing energy cost in aquatic locomotion. Seven elite sprint swimmers performed a 6×300-m incremental swimming test. Stroke parameters (speed, stroke rate and stroke length), motor organization (arm stroke phases and arm coordination index), swimming efficiency (swimming speed squared and hand speed squared) and stroke index were calculated from aerial and underwater side-view cameras. The energy cost of locomotion was assessed by measuring oxygen consumption and blood lactate. Results showed that the increase in energy cost of locomotion was correlated to an increase in the index of coordination and stroke rate, and a decrease in stroke length (pefficiency and stroke index did not change significantly with the speed increments (pefficiency despite the increase in energy cost. In parallel, an increase in the index of coordination IdC and stroke rate were observed, along with a decrease in stroke length, stroke index and hand speed squared with each increment, revealing an adaptation to the fatigue within the 300m. Copyright © 2011 Elsevier B.V. All rights reserved.
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 ...
Rendón-Medina, Marco A; Andrade-Delgado, Laura; Telich-Tarriba, Jose E; Fuente-Del-Campo, Antonio; Altamirano-Arcos, Carlos A
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.
Jensen, Kjeld; Neerup, Mathias Mikkel; Larsen, Leon Bonde
field experiments using field robots which is typically a demanding task in terms of time consumption and logistics. Small indoor robots are sometimes used to emulate the larger field robots which allows for rapid prototyping and intermediate testing in the laboratory before moving to the field...... experiments. In this work we present a novel FrobitPro robot platform designed for rapid prototyping of FroboMind field robot applications. FrobitPro has a fundamental design similar to many current wheeled and tracked robots such as the Kongskilde Robotti, and the workflow of migrating from simulation...... to FrobitPro to field robot is therefore merely a matter of using different low level interface components. The FrobitPro robot is capable of carrying larger sensors such as RTK- GNSS, LIDAR and 3d stereo vision cameras. The platform supports interchangeable wheels for accurate indoor driving as well...
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.
Van Boven, J.F.M.; Oosterhof, P.; Hiddink, E.G.; Stuurman-Bieze, A.G.G.; Postma, M.J.; Vegter, S.
OBJECTIVES: Increasing real-life adherence to bisphosphonates therapy is important to achieve the clinical benefits of reducing fractures reported in randomized clinical trials (RCTs). The aim of this pharmacoeconomic analysis was to determine the cost-effectiveness of a pharmaceutical care
Blakely, Tony; Cobiac, Linda J.; Cleghorn, Christine L.; Pearson, Amber L.; van der Deen, Frederieke S.; Kvizhinadze, Giorgi; Nghiem, Nhung; McLeod, Melissa; Wilson, Nick
Background Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 [“business as usual,” BAU]), in a country (New Zealand) with large ethnic inequalities in smoking-related and noncommunicable disease (NCD) burden. Methods and Findings We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs) gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million). A total of 260,000 (95% uncertainty interval [UI]: 155,000–419,000) QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000). QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population) compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41%) less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45–64-y-old women (3.01%). As with all such modeling, there were limitations pertaining to the model structure and input parameters. Conclusions Ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD
van Esch, Thamar E M; Brabers, Anne E M; van Dijk, Christel E; Gusdorf, Lisette; Groenewegen, Peter P; de Jong, Judith D
The compulsory deductible, a form of patient cost-sharing in the Netherlands, has more than doubled during the past years. There are indications that as a result, refraining from medical care has increased. We studied the relation between patient cost-sharing and refraining from medical care by evaluating noncompliance with referrals to medical specialists over several years. Noncompliance with specialty referrals was assessed in the Netherlands from 2008 until 2013, using routinely recorded referrals from general practitioners to medical specialists and claims from medical specialists to health insurers. Associations with patient characteristics were estimated using multilevel logistic regression analyses. Noncompliance rates were approximately stable from 2008 to 2010 and increased from 18% in 2010 to 27% in 2013. Noncompliance was highest in adults aged 25-39 years. The increase was highest in children and patients with chronic diseases. No significantly higher increase among patients from urban deprived areas was found. Noncompliance increased during the rise of the compulsory deductible. Our results do not suggest a one-to-one relationship between increased patient cost-sharing and noncompliance with specialty referrals. In order to develop effective policy for reducing noncompliance, it is advisable to focus on the mechanisms for noncompliance in the groups with the highest noncompliance rates (young adults) and with the highest increase in noncompliance (children and patients with chronic diseases). Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Hansen, Kristian S; Ndyomugyenyi, Richard; Magnussen, Pascal; Lal, Sham; Clarke, Siân E
In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision, allowances for CHWs and provision of mRDTs and ACTs. The opportunity costs of time utilised by CHWs were estimated based on self-reporting. Household costs of subsequent treatment-seeking at public health centres and private health providers were captured in a sample of households. mRDTs performed by CHWs was associated with large improvements in appropriate treatment of malaria in both transmission settings. This resulted in low incremental costs for the health sector at US$3.0 per appropriately treated child in the moderate-to-high transmission area. Higher incremental costs at US$13.3 were found in the low transmission area due to lower utilisation of CHW services and higher programme costs. Incremental costs from a societal perspective were marginally higher. The use of mRDTs by CHWs improved the targeting of ACTs to children with malaria and was likely to be considered a cost-effective intervention compared to a presumptive diagnosis in the moderate-to-high transmission area. In contrast to this, in the low transmission area with low attendance, RDT use by CHWs was
Grasso, Robert J.; West, Loyd A.; Holbrook, Nikki J.; Halkias, Demetrios G.; Paradise, Lois J.; Friedman, Herman
A newly developed rapid coagglutination test for identifying Haemophilus influenzae type b organisms isolated from clinical specimens correlated 100% with the slide agglutination test but was 100- to 200-fold more sensitive.
Kushniruk, Andre W; Borycki, Elizabeth M
The development of more usable and effective healthcare information systems has become a critical issue. In the software industry methodologies such as agile and iterative development processes have emerged to lead to more effective and usable systems. These approaches highlight focusing on user needs and promoting iterative and flexible development practices. Evaluation and testing of iterative agile development cycles is considered an important part of the agile methodology and iterative processes for system design and re-design. However, the issue of how to effectively integrate usability testing methods into rapid and flexible agile design cycles has remained to be fully explored. In this paper we describe our application of an approach known as low-cost rapid usability testing as it has been applied within agile system development in healthcare. The advantages of the integrative approach are described, along with current methodological considerations.
STEPHEN C. NEWBOLD; CHARLES GRIFFITHS; CHRIS MOORE; ANN WOLVERTON; ELIZABETH KOPITS
In this reply to the comment by Gerlagh, we confirm an error in our estimate of the certainty-equivalent social cost of carbon (SCC) reported in Newbold et al. (2013), and we discuss the underlying conceptual difficulties that arise in conducting a social welfare analysis when preferences are heterogeneous or uncertain. The certainty-equivalent SCC depends crucially on the reference level of per capita consumption used to normalize marginal utility across possible preference parameters, and o...
Schröder, Helmut; Serra-Majem, Luis; Subirana, Isaac; Izquierdo-Pulido, Maria; Fitó, Montserrat; Elosua, Roberto
Higher monetary diet cost is associated with healthier food choices and better weight management. How changes in diet cost affect changes in diet quality and weight remains unknown. The aim of this study was to assess the impact of changes in individual monetary diet cost on changes in diet quality, measured by the modified Mediterranean diet score recommendations (MDS-rec) and by energy density (ED), as well as changes in weight and BMI. We conducted a prospective, population-based study of 2181 male and female Spaniards aged between 25 and 74 years, who were followed up to the 2009-2010 academic year. We measured weight and height and recorded dietary data using a validated FFQ. Average food cost was calculated from official Spanish government data. We fitted multivariate linear and logistic regression models. The average daily diet cost increased from 3·68(SD0.0·89)€/8·36 MJ to 4·97(SD1·16)€/8·36 MJ during the study period. This increase was significantly associated with improvement in diet quality (Δ ED and Δ MDS-rec; Pcost per 8·36 MJ was associated with a decrease of 0·3 kg in body weight (P=0·02) and 0·1 kg/m(2) in BMI (P=0·04). These associations were attenuated after adjusting for changes in diet quality indicators. An improvement in diet quality and better weight management were both associated with an increase in diet cost; this could be considered in food policy decisions.
Winetsky, Daniel E.; Negoescu, Diana M.; DeMarchis, Emilia H.; Almukhamedova, Olga; Dooronbekova, Aizhan; Pulatov, Dilshod; Vezhnina, Natalia; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.
Background Prisons of the former Soviet Union (FSU) have high rates of multidrug-resistant tuberculosis (MDR-TB) and are thought to drive general population tuberculosis (TB) epidemics. Effective prison case detection, though employing more expensive technologies, may reduce long-term treatment costs and slow MDR-TB transmission. Methods and Findings We developed a dynamic transmission model of TB and drug resistance matched to the epidemiology and costs in FSU prisons. We evaluated eight strategies for TB screening and diagnosis involving, alone or in combination, self-referral, symptom screening, mass miniature radiography (MMR), and sputum PCR with probes for rifampin resistance (Xpert MTB/RIF). Over a 10-y horizon, we projected costs, quality-adjusted life years (QALYs), and TB and MDR-TB prevalence. Using sputum PCR as an annual primary screening tool among the general prison population most effectively reduced overall TB prevalence (from 2.78% to 2.31%) and MDR-TB prevalence (from 0.74% to 0.63%), and cost US$543/QALY for additional QALYs gained compared to MMR screening with sputum PCR reserved for rapid detection of MDR-TB. Adding sputum PCR to the currently used strategy of annual MMR screening was cost-saving over 10 y compared to MMR screening alone, but produced only a modest reduction in MDR-TB prevalence (from 0.74% to 0.69%) and had minimal effect on overall TB prevalence (from 2.78% to 2.74%). Strategies based on symptom screening alone were less effective and more expensive than MMR-based strategies. Study limitations included scarce primary TB time-series data in FSU prisons and uncertainties regarding screening test characteristics. Conclusions In prisons of the FSU, annual screening of the general inmate population with sputum PCR most effectively reduces TB and MDR-TB prevalence, doing so cost-effectively. If this approach is not feasible, the current strategy of annual MMR is both more effective and less expensive than strategies using self
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
Shen, Ying; Wu, Yiyun; Chen, Guangdi; Van Grinsven, Hans J M; Wang, Xiaofeng; Gu, Baojing; Lou, Xiaoming
China is experiencing severe and persistent air pollution, with concentrations of fine particulate matters (PM 2.5 ) reaching unprecedentedly high levels in many cities. Quantifying the detrimental effects on health and their costs derived from high PM 2.5 levels is crucial because of the unsolved challenges to mitigate air pollution in the following decades. Using the daily monitoring data on PM 2.5 concentrations and clinic visits, we found a non-linear increase of respiratory diseases, but not for other diseases (e.g., digestive diseases) under severe air pollution. We found an increase of respiratory diseases by 1% for each 10 μg m -3 increase in PM 2.5 when the annual average daily PM 2.5 concentration was less than 50 μg m -3 ; while this ratio was doubled (around 2%) with the daily PM 2.5 concentration larger than 50 μg m -3 . Under severe air pollution (PM 2.5 concentration >150 μg m -3 ), the respiratory diseases increased by over 50% compared to that in clean days. Children are more sensitive to the severe air pollution. The increase of clinic visits, especially for adults, was observed mainly in bigger (>500 beds) hospitals. Re-allocating medical resources (e.g., doctors) from big hospitals to community hospitals can benefit the respiratory patients due to air pollution. The total medical cost of clinic visits of respiratory diseases derived from PM 2.5 pollution was estimated at 17.2-57.0 billion Yuan in 2014 in China, accounting for 0.5-1.6% of national total health expenditure. Because these medical costs only represent a small part of total health cost derived from air pollution, the reduction of associated health costs would be an important co-benefit of implementation of air pollution preventive strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hansen, Kristian S; Ndyomugyenyi, Richard; Magnussen, Pascal
In Sub-Saharan Africa, malaria remains a major cause of morbidity and mortality among children under 5, due to lack of access to prompt and appropriate diagnosis and treatment. Many countries have scaled-up community health workers (CHWs) as a strategy towards improving access. The present study...... was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT......) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision...
Jayadev, Arjun; Stiglitz, Joseph
The pharmaceutical industry is undergoing a period of uncertainty. Profits are being squeezed by increasing costs and competitive pressures, and new drug production is slowing down. This Perspective reviews two policies that could assist in realigning incentives toward genuine innovation while also keeping drug spending growth under check. Value-based pricing can incentivize genuinely new discoveries and align research and development with social welfare. Public funding of clinical trials likewise can reduce both pharmaceutical costs and prices and direct research effort in a manner that is more socially productive than the current state of affairs.
Kidney transplantation is the best treatment option in comparison to dialysis, although patients are obliged to receive life-long medical treatment with immunosuppressive drugs (ISDs) for prevention of the graft rejection. Such immunosuppressive treatment may be costly and associated with multiple adverse effects. Since costs are viewed as one of the major constraints for the increasing number of transplantation, the use of generic ISDs may decrease the overall cost of transplantation and raise the possibility for its further development. An ideal ISD should have the security margin between toxic and therapeutic dose, and prevent development of acute or chronic rejection of the transplanted kidney. This is particularly important for drugs with a "narrow therapeutical index" (NTI), where small differences in dose or concentration lead to dose and concentration-dependent, serious therapeutic failures and/or adverse drug reactions. The NTI generic drug is approved if within 90%-112% of the area under the curve of the original product the pharmacokinetics fulfills the strict criteria of pharmaceutical equivalence and bioequivalence. Every generic has to be proven to be bioequivalent to the innovator product, and not to other generic products because of the possible generic "drift". Thus, the generic ISDs may be economically attractive, but theoretically, they may pose a risk to transplant patients. Such risks may be reduced if a long-term clinical studies showing cost-effectiveness of generic ISDs in de novo and prevalent transplant patients for every new generic ISD are performed. In conclusion, the increased number of solid organ transplantation goes in line with the increased health care expenditure for ISDs. The generic immunosuppressants could be a possible solution if safely substituted for innovator products or other generic drug of choice. The substantial cost reduction needs to be redirected into organ donation initiatives so that more patients can benefit
Zhang, Melvyn W B; Ho, Roger C M
There have been massive advances in E-Health and M-Health technology, with recent interest in the utility of games for healthcare and the promotion of well-being and recovery as well as patient empowerment. There has been various review demonstrating the clinical effectiveness and efficacy of games for healthcare. It is the aim of this technical note to illustrate how appropriate gaming engines could be used by non-expert clinicians to program games that could run across various platforms, as well as games that could integrate well with existing mechanical sensors. This would address the limitations with regards to the evidence base of games, as well as the limitations in the deployment of games to various participants. More importantly, games designed are also more likely to be cost-effective and lower in cost. The ability of integration with existing mechanical sensors would value-add existing games and enable recovery and remediation in various domains of health. This would further expand the potential of games as an adjunctive treatment for patients, or at least, to maintain the gains that they have made in their recovery process.
Sharma, Sanjiv; Saeed, Anwer; Johnson, Christopher; Gadegaard, Nikolaj; Cass, Anthony Eg
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.
Jagadish Chandra Tarafdar
Full Text Available Development of reliable and ecofriendly green approach for synthesis of metallic nanoparticles biologically is an important step in the field of application of nanoscience and nanotechnology. The present paper reports the green approach for iron nanoparticle synthesis using Aspergillus oryzae TFR9 using FeCl3 as a precursor metal salt. Valid characterization techniques employed for biosynthesized iron nanoparticles including dynamic light scattering (DLS, transmission electron microscopy (TEM, and high resolution-transmission electron microscopy (HR-TEM for morphological study. X-ray energy dispersive spectroscopy (EDS spectrum confirmed the presence of elemental iron signal in high percentage. Apart from ecofriendliness and easy availability, low-cost biomass production will be more advantageous when compared to other chemical methods. Biosynthesis of iron nanoparticles using fungus has greater commercial viability that it may be used in agriculture, biomedicals and engineering sector.
Asher Wolf, W; Huang, Kevin Z; Durban, Raquel; Iqbal, Zahra J; Robey, Benjamin S; Khalid, Farah J; Dellon, Evan S
The six-food elimination diet (SFED), where dairy, wheat, eggs, soy, nuts, and seafood are avoided, is an effective treatment for eosinophilic esophagitis (EoE). Patient-related costs of this approach, however, are unknown. We aimed to assess the cost of and ease of shopping for an SFED compared to an unrestricted diet. A dietitian with expertise in EoE generated menus meeting dietary requirements for a week's worth of meals for the SFED and an unrestricted diet. We compared prices and the number of missing items for both diets at standard and specialty grocery stores. The average weekly price of the SFED at a standard supermarket was $92.54 compared to $79.84 for an unrestricted diet (p = 0.0001). A patient shopping at a standard grocery store needed a higher proportion of items from a second store compared to an unrestricted diet (32 vs. 3 %, p = 0.0001). The prices of the SFED and unrestricted diet using a specialty supermarket were comparable ($106.47 vs. $105.96, p = 0.81), as was the percentage of items requiring a trip to a second store (6 vs. 2 % items, p = 0.03). Shopping at a specialty grocery store increased weekly grocery costs by $13.93 (p = 0.04) for the SFED and $26.12 (p = 0.03) for the unrestricted diet. In conclusion, for patients shopping at standard grocery stores, the cost of an SFED is higher, and an SFED requires more items from a second store. These differences disappear at specialty grocery stores, but costs were significantly higher. This cost and logistical burden can inform patients when selecting dietary therapy.
Doshi, Parag Mahendra
The final hurdle preventing widespread application of photovoltaics is cost-effectiveness. Solar cell efficiencies in the laboratory have reached 24%, but industrial cells, constrained by low-cost, high-throughput processes, are limited to 10-15%. This thesis focuses on industrially relevant technologies such as rapid thermal processing (RTP), PECVD, and screen-printing to simplify and speed up cell processing yet maintain the key features that give high efficiencies in the laboratory. RTP utilizes tungsten-halogen and UV lamps as a source of high energy photons that induce thermal and photophysical effects which can significantly increase the kinetics of semiconductor processes such as diffusion, oxidation, and annealing. PECVD also serves as a promising low-cost candidate for SiN/SiOsb2 antireflection coatings and passivation. Finally, screen printing serves as a very high-throughput technology for contact formation as a low-cost alternative to photolithography. Integration of these technologies into a single cell fabrication sequence, however, revealed the susceptibility to low internal quantum efficiencies in the long and short wavelengths. For example, the inherent rapid cooling during RTP can degrade minority-carrier lifetime and long wavelength response. Lack of knowledge in tailoring RTP emitter diffusion profiles coupled with less than perfect PECVD surface passivation and parasitic SiN absorption was found to limit short wavelength response. Problems like these limited RTP cell efficiencies to only 15.4% prior to this thesis. Through a combination of fundamental understanding of device physics, materials and device characterization, modeling, and cell fabrication these losses were quantified and overcome in this thesis. An in-situ annealing cycle during RTP was optimized to prevent quenching-induced lifetime degradation and to preserve high long wavelength response. Measurement of SiN extinction coefficients to compute parasitic absorption, optimization
Liu, Changchun; Mauk, Michael G; Hart, Robert; Bonizzoni, Mariangela; Yan, Guiyun; Bau, Haim H
Vector control is one of the most effective measures to prevent the transmission of malaria, a disease that causes over 600,000 deaths annually. Around 30-40 Anopheles mosquito species are natural vectors of malaria parasites. Some of these species cannot be morphologically distinguished, but have behavioral and ecological differences. Emblematic of this is the Anopheles gambiae species complex. The correct identification of vector species is fundamental to the development of control strategies and epidemiological studies of disease transmission. An inexpensive, disposable, field-deployable, sample-to-answer, microfluidic chip was designed, constructed, and tested for rapid molecular identification of Anopheles gambiae and Anopheles arabiensis. The chip contains three isothermal amplification reactors. One test reactor operates with specific primers to amplify Anopheles gambiae DNA, another with specific primers for Anopheles arabiensis DNA, and the third serves as a negative control. A mosquito leg was crushed on an isolation membrane. Two discs, laden with mosquito tissue, were punched out of the membrane and inserted into the two test chambers. The isolated, disc-bound DNA served as a template in the amplification processes. The amplification products were detected with intercalating fluorescent dye that was excited with a blue light-emitting diode. The emitted light was observed by eye and recorded with a cell-phone camera. When the target consisted of Anopheles gambiae, the reactor containing primers specific to An. gambiae lit up while the other two reactors remained dark. When the target consisted of Anopheles arabiensis, the reactor containing primers specific to An. arabiensis lit up while the other two reactors remained dark. The microfluidic chip provides a means to identify mosquito type through molecular analysis. It is suitable for field work, allowing one to track the geographical distribution of mosquito populations and community structure
Noel-Storr, J.; Cole, B. N.
We present three low cost educational technology tools that have been developed by the Rochester Institute of Technology Insight Lab. Our technology tools are designed with cost and "user-tinkerability" in mind, to increase the potential for technology-rich access to scientific data to be in the hands of a much larger slice of the population. The three tools presented are the Planeterrainium - A digital interactive floor projection system allowing users to explore the planets in 3D; the Digital Solar Explorer - a 5 foot inflatable sphere designed to allow for the exploration of solar imagery; and the Scube - a digital immersive tentware system. We describe projects that involve both undergraduate and high school students in the development of content for these systems, encouraging the growth of both scientific and technological literacy in the process.
Schill, Wolf-Peter; Pahle, Michael; Gambardella, Christian
The emerging literature on power markets with high shares of variable renewable energy sources suggests that the costs of more frequent start-ups of thermal power plants may become an increasing concern. Here we investigate how this develops in Germany, where the share of variable renewables is expected to grow from 14% in 2013 to 34% in 2030. We show that the overall number of start-ups grows by 81%, while respective costs increase by 119% in this period. Related to variable renewables' production, start-up costs increase by a mere €0.70 per additional megawatt hour. While the expansion of variable renewables alone would increase start-up costs, more flexible biomass power plants and additional power storage have counteracting effects. Yet changes in reserve provision and fuel prices increase start-up costs again. The relevance of start-up costs may grow further under continued renewable expansion, but could be mitigated by increasing system flexibility.
Rinaldi, Martina; Ranavolo, Alberto; Conforto, Silvia; Martino, Giovanni; Draicchio, Francesco; Conte, Carmela; Varrecchia, Tiwana; Bini, Fabiano; Casali, Carlo; Pierelli, Francesco; Serrao, Mariano
The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis. Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time-distance, kinematic, kinetic, and energetic parameters were estimated. Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery. Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity. Copyright © 2017 Elsevier Ltd. All rights reserved.
Pitt, H A; Gomes, A S; Lois, J F; Mann, L L; Deutsch, L S; Longmire, W P
Despite recent advances in perioperative support care, surgery for obstructive jaundice is still associated with significant morbidity and mortality. For this reason, preoperative percutaneous transhepatic drainage (PTD) has been recommended for these patients. This method of management, however, has only been supported by retrospective and nonrandomized studies. Therefore, a prospective, randomized study was performed to determine the effect of preoperative PTD on operative mortality, morbidity, hospital stay, and hospital cost. Thirty-day mortality was 8.1% among 37 patients undergoing preoperative PTD, compared to 5.3% for 38 patients who went to surgery without preoperative drainage. Overall morbidity was also slightly, but not significantly, higher in patients who underwent preoperative PTD, (57% versus 53%). However, total hospital stay was significantly longer (p less than 0.005) in the PTD group (31.4 days versus 23.1 days). The cost of this excess hospitalization and the PTD procedure at our university medical center was over +8000 per patient. The authors conclude that preoperative PTD does not reduce operative risk but does increase hospital cost and, therefore, should not be performed routinely. PMID:2986562
Wall-Scheffler, C M; Geiger, K; Steudel-Numbers, K L
Among the costs of reproduction, carrying one's infant incurs one of the greatest drains on maternal energy, simply because of the added mass alone. Because of the dearth of archaeological evidence, however, how early bipeds dealt with the additional cost of having to carry infants who were less able to support their body weight against gravity is not particularly well understood. This article presents evidence on the caloric drain of carrying an infant in one's arms versus having a tool with which to sling the infant and carry her passively. The burden of carrying an infant in one's arms is on average 16% greater than having a tool to support the baby's mass and seems to have the potential to be a greater energetic burden even than lactation. In addition, carrying a baby in one's arms shortens and quickens the stride. An anthropometric trait that seems to offset some of the increased cost of carrying a baby in the arms is a wider bi-trochanteric width.
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.
Lon M Chubiz
Full Text Available Understanding evolutionary dynamics within microbial populations requires the ability to accurately follow allele frequencies through time. Here we present a rapid, cost-effective method (FREQ-Seq that leverages Illumina next-generation sequencing for localized, quantitative allele frequency detection. Analogous to RNA-Seq, FREQ-Seq relies upon counts from the >10(5 reads generated per locus per time-point to determine allele frequencies. Loci of interest are directly amplified from a mixed population via two rounds of PCR using inexpensive, user-designed oligonucleotides and a bar-coded bridging primer system that can be regenerated in-house. The resulting bar-coded PCR products contain the adapters needed for Illumina sequencing, eliminating further library preparation. We demonstrate the utility of FREQ-Seq by determining the order and dynamics of beneficial alleles that arose as a microbial population, founded with an engineered strain of Methylobacterium, evolved to grow on methanol. Quantifying allele frequencies with minimal bias down to 1% abundance allowed effective analysis of SNPs, small in-dels and insertions of transposable elements. Our data reveal large-scale clonal interference during the early stages of adaptation and illustrate the utility of FREQ-Seq as a cost-effective tool for tracking allele frequencies in populations.
Liu, Xiaozhu; Cheng, Cheng; Wu, Jayne; Eda, Shigetoshi; Guo, Yongcai
Specific detection of protein biomarkers has a wide range of applications in areas such as medical science, diagnostics, and pharmacology. Quantitative detection of protein biomarkers in biological media, such as serum, is critically important in detecting disease or physiological malfunction, or tracking disease progression. Among various detection methods, electrical detection is particularly well suited for point-of-care (POC) specific protein detection, being of low cost, light weight and small form factor. A portable system for sensitive and quantitative detection of protein biomarkers will be highly valuable in controlling and preventing diseases outbreaks. Recently, an alternating current electrokinetic (ACEK) capacitive sensing method has been reported to demonstrate very promising performance on rapid and sensitive detection of specific protein from serum. In this work, a low cost and portable analyzer with good accuracy is developed to use with ACEK capacitive sensing to produce a true POC technology. The development of a board-level capacitance readout system is presented, as well as the adaption of the protocol for use with ACEK capacitive sensing. Results showed that the developed system could achieve a limit of detection of 10ng/mL, comparable to a sophisticated benchtop instrument. With its small size and light-weight similar to a smart phone, the developed system is ready to be applicable to POC diagnostics. Further, the readout system can be readily expanded for multichannel monitoring and telecommunication capabilities. Copyright © 2016 Elsevier B.V. All rights reserved.
Albrechtsen, Hans-Jørgen; Gülay, Arda; Lee, Carson
The aim of this research project is to improve our knowledge on biological rapid sand filters as they are present in thousands groundwater based water works. This includes molecular investigations of the microorganisms responsible for the individual processes (e.g. nitrification); and detailed...... monitoring and experiments in the filters and laboratory to provide insight in the process mechanisms, kinetics and effect of environmental factors. Management of the filters (e.g. backwashing, flow rate, carrier type) will be investigated at pilot and full scale, supported by mathematical models...... investigated by deep sequencing. This will also contribute to a verification of whether the selected qPCR probes include all important groups. Filters from three water works have been sampled and are currently being processed to investigate depth profiles and horizontal variation in filters. Assays...
Considine, Julie; Lucas, Elspeth; Martin, Roslyn; Stergiou, Helen E; Kropman, Matthew; Chiu, Herman
The impact of emergency nursing roles in demand management systems is poorly understood. The aim of this study was to evaluate emergency nurses' role in a specific emergency department (ED) demand management system: rapid intervention and treatment zone (RITZ). A descriptive exploratory approach was used. Data were collected from audit of 193 randomly selected patient records and 12 h of clinical practice observation. The median age of participants was 31 years, 51.8% were males and 99.5% were discharged home. Nurse qualifications or seniority had no significant effect on waiting time or length of stay (LOS). There were disparities between documented and observed nursing practice. The designation and qualifications of RITZ nurses made little difference to waiting times and ED LOS. Specific documentation and communication systems for areas of the ED that manage large numbers of low complexity patients warrant further research. © 2012 Blackwell Publishing Asia Pty Ltd.
McCray, Sally; Maunder, Kirsty; Krikowa, Renee; MacKenzie-Shalders, Kristen
Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ 2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ 2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ 2 used for the plate waste analysis. Significance was assessed at Pservice compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0.005) and protein (52 g/day vs 66 g/day, P=0.003) intake, as well as energy and protein intake as a percentage of requirements (63% vs 75%; P=0.024 and
Dallat, Mary Anne T; Soerjomataram, Isabelle; Hunter, Ruth F; Tully, Mark A; Cairns, Karen J; Kee, Frank
For many, physical activity has been engineered out of daily life, leading to high levels of sedentariness and obesity. Multi-faceted physical activity interventions, combining individual, community and environmental approaches, have the greatest potential to improve public health, but few have been evaluated. Approximately 100,000 people may benefit from improved opportunities for physical activity through an urban regeneration project in Northern Ireland, the Connswater Community Greenway. Using the macro-simulation PREVENT model, we estimated its potential health impacts and cost-effectiveness. To do so, we modelled its potential impact on the burden from cardiovascular disease, namely, ischaemic heart disease, type 2 diabetes mellitus and stroke, and colon and breast cancer, by the year 2050, if feasible increases in physical activity were to be achieved. If 10% of those classified as 'inactive' (perform less than 150 minutes of moderate activity/week) became 'active', 886 incident cases (1.2%) and 75 deaths (0.9%) could be prevented with an incremental cost-effectiveness ratio of £4469/disability-adjusted life year. For effectiveness estimates as low as 2%, the intervention would remain cost-effective (£18 411/disability-adjusted life year). Small gains in average life expectancy and disability-adjusted life expectancy could be achieved, and the Greenway population would benefit from 46 less years lived with disability. The Greenway intervention could be cost-effective at improving physical activity levels. Although the direct health gains are predicted to be small for any individual, summed over an entire population, they are substantial. In addition, the Greenway is likely to have much wider benefits beyond health.
Housley, S N; Garlow, A R; Ducote, K; Howard, A; Thomas, T; Wu, D; Richards, K; Butler, A J
An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation. Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy. Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy. Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care.
Dong, Meili; Wu, Jiandong; Ma, Zimin; Peretz-Soroka, Hagit; Zhang, Michael; Komenda, Paul; Tangri, Navdeep; Liu, Yong; Rigatto, Claudio; Lin, Francis
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.
Maresh, Jennifer L; Simmons, Samantha E; Crocker, Daniel E
Widely ranging marine predators often adopt stereotyped, energy-saving behaviours to minimize the energetic cost of transport while maximizing energy gain. Environmental and anthropogenic disturbances can disrupt energy balance by prompting avoidance behaviours that increase transport costs......, thereby decreasing foraging efficiency. We examined the ability of 12 free-ranging, juvenile northern elephant seals (Mirounga angustirostris) to mitigate the effects of experimentally increased transport costs by modifying their behaviour and/or energy use in a compensatory manner. Under normal...
Ross, Ashley E.; Nguyen, Michael D.; Privman, Eve; Venton, B. Jill
Mechanical perturbations can release ATP, which is broken down to adenosine. In this work, we used carbon-fiber microelectrodes and fast-scan cyclic voltammetry to measure mechanically-stimulated adenosine in the brain by lowering the electrode 50 μm. Mechanical stimulation evoked adenosine in vivo (average: 3.3 ± 0.6 μM) and in brain slices (average: 0.8 ± 0.1 μM) in the prefrontal cortex. The release was transient, lasting 18 ± 2 s. Lowering a 15 μm diameter glass pipette near the carbon-fiber microelectrode produced similar results as lowering the actual microelectrode. However, applying a small puff of artificial cerebral spinal fluid was not sufficient to evoke adenosine. Multiple stimulations within a 50 μm region of a slice did not significantly change over time or damage cells. Chelating calcium with EDTA or blocking sodium channels with tetrodotoxin (TTX) significantly decreased mechanically evoked adenosine, signifying that the release is activity-dependent. An alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA) receptor antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), did not affect mechanically-stimulated adenosine; however, the nucleoside triphosphate diphosphohydrolase 1,2 and 3 (NTDPase) inhibitor POM-1 significantly reduced adenosine so a portion of adenosine is dependent on extracellular ATP metabolism. Thus, mechanical perturbations from inserting a probe in the brain cause rapid, transient adenosine signaling which might be neuroprotective. PMID:24606335
Facente, Shelley N; Dowling, Teri; Vittinghoff, Eric; Sykes, Deanna L; Colfax, Grant N
Because a recent cluster of false positive results on the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test occurred in San Francisco on test kits close to their expiration date, we decided to assess the relationship between time to expiration and rate of false positive results from tests used with oral fluid. We analyzed results of 20,904 tests with either an initial HIV-negative result (n = 20,828) or a preliminary positive result that was then negative on confirmatory tests (n = 76). We computed specificity for kits with time to expiration from or = 6 months, with exact binomial confidence intervals, then used logistic regression to estimate the independent association of time to expiration with false positive results, adjusting for site and technician effects. For 1,108 kits used in the last month before expiration, specificity was 98.83% (95% exact binomial confidence interval (CI) 98.00%-99.37%); the upper bound is below the claimed specificity of 99.60%. After adjustment using regression standardization for the effects of site, test lot, and technician factors, adjusted specificity in the last month before expiration was 99.18% (95% bootstrap confidence interval 98.60-99.57%). We found that specificity of the OraQuick ADVANCE with oral fluid declined significantly with < or = 1 month remaining to expiration, leaving little margin for error from other sources.
Emma C Wootton
Full Text Available Marine reserves (or No-Take Zones are implemented to protect species and habitats, with the aim of restoring a balanced ecosystem. Although the benefits of marine reserves are commonly monitored, there is a lack of insight into the potential detriments of such highly protected waters. High population densities attained within reserves may induce negative impacts such as unfavourable trophic cascades and disease outbreaks. Hence, we investigated the health of lobster populations in the UK's Marine Conservation Zone (MCZ at Lundy Island. Comparisons were made between the fished, Refuge Zone (RZ and the un-fished, No-Take Zone (NTZ; marine reserve. We show ostensibly positive effects such as increased lobster abundance and size within the NTZ; however, we also demonstrate apparent negative effects such as increased injury and shell disease. Our findings suggest that robust cost-benefit analyses of marine reserves could improve marine reserve efficacy and subsequent management strategies.
Haastrup, Peter; Paulsen, Maja Skov; Zwisler, Jon Eik
2001-2011 and to assess the impacts of interventions on prescribing of antisecretory medication. Methods: Register-based cohort study covering the entire Danish population of currently 5.5 million inhabitants. Developments in the prescribing of antisecretory medication over time in Denmark between 2001...... increased substantially during the past decade. Both number of users and the average individual use have increased. The prescribing of ulcerogenic drugs to the elderly has stagnated in the same time range. Reimbursement modifications and scientific guidelines do not seem to have had a substantial influence...... on the steadily increasing prescribing of PPIs. Conclusion: Use of PPIs has increased substantially during the past decade, without a change in indications for use of PPIs in the same time range. Interventions to enhance adherence to guidelines and promote rational use of PPIs do not seem to have had...
Knowles, N R; Ries, S K
Triacontanol (TRIA) increased fresh and dry weight and total reducible nitrogen (total N) of rice (Oryza sativa L.) seedlings within 40 minutes. Increases in total N in the supernatants from homogenates of corn (Zea mays L.) and rice leaves treated with TRIA for one minute before grinding occurred within 30 and 80 minutes, respectively. The source for the increase was investigated utilizing atmospheric substitution and enrichment and depletion studies with (15)N. The increase in total N in seedlings was shown to be independent of method of N analysis and the presence of nitrate in the plants. Automated Kjeldahl determinations showing apparent increases in N composition due to TRIA were shown to be correlated with hand Kjeldahl, elemental analysis, and chemiluminescent analysis in three independent laboratories. TRIA did not alter the nitrate uptake or endogenous levels of nitrate in corn and rice seedlings. Enrichment experiments revealed that the total N increases in rice seedlings, in vivo, and in supernatants of corn leaf homogenates, in vitro, are not due to atmospheric N(2). TRIA increased the soluble N pools of the plants, specifically the free amino acid and soluble protein fractions. No differences in depletion or enrichment of (15)N incorporated into soluble and insoluble N fractions of rice seedlings could be detected on an atom per cent (15)N basis. The apparent short-term total N increases cannot be explained by current knowledge of major N assimilation pathways. TRIA may stimulate a change in the chemical composition of the seedlings, resulting in interference with standard methods of N analysis.
Rowe, Benjamin; Schmidt, James J; Smith, Leonard A; Ahmed, S Ashraf
The ultimate molecular action of botulinum neurotoxin (BoNT) is a Zn-dependent endoproteolytic activity on one of the three SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptor) proteins. There are seven serotypes (A-G) of BoNT having distinct cleavage sites on the SNARE substrates. The proteolytic activity is located on the N-terminal light chain (Lc) domain and is used extensively as the primary target toward therapeutic development against botulism. Here we describe an improved method using ultra-performance liquid chromatography (UPLC) whereby quantitative data were obtained in 1/10th the time using 1/20th the sample and solvent volumes compared with a widely used high-performance liquid chromatography (HPLC) method. We also synthesized a VAMP (vesicle-associated membrane protein)-based peptide containing an intact V1 motif that was efficiently used as a substrate by BoNT/D Lc. Although serotype C1 cleaves the serotype A substrate at a bond separated by only one residue, we were able to distinguish the two reactions by UPLC. The new method can accurately quantify as low as 7 pmol of the peptide substrates for BoNT serotypes A, B, C1, and D. We also report here that the catalytic efficiency of serotype A can be stimulated 35-fold by the addition of Triton X-100 to the reaction mixture. Combining the use of Triton X-100 with the newly introduced UPLC method, we were able to accurately detect very low levels of proteolytic activity in a very short time. Sensitivity of the assay and accuracy and rapidity of product analysis should greatly augment efforts in therapeutic development.
Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding
BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...
Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding
BACKGROUND: Inhibition of the quadriceps muscle and reduced knee-extension strength is common shortly following total knee arthroplasty (weeks to months), due to reduced voluntary activation of the quadriceps muscle. In healthy subjects, strength training with heavy loads is known to increase ago...
Wu, Sze-jung; Sylwestrzak, Gosia; Shah, Christiane; DeVries, Andrea
To encourage patients to select high-value providers, an insurer-initiated price transparency program that focused on elective advanced imaging procedures was implemented. Patients having at least one outpatient magnetic resonance imaging (MRI) scan in 2010 or 2012 were divided according to their membership in commercial health plans participating in the program (the intervention group) or in nonparticipating commercial health plans (the reference group) in similar US geographic regions. Patients in the intervention group were informed of price differences among available MRI facilities and given the option of selecting different providers. For those patients, the program resulted in a $220 cost reduction (18.7 percent) per test and a decrease in use of hospital-based facilities from 53 percent in 2010 to 45 percent in 2012. Price variation between hospital and nonhospital facilities for the intervention group was reduced by 30 percent after implementation. Nonparticipating members residing in intervention areas also observed price reductions, which indicates increased price competition among providers. The program significantly reduced imaging costs. This suggests that patients select lower-price facilities when informed about available alternatives. Project HOPE—The People-to-People Health Foundation, Inc.
James Wohlpart, Ph.D.
Full Text Available The appropriate use of technology to enhance learning and reduce costs has become a focal point in the discussion of online learning. Significantly, the use of robust teaching and learning platforms, along with videoconferencing and other technological tools, allows for a wide variety of course redesigns that range from the incorporation of online materials into traditional courses to teaching courses fully online. The purpose of this paper is to discuss the use of technology in general education introductory arts and arts appreciation courses, with a particular focus on increasing learning and reducing costs. We describe the successful redesign of a required general education course entitled Understanding the Visual and Performing Arts into a fully online course. Several unique characteristics of the course such as the use of an alternative staffing model, of computer graded practice tests, and of computer graded short essays were particularly effective in the redesign and could be duplicated in other courses even outside the arts. The paper concludes with a discussion of the improved learning that has occurred since the redesign was completed.
Bailey, Andy M.; Alberti, Fabrizio; Kilaru, Sreedhar; Collins, Catherine M.; de Mattos-Shipley, Kate; Hartley, Amanda J.; Hayes, Patrick; Griffin, Alison; Lazarus, Colin M.; Cox, Russell J.; Willis, Christine L.; O'Dwyer, Karen; Spence, David W.; Foster, Gary D.
Semi-synthetic derivatives of the tricyclic diterpene antibiotic pleuromutilin from the basidiomycete Clitopilus passeckerianus are important in combatting bacterial infections in human and veterinary medicine. These compounds belong to the only new class of antibiotics for human applications, with novel mode of action and lack of cross-resistance, representing a class with great potential. Basidiomycete fungi, being dikaryotic, are not generally amenable to strain improvement. We report identification of the seven-gene pleuromutilin gene cluster and verify that using various targeted approaches aimed at increasing antibiotic production in C. passeckerianus, no improvement in yield was achieved. The seven-gene pleuromutilin cluster was reconstructed within Aspergillus oryzae giving production of pleuromutilin in an ascomycete, with a significant increase (2106%) in production. This is the first gene cluster from a basidiomycete to be successfully expressed in an ascomycete, and paves the way for the exploitation of a metabolically rich but traditionally overlooked group of fungi.
Aslan T Turer
Full Text Available To determine whether increases in cardiac work lead to alterations in the plasma metabolome and whether such changes arise from the heart or peripheral organs.There is growing evidence that the heart influences systemic metabolism through endocrine effects and affecting pathways involved in energy homeostasis.Nineteen patients referred for cardiac catheterization were enrolled. Peripheral and selective coronary sinus (CS blood sampling was performed at serial timepoints following the initiation of pacing, and metabolite profiling was performed by liquid chromatography-mass spectrometry (LC-MS.Pacing-stress resulted in a 225% increase in the median rate·pressure product from baseline. Increased myocardial work induced significant changes in the peripheral concentration of 43 of 125 metabolites assayed, including large changes in purine [adenosine (+99%, p = 0.006, ADP (+42%, p = 0.01, AMP (+79%, p = 0.004, GDP (+69%, p = 0.003, GMP (+58%, p = 0.01, IMP (+50%, p = 0.03, xanthine (+61%, p = 0.0006], and several bile acid metabolites. The CS changes in metabolites qualitatively mirrored those in the peripheral blood in both timing and magnitude, suggesting the heart was not the major source of the metabolite release.Isolated increases in myocardial work can induce changes in the plasma metabolome, but these changes do not appear to be directly cardiac in origin. A number of these dynamic metabolites have known signaling functions. Our study provides additional evidence to a growing body of literature on metabolic 'cross-talk' between the heart and other organs.
Full Text Available Long-term phase shifts from coral to macroalgal dominated reef systems are well documented in the Caribbean. Although the impact of coral diseases, climate change and other factors is acknowledged, major herbivore loss through disease and overfishing is often assigned a primary role. However, direct evidence for the link between herbivore abundance, macroalgal and coral cover is sparse, particularly over broad spatial scales. In this study we use a database of coral reef surveys performed at 85 sites along the Mesoamerican Reef of Mexico, Belize, Guatemala and Honduras, to examine potential ecological links by tracking site trajectories over the period 2005–2014. Despite the long-term reduction of herbivory capacity reported across the Caribbean, the Mesoamerican Reef region displayed relatively low macroalgal cover at the onset of the study. Subsequently, increasing fleshy macroalgal cover was pervasive. Herbivorous fish populations were not responsible for this trend as fleshy macroalgal cover change was not correlated with initial herbivorous fish biomass or change, and the majority of sites experienced increases in macroalgae browser biomass. This contrasts the coral reef top-down herbivore control paradigm and suggests the role of external factors in making environmental conditions more favourable for algae. Increasing macroalgal cover typically suppresses ecosystem services and leads to degraded reef systems. Consequently, policy makers and local coral reef managers should reassess the focus on herbivorous fish protection and consider complementary measures such as watershed management in order to arrest this trend.
Munazah Fazal Qureshi
Full Text Available Increased bodily CO2 concentration alters cellular pH as well as sleep. The proton pump, which plays an important role in the homeostatic regulation of cellular pH, therefore, may modulate sleep. We investigated the effects of the proton pump inhibitor “lansoprazole” on sleep-wakefulness. Male Wistar rats were surgically prepared for chronic polysomnographic recordings. Two different doses of lansoprazole (low: 1 mg/kg; high: 10 mg/kg were injected intraperitoneally in the same animal (n=7 and sleep-wakefulness was recorded for 6 hrs. The changes in sleep-wakefulness were compared statistically. Percent REM sleep amount in the vehicle and lansoprazole low dose groups was 9.26±1.03 and 9.09±0.54, respectively, which increased significantly in the lansoprazole high dose group by 31.75% (from vehicle and 34.21% (from low dose. Also, REM sleep episode numbers significantly increased in lansoprazole high dose group. Further, the sodium-hydrogen exchanger blocker “amiloride” (10 mg/kg; i.p. (n=5 did not alter sleep-wake architecture. Our results suggest that the proton pump plays an important role in REM sleep modulation and supports our view that REM sleep might act as a sentinel to help maintain normal CO2 level for unperturbed sleep.
Gopalappa, Chaitra; Farnham, Paul G; Hutchinson, Angela B; Sansom, Stephanie L
One of the goals of the National HIV/AIDS Strategy (NHAS) is to increase the proportion of HIV-infected individuals linked to care within 3 months of diagnosis (early linkage) from 65% to 85%. Earlier access to care, and eventually, to treatment, increases life expectancy and quality of life for HIV-infected persons. However, longer treatment is also associated with higher costs, especially for antiretroviral drugs. We evaluated the cost effectiveness of achieving the NHAS goal and estimated the maximum cost that HIV programs could spend on linkage to care and remain cost effective. We used the Progression and Transmission of HIV/AIDS model to estimate the effects on life measures and costs associated with increasing early linkage to care from 65% to 85%. We estimated an incremental cost-effectiveness ratio as the additional cost required to reach the target divided by the quality-adjusted life years (QALYs) gained and assumed that programs costing $100,000 or less per QALY gained are cost effective. Achieving the NHAS linkage-to-care goal increased life expectancy by 0.4 years and delayed the onset of AIDS by 1.2 years on average for every HIV-diagnosed person. Increasing early linkage to care cost an extra $62,200 per QALY gained, considering only benefits to index persons. The maximum that could be cost effectively spent on early linkage-to-care interventions was approximately $5100 per HIV-diagnosed person. Considerable investment can be cost effectively made to achieve the NHAS goal on early linkage to care.
Hossack, Blake R; Lowe, Winsor H; Corn, Paul Stephen
Climate change is expected to increase the frequency and severity of drought and wildfire. Aquatic and moisture-sensitive species, such as amphibians, may be particularly vulnerable to these modified disturbance regimes because large wildfires often occur during extended droughts and thus may compound environmental threats. However, understanding of the effects of wildfires on amphibians in forests with long fire-return intervals is limited. Numerous stand-replacing wildfires have occurred since 1988 in Glacier National Park (Montana, U.S.A.), where we have conducted long-term monitoring of amphibians. We measured responses of 3 amphibian species to fires of different sizes, severity, and age in a small geographic area with uniform management. We used data from wetlands associated with 6 wildfires that burned between 1988 and 2003 to evaluate whether burn extent and severity and interactions between wildfire and wetland isolation affected the distribution of breeding populations. We measured responses with models that accounted for imperfect detection to estimate occupancy during prefire (0-4 years) and different postfire recovery periods. For the long-toed salamander (Ambystoma macrodactylum) and Columbia spotted frog (Rana luteiventris), occupancy was not affected for 6 years after wildfire. But 7-21 years after wildfire, occupancy for both species decreased ≥ 25% in areas where >50% of the forest within 500 m of wetlands burned. In contrast, occupancy of the boreal toad (Anaxyrus boreas) tripled in the 3 years after low-elevation forests burned. This increase in occupancy was followed by a gradual decline. Our results show that accounting for magnitude of change and time lags is critical to understanding population dynamics of amphibians after large disturbances. Our results also inform understanding of the potential threat of increases in wildfire frequency or severity to amphibians in the region. ©2012 Society for Conservation Biology.
Hossack, Blake R.; Lowe, Winsor H.; Corn, Paul Stephen
Climate change is expected to increase the frequency and severity of drought and wildfire. Aquatic and moisture-sensitive species, such as amphibians, may be particularly vulnerable to these modified disturbance regimes because large wildfires often occur during extended droughts and thus may compound environmental threats. However, understanding of the effects of wildfires on amphibians in forests with long fire-return intervals is limited. Numerous stand-replacing wildfires have occurred since 1988 in Glacier National Park (Montana, U.S.A.), where we have conducted long-term monitoring of amphibians. We measured responses of 3 amphibian species to fires of different sizes, severity, and age in a small geographic area with uniform management. We used data from wetlands associated with 6 wildfires that burned between 1988 and 2003 to evaluate whether burn extent and severity and interactions between wildfire and wetland isolation affected the distribution of breeding populations. We measured responses with models that accounted for imperfect detection to estimate occupancy during prefire (0-4 years) and different postfire recovery periods. For the long-toed salamander (Ambystoma macrodactylum) and Columbia spotted frog (Rana luteiventris), occupancy was not affected for 6 years after wildfire. But 7-21 years after wildfire, occupancy for both species decreased ≥ 25% in areas where >50% of the forest within 500 m of wetlands burned. In contrast, occupancy of the boreal toad (Anaxyrus boreas) tripled in the 3 years after low-elevation forests burned. This increase in occupancy was followed by a gradual decline. Our results show that accounting for magnitude of change and time lags is critical to understanding population dynamics of amphibians after large disturbances. Our results also inform understanding of the potential threat of increases in wildfire frequency or severity to amphibians in the region.
Markham, Michael R; Kaczmarek, Leonard K; Zakon, Harold H
We investigated the ionic mechanisms that allow dynamic regulation of action potential (AP) amplitude as a means of regulating energetic costs of AP signaling. Weakly electric fish generate an electric organ discharge (EOD) by summing the APs of their electric organ cells (electrocytes). Some electric fish increase AP amplitude during active periods or social interactions and decrease AP amplitude when inactive, regulated by melanocortin peptide hormones. This modulates signal amplitude and conserves energy. The gymnotiform Eigenmannia virescens generates EODs at frequencies that can exceed 500 Hz, which is energetically challenging. We examined how E. virescens meets that challenge. E. virescens electrocytes exhibit a voltage-gated Na(+) current (I(Na)) with extremely rapid recovery from inactivation (τ(recov) = 0.3 ms) allowing complete recovery of Na(+) current between APs even in fish with the highest EOD frequencies. Electrocytes also possess an inwardly rectifying K(+) current and a Na(+)-activated K(+) current (I(KNa)), the latter not yet identified in any gymnotiform species. In vitro application of melanocortins increases electrocyte AP amplitude and the magnitudes of all three currents, but increased I(KNa) is a function of enhanced Na(+) influx. Numerical simulations suggest that changing I(Na) magnitude produces corresponding changes in AP amplitude and that K(Na) channels increase AP energy efficiency (10-30% less Na(+) influx/AP) over model cells with only voltage-gated K(+) channels. These findings suggest the possibility that E. virescens reduces the energetic demands of high-frequency APs through rapidly recovering Na(+) channels and the novel use of KNa channels to maximize AP amplitude at a given Na(+) conductance.
Full Text Available Recombinant adeno-associated viruses (rAAV are largely used for gene transfer in research, preclinical developments, and clinical trials. Their broad in vivo biodistribution and long-term efficacy in postmitotic tissues make them good candidates for numerous gene transfer applications. Upstream processes able to produce large amounts of rAAV were developed, particularly those using baculovirus expression vector system. In parallel, downstream processes present a large panel of purification methods, often including multiple and time consuming steps. Here, we show that simple tangential flow filtration, coupled with an optimized iodixanol-based isopycnic density gradient, is sufficient to purify several liters of crude lysate produced by baculovirus expression vector system in only one working day, leading to high titers and good purity of rAAV products. Moreover, we show that the viral vectors retain their in vitro and in vivo functionalities. Our results demonstrate that simple, rapid, and relatively low-cost methods can easily be implemented for obtaining a high-quality grade of gene therapy products based on rAAV technology.
Chen, Weiye; Wen, Zhiyuan; Zhang, Jialin; Li, Cuicui; Huang, Kehe; Bu, Zhigao
The methods of the quantitative assay of the antiviral activity of interferons (IFNs) (type I, II or III) are very important during carrying out of the research of them, since they were found. Here a recombinant vesicular stomatitis virus expressing green fluorescent protein (GFP) (VSV/GFP) and MDBK cells were used to develop an antiviral assay (AVA) for IFNs. This method was carried out on a 96-well cell culture plate, and the half reduction of virus replication was quantified by assaying GFP. To quantify GFP, cell lysis buffer was directly added to the wells infected with VSV/GFP to lyse cells, the VSV/GFP was then inactivated, and relative fluorescence unit (RFU) of GFP was measured and used to calculate the antiviral activity. This method needed only one step instead of three steps in the staining method with naphthol blue black, medium with phenol red can be used, and it had good reproducibility. The GFP-containing samples could be stored at 4°C in a wet box for at least 1 week without affecting the assay results. In addition, the results obtained with this method were similar to those obtained with the staining method. In conclusion, a safe, rapid, convenient and low-cost AVA of IFN based on recombinant VSV/GFP was established. Copyright © 2017. Published by Elsevier B.V.
Diefenbach, Angela K.; Crider, Juliet G.; Schilling, Steve P.; Dzurisin, Daniel
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.
Lindenberger, U; Marsiske, M; Baltes, P B
The dual task of memorizing word lists while walking was predicted to become more difficult with age because balance and gait are in greater need of "attentional resources." Forty-seven young (ages 20-30 years), 45 middle-aged (40-50), and 48 old (60-70) adults were trained to criterion in a mnemonic technique and instructed to walk quickly and accurately on 2 narrow tracks of different path complexity. Then. participants encoded the word lists while sitting, standing, or walking on either track; likewise, speed and accuracy of walking performance were assessed with and without concurrent memory encoding. Dual-task costs increased with age in both domains; relative to young adults, the effect size of the overall increase was 0.98 standard deviation units for middle-aged and 1.47 standard deviation units for old adults. It is argued that sensory and motor aspects of behavior are increasingly in need of cognitive control with advancing age.
Kervinen, K.; Savolainen, J.J.; Kesaeniemi, Y.A. (Univ. of Oulu (Finland))
Plasma concentrations of lipoprotein (a) (Lp(a)) were studied in 11 male alcoholics at the end of a drinking period and monitored during subsequent abstinence. Lp(a) levels showed a daily increase for four consecutive days after the beginning of abstinence, the values for the third and the fourth day being significantly higher than those of the first day. The changes in Lp(a) showed no association with the changes in low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol levels. In one alcoholic subject with a heterozygous form of familial hypercholesterolemia who was monitored for 11 days, the Lp(a) levels rose up to the fourth day and remained at a high level thereafter. These results suggest that ethanol ingestion may be associated with a lower of Lp(a) levels, which may contribute to the delayed progression of atherosclerosis observed in alcohol drinkers.
Zimmerman, E.G.; Richmond, M.C.
Populations of a common forage fish, red shiner Notropis lutrensis, were sampled from four localities on the Brazos River, Texas, affected by cold-water discharge from a hydroelectric dam and from unaltered sites in the same region. Polymorphism at the Mdh-B locus, encoding supernatant malate dehydrogenase, indicates that populations within 57 km of the dam are distinctive from other regional populations and possess a unique Mdh-B allele, have significantly higher levels of heterozygosity at the Mdh-B locus, represent a homogeneous set that have significantly different Mdh-B zygotic frequencies from other regional populations, and have significantly different Mdh-B zygotic proportions than would be expected under a Hardy-Weinberg equilibrium. Increased levels of heterozygosity in fish within 57 km of the dam were correlated with discharge-associated fluctuations in water temperature at sampling stations.
Scott Braithwaite, R.; Omokaro, Cynthia; Justice, Amy C.; Nucifora, Kimberly; Roberts, Mark S.
Background Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. Methods and Findings We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. Conclusion Broader diffusion of VBID may amplify benefits
Braithwaite, R Scott; Omokaro, Cynthia; Justice, Amy C; Nucifora, Kimberly; Roberts, Mark S
Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services ($300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. Broader diffusion of VBID may amplify benefits from US health care without increasing health expenditures.
Sartorius, B; Sartorius, K; Taylor, M; Aagaard-Hansen, J; Dukhi, N; Day, C; Ndlovu, N; Slotow, R; Hofman, K
There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors. We analysed mean BMI of 28 247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals. From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country. We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.
Moore, Charles James
Synthetic polymers, commonly known as plastics, have been entering the marine environment in quantities paralleling their level of production over the last half century. However, in the last two decades of the 20th Century, the deposition rate accelerated past the rate of production, and plastics are now one of the most common and persistent pollutants in ocean waters and beaches worldwide. Thirty years ago the prevailing attitude of the plastic industry was that "plastic litter is a very small proportion of all litter and causes no harm to the environment except as an eyesore" [Derraik, J.G.B., 2002. The pollution of the marine environment by plastic debris: a review. Mar. Pollut. Bull. 44(9), 842-852]. Between 1960 and 2000, the world production of plastic resins increased 25-fold, while recovery of the material remained below 5%. Between 1970 and 2003, plastics became the fastest growing segment of the US municipal waste stream, increasing nine-fold, and marine litter is now 60-80% plastic, reaching 90-95% in some areas. While undoubtedly still an eyesore, plastic debris today is having significant harmful effects on marine biota. Albatross, fulmars, shearwaters and petrels mistake floating plastics for food, and many individuals of these species are affected; in fact, 44% of all seabird species are known to ingest plastic. Sea turtles ingest plastic bags, fishing line and other plastics, as do 26 species of cetaceans. In all, 267 species of marine organisms worldwide are known to have been affected by plastic debris, a number that will increase as smaller organisms are assessed. The number of fish, birds, and mammals that succumb each year to derelict fishing nets and lines in which they become entangled cannot be reliably known; but estimates are in the millions. We divide marine plastic debris into two categories: macro, >5 mm and micro, plastic micro-debris by filter feeders at the base of the food web is known to occur, but has not been quantified
Full Text Available The aim of the present study was to investigate effects of muscle fatigue on oxygen costs of ergometer cycling and slow component of pulmonary oxygen uptake (VO2 kinetics. Seven young men performed 100 drop jumps (drop height of 40 cm with 20 s of rest after each jump. After the subsequent hour of rest, they cycled at 70, 105, 140 and 175 W, which corresponded to 29.6 ± 5.4, 39.4 ± 7.0, 50.8 ± 8.4 and 65.8 ± 11.8 % of VO2peak, respectively, for 6 min at each intensity with 4-min intervals of rest in between the exercise bouts. The VO2 response to cycling after the exercise (fatigue condition was compared to ergometer cycling without prior exercise (control condition. From 3rd to 6th min of cycling at 105, 140 and 175 W, VO2 was higher (p < 0.05-0.01 when cycling in the fatigue compared to the control condition. Slow component of VO2 kinetics was observed when cycling at 175 W in the control condition (0.17 ± 0.09, l·min-1, mean ± SD, but tended to decrease in the fatigue condition (0.13 ± 0.15 l·min-1. In summary, results of the study are in agreement with the hypothesis that muscle fatigue increases oxygen costs of cycling exercise, but does not affect significantly the slow component of pulmonary oxygen uptake (VO2 kinetics
Robinson, James C; Brown, Timothy T
Some employers are implementing reference-pricing benefit designs, which establish limits on the amount they will pay for some procedures covered by employer-sponsored insurance. Employees are required to pay the difference between the employer's contribution limit and the actual price received by the hospital. These initiatives encourage patients to select low-price facilities and indirectly encourage facilities to reduce prices to increase patient volume. We evaluated the impact of reference pricing on the use of and prices paid for knee and hip replacement surgery by members of the California Public Employees' Retirement System (CalPERS) from 2008 to 2012, using enrollees in Anthem Blue Cross as a comparison group. In the first year after implementation, surgical volumes for CalPERS members increased by 21.2 percent at low-price facilities and decreased by 34.3 percent at high-price facilities. Prices charged to CalPERS members declined by 5.6 percent at low-price facilities and by 34.3 percent at high-price facilities. Our analysis indicates that in 2011 reference pricing accounted for $2.8 million in savings for CalPERS and $0.3 million in lower cost sharing for CalPERS members.
Pittman, D W; Parker, J S; Getz, B R; Jackson, C M; Le, T-A P; Riggs, S B; Shay, J M
We aimed to develop a cost-free and sustainable program to influence healthier eating decisions during elementary school lunch. Baseline food and beverage choices were assessed for 9 days during lunch service at two racially and economically diverse elementary schools in Spartanburg County, SC, USA. After being informed that the labeled items on the daily lunch menu represented the healthiest choice, students were allowed to ring a call bell in the cafeteria for public recognition when they chose all of the identified healthiest food and beverage items during lunch service. Using menus matched to the baseline phase, food and beverage choices were measured during a 9-day intervention phase. After 30 days, food and beverage choices were reassessed during a 3-day follow-up phase. Healthiest food & beverage choices increased 49% with >60% of students choosing non-flavored milk over flavored milk during the intervention phase. There was no difference in the success of the program between the two schools. The program continued and healthy eating decisions were significantly sustained at a 30-day follow-up assessment. Public recognition through bell ringing appears to be an effective practice to sustain increases in healthy eating decisions during elementary school lunch and warrants expansion to larger scale, longitudinal trials.
Full Text Available To explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost.Individual diet modelling was used to design iso-caloric, nutritionally adequate optimised diets for each observed diet in a sample of adult normo-reporters aged ≥20 years (n = 1,719 from the Individual and National Dietary Survey (INCA2, 2006-2007. Diet cost was estimated from mean national food prices (2006-2007. A first set of free-cost models explored the impact of optimisation on the variation of diet cost. A second set of iso-cost models explored the dietary changes induced by the optimisation with cost set equal to the observed one. Analyses of dietary changes were conducted by income quintiles, adjusting for energy intake, sociodemographic and socioeconomic variables, and smoking status.The cost of observed diets increased with increasing income quintiles. In free-cost models, the optimisation increased diet cost on average (+0.22 ± 1.03 euros/d and within each income quintile, with no significant difference between quintiles, but with systematic increases for observed costs lower than 3.85 euros/d. In iso-cost models, it was possible to design nutritionally adequate diets whatever the initial observed cost. On average, the optimisation at iso-cost increased fruits and vegetables (+171 g/day, starchy foods (+121 g/d, water and beverages (+91 g/d, and dairy products (+20 g/d, and decreased the other food groups (e.g. mixed dishes and salted snacks, leading to increased total diet weight (+300 g/d. Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones.In France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d.
Levin, Carol E; Sellors, John; Shi, Ju-Fang; Ma, Li; Qiao, You-lin; Ortendahl, Jesse; O'Shea, Meredith K H; Goldie, Sue J
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.
Sorin Briciu; Sorinel Capusneanu
This article offers an intrinsic image of the hidden and identified costs at thelevel of an entity, including the causes and their ways of control. The main researchinstrument used here was the questionnaire and the results determined a better knowledge ofthe theoretical and methodological aspects necessary in order to identify the hidden costs atthe level of an entity. Several aspects of the hidden costs are discussed, as well as theircharacteristics, evaluation, causes and generating source...
Obure, Carol Dayo; Gaitan-Duarte, Hernando; Losada Saenz, Ricardo; Gonzalez, Lina; Angel-Muller, Edith; Laverty, Maura; Perez, Freddy
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/.
Stensby, Kjell Erik (ed.)
This report seeks to highlight the costs associated with increased installed capacity of existing hydropower plants. Five selected power plant is further studied. Furthermore, given an overview of the technical possibilities of power expansions in Norway. (AG)
McLean, Sarah; Lennon, Paul; Glare, Paul
A lack of public awareness of palliative care (PC) has been identified as one of the main barriers to appropriate PC access. Internet search query analysis is a novel methodology, which has been effectively used in surveillance of infectious diseases, and can be used to monitor public awareness of health-related topics. We aimed to demonstrate the utility of internet search query analysis to evaluate changes in public awareness of PC in the USA between 2005 and 2015. Google Trends provides a referenced score for the popularity of a search term, for defined regions over defined time periods. The popularity of the search term 'palliative care' was measured monthly between 1/1/2005 and 31/12/2015 in the USA and in the UK. Results were analysed using independent t-tests and joinpoint analysis. The mean monthly popularity of the search term increased between 2008-2009 (pquery surveillance is a novel methodology, it is freely accessible and has significant potential to monitor health-seeking behaviour among the public. PC is rapidly growing in the USA, and the rapidly increasing public awareness of PC as demonstrated in this study, in comparison with the UK, where PC is relatively well established is encouraging in increasingly ensuring appropriate PC access for all. 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/.
Rasmussen, Henrik Berg; Madsen, Majbritt Busk; Lyauk, Yassine Kamal
The carboxylesterase 1 gene (CES1) encodes a hydrolase implicated in the metabolism of commonly used drugs. CES1A2, a hybrid of CES1 and a CES1-like pseudogene, has a promoter that is weak in most individuals. However, some individuals harbor a promoter haplotype of this gene with two overlapping...... Sp1 sites that confer significantly increased transcription potentially leading to rapid drug metabolism. This CES1A2 haplotype has previously been reported to be common among Asians. Using polymerase chain reaction followed by sequencing, the present study examined variation in the promoter and 5...
Deelen, J. van; Barink, M.; Klerk, L.; Voorthuijzen, P.; Hovestad, A.
Most development work in the laboratory is dedicated to efficiency enhancements at the cell level; improvements in efficiency can lead to higher cost-competitiveness of PV. However, the cost of panel manufacturing is an important aspect as well. For CIGS panels the deposition of the active layer is
Cellulosic ethanol prices depend heavily on the cost of the cellulase enzymes used to break down the biomass into fermentable sugars. To reduce these costs, NREL partnered with two leading enzyme companies, Novozymes and Genencor, to engineer new cellulase enzymes that are exceptionally good at breaking down cellulose. Genencor is now part of DuPont Industrial Biosciences.
P.H.M. Van Baal (Pieter); J.J. Polder (Johan); G.A. de Wit (Ardine); R.T. Hoogenveen (Rudolf); T.L. Feenstra (Talitha); H.C. Boshuizen (Hendriek); P.M. Engelfriet (Peter); W.B.F. Brouwer (Werner)
textabstractBackground: Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to
A newly patented process for completing the spectral light array emitted by LED bulbs provides a low-cost method for producing better human centered lighting (HCL). This process uses non-luminescent colorant filters, filling out the jagged LED spectral emission into a full, white light array. While LED bulbs have the distinct economic advantages of using less energy, producing less heat and lasting years longer than traditional incandescent bulbs, the persistent metameric failure of LED bulbs has resulted in slower, and sometimes reluctant, adoption of LED lighting by the residential, retail and architectural markets. Adding missing wavelengths to LED generated bulbs via colorant filters increases the aesthetic appeal of the light by decreasing current levels of metameric failure, reducing the `flatness', `harshness', and `dullness' of LED generated light reported by consumers. LED phosphor-converted light can be successfully tuned to "whiter" white light with selective color filtering using permanent, durable transparent pigments. These transparent pigments are selectively applied in combination with existing manufacturing technologies and utilized as a final color-tuning step in bulb design. The quantity of emitted light chosen for color filtering can be adjusted from 1% to 100% of emitted light, creating a custom balance of light quantity with light quality. This invention recognizes that "better light" is frequently chosen over "more light" in the consumer marketplace.
Full Text Available Convincing participants to deceive remains one of the biggest and most important challenges of laboratory-based deception research. The simplest and most prevalent method involves explicitly instructing participants to lie or tell the truth before presenting each task item. The usual finding of such experiments is increased cognitive load associated with deceptive responses, explained by necessity to inhibit default and automatic honest responses. However, explicit instructions are usually coupled with the absence of social context in the experimental task. Context plays a key role in social cognition by activating prior knowledge, which facilitates behaviors consistent with the latter. We hypothesized that in the presence of social context, both honest and deceptive responses can be produced on the basis of prior knowledge, without reliance on truth and without additional cognitive load during deceptive responses. In order to test the hypothesis, we have developed Speed-Dating Task (SDT, which is based on a real-life social event. In SDT, participants respond both honestly and deceptively to questions in order to appear similar to each of the dates. The dates are predictable and represent well-known categories (i.e. atheist or conservative. In one condition participants rely on explicit instructions preceding each question (external cue. In the second condition no explicit instructions are present, so the participants need to adapt based on prior knowledge about the category the dates belong to (internal cue. With internal cues, reaction times are similar for both honest and deceptive responses. However, in the presence of external cues, reaction times are longer for deceptive than honest responses, suggesting that deceptive responses are associated with increased cognitive load. Compared to internal cues, deception costs were higher when external cues were present. However, the effect was limited to the first part of the experiment, only
Yalanis, Georgia C.; Nag, Shayoni; Georgek, Jakob R.; Cooney, Carisa M.; Manahan, Michele A.; Rosson, Gedge D.
Introduction: Impaired vascular perfusion in tissue expander (TE) breast reconstruction leads to mastectomy skin necrosis. We investigated factors and costs associated with skin necrosis in postmastectomy breast reconstruction. Methods: Retrospective review of 169 women with immediate TE placement following mastectomy between May 1, 2009 and May 31, 2013 was performed. Patient demographics, comorbidities, intraoperative, and postoperative outcomes were collected. Logistic regression analysis on individual variables was performed to determine the effects of tissue expander fill volume and mastectomy specimen weight on skin necrosis. Billing data was obtained to determine the financial burden associated with necrosis. Results: This study included 253 breast reconstructions with immediate TE placement from 169 women. Skin necrosis occurred in 20 flaps for 15 patients (8.9%). Patients with hypertension had 8 times higher odds of skin necrosis [odd ratio (OR), 8.10, P 300 cm3 had 10 times higher odds of skin necrosis (OR, 10.66, P =0.010). Volumes >400 cm3 had 15 times higher odds of skin necrosis (OR, 15.56, P = 0.002). Mastectomy specimen weight was correlated with skin necrosis. Specimens >500 g had 10 times higher odds of necrosis and specimens >1000 g had 18 times higher odds of necrosis (OR, 10.03 and OR, 18.43; P =0.003 and P Mastectomy skin necrosis was associated with a 50% increased inpatient charge. Conclusion: Mastectomy flap necrosis is associated with HTN, larger TE volumes and mastectomy specimen weights, resulting in increased inpatient charges. Conservative TE volumes should be considered for patients with hypertension and larger mastectomy specimens. PMID:26301139
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.
O'Meara, S; Riemsma, R; Shirran, L; Mather, L; ter Riet, G
The prevalence of obesity in developed societies is increasing. Obesity is associated with an increased risk of co-morbidity, including cardiovascular disease and diabetes. Following the withdrawal of fenfluramine and dexfenfluramine, interest has focused on a novel anti-obesity drug orlistat. To systematically assess the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity. METHODS - SEARCH STRATEGY: Nineteen electronic databases were searched from inception to June 2000. Additionally, Internet searches were carried out, bibliographies of retrieved articles were examined and submissions were received from the manufacturer of orlistat. METHODS - INCLUSION AND EXCLUSION CRITERIA: Randomised controlled trials (RCTs) evaluating the effectiveness of orlistat used for weight loss or maintenance of weight loss in overweight or obese patients were eligible for inclusion. Primary outcome measures were changes in body weight, fat content or fat distribution. Secondary outcomes were changes in obesity-related risk-factor profiles, such as lipid levels, indicators of glycaemic control and blood pressure. Studies recruiting people with eating disorders such as anorexia nervosa and bulimia nervosa were excluded. METHODS - PROCESS OF STUDY SELECTION: Assessment of titles and abstracts was performed independently by two reviewers. If either reviewer considered a reference to be relevant, the full paper was retrieved. Full papers were assessed against the review selection criteria by two independent reviewers, and disagreements were resolved through discussion. METHODS - DATA EXTRACTION: Data were extracted by one reviewer into structured summary tables and checked by a second reviewer. Any disagreements about data were resolved by discussion. METHODS - QUALITY ASSESSMENT: Each included trial was assessed against a comprehensive checklist for methodological quality. Quality assessment was performed independently by two reviewers with disagreements
Baal PHM van; Vijgen SMC; Bemelmans WJE; Hoogenveen RT; Feenstra TL; PZO
Increasing tobacco taxes is a cost effective measure to reduce smoking among youth. A price increase on tobacco products reduces the number of young smokers by almost 20,000 in the short run. Although, in the end, effects of current price increases on smoking behaviour will fade away, tobacco taxes
Chan, Kamfai; Wong, Pui-Yan; Parikh, Chaitanya; Wong, Season
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.
Myers, J.; Hedstrom, M.; Plale, B. A.; Kumar, P.; McDonald, R.; Kooper, R.; Marini, L.; Kouper, I.; Chandrasekar, K.
What if everything that researchers know about their data, and everything their applications know, were directly available to curators? What if all the information that data consumers discover and infer about data were also available? What if curation and preservation activities occurred incrementally, during research projects instead of after they end, and could be leveraged to make it easier to manage research data from the moment of its creation? These are questions that the Sustainable Environments - Actionable Data (SEAD) project, funded as part of the National Science Foundation's DataNet partnership, was designed to answer. Data curation is challenging, but it is made more difficult by the historical separation of data production, data use, and formal curation activities across organizations, locations, and applications, and across time. Modern computing and networking technologies allow a much different approach in which data and metadata can easily flow between these activities throughout the data lifecycle, and in which heterogeneous and evolving data and metadata can be managed. Sustainability research, SEAD's initial focus area, is a clear example of an area where the nature of the research (cross-disciplinary, integrating heterogeneous data from independent sources, small teams, rapid evolution of sensing and analysis techniques) and the barriers and costs inherent in traditional methods have limited adoption of existing curation tools and techniques, to the detriment of overall scientific progress. To explore these ideas and create a sustainable curation capability for communities such as sustainability research, the SEAD team has developed and is now deploying an interacting set of open source data services that demonstrate this approach. These services provide end-to-end support for management of data during research projects; publication of that data into long-term archives; and integration of it into community networks of publications, research
Lee, Chung-Il; Kim, Chung-Soo; Han, Jin-Yi; Oh, Eun-Hye; Oh, Ki-Wan; Eun, Jae Soon
The current inquiry was conducted to assess the change in sleep architecture after long periods of administration to determine whether ginseng can be used in the therapy of sleeplessness. Following post-surgical recovery, red ginseng extract (RGE, 200 mg/ kg) was orally administrated to rats for 9 d. Data were gathered on the 1st, 5th, and 9th day, and an electroencephalogram was recorded 24 h after RGE administration. Polygraphic signs of unobstructed sleep-wake activities were simultaneously recorded with sleep-wake recording electrodes from 11:00 a.m. to 5:00 p.m. for 6 h. Rodents were generally tamed to freely moving polygraphic recording conditions. Although the 1st and 5th day of RGE treatment showed no effect on power densities in non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, the 9th day of RGE administration showed augmented α-wave (8.0 to 13.0 Hz) power densities in NREM and REM sleep. RGE increased total sleep and NREM sleep. The total percentage of wakefulness was only decreased on the 9th day, and the number of sleep-wake cycles was reduced after the repeated administration of RGE. Thus, the repeated administration of RGE increased NREM sleep in rats. The α-wave activities in the cortical electroencephalograms were increased in sleep architecture by RGE. Moreover, the levels of both α- and β-subunits of the γ-aminobutyric acid (GABA)A receptor were reduced in the hypothalamus of the RGE-treated groups. The level of glutamic acid decarboxylase was over-expressed in the hypothalamus. These results demonstrate that RGE increases NREM sleep via GABAAergic systems.
Chumak Larysa F.
Full Text Available The article is aimed at studying the current directions and ways to improve the cost management systems, allowing to increase the competitiveness of enterprise. Costs of enterprise, in any conditions of existence, are the most significant aspect of the influence on formation of economic performance, as well as obtaining the important competitive advantages, playing a special role in achieving sustainable development. Cost management system of enterprise is one of the basic elements in developing and careful substantiating the managerial decisions, therefore its continuous improvement is necessary. Improving the enterprise’s cost management system requires an integrated approach to its formation, introduction of the latest modern approaches, methods, and elaborations. Analysis of directions for improving the efficiency of cost management systems allows to define the most promising way of adapting to the practical use of the most advanced automated systems.
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.
prestressed concrete that are driven into the ground to retain earth or prevent water seepage. 21According to the Corps, a flowage easement is...low estimates of land acquisition and associated costs, pipeline costs, utilities, and bridge adjustments. However, Corps officials attribute all...involves installing larger box culverts, day-lighting two sections of the river, and modifying a bridge and culvert headwall for flood risk management
Full Text Available Shiga toxin-producing Escherichia coli (STEC is a leading cause of foodborne illness worldwide. The present study developed the use of DNA microarrays with the ampliPHOX colorimetric method to rapidly detect and genotype STEC strains. A low-density 30-mer oligonucleotide DNA microarray was designed to target O-antigen gene clusters of eleven E. coli serogroups (O26, O45, O91, O103, O104, O111, O113, O121, O128, O145 and O157 that have been associated with the majority of STEC infections. In addition, the DNA microarray targeted eleven virulence genes, encoding adhesins, cytotoxins, proteases, and receptor proteins, which have been implicated in conferring increased ability to cause disease for STEC. Results from the validation experiments demonstrated that this microarray-based colorimetric method allowed for a rapid and accurate genotyping of STEC reference strains from environmental and clinical sources and from distinct geographical locations. Positive hybridization signals were detected only for probes targeting serotype and virulence genes known to be present in the STEC reference strains. Quantification analysis indicated that the mean pixel intensities of the signal for probes targeting O-antigen or virulence genes were at least three times higher when compared to the background. Furthermore, this microarray-based colorimetric method was then employed to genotype a group of E. coli isolates from watershed sediment and animal fecal samples that were collected from an important region for leafy-vegetable production in the central coast of California. The results indicated an accurate identification of O-type and virulence genes in the tested isolates and confirmed that the ampliPHOX colorimetric method with low density DNA microarrays enabled a fast assessment of the virulence potential of STEC using low-cost reagents and instrumentation.
Batt, Katherine; Fox-Rushby, J A; Castillo-Riquelme, Marianela
Evidence-based reviews of published literature can be subject to several biases. Grey literature, however, can be of poor quality and expensive to access. Effective search strategies also vary by topic and are rarely known in advance. This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries. The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature. After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses. Interventions in the grey literature are more up to date and cover a different geographical spread. Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions. We recommend that in future researchers consider using non-English keywords in their searches.
Brignone, Emily; Gundlapalli, Adi V; Blais, Rebecca K; Kimerling, Rachel; Barrett, Tyson S; Nelson, Richard E; Carter, Marjorie E; Samore, Matthew H; Fargo, Jamison D
The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and $10,734 among women, and 33.5 encounters and $11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and $4803 among women, and 19.5 encounters and $8001 among men. Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.
Background Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. Methods Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose–response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. Results The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. Conclusions Increasing dietary fiber
Costa, M. N.; Veigas, B.; Jacob, J. M.; Santos, D. S.; Gomes, J.; Baptista, P. V.; Martins, R.; Inácio, J.; Fortunato, E.
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
Benzaken, A S; Sabidó, M; Galban, E G; Pedroza, V; Vasquez, F; Araújo, A; Peeling, R W; Mayaud, P
To assess the performance, usefulness and cost of a rapid treponemal antibody assay (VisiTect Syphilis) to detect syphilis in high risk populations. People who attended STI clinics in Manaus, Brazil, were screened for syphilis using the fluorescent treponemal antibody absorption (FTA-Abs) test and a non-treponemal test (Venereal Diseases Research Laboratory (VDRL)), and for HIV. Finger prick blood samples were tested with VisiTect Syphilis. The rapid test was evaluated against the reference FTA-Abs and for its usefulness in detecting active syphilis (FTA-Abs and VDRL positive). Operational performance was assessed through providers' and patients' interviews. An economic evaluation was conducted from the provider's perspective. 510 patients (60% men) were enrolled, of whom 13 (2.5%) were HIV-1 seropositive. Syphilis prevalence (FTA-Abs) was 18% and active syphilis prevalence was 7.5%. 11% (57/506) of samples were positive by VisiTect. The sensitivity, specificity, positive and negative predictive values of VisiTect Syphilis were 57% (95% CI 45.8 to 66.7), 99% (95% CI 97.0 to 99.6), 91% (95% CI 80.0 to 96.7) and 91% (95% CI 88.0 to 93.5), respectively. VisiTect Syphilis identified 79% (30/38) of active syphilis cases. The cost per case of syphilis was $16.8 for VDRL, $33.2 for low cost and $56.3 for high cost VisiTect Syphilis; the cost per case of active syphilis was $21.3, $57.5 and $97.6, respectively. Patients identified finger prick pain and preference for venous blood collection as minor barriers to test use. VisiTect Syphilis had low sensitivity in field use and was less cost effective than conventional VDRL. However, rapid and correct identification of a high proportion of active syphilis cases combined with operational characteristics suggest a role in high risk populations.
Erdem, S. Sibel; Khan, Shazia; Palanisami, Akilan; Hasan, Tayyaba
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.
The Geriatric Nutritional Risk Index predicts increased healthcare costs and hospitalization in a cohort of community-dwelling older adults: results from the MONICA/KORA Augsburg cohort study, 1994-2005.
Baumeister, Sebastian E; Fischer, Beate; Döring, Angela; Koenig, Wolfgang; Zierer, Astrid; John, Jürgen; Heier, Margit; Meisinger, Christa
To determine if the Geriatric Nutritional Risk Index (GNRI), an index for the risk of nutrition-related complications, is associated with healthcare costs and risk of hospitalization at baseline and after 10 y. Data from a German population-based cohort of 1999 subjects 55 to 74 y of age at baseline were used. Self-reported physician visits, length of hospital stay, and drug intake were used to estimate costs. The GNRI is based on serum albumin values and the discrepancy between real and ideal body weights. Low GNRI values were defined as mean minus 2 times standard deviation. Mean GNRI values were regarded as normal. Low baseline GNRI was consistently associated with increased total costs, probability of hospitalization, inpatient costs, and pharmaceutical costs at baseline and follow-up, after adjustment for socioeconomic characteristics, lifestyle factors, and coexisting conditions. Subjects with low GNRI at baseline had approximately 47% higher total costs, 50% higher risk of hospitalization, 62% higher inpatient costs and 27% higher pharmaceutical costs at follow-up than subjects with normal GNRI values. The GNRI risk predicted increased future healthcare costs and higher risk of hospitalization in independent-living older adults. The GNRI is a rapid and low-cost tool that might be routinely used in population-based settings. Copyright © 2011 Elsevier Inc. All rights reserved.
Teixido, Alberto L; Valladares, Fernando
Large floral displays receive more pollinator visits but involve higher production and maintenance costs. This can result in indirect costs which may negatively affect functions like reproductive output. In this study, we explored the relationship between floral display and indirect costs in two pairs of coflowering sympatric Mediterranean Cistus of contrasting flower size. We hypothesized that: (1) corolla production entails direct costs in dry mass, N and P, (2) corollas entail significant indirect costs in terms of fruit set and seed production, (3) indirect costs increase with floral display, (4) indirect costs are greater in larger-flowered sympatric species, and (5) local climatic conditions influence indirect costs. We compared fruit set and seed production of petal-removed flowers and unmanipulated control flowers and evaluated the influence of mean flower number and mean flower size on relative fruit and seed gain of petal-removed and control flowers. Fruit set and seed production were significantly higher in petal-removed flowers in all the studied species. A positive relationship was found between relative fruit gain and mean individual flower size within species. In one pair of species, fruit gain was higher in the large-flowered species, as was the correlation between fruit gain and mean number of open flowers. In the other pair, the correlation between fruit gain and mean flower size was also higher in the large-flowered species. These results reveal that Mediterranean environments impose significant constraints on floral display, counteracting advantages of large flowers from the pollination point of view with increased indirect costs of such flowers.
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.
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.
Henriksen, Tone E G; Skrede, Silje; Fasmer, Ole Bernt; Hamre, Børge; Grønli, Janne; Lund, Anders
Available pharmacological treatment of mania is insufficient. Virtual darkness therapy (blue light-blocking treatment by means of orange-tinted glasses) is a promising new treatment option for mania. The basis for this might be the recently identified blue light-sensitive retinal photoreceptor, which is solely responsible for light stimulus to the circadian master clock. This is the first case report describing the clinical course of a closely monitored, hospitalized patient in a manic episode first receiving clear-lensed, and then blue light-blocking glasses. A 58-year-old Caucasian man, with bipolar I disorder and three previous manic episodes, was hospitalized during a manic episode. In addition to pharmacological treatment, he was treated with clear-lensed glasses for seven days, then one day without glasses, followed by six days of blue light-blocking glasses. During the entire observational period, he wore an actigraph with internal light sensors. Manic symptoms were unaltered during the first seven days. The transition to the blue-blocking regime was followed by a rapid and sustained decline in manic symptoms accompanied by a reduction in total sleep, a reduction in motor activity during sleep intervals, and markedly increased regularity of sleep intervals. The patient's total length of hospital stay was 20 days shorter than the average time during his previous manic episodes. The unusually rapid decline in symptoms, accompanied by uniform sleep parameter changes toward markedly increased regularity, suggest that blue-blockers might be targeting a central mechanism in the pathophysiology of mania that needs to be explored both in clinical research and in basic science. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available We performed lipid analyses at the early period of therapy in patients with chronic hepatitis C who underwent interferon (IFN-free direct-acting antiviral (DAA treatment, and we attempted to identify the factors that contributed to a rapid increase in the patients' serum low-density lipoprotein cholesterol (LDL-C concentration.We retrospectively analyzed the cases of 100 consecutive patients with HCV infection treated at the National Hospital Organization Nagasaki Medical Center: 24 patients underwent daclatasvir (DCV and asunaprevir (ASV combination therapy (DCV/ASV for 24 weeks, and the other 76 patients underwent ledipasvir and sofosbuvir combination therapy (LDV/SOF for 12 weeks. ΔLDL-C was defined as the changed in LDL-C level at 28 days from the start of therapy. To determine whether ΔLDL-C was associated with several kinds of factors including viral kinetics, we performed a stepwise multiple linear regression analysis.The LDL-C levels in patients treated with LDV/SOF were markedly and significantly elevated (87.45 to 122.5 mg/dl; p<10-10 compared to those in the DCV/ASV-treated patients (80.15 to 87.8 mg/dl; p = 0.0056. The median levels of ΔLDL-C in the LDV/SOF and DCV/ASV groups were 33.2 and 13.1, respectively. LDV/SOF combination therapy as an IFN-free regimen (p<0.001 and ΔHCV core antigen (0-1 day drop (p<0.044 were identified as independent factors that were closely related to the ΔLDL-C.A rapid increase in the serum LDL-C concentration during the IFN-free treatment of hepatitis C was associated with the type of HCV therapy and a decline of HCV core protein.
Barnet, Beth; Rapp, Thomas; DeVoe, Margo; Mullins, C Daniel
To determine the cost-effectiveness of an intervention that successfully reduced rapid repeated births within 2 years of an index birth to adolescent mothers. Randomized, controlled trial conducted from February 2003 to October 2007. Home-based intervention with participants recruited from 5 urban clinics that provide care to low-income African American communities. Two hundred thirty-five pregnant teenagers (n = 235) aged 18 years or younger who were at 24 or more weeks of gestation at recruitment were followed up for 27 months. Participants were randomly assigned to usual care (n = 68) or 1 of 2 home-based interventions conducted by community outreach workers: (1) computer-assisted motivational intervention (CAMI) conducted quarterly with additional visits (CAMI+ [n = 80]) or (2) CAMI only (n = 87), a single-component motivational intervention conducted quarterly. Additional births by 24 months post partum determined from birth certificates, total and weighted mean intervention costs, cost per participant, and incremental cost-effectiveness ratios, defined as cost per prevented repeated birth. Relative to usual care, CAMI significantly reduced repeated births (adjusted odds ratio, 0.47; 95% confidence interval, 0.22-0.97). Mean intervention costs per adolescent were $2064, with incremental cost-effectiveness ratios per prevented repeated birth of $21 895 (unadjusted), $17 388 (adjusted), and $13 687 for a high-risk subgroup termed newly insured (eligible for but not enrolled in public insurance). The CAMI costs and cost-effectiveness compare favorably with other effective programs aimed at preventing repeated teenage births. Replication of these results in broader samples of adolescents would provide policy guidance for what works, for whom, and at what cost.
Brown, Jack; Paladino, Joseph A
Patients hospitalized with Staphylococcus aureus bacteraemia have an unacceptably high mortality rate. Literature available to date has shown that timely selection of the most appropriate antibacterial may reduce mortality. One tool that may help with this selection is a polymerase chain reaction (PCR) assay that distinguishes methicillin (meticillin)-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) in less than 1 hour. To date, no information is available evaluating the impact of this PCR technique on clinical or economic outcomes. To evaluate the effect of a rapid PCR assay on mortality and economics compared with traditional empiric therapy, using a literature-derived model. A literature search for peer-reviewed European (EU) and US publications regarding treatment regimens, outcomes and costs was conducted. Information detailing the rates of infection, as well as the specificity and sensitivity of a rapid PCR assay (Xpert MRSA/SA Blood Culture PCR) were obtained from the peer-reviewed literature. Sensitivity analysis varied the prevalence rate of MRSA from 5% to 80%, while threshold analysis was applied to the cost of the PCR test. Hospital and testing resource consumption were valued with direct medical costs, adjusted to year 2009 values. Adjusted life-years were determined using US and WHO life tables. The cost-effectiveness ratio was defined as the cost per life-year saved. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the additional cost necessary to produce additional effectiveness. All analyses were performed using TreeAge Software (2008). The mean mortality rates were 23% for patients receiving empiric vancomycin subsequently switched to semi-synthetic penicillin (SSP) for MSSA, 36% for patients receiving empiric vancomycin treatment for MRSA, 59% for patients receiving empiric SSP subsequently switched to vancomycin for MRSA and 12% for patients receiving empiric SSP for MSSA. Furthermore, with an
Schaeffer, M.; Kram, T.; Meinshausen, M.; Vuuren, van D.P.; Hare, W.L.
One approach in climate-change policy is to set normative long-term targets first and then infer the implied emissions pathways. An important example of a normative target is to limit the global-mean temperature change to a certain maximum. In general, reported cost estimates for limiting global
Curtis L. VanderSchaaf; Dean W. Coble; David B. South
When conducting inventories, reducing variability among tree diameters, heights, and ultimately volumes or biomass, can reduce the number of points/plots needed to obtain a desired level of precision. We present a simple analysis examining the potential reduction in discounted inventory costs when stand variability is decreased (via improved genetics and intensive...
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.
Angiomax allows for easier post-percutaneous coronary intervention care and enhanced throughput and has become the gold standard of care in our institution. This article describes how Angiomax was brought into our hospital; the rationale and science to support its use; and the resulting patient and staff satisfaction, improved throughput, and cost savings.
Faurholt-Jepsen, Daniel; Hansen, Kristina Beck; van Hees, Vincent T; Christensen, Line Brinch; Girma, Tsinuel; Friis, Henrik; Brage, Søren
To assess physical activity at admission and during recovery from severe acute malnutrition. Ethiopian children who were admitted with severe acute malnutrition received a clinical examination each week to monitor their recovery during rehabilitation. Using accelerometry (24 h/d for 5 consecutive days) at admission and again after 10 days of rehabilitation, we assessed the level and changes of physical activity. Among 13 children included, the mean (SD) age was 31.1 months (15.5). At baseline, the day-night activity difference was relatively small, whereas the level of activity had substantially increased at follow-up. The diurnal mean acceleration level was significantly greater at follow-up for wrist (1158.8 vs 541.4 counts per minute, P = .003) but not hip movements (204.1 vs 141.5, P = .261). During daytime (6 a.m. to 10 p.m.), hip activity increased by 38% from baseline to follow-up (e(B) 1.38, 95% CI 1.17-1.62), and wrist activity more than doubled (e(B) 2.50, 95% CI 2.17-2.87). The level of physical activity among children with severe acute malnutrition is very low but increases rapidly during recovery. Accelerometry may be a useful approach in the recovery phase as an indicator of early improvement. Copyright © 2014 The Authors. Published by Mosby, Inc. All rights reserved.
Kark, Salit; Levin, Noam; Grantham, Hedley S.; Possingham, Hugh P.
The importance of global and regional coordination in conservation is growing, although currently, the majority of conservation programs are applied at national and subnational scales. Nevertheless, multinational programs incur transaction costs and resources beyond what is required in national programs. Given the need to maximize returns on investment within limited conservation budgets, it is crucial to quantify how much more biodiversity can be protected by coordinating multinational conservation efforts when resources are fungible. Previous studies that compared different scales of conservation decision-making mostly ignored spatial variability in biodiversity threats and the cost of actions. Here, we developed a simple integrating metric, taking into account both the cost of conservation and threats to biodiversity. We examined the Mediterranean Basin biodiversity hotspot, which encompasses over 20 countries. We discovered that for vertebrates to achieve similar conservation benefits, one would need substantially more money and area if each country were to act independently as compared to fully coordinated action across the Basin. A fully coordinated conservation plan is expected to save approximately US$67 billion, 45% of total cost, compared with the uncoordinated plan; and if implemented over a 10-year period, the plan would cost ≈0.1% of the gross national income of all European Union (EU) countries annually. The initiative declared in the recent Paris Summit for the Mediterranean provides a political basis for such complex coordination. Surprisingly, because many conservation priority areas selected are located in EU countries, a partly coordinated solution incorporating only EU-Mediterranean countries is almost as efficient as the fully coordinated scenario. PMID:19717457
Hirayama, Hiroyuki; Kasuya, Eiiti
Females generally avoid selecting sites for oviposition which have a high predation risk to increase offspring survival. Previous studies have focused on costs to ovipositing females. However, although offspring may also incur costs by being oviposited at low predation risk sites, no studies have focused on costs to offspring. Such costs to offspring were examined by using Aquarius paludum insularis, females of which avoid eggs parasitism by ovipositing at deep sites. Deep sites are safe from egg parasitism but may be unsuitable for hatching due to environmental factors. We examined the costs to offspring at deep sites by comparing the hatching rate, the duration to hatching and the proportion of drowned larvae between eggs that were set at three levels of water depth (0 cm, 25 cm and 50 cm depth). While the hatching rate at 50 cm was lower than that at 0 cm, the rate at 25 cm did not differ from that at 0 cm. Duration to hatching and the proportion of drowned larvae did not differ between the three depths. It is suggested that the declining survival rate of A. paludum eggs was due to increased water pressure at greater depth. Such a cost may exist in other species and such an observation may aid in understanding oviposition site selection. Copyright 2010 Elsevier Ltd. All rights reserved.
Par, Gabriella; Szereday, Laszlo; Berki, Timea; Palinkas, Laszlo; Halasz, Melinda; Miseta, Attila; Hegedus, Geza; Szekeres-Bartho, Julia; Vincze, Aron; Hunyady, Bela; Par, Alajos
Chronic hepatitis C (CHC) patients achieving rapid virological response (RVR) on PEG-IFN/ribavirin (P/R) therapy have high chance of sustained virological response (SVR). To analyze host immunological factors associated with RVR, viral kinetics, phenotype distribution and Th1/Th2 cytokine production by peripheral blood mononuclear cells (PBMC) were studied prior to and during P/R therapy. TNF-α, IFN-γ, IL-2, IL-6, IL-4 and IL-10 production by PBMC were measured after Toll-like receptor 4 (TLR-4) or phorbol myristate acetate/Ionomycin stimulation in 20 healthy controls and in 50 CHC patients before receiving and during P/R therapy. RVR was achieved by 14, complete early virological response (cEVR) by 19 patients and 17 patients were null-responders (NR). Patients with RVR showed an increased baseline TNF-α and IL-6 production by TLR-4 activated monocytes and increased IFN-γ, decreased IL-4 and IL-10 production by lymphocytes compared to non-RVR patients. SVR was also associated with increased baseline TNF-α production and decreased IL-10 levels compared to patients who did not achieve SVR. Baseline IL-2 production was higher in cEVR compared to NR patients. Antiviral treatment increased TNF-α, IL-6 production by monocytes and IFN-γ secretion by lymphocytes and decreased IL-4 and IL-10 production by lymphocytes in cEVR compared to NR patients. RVR was associated with increased baseline proinflammatory cytokine production by TLR-4 stimulated monocytes and by activated lymphocytes. In null-responders and in patients who did not achieve SVR both TLR-4 sensing function and proinflammatory cytokine production were impaired, suggesting that modulation of TLR activity and controlled induction of inflammatory cytokine production may provide further therapeutic strategy for CHC patients non-responding to P/R treatment.
Full Text Available BACKGROUND: Chronic hepatitis C (CHC patients achieving rapid virological response (RVR on PEG-IFN/ribavirin (P/R therapy have high chance of sustained virological response (SVR. To analyze host immunological factors associated with RVR, viral kinetics, phenotype distribution and Th1/Th2 cytokine production by peripheral blood mononuclear cells (PBMC were studied prior to and during P/R therapy. METHODS: TNF-α, IFN-γ, IL-2, IL-6, IL-4 and IL-10 production by PBMC were measured after Toll-like receptor 4 (TLR-4 or phorbol myristate acetate/Ionomycin stimulation in 20 healthy controls and in 50 CHC patients before receiving and during P/R therapy. RVR was achieved by 14, complete early virological response (cEVR by 19 patients and 17 patients were null-responders (NR. RESULTS: Patients with RVR showed an increased baseline TNF-α and IL-6 production by TLR-4 activated monocytes and increased IFN-γ, decreased IL-4 and IL-10 production by lymphocytes compared to non-RVR patients. SVR was also associated with increased baseline TNF-α production and decreased IL-10 levels compared to patients who did not achieve SVR. Baseline IL-2 production was higher in cEVR compared to NR patients. Antiviral treatment increased TNF-α, IL-6 production by monocytes and IFN-γ secretion by lymphocytes and decreased IL-4 and IL-10 production by lymphocytes in cEVR compared to NR patients. CONCLUSION: RVR was associated with increased baseline proinflammatory cytokine production by TLR-4 stimulated monocytes and by activated lymphocytes. In null-responders and in patients who did not achieve SVR both TLR-4 sensing function and proinflammatory cytokine production were impaired, suggesting that modulation of TLR activity and controlled induction of inflammatory cytokine production may provide further therapeutic strategy for CHC patients non-responding to P/R treatment.
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
Zauberman, Ayelet; Tidhar, Avital; Levy, Yinon; Bar-Haim, Erez; Halperin, Gideon; Flashner, Yehuda; Cohen, Sara; Shafferman, Avigdor; Mamroud, Emanuelle
An important virulence strategy evolved by bacterial pathogens to overcome host defenses is the modulation of host cell death. Previous observations have indicated that Yersinia pestis, the causative agent of plague disease, exhibits restricted capacity to induce cell death in macrophages due to ineffective translocation of the type III secretion effector YopJ, as opposed to the readily translocated YopP, the YopJ homologue of the enteropathogen Yersinia enterocolitica Oratio8. This led us to suggest that reduced cytotoxic potency may allow pathogen propagation within a shielded niche, leading to increased virulence. To test the relationship between cytotoxic potential and virulence, we replaced Y. pestis YopJ with YopP. The YopP-expressing Y. pestis strain exhibited high cytotoxic activity against macrophages in vitro. Following subcutaneous infection, this strain had reduced ability to colonize internal organs, was unable to induce septicemia and exhibited at least a 10(7)-fold reduction in virulence. Yet, upon intravenous or intranasal infection, it was still as virulent as the wild-type strain. The subcutaneous administration of the cytotoxic Y. pestis strain appears to activate a rapid and potent systemic, CTL-independent, immunoprotective response, allowing the organism to overcome simultaneous coinfection with 10,000 LD(50) of virulent Y. pestis. Moreover, three days after subcutaneous administration of this strain, animals were also protected against septicemic or primary pneumonic plague. Our findings indicate that an inverse relationship exists between the cytotoxic potential of Y. pestis and its virulence following subcutaneous infection. This appears to be associated with the ability of the engineered cytotoxic Y. pestis strain to induce very rapid, effective and long-lasting protection against bubonic and pneumonic plague. These observations have novel implications for the development of vaccines/therapies against Y. pestis and shed new light on the
Full Text Available An important virulence strategy evolved by bacterial pathogens to overcome host defenses is the modulation of host cell death. Previous observations have indicated that Yersinia pestis, the causative agent of plague disease, exhibits restricted capacity to induce cell death in macrophages due to ineffective translocation of the type III secretion effector YopJ, as opposed to the readily translocated YopP, the YopJ homologue of the enteropathogen Yersinia enterocolitica Oratio8. This led us to suggest that reduced cytotoxic potency may allow pathogen propagation within a shielded niche, leading to increased virulence. To test the relationship between cytotoxic potential and virulence, we replaced Y. pestis YopJ with YopP. The YopP-expressing Y. pestis strain exhibited high cytotoxic activity against macrophages in vitro. Following subcutaneous infection, this strain had reduced ability to colonize internal organs, was unable to induce septicemia and exhibited at least a 10(7-fold reduction in virulence. Yet, upon intravenous or intranasal infection, it was still as virulent as the wild-type strain. The subcutaneous administration of the cytotoxic Y. pestis strain appears to activate a rapid and potent systemic, CTL-independent, immunoprotective response, allowing the organism to overcome simultaneous coinfection with 10,000 LD(50 of virulent Y. pestis. Moreover, three days after subcutaneous administration of this strain, animals were also protected against septicemic or primary pneumonic plague. Our findings indicate that an inverse relationship exists between the cytotoxic potential of Y. pestis and its virulence following subcutaneous infection. This appears to be associated with the ability of the engineered cytotoxic Y. pestis strain to induce very rapid, effective and long-lasting protection against bubonic and pneumonic plague. These observations have novel implications for the development of vaccines/therapies against Y. pestis and shed
Nshimyumukiza, Léon; Douville, Xavier; Fournier, Diane; Duplantie, Julie; Daher, Rana K; Charlebois, Isabelle; Longtin, Jean; Papenburg, Jesse; Guay, Maryse; Boissinot, Maurice; Bergeron, Michel G; Boudreau, Denis; Gagné, Christian; Rousseau, François; Reinharz, Daniel
A point-of-care rapid test (POCRT) may help early and targeted use of antiviral drugs for the management of influenza A infection. (i) To determine whether antiviral treatment based on a POCRT for influenza A is cost-effective and, (ii) to determine the thresholds of key test parameters (sensitivity, specificity and cost) at which a POCRT based-strategy appears to be cost effective. An hybrid « susceptible, infected, recovered (SIR) » compartmental transmission and Markov decision analytic model was used to simulate the cost-effectiveness of antiviral treatment based on a POCRT for influenza A in the social perspective. Data input parameters used were retrieved from peer-review published studies and government databases. The outcome considered was the incremental cost per life-year saved for one seasonal influenza season. In the base-case analysis, the antiviral treatment based on POCRT saves 2 lives/100,000 person-years and costs $7600 less than the empirical antiviral treatment based on clinical judgment alone, which demonstrates that the POCRT-based strategy is dominant. In one and two way-sensitivity analyses, results were sensitive to the POCRT accuracy and cost, to the vaccination coverage as well as to the prevalence of influenza A. In probabilistic sensitivity analyses, the POCRT strategy is cost-effective in 66% of cases, for a commonly accepted threshold of $50,000 per life-year saved. The influenza antiviral treatment based on POCRT could be cost-effective in specific conditions of performance, price and disease prevalence. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.
Rosenberg, Michael I.; Hart, Philip R.; Athalye, Rahul A.; Zhang, Jian; Wang, Weimin
The US Department of Energy’s most recent commercial energy code compliance evaluation efforts focused on determining a percent compliance rating for states to help them meet requirements under the American Recovery and Reinvestment Act (ARRA) of 2009. That approach included a checklist of code requirements, each of which was graded pass or fail. Percent compliance for any given building was simply the percent of individual requirements that passed. With its binary approach to compliance determination, the previous methodology failed to answer some important questions. In particular, how much energy cost could be saved by better compliance with the commercial energy code and what are the relative priorities of code requirements from an energy cost savings perspective? This paper explores an analytical approach and pilot study using a single building type and climate zone to answer those questions.
James Wohlpart; Craig Rademacher; Scott Karakas; Lisa Courcier; Charles Lindsey
The appropriate use of technology to enhance learning and reduce costs has become a focal point in the discussion of online learning. Significantly, the use of robust teaching and learning platforms, along with videoconferencing and other technological tools, allows for a wide variety of course redesigns that range from the incorporation of online materials into traditional courses to teaching courses fully online. The purpose of this paper is to discuss the use of technology in general educa...
Burdick, William P; Boulet, John R; LeBlanc, Kim Edward
Although the authors do not agree with medical students' bid to end the United States Medical Licensing Examination Step 2 Clinical Skills or Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation tests, they concur with Ecker and colleagues that conducting further research to support the validity argument, providing greater feedback on performance, and exploring options to reduce costs are important for addressing students' concerns. Evidence to support the validity of clinical skills exam scores and associated inferences already exists. What is lacking, and would help further justify the use of these examinations, is more evidence to support the "extrapolation" argument-that is, is performance on these examinations related to actual patient care? Enhanced feedback on exam performance should also be considered. While performance data from licensing examinations should be used judiciously given the primary purpose of these tests, additional data would be helpful to learners and their institutions. Centralized testing remains the least costly design, but efficiencies of standardized patient training, case development, and scoring can be reviewed. Scoring modifications made in the past several years at substantial cost should be evaluated to determine whether they have achieved desired goals. Testing organizations can and should embrace these essential elements of transparency and accountability to address concerns about the value of clinical skills examinations.
Bovet, Pascal; Chiolero, Arnaud; Madeleine, George; Gabriel, Anne; Stettler, Nicolas
There are few data on overweight in children in developing countries. Such data are important to guide public health policy. We assessed trends in the prevalence of overweight and obesity in children from the Seychelles, a middle-income island state in the Indian Ocean. Multiple cross-sectional surveys were conducted each year between 1998 and 2004 on all students of all schools in four selected school grades (creche, 4th, 7th and 10th years of mandatory school). Weight and height were measured and children were asked about walking time and frequency of physical exercise at leisure time. Excess weight categories were defined according to the criteria of the International Obesity Task Force (IOTF) and the U.S. Centers for Disease Control and Prevention (CDC). Data were available for 33 340 observations in 1998-2004, corresponding to 23,459 individual children measured once or several times. Based on IOTF criteria, the prevalence of 'overweight' or 'obesity' increased from 8.7% to 13.5% in boys, and from 11.8% to 18.6% in girls from 1998 to 2004 (P risk of overweight' and 'overweight' increased by similar proportions. The shift towards higher values over time was larger in the upper than the lower tail of the BMI distribution. Physical activity decreased over calendar years and was inversely associated with excess weight. The prevalence of excess weight increased markedly over a seven-year period in children in the Seychelles. This is likely to reflect a rapid nutrition transition with increasingly positive energy balance. These findings stress the need for programs and policies aimed at promoting physical activity and healthy nutrition in countries in epidemiological transition.
The Social Costs of Carbon (SCC) equals the marginal welfare loss associated with one unit of emitted CO2, divided by the marginal welfare gain associated with one unit of consumption. In stochastic assessments, both the nominator and denominator can depend on uncertain parameters; specifically they depend on the (implicit) scaling of the welfare function with the parameters. I discuss some pitfalls when calculating the expected value or the certainty equivalent of the SCC, and show that a mi...
Functional improvements have been seen in stroke patients who have received an increased intensity of physiotherapy. This requires additional costs in the form of increased physiotherapist time. The objective of this economic analysis is to determine the cost-effectiveness of increasing the intensity of physiotherapy (duration and/or frequency) during inpatient rehabilitation after stroke, from the perspective of the Ontario Ministry of Health and Long-term Care. The inputs for our economic evaluation were extracted from articles published in peer-reviewed journals and from reports from government sources or the Canadian Stroke Network. Where published data were not available, we sought expert opinion and used inputs based on the experts' estimates. The primary outcome we considered was cost per quality-adjusted life-year (QALY). We also evaluated functional strength training because of its similarities to physiotherapy. We used a 2-state Markov model to evaluate the cost-effectiveness of functional strength training and increased physiotherapy intensity for stroke inpatient rehabilitation. The model had a lifetime timeframe with a 5% annual discount rate. We then used sensitivity analyses to evaluate uncertainty in the model inputs. We found that functional strength training and higher-intensity physiotherapy resulted in lower costs and improved outcomes over a lifetime. However, our sensitivity analyses revealed high levels of uncertainty in the model inputs, and therefore in the results. There is a high level of uncertainty in this analysis due to the uncertainty in model inputs, with some of the major inputs based on expert panel consensus or expert opinion. In addition, the utility outcomes were based on a clinical study conducted in the United Kingdom (i.e., 1 study only, and not in an Ontario or Canadian setting). Functional strength training and higher-intensity physiotherapy may result in lower costs and improved health outcomes. However, these results
Westaby Daniel T
Full Text Available Abstract Background There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP, especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate. Methods We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1 investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2 to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1 those who had initial medical management with methotrexate, (2 those who were eligible for initial medical management but chose surgery (‘elected’ surgery and (3 those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method. Results Methotrexate was £1179 (CI 819–1550 per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures. Conclusions Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.
Marr, Kieren A.; Lyons, Christopher N.; Rustad, Tiger; Bowden, Raleigh A.; White, Theodore C.
Fluconazole-resistant Candida albicans, a cause of recurrent oropharyngeal candidiasis in patients with human immunodeficiency virus infection, has recently emerged as a cause of candidiasis in patients receiving cancer chemotherapy and marrow transplantation (MT). In this study, we performed detailed molecular analyses of a series of C. albicans isolates from an MT patient who developed disseminated candidiasis caused by an azole-resistant strain 2 weeks after initiation of fluconazole prophylaxis (K. A. Marr, T. C. White, J. A. H. vanBurik, and R. A. Bowden, Clin. Infect. Dis. 25:908–910, 1997). DNA sequence analysis of the gene (ERG11) for the azole target enzyme, lanosterol demethylase, revealed no difference between sensitive and resistant isolates. A sterol biosynthesis assay revealed no difference in sterol intermediates between the sensitive and resistant isolates. Northern blotting, performed to quantify mRNA levels of genes encoding enzymes in the ergosterol biosynthesis pathway (ERG7, ERG9, and ERG11) and genes encoding efflux pumps (MDR1, ABC1, YCF, and CDR), revealed that azole resistance in this series is associated with increased mRNA levels for members of the ATP binding cassette (ABC) transporter superfamily, CDR genes. Serial growth of resistant isolates in azole-free media resulted in an increased susceptibility to azole drugs and corresponding decreased mRNA levels for the CDR genes. These results suggest that C. albicans can become transiently resistant to azole drugs rapidly after exposure to fluconazole, in association with increased expression of ABC transporter efflux pumps. PMID:9756759
Hefer, Carmen; Dreisbach, Gesine
Growing evidence suggests that reward prospect promotes cognitive stability in terms of increased context or cue maintenance. In 3 Experiments, using different versions of the AX-continuous performance task, we investigated whether this reward effect comes at the cost of decreased cognitive flexibility. Experiment 1 shows that the reward induced…
Kim, Chi Heon; Chung, Chun Kee; Kim, Myo Jeong; Choi, Yunhee; Kim, Min-Jung; Hahn, Seokyung; Shin, Sukyoun; Jung, Jong-Myung; Lee, Jun Ho
Retrospective cohort study of a nationwide database OBJECTIVE.: The primary objective was to summarize the use of surgical methods for lumbar herniated intervertebral disc disease (HIVD) at two different time periods under the national health insurance system (NHIS). The secondary objective was to perform a cost-effectiveness analysis by utilizing incremental cost-effectiveness ratio (ICER). The selection of surgical method for HIVD may or may not be consistent with cost effectiveness under NHIS, but this issue has rarely been analyzed. The data of all patients who underwent surgeries for HIVD in 2003 (n = 17,997) and 2008 (n = 38,264) were retrieved. The surgical methods included open discectomy (OD), fusion surgery, laminectomy and percutaneous endoscopic lumbar discectomy (PELD). The hospitals were classified as tertiary-referral hospitals (≥ 300 beds), medium-sized hospitals (30-300 beds), or clinics (< 30 beds). ICER showed the difference in the mean total cost per 1% decrease in the reoperation probability among surgical methods. The total cost included the costs of the index surgery and the reoperation. In 2008, the number of surgeries increased by 2.13-fold. The number of hospitals increased by 34.75% (731 in 2003 and 985 in 2008). The proportion of medium-sized hospitals increased from 62.79% to 70.86%, but the proportion of surgeries performed at those hospitals increased from 61.31% to 85.08%. The probability of reoperation was highest after laminectomy (10.77%), followed by OD (10.50%), PELD (9.20%) and fusion surgery (7.56%). The ICERs indicated that PELD was cost-effective surgical method. The proportion of OD increased from 71.21% to 84.12%, but that of PELD decreased from 16.68% to 4.57%. The choice of surgical method might not always be consistent with cost-effectiveness strategies, and a high proportion of medium-sized hospitals may be responsible for this change. 4.
Jovanović Jelena; Denić Dragan
A cost-effective method for resolution increase of a two-stage piecewise linear analog-to-digital converter used for sensor linearization is proposed in this paper. In both conversion stages flash analog-to-digital converters are employed. Resolution increase by one bit per conversion stage is performed by introducing one additional comparator in front of each of two flash analog-to-digital converters, while the converters’ resolutions remain the same. As a result, the number of employed comp...
Shell, Elaine M.; Lue, Yvonne; Chu, Martha I.
Flight software is a mission critical element of spacecraft functionality and performance. When ground operations personnel interface to a spacecraft, they are typically dealing almost entirely with the capabilities of onboard software. This software, even more than critical ground/flight communications systems, is expected to perform perfectly during all phases of spacecraft life. Due to the fact that it can be reprogrammed on-orbit to accommodate degradations or failures in flight hardware, new insights into spacecraft characteristics, new control options which permit enhanced science options, etc., the on- orbit flight software maintenance team is usually significantly responsible for the long term success of a science mission. Failure of flight software to perform as needed can result in very expensive operations work-around costs and lost science opportunities. There are three basic approaches to maintaining spacecraft software--namely using the original developers, using the mission operations personnel, or assembling a center of excellence for multi-spacecraft software maintenance. Not planning properly for flight software maintenance can lead to unnecessarily high on-orbit costs and/or unacceptably long delays, or errors, in patch installations. A common approach for flight software maintenance is to access the original development staff. The argument for utilizing the development staff is that the people who developed the software will be the best people to modify the software on-orbit. However, it can quickly becomes a challenge to obtain the services of these key people. They may no longer be available to the organization. They may have a more urgent job to perform, quite likely on another project under different project management. If they havn't worked on the software for a long time, they may need precious time for refamiliarization to the software, testbeds and tools. Further, a lack of insight into issues related to flight software in its on
Lopes-Silva, Joao P.; Felippe, Leandro J. C.; Silva-Cavalcante, Marcos D.; Bertuzzi, Romulo; Lima-Silva, Adriano E.
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 judo fitness test after a 5-day weight loss period, but reduced perceived exertion and increased plasma lactate. PMID:25054553
Velasco, Ignacio; Vahdani, Soheil; Ramos, Hector
Three-dimensional (3D) printing is relatively a new technology with clinical applications, which enable us to create rapid accurate prototype of the selected anatomic region, making it possible to plan complex surgery and pre-bend hardware for individual surgical cases. This study aimed to express our experience with the use of medical rapid prototype (MRP) of the maxillofacial region created by desktop 3D printer and its application in maxillofacial reconstructive surgeries. Three patients with benign mandible tumors were included in this study after obtaining informed consent. All patient's maxillofacial CT scan data was processed by segmentation and isolation software and mandible MRP was printed using our desktop 3D printer. These models were used for preoperative surgical planning and prebending of the reconstruction plate. MRP created by desktop 3D printer is a cost-efficient, quick and easily produced appliance for the planning of reconstructive surgery. It can contribute in patient orientation and helping them in a better understanding of their condition and proposed surgical treatment. It helps surgeons for pre-operative planning in the resection or reconstruction cases and represent an excellent tool in academic setting for residents training. The pre-bended reconstruction plate based on MRP, resulted in decreased surgery time, cost and anesthesia risks on the patients. Key words: 3D printing, medical modeling, rapid prototype, mandibular reconstruction, ameloblastoma.
Yin, Hongbin; Yan, Xiaowei; Gu, Xiaohong
The cost-effective and geographically available substrates are vital for the design of constructed wetlands (CWs), especially the saturated subsurface flow CWs, which are deemed as an efficient way to remove the inlet-lake phosphorus concentrations. In this study, phosphorus removal of thermally-treated calcium-rich attapulgite (TCAP) with varied particle sizes (0.2-0.5 mm, 0.5-1 mm and 1-2 mm) was assessed using batch and long-term column experiments to evaluate its feasibility as a CWs substrate. The phosphorus-bound mechanism in TCAP was identified in various initial phosphorus concentrations. Batch studies indicated that more than 95% of P can be rapidly (hydraulic retention time (HRT) exerts great influence on P removal performance and longer HRTs favor the dissolution of CaO in TCAP, consequently increasing the P removal rate. In a 150-day P removal experiment, TCAP removed an average of 93.1%-95.4% of the influent P with a HRT of eight hours. Both the batch and chemical extraction of the P fraction of TCAP showed that the P removed by TCAP was mainly through formation of Ca phosphate precipitation. However, the species of Ca-P precipitation formed might be varied in different phosphorus concentrations. All results indicated that TCAP can be a suitable substrate when used in CWs, and field experiments should be carried out to test its real P removal performance in the future. Copyright © 2017 Elsevier Ltd. All rights reserved.
Calantropio, A.; Colucci, E.; Teppati Losè, L.
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.
Huber, Manuel B; Präger, Maximilian; Coyle, Kathryn; Coyle, Doug; Lester-George, Adam; Trapero-Bertran, Marta; Nemeth, Bertalan; Cheung, Kei Long; Stark, Renee; Vogl, Matthias; Pokhrel, Subhash; Leidl, Reiner
To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany. A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. Germany. Cohort of current smoking population (18+ years) in Germany. Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. EQUIPTMOD considered reach, intervention cost, number of quitters, quality-of-life years (QALYs) gained, cost-effectiveness and return on investment. The highest returns through reduction in smoking-related health-care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group-based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5000, the probability of being cost-effective is approximately 75% for prospective scenario 1. Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by
Vahlenkamp, Thomas; Kropeit, Julia [McKinsey and Company, Duesseldorf (Germany); Ritzenhofen, Ingmar [McKinsey and Company, Koeln (Germany); Gersema, Gerke [McKinsey and Company, Hamburg (Germany)
How expensive the energy transition truly will be? The question of costs is coming more and more into the focus: The Bundesrechnungshof calls for more transparency, the policy confronted with the complexity of the subject matter is not able to quantify concrete costs. At the same time, all participants are working to curb spending growth. The fact is, the total costs will continue to rise. It is already foreseeable that by 2025 the annual electricity costs will increase by Euro 14 billion - to then Euro 77 billion. The main drivers are grid charges and rising fuel costs. [German] Wie teuer wird die Energiewende wirklich? Die Frage nach den Kosten geraet zunehmend in den Fokus: Der Bundesrechnungshof fordert mehr Transparenz, die Politik sieht sich mit Blick auf die Komplexitaet der Thematik ausserstande, konkrete Kosten zu beziffern. Gleichzeitig treten alle Beteiligten dafuer ein, die Ausgabenentwicklung zu bremsen. Fakt ist: Die Gesamtkosten werden weiter steigen. Bereits heute ist absehbar, dass sich bis 2025 die jaehrlich anfallenden Stromkosten um 14 Mrd. Euro erhoehen werden - auf dann 77 Mrd. Euro. Haupttreiber sind die Netzentgelte und steigende Brennstoffkosten.
Full Text Available Abstract Background The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. Methods Women aged from 30 to 70 years (n = 15,965 were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG; one group where women received an invitation letter to participate in the screening (IG1; one group where women received an invitation letter and informative leaflet (IG2; and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3. Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years – the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. Results The incremental cost-effectiveness ratio (ICER for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years. Conclusions In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women. Trial registration ClinicalTrials.gov Identifier: NCT01373723 .
Sankes, Karen J
On 9 June 2008, during the Future Years Defense Program Officer Accessions Brief, the Chief of Naval Personnel requested more information on increasing the Naval Reserve Officer Training Corps (NROTC...
Pandya, Ankur; Gaziano, Thomas A.; Weinstein, Milton C.; Cutler, David
In the past several decades some risk factors for cardiovascular disease have improved, while others have worsened. For example, smoking rates have dropped and treatment rates for cardiovascular disease have increased--factors that have made the disease less fatal. At the same time, Americans’ average body mass index and incidence of diabetes have increased as the population continues to live longer--factors that have made cardiovascular disease more prevalent. To assess the aggregate impact ...
William Van Geertruyden
The main objective of this research was to develop a new re-melting process for fine or light gauge aluminum scrap products that exhibits dramatic improvements in energy efficiency. Light gauge aluminum scrap in the form of chips, turnings, and borings has historically been underutilized in the aluminum recycling process due to its high surface area to volume ratio resulting in low melt recovery. Laboratory scale consolidation experiments were performed using loose aluminum powder as a modeling material as well as shredded aluminum wire scrap. The processing parameters necessary to create consolidated aluminum material were determined. Additionally, re-melting experiments using consolidated and unconsolidated aluminum powder confirmed the hypothesis that metal recovery using consolidated material will significantly improve by as much as 20%. Based on this research, it is estimated that approximately 495 billion Btu/year can be saved by implementation of this technology in one domestic aluminum rolling plant alone. The energy savings are realized by substituting aluminum scrap for primary aluminum, which requires large amounts of energy to produce. While there will be an initial capital investment, companies will benefit from the reduction of dependence on primary aluminum thus saving considerable costs. Additionally, the technology will allow companies to maintain in-house alloy scrap, rather than purchasing from other vendors and eliminate the need to discard the light gauge scrap to landfills.
Full Text Available Both the transparent reporting of logistics costs and the related accounting of their cost drivers present a significant factor for the successful management of material flows and the related logistics activities in production companies. These costs, which are mainly reported as part of overhead (indirect costs in such companies, usually remain hidden or are not explicitly visible when the traditional method of accounting is applied. The aim of this research is to create a model of activity-based accounting of logistics costs in a production company, and to test its efficiency in the disclosure of logistics costs compared with traditional cost accounting. The application of the model in a production company shows that an activity-based approach discloses as much as 108% more logistics costs at the level of a group of products than the traditional cost-accounting approach. Further, detailed information on logistics costs obtained in this way enables their more efficient management. Key words: logistics costs; activity-based costing; cost allocation; cost visibility; cost management
Paul C Coleman
Full Text Available Virtually all temperate insects survive the winter by entering a physiological state of reduced metabolic activity termed diapause. However, there is increasing evidence that climate change is disrupting the diapause response resulting in non-diapause life stages encountering periods of winter cold. This is a significant problem for adult life stages in particular, as they must remain mobile, periodically feed, and potentially initiate reproductive development at a time when resources should be diverted to enhance stress tolerance. Here we present the first evidence of protein/meat feeding restricting rapid cold hardening (RCH ability and increasing low temperature activity thresholds. No RCH response was noted in adult female blow flies (Calliphora vicina Robineau-Desvoidy fed a sugar, water and liver (SWL diet, while a strong RCH response was seen in females fed a diet of sugar and water (SW only. The RCH response in SW flies was induced at temperatures as high as 10°C, but was strongest following 3h at 0°C. The CTmin (loss of coordinated movement and chill coma (final appendage twitch temperature of SWL females (-0.3 ± 0.5°C and -4.9 ± 0.5°C, respectively was significantly higher than for SW females (-3.2 ± 0.8°C and -8.5 ± 0.6°C. We confirmed this was not directly the result of altered extracellular K+, as activity thresholds of alanine-fed adults were not significantly different from SW flies. Instead we suggest the loss of cold tolerance is more likely the result of diverting resource allocation to egg development. Between 2009 and 2013 winter air temperatures in Birmingham, UK, fell below the CTmin of SW and SWL flies on 63 and 195 days, respectively, suggesting differential exposure to chill injury depending on whether adults had access to meat or not. We conclude that disruption of diapause could significantly impact on winter survival through loss of synchrony in the timing of active feeding and reproductive development with
Theodore, Brian R; Whittington, Jan; Towle, Cara; Tauben, David J; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z
With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. Wiley Periodicals, Inc.
Govindarajan, R; Llueguera, E; Melero, A; Molero, J; Soler, N; Rueda, C; Paradinas, C
Statistical Process Control (SPC) was applied to monitor patient set-up in radiotherapy and, when the measured set-up error values indicated a loss of process stability, its root cause was identified and eliminated to prevent set-up errors. Set up errors were measured for medial-lateral (ml), cranial-caudal (cc) and anterior-posterior (ap) dimensions and then the upper control limits were calculated. Once the control limits were known and the range variability was acceptable, treatment set-up errors were monitored using sub-groups of 3 patients, three times each shift. These values were plotted on a control chart in real time. Control limit values showed that the existing variation was acceptable. Set-up errors, measured and plotted on a X chart, helped monitor the set-up process stability and, if and when the stability was lost, treatment was interrupted, the particular cause responsible for the non-random pattern was identified and corrective action was taken before proceeding with the treatment. SPC protocol focuses on controlling the variability due to assignable cause instead of focusing on patient-to-patient variability which normally does not exist. Compared to weekly sampling of set-up error in each and every patient, which may only ensure that just those sampled sessions were set-up correctly, the SPC method enables set-up error prevention in all treatment sessions for all patients and, at the same time, reduces the control costs. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.
Y. N. Kolesnik
Full Text Available The paper gives complex evaluation of efficiency of incandescent lamps, luminescent and light-emitting-diode (LED light sources in case of electric power price increase. On the basis of experimental table lamp electric power indices of light-emitting-diode (LED light sources with equivalent luminous flux have been determined. Dependences of main indices of economic efficiency of various light sources on their operational regimes have been obtained and rate of influence on these indices of electric power price increase have been determined. Economically justified variants and conditions for application of various light sources have been substantiated.
Delaloge, Suzette; Bonastre, Julia; Borget, Isabelle; Garbay, Jean-Rémi; Fontenay, Rachel; Boinon, Diane; Saghatchian, Mahasti; Mathieu, Marie-Christine; Mazouni, Chafika; Rivera, Sofia; Uzan, Catherine; André, Fabrice; Dromain, Clarisse; Boyer, Bruno; Pistilli, Barbara; Azoulay, Sandy; Rimareix, Françoise; Bayou, El-Hadi; Sarfati, Benjamin; Caron, Hélène; Ghouadni, Amal; Leymarie, Nicolas; Canale, Sandra; Mons, Muriel; Arfi-Rouche, Julia; Arnedos, Monica; Suciu, Voichita; Vielh, Philippe; Balleyguier, Corinne
Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.
... Documents#0;#0; ] Memorandum of June 10, 2010 Disposing of Unneeded Federal Real Estate-- Increasing Sales... Government, the largest property owner and energy user in the United States, has managed more real estate... were not sufficiently comprehensive in disposing of excess real estate and did not emphasize making...
Tanja G M Sanders
Full Text Available Intrinsic water use efficiency (WUEi in trees is an indication of the ratio of carbon assimilation to the rate of transpiration. It is generally assumed that it is a response to water availability. In agricultural research, the question of drought tolerance by increased WUEi has been well studied. In general, the increase is a trade-off for productivity and is therefore not desired. For forest trees, this question is less clearly understood. Using stable carbon isotopes derived from tree rings combined with productivity as the product of the annual growth increment and annual density measurements, we compared the change in WUEi over a 15 year period. While WUEi increased over this period, the productivity decreased, causing an opposing trend. The gradient of the correlation between WUEi and productivity varies between provenances and sites. Counterintuitively, the populations at the drier site showed low WUEi values at the beginning of the investigation. Slopes vary with the provenance from Poland showing the least decline in productivity. In general, we found that a decline in productivity aligned with an increase in WUEi.
Nousiainen, Markku T; McQueen, Sydney A; Ferguson, Peter; Alman, Benjamin; Kraemer, William; Safir, Oleg; Reznick, Richard; Sonnadara, Ranil
among the competency-based curriculum and regular stream residents for teaching (60 residents) and among 14 competency-based curriculum residents and 21 regular stream residents for assessment. The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012-2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competency-based curriculum (academic year 2008-2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase. Although the financial costs and time demands on faculty in running the simulation program in the new competency-based curriculum at the University of Toronto have been substantial, augmented learner and trainer satisfaction has been accompanied by direct evidence of improved and more efficient learning outcomes. The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.
Sheff, Kelly W; York, Emily R; Driebe, Elizabeth M; Barker, Bridget M; Rounsley, Steven D; Waddell, Victor G; Beckstrom-Sternberg, Stephen M; Beckstrom-Sternberg, James S; Keim, Paul S; Engelthaler, David M
Coccidioidomycosis is an infection caused by Coccidioides immitis or C. posadasii. We developed a TaqMan real-time PCR assay that rapidly and accurately differentiates the species. This assay can be used as a tool to improve disease surveillance, increase understanding of the natural history of the infection, and assist in clinical differentiation studies.
Full Text Available The threat of West Nile virus (WNV epidemics necessitates the development of a technology platform that can produce reagents to support detection and diagnosis rapidly and inexpensively. A plant expression system is attractive for protein production due to its low-cost and high-scalability nature and its ability to make appropriate posttranslational modifications. Here, we investigated the feasibility of using plants to produce two WNV detection and diagnostic reagents to address the current cost and scalability issues. We demonstrated that WNV DIII antigen and E16 monoclonal antibody are rapidly produced at high levels in two plant species and are easily purified. Furthermore, they are effective in identifying WNV and in detecting human IgM response to WNV infection. E16 mAb does not cross-react with other flaviviruses, therefore, is valuable for improving diagnostic accuracy. This study provides a proof of principle for using plants as a robust and economical system to produce diagnostic reagents for arboviruses.
Xu, Xiao-Ming; Chi, Qing-Sheng; Cao, Jing; Zhao, Zhi-Jun
Aggression can benefit individuals by enhancing their dominance and thereby their ability to acquire and retain resources that increase survival or fitness. Engaging in aggressive behavior costs energy and how animals manage their energy budget to accommodate aggression remains unclear. We conducted three experiments to examine changes in physiological, behavioral and hormonal markers indicative of energy budget in male striped hamsters subject to resident-intruder aggression tests. Body temperature, metabolic rate and serum corticosterone levels significantly increased in resident hamsters immediately after the introduction of intruders. Energy intake did not change, but the metabolic rate of residents increased by 16.1% after 42-days of repeated encounters with intruders. Residents had significantly decreased body fat content and serum thyroxine (T4) levels, and a considerably elevated tri-iodothyronine (T3)/T4 ratio compared to a control group that had no intruders. Attack latency considerably shortened, and the number of attack bouts and total duration of attacks, significantly increased in residents on day 42 compared to day 1 of experiments. These findings may suggest that the conversion of T4 to T3 is involved in defensive aggression behavior. The mobilization of fat reserves resulting in lean body mass is probably common response to the increased metabolic cost of aggression in small mammals. Aggressive behavior, which is important for the successful acquisition and defense of resources, may be of significance for adaptation and evolution of metabolic rate. Copyright © 2017 Elsevier Inc. All rights reserved.
Pirdavani, Ali; Brijs, Tom; Bellemans, Tom; Kochan, Bruno; Wets, Geert
Travel demand management (TDM) consists of a variety of policy measures that affect the transportation system's effectiveness by changing travel behavior. The primary objective to implement such TDM strategies is not to improve traffic safety, although their impact on traffic safety should not be neglected. The main purpose of this study is to evaluate the traffic safety impact of conducting a fuel-cost increase scenario (i.e. increasing the fuel price by 20%) in Flanders, Belgium. Since TDM strategies are usually conducted at an aggregate level, crash prediction models (CPMs) should also be developed at a geographically aggregated level. Therefore zonal crash prediction models (ZCPMs) are considered to present the association between observed crashes in each zone and a set of predictor variables. To this end, an activity-based transportation model framework is applied to produce exposure metrics which will be used in prediction models. This allows us to conduct a more detailed and reliable assessment while TDM strategies are inherently modeled in the activity-based models unlike traditional models in which the impact of TDM strategies are assumed. The crash data used in this study consist of fatal and injury crashes observed between 2004 and 2007. The network and socio-demographic variables are also collected from other sources. In this study, different ZCPMs are developed to predict the number of injury crashes (NOCs) (disaggregated by different severity levels and crash types) for both the null and the fuel-cost increase scenario. The results show a considerable traffic safety benefit of conducting the fuel-cost increase scenario apart from its impact on the reduction of the total vehicle kilometers traveled (VKT). A 20% increase in fuel price is predicted to reduce the annual VKT by 5.02 billion (11.57% of the total annual VKT in Flanders), which causes the total NOCs to decline by 2.83%. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Personal exemption (PE was one of the remedies of the government to offset the burden of taxation imposed to its sovereignty. In the Philippines, a motion to increase the PE has already been made by lawmakers, and this prompted the researchers to conduct a study on the effect of this disposable income of fixed income earners on their spending pattern on identified goods and services to VAT and other taxes collected by the government. The study made use of descriptive-survey method given to 100 random respondents earning fixed income in the City of Davao, Philippines. The study determined that the respondents’ age, civil status, sex, and number of qualified dependents affects her/his spending pattern. Married people spend more on basic commodities than single people, male spends more alcohol and tobacco than the female, zero dependents spends more on recreation than more dependents and there is a decrease of spending in recreation as people aged. Moreover, the survey revealed that implementing additional PE will decrease direct income tax of the government. However, forty percent of this will return in the form of indirect taxes since respondents have lower marginal propensity to save than their marginal propensity to consume, it results in a positive impact in the economy as a whole. This is done through the use of the concept of the Tax Cut Multiplier (m[tax]= -MPC/MPS effect. Given the prospective increase in PE, consumers spend their additional disposable income on basic commodities, additional clothing, recreation and excises taxed products, among others.
Anna G Warrener
Full Text Available The shape of the human female pelvis is thought to reflect an evolutionary trade-off between two competing demands: a pelvis wide enough to permit the birth of large-brained infants, and narrow enough for efficient bipedal locomotion. This trade-off, known as the obstetrical dilemma, is invoked to explain the relative difficulty of human childbirth and differences in locomotor performance between men and women. The basis for the obstetrical dilemma is a standard static biomechanical model that predicts wider pelves in females increase the metabolic cost of locomotion by decreasing the effective mechanical advantage of the hip abductor muscles for pelvic stabilization during the single-leg support phase of walking and running, requiring these muscles to produce more force. Here we experimentally test this model against a more accurate dynamic model of hip abductor mechanics in men and women. The results show that pelvic width does not predict hip abductor mechanics or locomotor cost in either women or men, and that women and men are equally efficient at both walking and running. Since a wider birth canal does not increase a woman's locomotor cost, and because selection for successful birthing must be strong, other factors affecting maternal pelvic and fetal size should be investigated in order to help explain the prevalence of birth complications caused by a neonate too large to fit through the birth canal.
Warrener, Anna G.; Lewton, Kristi L.; Pontzer, Herman; Lieberman, Daniel E.
The shape of the human female pelvis is thought to reflect an evolutionary trade-off between two competing demands: a pelvis wide enough to permit the birth of large-brained infants, and narrow enough for efficient bipedal locomotion. This trade-off, known as the obstetrical dilemma, is invoked to explain the relative difficulty of human childbirth and differences in locomotor performance between men and women. The basis for the obstetrical dilemma is a standard static biomechanical model that predicts wider pelves in females increase the metabolic cost of locomotion by decreasing the effective mechanical advantage of the hip abductor muscles for pelvic stabilization during the single-leg support phase of walking and running, requiring these muscles to produce more force. Here we experimentally test this model against a more accurate dynamic model of hip abductor mechanics in men and women. The results show that pelvic width does not predict hip abductor mechanics or locomotor cost in either women or men, and that women and men are equally efficient at both walking and running. Since a wider birth canal does not increase a woman’s locomotor cost, and because selection for successful birthing must be strong, other factors affecting maternal pelvic and fetal size should be investigated in order to help explain the prevalence of birth complications caused by a neonate too large to fit through the birth canal. PMID:25760381
Degli Esposti, L; Desideri, G; Saragoni, S; Buda, S; Pontremoli, R; Borghi, C
Chronic hyperuricemia is responsible for a relevant burden of articular diseases and cardio-nephrometabolic disorders. We evaluated the effect of high serum uric acid (SUA) levels on hospitalization risk and mortality and on healthcare costs in a real-life setting. We conducted a retrospective analysis using a large administrative database and a clinical registry among 112,170 subjects from three Italian local health units. Individuals were divided into four groups according to their SUA levels: 6 mg/dL and ≤7 mg/dL (19.3%), >7 mg/dL and ≤8 mg/dL (8.7%), and >8 mg/dL (5.5%). Compared to those with SUA level of 8 mg/dL). Increased SUA levels are associated with an increased risk of hospitalizations related to hyperuricemia, CKD, and CVDs and total mortality, and consequently with higher total healthcare costs and hospitalization costs per patient. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
Gutzweiler, Ludwig; Gleichmann, Tobias; Tanguy, Laurent; Koltay, Peter; Zengerle, Roland; Riegger, Lutz
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.
Full Text Available Companies tend to outsource transport to fleet management companies to increase efficiencies if transport is a non-core activity. The provision of fleet management services on contract introduces a certain amount of financial risk to the fleet management company, specifically fixed rate maintenance contracts. The quoted rate needs to be sufficient and also competitive in the market. Currently the quoted maintenance rates are based on the maintenance specifications of the manufacturer and the risk management approach of the fleet management company. This is usually reflected in a contingency that is included in the quoted maintenance rate. An alternative methodology for calculating the average maintenance cost for a vehicle fleet is proposed based on the actual maintenance expenditures of the vehicles and accepted statistical techniques. The proposed methodology results in accurate estimates (and associated confidence limits of the true average maintenance cost and can beused as a basis for the maintenance quote.
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.
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
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.
Bond, William F; Kim, Minchul; Franciskovich, Chris M; Weinberg, Jason E; Svendsen, Jessica D; Fehr, Linda S; Funk, Amy; Sawicki, Robert; Asche, Carl V
Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6-54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02-1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (-0.37 admissions, 95% CI -0.66 to -0.08), and inpatient days (-3.66 days, 95% CI -6.23 to -1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI -$16,207 to -$2,793). ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients.
Lehmann, Philipp; Boratyński, Zbyszek; Mappes, Tapio; Mousseau, Timothy A; Møller, Anders P
A cataract is a clouding of the lens that reduces light transmission to the retina, and it decreases the visual acuity of the bearer. The prevalence of cataracts in natural populations of mammals, and their potential ecological significance, is poorly known. Cataracts have been reported to arise from high levels of oxidative stress and a major cause of oxidative stress is ionizing radiation. We investigated whether elevated frequencies of cataracts are found in eyes of bank voles Myodes glareolus collected from natural populations in areas with varying levels of background radiation in Chernobyl. We found high frequencies of cataracts in voles collected from different areas in Chernobyl. The frequency of cataracts was positively correlated with age, and in females also with the accumulated radiation dose. Furthermore, the number of offspring in female voles was negatively correlated with cataract severity. The results suggest that cataracts primarily develop as a function of ionizing background radiation, most likely as a plastic response to high levels of oxidative stress. It is therefore possible that the elevated levels of background radiation in Chernobyl affect the ecology and fitness of local mammals both directly through, for instance, reduced fertility and indirectly, through increased cataractogenesis.
O'Meara, S.; Riemsma, R.; Shirran, L.; Mather, L.; ter Riet, G.
BACKGROUND: The prevalence of obesity in developed societies is increasing. Obesity is associated with an increased risk of co-morbidity, including cardiovascular disease and diabetes. Following the withdrawal of fenfluramine and dexfenfluramine, interest has focused on a novel anti-obesity drug
Yu, Li; Peng, Guoping; Li, Cunyu; Jiang, Baoping; Xu, Haokun; Ding, Ning; Zheng, Yunfeng; Leng, John Q.
Herbal medicines have ever been thought harmless, but it is obviously not true. Many adverse reports emerged with the development of their popular application in the world. Allergic reactions, especially serious immediate hypersensitivity, frequently occurred when herbal injections were used in clinic and made this ever prevailing agent nearly disappear in China. The aim of this study is to establish a rapid and economical method for the prediction of the allergenicity of herbal injections. Ovalbumin (OVA) and four other herbal injections, in which two of them were well known for their allergenicity, were selected to sensitize and stimulate the animals. Serotonin in the animal serum was detected with HPLC to reflect the anaphylactic response and compared with the other cytokines which could mediate the anaphylaxis, including histamine, IgE and β-hexosaminidase. The results suggest that serotonin can be detected quickly and has good correlation with the other allergy-related cytokines. It is a promising way for predicting the allergenicity of the herbal injections and those complicated natural products. PMID:23587872
Increased extracellular collagen matrix in myocardial sleeves of pulmonary veins: an additional mechanism facilitating repetitive rapid activities in chronic pacing-induced sustained atrial fibrillation.
Chiu, Yung-Tsung; Wu, Tsu-Juey; Wei, Hao-Ji; Cheng, Ching-Chang; Lin, Nai-Nu; Chen, Ying-Tsung; Ting, Chih-Tai
Increased ECM in canine PVs. Cell uncoupling due to fibrosis or increased extracellular collagen matrix (ECM) affects the formation of ectopic focal activity. Whether or not the increase of ECM also exists in the pulmonary veins (PVs) with rapid atrial pacing is unknown. We sought to test the hypothesis that in chronic atrial pacing dogs with sustained atrial fibrillation (AF), the amount of ECM was increased in both atria and the PVs. We induced sustained AF in dogs by rapid atrial pacing. Computerized mapping techniques were used to map both atria and the PVs. We also used histological assessment to quantify the amount of ECM. After 118+/-24 days of rapid atrial pacing, sustained AF was induced in 7 dogs. Repetitive rapid activities (RRAs) either continuously or intermittently arose from the PVs during sustained AF. Histological study shows that there was no fibrosis in both atrial free walls and the PVs. However, the amount of ECM was increased in these regions. The mean ECM surface area fraction at each region in the dogs with sustained AF was all significantly higher compared to the corresponding region in normal dogs. Similarly, the heterogeneity of the ECM surface area fraction at each region in the dogs with sustained AF was also all significantly higher compared to normal dogs. In chronic atrial pacing-induced sustained AF, structural remodeling (i.e., inhomogeneous increase of ECM) also involves the PVs. Reduced coupling of the myocytes in the PV due to histological changes may provide an additional mechanism facilitating RRAs.
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.
G. P. Petropoulos
Full Text Available Remote sensing is increasingly being used as a cost-effective and practical solution for the rapid evaluation of impacts from wildland fires. The present study investigates the use of the support vector machine (SVM classification method with multispectral data from the Advanced Spectral Emission and Reflection Radiometer (ASTER for obtaining a rapid and cost effective post-fire assessment in a Mediterranean setting. A further objective is to perform a detailed intercomparison of available burnt area datasets for one of the most catastrophic forest fire events that occurred near the Greek capital during the summer of 2007. For this purpose, two ASTER scenes were acquired, one before and one closely after the fire episode. Cartography of the burnt area was obtained by classifying each multi-band ASTER image into a number of discrete classes using the SVM classifier supported by land use/cover information from the CORINE 2000 land nomenclature. Overall verification of the derived thematic maps based on the classification statistics yielded results with a mean overall accuracy of 94.6% and a mean Kappa coefficient of 0.93. In addition, the burnt area estimate derived from the post-fire ASTER image was found to have an average difference of 9.63% from those reported by other operationally-offered burnt area datasets available for the test region.
Saxe, Henrik; Jensen, Jørgen Dejgard
The new Nordic diet (NND) was designed by gastronomic, nutritional and environmental specialists to be a palatable, healthy and sustainable diet containing 30%-40% less meat than the average Danish diet (ADD), ≥ 75% organics, and more locally grown wholegrain products, nuts, fruit and vegetables...... important environmental impacts by 16%-22%, mainly caused by reduced meat content. The surcharge to consumers of the ADD-to-NND diet-shift was €216/capita/year. In monetary terms, the savings related to the environmental impact of the diet-shift were €151/capita/year. 70% of the increased consumer cost...
Saxe, Henrik; Jensen, Jørgen Dejgård
The new Nordic diet (NND) was designed by gastronomic, nutritional and environmental specialists to be a palatable, healthy and sustainable diet containing 30%-40% less meat than the average Danish diet (ADD), ≥ 75% organics, and more locally grown wholegrain products, nuts, fruit and vegetables...... important environmental impacts by 16%-22%, mainly caused by reduced meat content. The surcharge to consumers of the ADD-to-NND diet-shift was €216/capita/year. In monetary terms, the savings related to the environmental impact of the diet-shift were €151/capita/year. 70% of the increased consumer cost...
Par, Gabriella; Szereday, Laszlo; Berki, Timea; et al.
BACKGROUND: Chronic hepatitis C (CHC) patients achieving rapid virological response (RVR) on PEG-IFN/ribavirin (P/R) therapy have high chance of sustained virological response (SVR). To analyze host immunological factors associated with RVR, viral kinetics, phenotype distribution and Th1/Th2 cytokine production by peripheral blood mononuclear cells (PBMC) were studied prior to and during P/R therapy. METHODS: TNF-α, IFN-γ, IL-2, IL-6, IL-4 and IL-10 production by PBMC were measured after Toll...
To determine changes in the morbidity and mortality of ventilated, very low-birth-weight infants before and after the introduction of surfactant therapy in 1990, we retrospectively studied the infants in a tertiary neonatal intensive care unit. All ventilated patients admitted from January 1, 1984, to December 31, 1997, with birth weight of 1500 g or less, excluding 76 transferred to other hospitals, were included in the analysis (N = 1336). The primary outcomes studied included mortality, length of stay, and survival without bronchopulmonary dysplasia. Although post-surfactant mortality and pulmonary air leak for infants with birth weight greater than 750 g decreased more than 50% (P < or = .026), the proportion of infants surviving without bronchopulmonary dysplasia also decreased (P < or = .034). For surviving infants with birth weight of 751 to 1000 g, mean post-surfactant length of stay increased 16 days (P = .008). Postnatal age at death also increased in the post-surfactant period for infants with birth weight of 750 g or less (P = .002). For infants with birth weight of 1000 g or less, post-surfactant increases were seen in the mean duration of assisted ventilation (+22% to 32%, P < or = .005) and the incidence of bronchopulmonary dysplasia at 36 weeks' postmenstrual age (+62% to 162%, P < .001). For all infants, the incidence of bacteremia, duration of supplemental oxygen therapy, and likelihood of discharge on home oxygen were increased in the post-surfactant period (P < or = .011). The implicit benefits of mortality reduction in the post-surfactant era may be offset by increasing respiratory morbidity in some survivors and by an unwelcome prolongation of death for some nonsurvivors. We speculate that the ultimate costs of these undesirable outcomes may greatly surpass the ostensible cost benefits of neonatal surfactant therapy.
Reddy, Jitendar; Madishetti, Sreedhar; Vachaspati, Prakash R
We describe a rapid screening methodology for performing pharmacokinetic (PK) studies in mice called Fast PK. In this Fast PK method, two mice were used per compound and four blood samples were collected from each mouse. The sampling times were staggered (sparse sampling) between the two mice, thus yielding complete PK profile in singlicate across eight time points. The plasma PK parameters from Fast PK were comparable to that obtained from conventional PK methods. This method has been used to rapidly screen compounds in the early stages of drug discovery and about 600 compounds have been profiled in the last 3 years, which has resulted in reduction in the usage of mice by 800 per year in compliance with the 3R principles of animal ethics. In addition, this Fast PK method can also help in evaluating the PK parameters from the same set of animals used in safety/toxicology/efficacy studies without the need for satellite groups. Copyright © 2012 Elsevier B.V. All rights reserved.
Warringa, G.E.A.; De Bruyn, M.; Bijleveld, M.M.
While the environmental benefits of scenarios geared to increased recycling have been convincingly demonstrated by previous studies, the question arises whether such scenarios bring economic benefits, too. This study therefore assesses the main economic effects of increased recycling in the Netherlands, providing data that can be used to advance policy development in this area. To address the main issue we performed a social cost-benefit analysis (SCBA), a welfare-theory-based tool that can be used to chart the full range of economic impacts ('welfare impacts') of a project or policy intervention. In doing so, a broad definition of welfare is adopted, encompassing not only financial and economic consequences, but also environmental and employment impacts and so on. Using SimaPro, all the environmental interventions inventoried (including energy consumption, transport and recycling process emissions) were assessed for each individual material flow, with impacts being expressed as far as possible in monetary terms to enable comparison. The main social costs of increased recycling are the higher costs for local authorities associated with separate waste collection. There is also reduced revenue for waste incinerators, because more waste will need to be imported from abroad. Finally, there are the policy costs of incentives for increased recycling and extra efforts to induce citizens to separate their waste. The latter costs were not quantified. Over and against these costs are positive welfare impacts. The main benefits are environmental, expressed monetarily in the present study in terms of avoided damage costs for society as a whole and avoided measures for securing government reduction targets. In addition, the separated waste has a value, reflected in lower processing costs. Increased recycling also creates new jobs, while recycling firms generate more profit than waste incinerators. Finally, there are the benefits accruing from greater innovation and
Löfström, Charlotta; Hansen, F.; Mansdal, S.
samples using a real-time PCR method. The protocol included incubation in buffered peptone water, centrifugation of an aliquot and a boiling procedure. The validation study included comparative and collaborative trials recommended by the Nordic Organization for Validation of Alternative Methods (Nord......Cost-effective and rapid monitoring of Salmonella in the meat production chain can contribute to food safety. The objective was, for the first time, to validate an easy-to-use pre-PCR sample preparation method based on a simple boiling protocol for screening of Salmonella in meat and carcass swab....../sample for the boiling, magnetic bead-based and NMKL187 methods, respectively. When comparing the boiling method with the magnetic beads, the relative accuracy (AC), relative sensitivity (SE) and relative specificity (SP) were found to be 98%, 102% and 98%, respectively (Cohen’s kappa index 0.95). When comparing results...
Lukash, James A.; Daley, Earl
This work describes the design and development effort to adapt rapid-development space hardware by creating a ground system using solutions of low complexity, mass, & cost. The Lunar Atmosphere and Dust Environment Explorer (LADEE) spacecraft is based on the modular common spacecraft bus architecture developed at NASA Ames Research Center. The challenge was building upon the existing modular common bus design and development work and improving the LADEE spacecraft design by adding an Equipotential Voltage Reference (EVeR) system, commonly referred to as a ground system. This would aid LADEE in meeting Electromagnetic Environmental Effects (E3) requirements, thereby making the spacecraft more compatible with itself and its space environment. The methods used to adapt existing hardware are presented, including provisions which may be used on future spacecraft.
Dillon, David G; Pirie, Fraser; Rice, Stephen; Pomilla, Cristina; Sandhu, Manjinder S; Motala, Ayesha A; Young, Elizabeth H
Existing electronic data capture options are often financially unfeasible in resource-poor settings or difficult to support technically in the field. To help facilitate large-scale multicenter studies in sub-Saharan Africa, the African Partnership for Chronic Disease Research (APCDR) has developed an open-source electronic questionnaire (EQ). To assess its relative validity, we compared the EQ against traditional pen-and-paper methods using 200 randomized interviews conducted in an ongoing type 2 diabetes case-control study in South Africa. During its 3-month validation, the EQ had a lower frequency of errors (EQ, 0.17 errors per 100 questions; paper, 0.73 errors per 100 questions; P-value ≤0.001), and a lower monetary cost per correctly entered question, compared with the pen-and-paper method. We found no marked difference in the average duration of the interview between methods (EQ, 5.4 minutes; paper, 5.6 minutes). This validation study suggests that the EQ may offer increased accuracy, similar interview duration, and increased cost-effectiveness compared with paper-based data collection methods. The APCDR EQ software is freely available (https://github.com/apcdr/questionnaire). Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.
N. Satheesh Kumar
Full Text Available Poor cruise performance of Electric Vehicles (EVs continues to be the primary reason that impends their market penetration. Adding more battery to extend the cruise range is not a viable solution as it increases the structural weight and capital cost of the EV. Simulations identified that a vehicle spends on average 15% of its total time in braking, signifying an immense potential of the utilization of regenerative braking mechanism. Based on the analysis, a 3 kW auxiliary electrical unit coupled with the traction drive during braking events increases the recoverable energy by 8.4%. In addition, the simulation revealed that, on average, the energy drawn from the battery is reduced by 3.2% when traction drive is integrated with the air-conditioning compressor (an auxiliary electrical load. A practical design solution of the integrated unit is also included in the paper. Based on the findings, it is evident that the integration of an auxiliary unit with the traction drive results in enhancing the energy capturing capacity of the regenerative braking mechanism and decreases the power consumed from the battery. Further, the integrated unit boosts other advantages such as reduced material cost, improved reliability, and a compact and lightweight design.
Full Text Available A cost-effective method for resolution increase of a two-stage piecewise linear analog-to-digital converter used for sensor linearization is proposed in this paper. In both conversion stages flash analog-to-digital converters are employed. Resolution increase by one bit per conversion stage is performed by introducing one additional comparator in front of each of two flash analog-to-digital converters, while the converters’ resolutions remain the same. As a result, the number of employed comparators, as well as the circuit complexity and the power consumption originating from employed comparators are for almost 50 % lower in comparison to the same parameters referring to the linearization circuit of the conventional design and of the same resolution. Since the number of employed comparators is significantly reduced according to the proposed method, special modifications of the linearization circuit are needed in order to properly adjust reference voltages of employed comparators.
Jovanović, Jelena; Denić, Dragan
A cost-effective method for resolution increase of a two-stage piecewise linear analog-to-digital converter used for sensor linearization is proposed in this paper. In both conversion stages flash analog-to-digital converters are employed. Resolution increase by one bit per conversion stage is performed by introducing one additional comparator in front of each of two flash analog-to-digital converters, while the converters' resolutions remain the same. As a result, the number of employed comparators, as well as the circuit complexity and the power consumption originating from employed comparators are for almost 50 % lower in comparison to the same parameters referring to the linearization circuit of the conventional design and of the same resolution. Since the number of employed comparators is significantly reduced according to the proposed method, special modifications of the linearization circuit are needed in order to properly adjust reference voltages of employed comparators.
Lee, Su Jung; Ramesh, Rashmi; de Boor, Valerie; Gebler, Jan M; Silva, Richard C; Sattlegger, Evelyn
The common method for liberating proteins from Saccharomyces cerevisiae cells involves mechanical cell disruption using glass beads and buffer containing inhibitors (protease, phosphatase and/or kinase inhibitors), followed by centrifugation to remove cell debris. This procedure requires the use of costly inhibitors and is laborious, in particular when many samples need to be processed. Also, enzymatic reactions can still occur during harvesting and cell breakage. As a result low-abundance and labile proteins may be degraded, and enzymes such as kinases and phosphatases may still modify proteins during and after cell lysis. We believe that our rapid sample preparation method helps overcome the above issues and offers the following advantages: (a) it is cost-effective, as no inhibitors and breaking buffer are needed; (b) cell breakage is fast (about 15 min) since it only involves a few steps; (c) the use of formaldehyde inactivates endogenous proteases prior to cell lysis, dramatically reducing the risk of protein degradation; (d) centrifugation steps only occur prior to cell lysis, circumventing the problem of losing protein complexes, in particular if cells were treated with formaldehyde intended to stabilize and capture large protein complexes; and (e) since formaldehyde has the potential to instantly terminate protein activity, this method also allows the study of enzymes in live cells, i.e. in their true physiological environment, such as the short-term effect of a drug on enzyme activity. Taken together, the rapid sample preparation procedure provides a more accurate snapshot of the cell's protein content at the time of harvesting. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Workman, E R; Haddick, P C G; Bush, K; Dilly, G A; Niere, F; Zemelman, B V; Raab-Graham, K F
A single injection of N-methyl-D-aspartate receptor (NMDAR) antagonists produces a rapid antidepressant response. Lasting changes in the synapse structure and composition underlie the effectiveness of these drugs. We recently discovered that rapid antidepressants cause a shift in the γ-aminobutyric acid receptor (GABABR) signaling pathway, such that GABABR activation shifts from opening inwardly rectifiying potassium channels (Kir/GIRK) to increasing resting dendritic calcium signal and mammalian Target of Rapamycin activity. However, little is known about the molecular and biochemical mechanisms that initiate this shift. Herein, we show that GABABR signaling to Kir3 (GIRK) channels decreases with NMDAR blockade. Blocking NMDAR signaling stabilizes the adaptor protein 14-3-3η, which decouples GABABR signaling from Kir3 and is required for the rapid antidepressant efficacy. Consistent with these results, we find that key proteins involved in GABABR signaling bidirectionally change in a depression model and with rapid antidepressants. In socially defeated rodents, a model for depression, GABABR and 14-3-3η levels decrease in the hippocampus. The NMDAR antagonists AP5 and Ro-25-6981, acting as rapid antidepressants, increase GABABR and 14-3-3η expression and decrease Kir3.2. Taken together, these data suggest that the shift in GABABR function requires a loss of GABABR-Kir3 channel activity mediated by 14-3-3η. Our findings support a central role for 14-3-3η in the efficacy of rapid antidepressants and define a critical molecular mechanism for activity-dependent alterations in GABABR signaling. PMID:25560757
Workman, E R; Haddick, P C G; Bush, K; Dilly, G A; Niere, F; Zemelman, B V; Raab-Graham, K F
A single injection of N-methyl-D-aspartate receptor (NMDAR) antagonists produces a rapid antidepressant response. Lasting changes in the synapse structure and composition underlie the effectiveness of these drugs. We recently discovered that rapid antidepressants cause a shift in the γ-aminobutyric acid receptor (GABABR) signaling pathway, such that GABABR activation shifts from opening inwardly rectifiying potassium channels (Kir/GIRK) to increasing resting dendritic calcium signal and mammalian Target of Rapamycin activity. However, little is known about the molecular and biochemical mechanisms that initiate this shift. Herein, we show that GABABR signaling to Kir3 (GIRK) channels decreases with NMDAR blockade. Blocking NMDAR signaling stabilizes the adaptor protein 14-3-3η, which decouples GABABR signaling from Kir3 and is required for the rapid antidepressant efficacy. Consistent with these results, we find that key proteins involved in GABABR signaling bidirectionally change in a depression model and with rapid antidepressants. In socially defeated rodents, a model for depression, GABABR and 14-3-3η levels decrease in the hippocampus. The NMDAR antagonists AP5 and Ro-25-6981, acting as rapid antidepressants, increase GABABR and 14-3-3η expression and decrease Kir3.2. Taken together, these data suggest that the shift in GABABR function requires a loss of GABABR-Kir3 channel activity mediated by 14-3-3η. Our findings support a central role for 14-3-3η in the efficacy of rapid antidepressants and define a critical molecular mechanism for activity-dependent alterations in GABABR signaling.
Comor, Lubos; Dolinska, Saskia; Bhide, Katarina; Pulzova, Lucia; Jiménez-Munguía, Irene; Bencurova, Elena; Flachbartova, Zuzana; Potocnakova, Lenka; Kanova, Evelina; Bhide, Mangesh
Camelids possess unique functional heavy chain antibodies, which can be produced and modified in vitro as a single domain antibody (sdAb or nanobody) with full antigen binding ability. Production of sdAb in conventional manner requires active immunization of Camelidae animal, which is laborious, time consuming, costly and in many cases not feasible (e.g. in case of highly toxic or infectious antigens). In this study, we describe an alternative pipeline that includes in vitro stimulation of naïve alpaca B-lymphocytes by antigen of interest (in this case endothelial cell binding domain of OspA of Borrelia) in the presence of recombinant alpaca interleukins 2 and 4, construction of sdAb phage library, selection of antigen specific sdAb expressed on phages (biopanning) and confirmation of binding ability of sdAb to the antigen. By joining the in vitro immunization and the phage display ten unique phage clones carrying sdAb were selected. Out of ten, seven sdAb showed strong antigen binding ability in phage ELISA. Furthermore, two soluble forms of sdAb were produced and their differential antigen binding affinity was measured with bio-layer interferometry. A proposed pipeline has potential to reduce the cost substantially required for maintenance of camelid herd for active immunization. Furthermore, in vitro immunization can be achieved within a week to enrich mRNA copies encoding antigen-specific sdAbs in B cell. This rapid and cost effective pipeline can help researchers to develop efficiently sdAb for diagnostic and therapeutic purposes.
Chen, K.S.; Morgan, W.P.; Zich, J.L.
A low-cost, thermally-activated, palladium-catalyzed metallization process was developed for rapid prototyping of polymeric electronic substrates and devices. The process was successfully applied in producing adhesiveless copper/polyimide laminates with high peel strengths and thick copper coating; copper/polyimide laminates are widely used in fabricating interconnects such as printed wiring boards (PWBs) and flexible circuits. Also successfully metallized using this low-cost metallization process were: (1) scaled-down models of radar-and-communication antenna and waveguide; (2) scaled-down model of pulsed-power-accelerator electrode; (3) three-dimensional micro-porous, open-cell vitreous carbon foams. Moreover, additive patterned metallization was successfully achieved by selectively printing or plotting the catalyst ink only on areas where metallization is desired, and by uniform thermal activation. Additive patterned metallization eliminates the time-consuming, costly and environmentally-unfriendly etching process that is routinely carried out in conventional subtractive patterned metallization. A metallization process via ultraviolet (UV) irradiation activation was also demonstrated. In this process palladium-catalyst solution is first uniformly coated onto the substrate. A masking pattern is used to cover the areas where metallization is not wanted. UV irradiation is applied uniformly to activate the palladium catalyst and to cure the polymer carrier in areas that are not covered by the mask. Metal is then deposited by electroless plating only or by a combination of electroless and electrolytic plating. This UV-activation technique is particularly useful in additive fine-line patterned metallization. Lastly, computer models for electrolytic and electroless plating processes were developed to provide guidance in plating-process design.
Ryder Oliver A
Full Text Available Abstract Background Despite the small number of ursid species, bear phylogeny has long been a focus of study due to their conservation value, as all bear genera have been classified as endangered at either the species or subspecies level. The Ursidae family represents a typical example of rapid evolutionary radiation. Previous analyses with a single mitochondrial (mt gene or a small number of mt genes either provide weak support or a large unresolved polytomy for ursids. We revisit the contentious relationships within Ursidae by analyzing complete mt genome sequences and evaluating the performance of both entire mt genomes and constituent mtDNA genes in recovering a phylogeny of extremely recent speciation events. Results This mitochondrial genome-based phylogeny provides strong evidence that the spectacled bear diverged first, while within the genus Ursus, the sloth bear is the sister taxon of all the other five ursines. The latter group is divided into the brown bear/polar bear and the two black bears/sun bear assemblages. These findings resolve the previous conflicts between trees using partial mt genes. The ability of different categories of mt protein coding genes to recover the correct phylogeny is concordant with previous analyses for taxa with deep divergence times. This study provides a robust Ursidae phylogenetic framework for future validation by additional independent evidence, and also has significant implications for assisting in the resolution of other similarly difficult phylogenetic investigations. Conclusion Identification of base composition bias and utilization of the combined data of whole mitochondrial genome sequences has allowed recovery of a strongly supported phylogeny that is upheld when using multiple alternative outgroups for the Ursidae, a mammalian family that underwent a rapid radiation since the mid- to late Pliocene. It remains to be seen if the reliability of mt genome analysis will hold up in studies of other
Gabel, Jon R; Arnold, Daniel R; Fulton, Brent D; Stromberg, Sam T; Green, Matthew; Whitmore, Heidi; Scheffler, Richard M
With the notable exception of California, states have not made enrollment data for their Affordable Care Act (ACA) Marketplace plans publicly available. Researchers thus have tracked premium trends by calculating changes in the average price for plans offered (a straight average across plans) rather than for plans purchased (a weighted average). Using publicly available enrollment data for Covered California, we found that the average purchased price for all plans was 11.6 percent less than the average offered price in 2014, 13.2 percent less in 2015, and 15.2 percent less in 2016. Premium growth measured by plans purchased was roughly 2 percentage points less than when measured by plans offered in 2014-15 and 2015-16. We observed shifts in consumer choices toward less costly plans, both between and within tiers, and we estimate that a $100 increase in a plan's net annual premium reduces its probability of selection. These findings suggest that the Marketplaces are helping consumers moderate premium cost growth. Project HOPE—The People-to-People Health Foundation, Inc.
The development of new technologies for large-scale electricity storage is a key element in future flexible electricity transmission systems. Electricity storage in adiabatic compressed air energy storage (A-CAES) power plants offers the prospect of making a substantial contribution to reach this goal. This concept allows efficient, local zero-emission electricity storage on the basis of compressed air in underground caverns. The compression and expansion of air in turbomachinery help to balance power generation peaks that are not demand-driven on the one hand and consumption-induced load peaks on the other. For further improvements in cost efficiencies and flexibility, system modifications are necessary. Therefore, a novel concept regarding the integration of an electrical heating component is investigated. This modification allows increased power plant flexibilities and decreasing component sizes due to the generated high temperature heat with simultaneously decreasing total round trip efficiencies. For an exemplarily A-CAES case simulation studies regarding the electrical heating power and thermal energy storage sizes were conducted to identify the potentials in cost reduction of the central power plant components and the loss in round trip efficiency.
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
Caughey, Aaron B; Burchfield, David J
With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.
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,...
Zhu, Xudong; Arman, Bessembayev; Chu, Ju; Wang, Yonghong; Zhuang, Yingping
To develop an efficient cost-effective screening process to improve production of glucoamylase in Aspergillus niger. The cultivation of A. niger was achieved with well-dispersed morphology in 48-deep-well microtiter plates, which increased the throughput of the samples compared to traditional flask cultivation. There was a close negative correlation between glucoamylase and its pH of the fermentation broth. A novel high-throughput analysis method using Methyl Orange was developed. When compared to the conventional analysis method using 4-nitrophenyl α-D-glucopyranoside as substrate, a correlation coefficient of 0.96 by statistical analysis was obtained. Using this novel screening method, we acquired a strain with an activity of 2.2 × 10(3) U ml(-1), a 70% higher yield of glucoamylase than its parent strain.
Knowles, N. Richard; Ries, Stanley K.
Triacontanol (TRIA) increased fresh and dry weight and total reducible nitrogen (total N) of rice (Oryza sativa L.) seedlings within 40 minutes. Increases in total N in the supernatants from homogenates of corn (Zea mays L.) and rice leaves treated with TRIA for one minute before grinding occurred within 30 and 80 minutes, respectively. The source for the increase was investigated utilizing atmospheric substitution and enrichment and depletion studies with 15N. The increase in total N in seedlings was shown to be independent of method of N analysis and the presence of nitrate in the plants. Automated Kjeldahl determinations showing apparent increases in N composition due to TRIA were shown to be correlated with hand Kjeldahl, elemental analysis, and chemiluminescent analysis in three independent laboratories. TRIA did not alter the nitrate uptake or endogenous levels of nitrate in corn and rice seedlings. Enrichment experiments revealed that the total N increases in rice seedlings, in vivo, and in supernatants of corn leaf homogenates, in vitro, are not due to atmospheric N2. TRIA increased the soluble N pools of the plants, specifically the free amino acid and soluble protein fractions. No differences in depletion or enrichment of 15N incorporated into soluble and insoluble N fractions of rice seedlings could be detected on an atom per cent 15N basis. The apparent short-term total N increases cannot be explained by current knowledge of major N assimilation pathways. TRIA may stimulate a change in the chemical composition of the seedlings, resulting in interference with standard methods of N analysis. PMID:16662092
Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki
Gout is a chronic disease characterized by the deposition of urate crystals in the joints and throughout the body, caused by an excess burden of serum uric acid (sUA). The study estimates pharmacy and medical cost budgetary impacts of wider adoption by US payers of febuxostat, a urate-lowering therapy (ULT) for the treatment of gout. A US payer-perspective budget impact model followed ULT patients from a 1,000,000-member plan over 3 years. The current market share scenario, febuxostat (6%) and ULT allopurinol (94%), was compared with an 18% febuxostat market share. Data were implemented from randomized controlled trials, census and epidemiologic studies, and real-world database analyses. An innovation was the inclusion of gout-related chronic kidney disease costs. Cost results were estimated as annual and cumulative incremental costs, expressed as total costs, cost per member per month, and cost per treated member per month. Clinical results were also estimated. Increasing the febuxostat market share resulted in a 6.3% increase in patients achieving the sUA target level of gout flares during the 3-year period. Total cost increased 1.4%, with a 49.9% increase in ULT costs, a 1.4% reduction in flare costs, a 1.2% reduction in chronic kidney disease costs, and a 2.8% reduction in gout care costs. The cumulative incremental costs were $1,307,425 in the first year, $1,939,016 through the second year, and $2,092,744 through the third year. By the third year, savings in medical costs offset most of the increase in treatment costs. Impacts on cumulative cost per member per month and cumulative cost per treated member per month followed the same pattern, with the highest impact in the first year and cumulative impacts declining during the 3-year period. The cumulative cost per member per month impact was estimated as $0.109, $0.081, and $0.058 and the cumulative cost per treated member per month impact was estimated as $12.416, $9.207, and $6.625 in the first year, through
Gregory J Pec
Full Text Available The current unprecedented outbreak of mountain pine beetle (Dendroctonus ponderosae in lodgepole pine (Pinus contorta forests of western Canada has resulted in a landscape consisting of a mosaic of forest stands at different stages of mortality. Within forest stands, understory communities are the reservoir of the majority of plant species diversity and influence the composition of future forests in response to disturbance. Although changes to stand composition following beetle outbreaks are well documented, information on immediate responses of forest understory plant communities is limited. The objective of this study was to examine the effects of D. ponderosae-induced tree mortality on initial changes in diversity and productivity of understory plant communities. We established a total of 110 1-m2 plots across eleven mature lodgepole pine forests to measure changes in understory diversity and productivity as a function of tree mortality and below ground resource availability across multiple years. Overall, understory community diversity and productivity increased across the gradient of increased tree mortality. Richness of herbaceous perennials increased with tree mortality as well as soil moisture and nutrient levels. In contrast, the diversity of woody perennials did not change across the gradient of tree mortality. Understory vegetation, namely herbaceous perennials, showed an immediate response to improved growing conditions caused by increases in tree mortality. How this increased pulse in understory richness and productivity affects future forest trajectories in a novel system is unknown.
Pec, Gregory J; Karst, Justine; Sywenky, Alexandra N; Cigan, Paul W; Erbilgin, Nadir; Simard, Suzanne W; Cahill, James F
The current unprecedented outbreak of mountain pine beetle (Dendroctonus ponderosae) in lodgepole pine (Pinus contorta) forests of western Canada has resulted in a landscape consisting of a mosaic of forest stands at different stages of mortality. Within forest stands, understory communities are the reservoir of the majority of plant species diversity and influence the composition of future forests in response to disturbance. Although changes to stand composition following beetle outbreaks are well documented, information on immediate responses of forest understory plant communities is limited. The objective of this study was to examine the effects of D. ponderosae-induced tree mortality on initial changes in diversity and productivity of understory plant communities. We established a total of 110 1-m2 plots across eleven mature lodgepole pine forests to measure changes in understory diversity and productivity as a function of tree mortality and below ground resource availability across multiple years. Overall, understory community diversity and productivity increased across the gradient of increased tree mortality. Richness of herbaceous perennials increased with tree mortality as well as soil moisture and nutrient levels. In contrast, the diversity of woody perennials did not change across the gradient of tree mortality. Understory vegetation, namely herbaceous perennials, showed an immediate response to improved growing conditions caused by increases in tree mortality. How this increased pulse in understory richness and productivity affects future forest trajectories in a novel system is unknown.
Birch-Johansen, Fatima; Jensen, Allan; Mortensen, Lone
Nonmelanoma skin cancer (NMSC) is the most common cancer among Caucasian populations worldwide, and incidence rates are increasing. However, NMSC data are not routinely collected by cancer registries, but Denmark has extensive registration of NMSC in two nationwide population-based registries. We...
Berland, Brian [ITN Energy Systems, Inc., Littleton, CO (United States); Hollingsworth, Russell [ITN Energy Systems, Inc., Littleton, CO (United States)
Five Quads of energy are lost through windows annually in the U.S. Low-e coatings are increasingly employed to reduce the wasted energy. Most commonly, the low-e coating is an oxide material applied directly to the glass at high temperature. With over 100,000,000 existing homes, a retrofit product is crucial to achieve widespread energy savings. Low-e films, i.e. coatings on polymeric substrates, are now also available to meet this need. However, the traditional oxide materials and process is incompatible with low temperature plastics. Alternate high performing low-e films typically incorporate materials that limit visible transmission to 35% or less. Further, the cost is high. The objective of this award was to develop a retrofit, integrated low-e/electrochromic window film to dramatically reduce energy lost through windows. While field testing of state-of-the-art electrochromic (EC) windows show the energy savings are maximized if a low-e coating is used in conjunction with the EC, available low-e films have a low visible transmission (~70% or less) that limits the achievable clear state and therefore, appearance and energy savings potential. Comprehensive energy savings models were completed at Lawrence Berkeley National Lab (LBNL). A parametric approach was used to project energy usage for windows with a large range of low-e properties across all U.S. climate zones, without limiting the study to materials that had already been produced commercially or made in a lab. The model enables projection of energy savings for low-e films as well as integrated low-e/EC products. This project developed a novel low-e film, optimized for compatibility with EC windows, using low temperature, high deposition rate processes for the growth of low-e coatings on plastic films by microwave plasma enhanced chemical vapor deposition. Silica films with good density and optical properties were demonstrated at deposition rates as high as 130Å/sec. A simple bi-layer low-e stack of
Ozaki, Yori; Saito, Kenji; Nakazawa, Kyoko; Konishi, Morichika; Itoh, Nobuyuki; Hakuno, Fumihiko; Takahashi, Shin-Ichiro; Kato, Hisanori; Takenaka, Asako
Protein malnutrition promotes hepatic steatosis, decreases insulin-like growth factor (IGF)-I production and retards growth. To identify new molecules involved in such changes, we conducted DNA microarray analysis on liver samples from rats fed an isoenergetic low-protein diet for 8 h. We identified the fibroblast growth factor 21 gene (Fgf21) as one of the most strongly up-regulated genes under conditions of acute protein malnutrition (P<0·05, false-discovery rate<0·001). In addition, amino acid deprivation increased Fgf21 mRNA levels in rat liver-derived RL-34 cells (P<0·01). These results suggested that amino acid limitation directly increases Fgf21 expression. FGF21 is a polypeptide hormone that regulates glucose and lipid metabolism. FGF21 also promotes a growth hormone-resistance state and suppresses IGF-I in transgenic mice. Therefore, to determine further whether Fgf21 up-regulation causes hepatic steatosis and growth retardation after IGF-I decrease in protein malnutrition, we fed an isoenergetic low-protein diet to Fgf21-knockout (KO) mice. Fgf21-KO did not rescue growth retardation and reduced plasma IGF-I concentration in these mice. Fgf21-KO mice showed greater epididymal white adipose tissue weight and increased hepatic TAG and cholesterol levels under protein malnutrition conditions (P<0·05). Overall, the results showed that protein deprivation directly increased Fgf21 expression. However, growth retardation and decreased IGF-I were not mediated by increased FGF21 expression in protein malnutrition. Furthermore, FGF21 up-regulation rather appears to have a protective effect against obesity and hepatic steatosis in protein-malnourished animals.
Vieux, Florent; Dubois, Christophe; Allegre, Laëtitia; Mandon, Lionel; Ciantar, Laurent; Darmon, Nicole
To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France. A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals. Food-related cost of meals. Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively. The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes. Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: The converging epidemics of HIV and tuberculosis (TB pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. Objective: The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB directly from sputum specimens, in the Indian setting. Materials and Methods: This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. Results: Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P < 0.001. Conclusion: Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.
Full Text Available Abstract The Swedish Family-Cancer Database has been used for some 10 years in the study of familial risks at all common sites. In the present paper we describe some of the main features of version VII of this Database, assembled in year 2006. This update included all residents in Sweden born or immigrated in 1932 and later (offspring with their biological parents, a total of 11.5 million individuals. Cancer cases were retrieved from the Swedish Cancer Registry from years 1958 to 2004, including over 1.2 million first and multiple primary cancers and in situ tumours. We show one application of the Database in the study of familial risks in prostate cancer, with special reference to the modification of familial risk at the time of about 50% increase in incidence due to prostate specific antigen (PSA screening. The familial risks for prostate cancer were 1.92 for sons of affected fathers, 3.03 for brothers and 5.44 for men with an affected father and an affected brother. Familial risk for prostate cancer according to the time since the first family member was diagnosed showed significant increases for two family members being diagnosed in the same year compared to 5+ years apart. Increased surveillance and the availability of PSA screening are the likely reasons for the overestimated familial relative risk shortly after the first diagnosis. This lead time bias should be considered in clinical counselling.
Full Text Available Ocean acidification is potentially one of the greatest threats to marine ecosystems and global carbon cycling. Amongst calcifying organisms, coccolithophores have received special attention because their calcite precipitation plays a significant role in alkalinity flux to the deep ocean (i.e., inorganic carbon pump. Currently, empirical effort is devoted to evaluating the plastic responses to acidification, but evolutionary considerations are missing from this approach. We thus constructed an optimality model to evaluate the evolutionary response of coccolithophorid life history, assuming that their exoskeleton (coccolith serves to reduce the instantaneous mortality rates. Our model predicted that natural selection favors constructing more heavily calcified exoskeleton in response to increased acidification-driven costs. This counter-intuitive response occurs because the fitness benefit of choosing a better-defended, slower growth strategy in more acidic conditions, outweighs that of accelerating the cell cycle, as this occurs by producing less calcified exoskeleton. Contrary to the widely held belief, the evolutionarily optimized population can precipitate larger amounts of CaCO(3 during the bloom in more acidified seawater, depending on parameter values. These findings suggest that ocean acidification may enhance the calcification rates of marine organisms as an adaptive response, possibly accompanied by higher carbon fixation ability. Our theory also provides a compelling explanation for the multispecific fossil time-series record from ∼200 years ago to present, in which mean coccolith size has increased along with rising atmospheric CO(2 concentration.
Geddes, Gabrielle C; Basel, Donald; Frommelt, Peter; Kinney, Aaron; Earing, Michael
Genetic testing is routinely performed on infants with critical congenital heart disease (CHD). This project reviewed the effect of implementing a genetic testing protocol in this population. Charts of infants with critical CHD were reviewed for genetic testing and results across two time periods: the time before implementation of a genetic testing protocol (pre-protocol) and the time after implementation (post-protocol). The use of karyotype, 22q11.2 Deletion testing, and chromosomal microarray were compared across these two time periods. Records of 891 infants were reviewed. 562 (63%) had at least one of the target genetic tests completed. During the pre-protocol time period, 66% of patients who had genetic testing underwent multiple tests versus 24% during the post-protocol time period (p testing increased from 60% in the pre-protocol time period to 77% in the post-protocol time period (p tests and more likely to have a diagnosis of genetic disease. In addition there was a significant reduction in cost per diagnosis during the post-protocol time period. Genetic testing protocols for infants with critical CHD promoted more efficient use of genetic testing and increased the rate of diagnosis of genetic conditions in this population.
Irie, Takahiro; Bessho, Kazuhiro; Findlay, Helen S; Calosi, Piero
Ocean acidification is potentially one of the greatest threats to marine ecosystems and global carbon cycling. Amongst calcifying organisms, coccolithophores have received special attention because their calcite precipitation plays a significant role in alkalinity flux to the deep ocean (i.e., inorganic carbon pump). Currently, empirical effort is devoted to evaluating the plastic responses to acidification, but evolutionary considerations are missing from this approach. We thus constructed an optimality model to evaluate the evolutionary response of coccolithophorid life history, assuming that their exoskeleton (coccolith) serves to reduce the instantaneous mortality rates. Our model predicted that natural selection favors constructing more heavily calcified exoskeleton in response to increased acidification-driven costs. This counter-intuitive response occurs because the fitness benefit of choosing a better-defended, slower growth strategy in more acidic conditions, outweighs that of accelerating the cell cycle, as this occurs by producing less calcified exoskeleton. Contrary to the widely held belief, the evolutionarily optimized population can precipitate larger amounts of CaCO(3) during the bloom in more acidified seawater, depending on parameter values. These findings suggest that ocean acidification may enhance the calcification rates of marine organisms as an adaptive response, possibly accompanied by higher carbon fixation ability. Our theory also provides a compelling explanation for the multispecific fossil time-series record from ∼200 years ago to present, in which mean coccolith size has increased along with rising atmospheric CO(2) concentration.
Eskens, Bart J M; Mooij, Hans L; Cleutjens, Jack P M; Roos, Jozef M A; Cobelens, Johanna E; Vink, Hans; Vanteeffelen, Jurgen W G E
It has been demonstrated that insulin-mediated recruitment of microvascular blood volume is associated with insulin sensitivity. We hypothesize that insulin rapidly stimulates penetration of red blood cells (RBC) and plasma into the glycocalyx and thereby promotes insulin-mediated glucose uptake by increasing intracapillary blood volume. Experiments were performed in rats; the role of the glycocalyx was assessed by enzymatic degradation using a bolus of hyaluronidase. First, the effect of insulin on glycocalyx accessibility was assessed by measuring the depth of penetration of RBCs into the glycocalyx in microvessels of the gastrocnemius muscle with Sidestream Dark-field imaging. Secondly, peripheral insulin sensitivity was determined using intravenous insulin tolerance tests (IVITT). In addition, in a smaller set of experiments, intravital microscopy of capillary hemodynamics in cremaster muscle and histological analysis of the distribution of fluorescently labeled 40 kDa dextrans (D40) in hindlimb muscle was used to evaluate insulin-mediated increases in capillary blood volume. Insulin increased glycocalyx penetration of RBCs by 0.34±0.44 µm (Pglucose disposal compared to control rats. Insulin-mediated increases in capillary blood volume were reflected by a rapid increase in capillary tube hematocrit from 21.1±10.1% to 29.0±9.8% (Pblood in muscle, and this is associated with an increased blood volume in individual capillaries. Hyaluronidase treatment of the glycocalyx abolishes the effects of insulin on capillary blood volume and impairs insulin-mediated glucose disposal.
Geertsen, Svend Sparre; Kirk, Henrik; Lorentzen, Jakob
(mean age 34.3, range 18-57years) and fifteen healthy age-matched controls were biomechanically measured for passive and reflex-mediated stiffness of the ankle plantarflexors at rest, maximal voluntary plantarflexion and dorsiflexion effort (MVCpf,df) and rate of force development (RFDpf,df). Kinematic......, range of movement in the ankle joint and gait speed. Reflex-mediated stiffness was not correlated to any parameters of impaired gait. CONCLUSIONS: Impaired gait function in adults with CP is associated with reduced RFD and increased passive stiffness of ankle muscles. SIGNIFICANCE: These findings...
Full Text Available [b]Introduction.[/b] The dynamic rise of alcohol consumption in adolescents is a matter of serious concern, requiring frequently updated monitoring. By such means, it is possible to optimise preventative measures for dealing with this problem. [b]Objective[/b]. To estimate the magnitude/amount and frequency of alcohol consumed by middle and high school pupils in Poland, including the circumstances when alcohol was first drunk. [b]Materials and Methods[/b]. A randomised survey was performed throughout Poland on middle school (junior high school pupils, (n=9360 in 2009, followed by both middle and high school pupils in 2011 (n=7971. The questionnaire was devised by the Polish Chief Sanitary Inspectorate (GIS. [b]Results[/b]. A strikingly sharp increase in alcohol consumption (29% was observed in subjects between 2009 – 2011. In the latter year, 1 month prior to survey, respectively, 50% and 71% of middle school and high school pupils drank alcohol, and correspondingly, 36% and 63% of these pupils ever became intoxicated/drunk. [b]Conclusions[/b]. 1 Adolescent alcohol consumption increases with age and is highest in girls. Monitoring as well as in-depth analysis thus becomes necessary. 2 Systematic monitoring and analysis of changing healthy lifestyle behaviour should be used for taking the necessary corrective action. This should happen concurrently and consist of planned health education programmes, including health promotion.
Ennis, Gretchen; Tofa, Matalena; Finlayson, Mary; U'Ren, Julie
A rapidly expanding natural-resource extraction industry and a growing military presence mean an increasingly male-skewed population for the city of Darwin, Australia. This has sparked concerns about the potential for increased violence against women. In this article, we present qualitative research detailing the views of 13 participants from 10 women's support services in the Darwin area. We argue that women's support services bear witness to and are tasked with responding to the impacts of population change on women, yet their work is undermined by uncertainties that stem from neoliberal funding rationales and limited demands on companies to address social issues. © The Author(s) 2016.
Kalkan, Almina; Bodegard, Johan; Sundström, Johan; Svennblad, Bodil; Östgren, Carl Johan; Nilsson, Peter Nilsson; Johansson, Gunnar; Ekman, Mattias
To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Patients newly initiated on insulin (n=2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. The total mean annual healthcare cost increased from €1656 per patient 2 years before insulin initiation to €3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was €13,823 in the insulin group compared to €9989 in the NIAD group. Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Huang, Guoliang; Huang, Qin; Xie, Lan; Xiang, Guangxin; Wang, Lei; Xu, Hui; Ma, Li; Luo, Xianbo; Xin, Juan; Zhou, Xinying; Jin, Xiangyu; Zhang, Lei
An air-insulated microfluidic chip was designed for the automatic centrifugal distribution of samples to 24-test cells, enabling the parallel identification of multiple clinical pneumonia-related pathogens in 1.45-μL reactions without cross-contamination in 45 min. A portable nucleic acid analyzer that integrates mechanical, confocal optical, electronic, and software functions was also developed to collect fluorescence data in a Ø3 mm imaging field near the optical diffraction limit for highly sensitive fluorescence detection of nucleic acid amplification in real time. This microfluidic chip-based portable nucleic acid analyzer could detect low abundance nucleic acids present at as few as 10 copies. In a blinded experiment, specific identification of Mycoplasma pneumoniae, Staphylococcus aureus, and methicillin-resistant S. aureus was achieved with 229 clinical patient sputum samples. The total coincidence rate of our system and traditional RT-PCR with an ABI 7500 was 99.56%. Four samples accounting for the 0.44% inconformity were retested by gene sequencing, revealing that our system reported the correct results. This novel microfluidic chip-based detection system is cost-effective, rapid, sensitive, specific, and has a relatively high throughput for parallel identification, which is especially suitable for resource-limited facilities/areas and point-of-care testing.
Ribeiro-Silva, Neila; Nejm, Mariana Bocca; da Silva, Sylvia Maria Affonso; Suchecki, Deborah; Luz, Jacqueline
What is the central question of this study? Sleep curtailment in infancy and adolescence may lead to long-term risk for obesity, but the mechanisms involved have not yet been determined. This study examined the immediate and long-term metabolic effects produced by sleep restriction in young rats. What is the main finding and its importance? Prolonged sleep restriction reduced weight gain (body fat stores) in young animals. After prolonged recovery, sleep-restricted rats tended to save more energy and to store more fat, possibly owing to increased gross food efficiency. This could be the first step to understand this association. Sleep curtailment is associated with obesity and metabolic changes in adults and children. The aim of the present study was to evaluate the immediate and long-term metabolic alterations produced by sleep restriction in pubertal male rats. Male Wistar rats (28 days old) were allocated to a control (CTL) group or a sleep-restricted (SR) group. This was accomplished by the single platform technique for 18 h per day for 21 days. These groups were subdivided into the following four time points for assessment: sleep restriction and 1, 2 and 4 months of recovery. Body weight and food intake were monitored throughout the experiment. At the end of each time period, blood was collected for metabolic profiling, and the carcasses were processed for measurement of body composition and energy balance. During the period of sleep restriction, SR animals consumed less food in the home cages. This group also displayed lower body weight, body fat, triglycerides and glucose levels than CTL rats. At the end of the first month of recovery, despite eating as much as CTL rats, SR animals showed greater energy and body weight gain, increased gross food efficiency and decreased energy expenditure. At the end of the second and fourth months of recovery, the groups were no longer different, except for energy gain and gross food efficiency, which remained higher in SR
Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis.
Fayet-Moore, Flavia; George, Alice; Cassettari, Tim; Yulin, Lev; Tuck, Kate; Pezzullo, Lynne
An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.
Marko Vlahović; Mila Kavalić; Ljiljana Radovanović; Darko Baðok; Arben Lunjić
.... In order to try to reduce the cost of tires and increase transport efficiency within their logistics and distribution centers, the company Mercator-S has made an internal decision on additional quality control measures...
Li, Yiqing; Andereggen, Lukas; Yuki, Kenya; Omura, Kumiko; Yin, Yuqin; Gilbert, Hui-Ya; Erdogan, Burcu; Asdourian, Maria S; Shrock, Christine; de Lima, Silmara; Apfel, Ulf-Peter; Zhuo, Yehong; Hershfinkel, Michal; Lippard, Stephen J; Rosenberg, Paul A; Benowitz, Larry
Retinal ganglion cells (RGCs), the projection neurons of the eye, cannot regenerate their axons once the optic nerve has been injured and soon begin to die. Whereas RGC death and regenerative failure are widely viewed as being cell-autonomous or influenced by various types of glia, we report here that the dysregulation of mobile zinc (Zn(2+)) in retinal interneurons is a primary factor. Within an hour after the optic nerve is injured, Zn(2+) increases several-fold in retinal amacrine cell processes and continues to rise over the first day, then transfers slowly to RGCs via vesicular release. Zn(2+) accumulation in amacrine cell processes involves the Zn(2+) transporter protein ZnT-3, and deletion of slc30a3, the gene encoding ZnT-3, promotes RGC survival and axon regeneration. Intravitreal injection of Zn(2+) chelators enables many RGCs to survive for months after nerve injury and regenerate axons, and enhances the prosurvival and regenerative effects of deleting the gene for phosphatase and tensin homolog (pten). Importantly, the therapeutic window for Zn(2+) chelation extends for several days after nerve injury. These results show that retinal Zn(2+) dysregulation is a major factor limiting the survival and regenerative capacity of injured RGCs, and point to Zn(2+) chelation as a strategy to promote long-term RGC protection and enhance axon regeneration.
Rúbia M de Medeiros
Full Text Available Cytokines are intrinsically related to disease progression in HIV infection. We evaluated the plasma levels of Th1/Th2/Th17 cytokines in extreme progressors, including slow (SPs and rapid (RPs progressors, who were thus classified based on clinical and laboratory follow-up covering a period of time before the initiation of HAART, ranging from 93-136.5 months for SPs and 7.5-16.5 months for RPs. Analyses were also performed based on the different stages of HIV infection (chronic, pre-HAART individuals-subjects sampled before initiating HAART but who initiated therapy from 12 to 24 months-and those receiving HAART. The plasma cytokine levels of 16 HIV-infected rapid progressors and 25 slow progressors were measured using a Human Th1/Th2/Th17 CBA kit. The IL-6 and IL-10 plasma levels differed significantly between the stages of HIV infection. The IL-6 levels were higher in slow progressors pre-HAART than in chronically infected SPs and HIV-seronegative individuals. The IL-10 levels were higher in slow progressors pre-HAART than in slow progressors receiving HAART and HIV-seronegative controls, and in rapid progressors, the IL-10 levels were higher in pre-HAART subjects than in HIV-seronegative controls. The results reflect the changes in the cytokine profile occurring during different clinical stages in HIV+ subjects. Our results suggest an association between increased IL-6 and IL-10 levels and pre-HAART stages independent of the slow or rapid progression status of the subjects. Thus, increased IL-6 and IL-10 levels could indicate a global inflammatory status and could be used as markers of the disease course in HIV-infected individuals.
Harriet J Forbes
Full Text Available To estimate the prevalence of circumcision among young men in rural Mwanza, North-Western Tanzania, and document trends in circumcision prevalence over time. To investigate associations of circumcision with socio-demographic characteristics, reported sexual behaviours and sexually transmitted infections (STIs.A cross-sectional survey in communities which had previously participated in a cluster-randomized trial of an adolescent sexual health intervention that did not include male circumcision in 20 rural communities.In 2007/08, 7300 young men (age 16-23 years were interviewed and examined by a clinician. The prevalence of circumcision by age was compared with data collected during the trial in 1998-2002. Odds ratios (OR and 95% confidence intervals (CI for the association of circumcision with socio-demographic characteristics, reported sexual behaviours and with HIV and other STIs were estimated using multivariable conditional logistic regression.The prevalence of male circumcision was 40.6%, and age-specific prevalence had more than doubled since 2001/2002. Circumcised men reported less risky sexual behaviours, being more likely to report having ever used a condom (adjusted OR = 2.62, 95%CI:2.32-2.95. Men circumcised before sexual debut were at reduced risk of being HIV seropositive compared with non-circumcised men (adjusted OR = 0.50, 95%CI:0.25-0.97, and also had reduced risks of HSV-2 infection and genital ulcer syndrome in the past 12 months compared with non-circumcised men.There was a steep increase in circumcision prevalence between 2001/02 and 2007/08 in the absence of a promotional campaign. Circumcised men reported safer sexual practices than non-circumcised men and had lower prevalence of HIV and HSV-2 infection.
Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.
The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…
Tieleman, B. Irene; Dijkstra, Thomas H.; Klasing, Kirk C.; Visser, G. Henk; Williams, Joseph B.
Life-history theory assumes that organisms trade-off current against future reproduction to maximize fitness. Experimental explorations of the costs of reproduction have not yielded a clear understanding of the nature of these costs but rather point to a complex set of allocation possibilities among
Full Text Available A transition to renewable energy sources and a circular economy has increased interest in renewable resources not usually considered as energy sources or plant nutrient resources. Horse manure exemplifies this, as it is sometimes recycled but not often used for energy purposes. The purpose of this study was to explore horse manure management in a Swedish municipality and prospects for energy recovery. The case study includes a survey of horse manure practices, environmental assessment of horse manure treatment in a biogas plant, including associated transport, compared to on-site unmanaged composting, and finally a simplified economic analysis. It was found that horse manure management was characterized by indoor collection of manure most of the year and storage on concrete slabs or in containers, followed by direct application on arable land. Softwood was predominantly used as bedding, and bedding accounted for a relatively small proportion (13% of the total mix. Anaerobic digestion was indicated to reduce potential environmental impact in comparison to unmanaged composting, mainly due to biogas substituting use of fossil fuels. The relative environmental impact from transport of manure from horse facilities to anaerobic digestion plant was small. Results also indicate a relatively high cost for horse keepers to change from composting on site to anaerobic digestion in a centralized plant.
Riall, Taylor S; Zhang, Dong; Townsend, Courtney M; Kuo, Yong-Fang; Goodwin, James S
Background Cholecystectomy during initial hospitalization is the current recommended therapy for acute cholecystitis. The rate of cholecystectomy and subsequent healthcare trajectory in elderly patients with acute cholecystitis has not been evaluated. Study Design We used 5% national Medicare sample claims data from 1996–2005 to identify a cohort of patients ≥66 requiring urgent/emergent admission for acute cholecystitis. We evaluated cholecystectomy rates on initial hospitalization, the factors independently predicting receipt of cholecystectomy, the factors predicting further gallstone-related complications, and 2-year survival in the cholecystectomy and no cholecystectomy group in univariate and multivariate models. Results 29,818 Medicare beneficiaries were urgently/emergently admitted for acute cholecystitis from 1996–2005. The mean age was 77.7±7.3 years. 89% of patients were white and 58% were female. 25% of patients did not undergo cholecystectomy during the index admission. Lack of definitive therapy was associated with a 27% subsequent cholecystectomy rate and a 38% gallstone-related readmission rate over in the two years after discharge, while the readmission rate was only 4% in patients undergoing cholecystectomy (Pacute cholecystitis in elderly patients should be performed during initial hospitalization to prevent recurrent episodes of cholecystitis, multiple readmissions, higher readmission rates, and increased costs. PMID:20421027
Wasserfall, C; Montgomery, E; Yu, L; Michels, A; Gianani, R; Pugliese, A; Nierras, C; Kaddis, J S; Schatz, D A; Bonifacio, E; Atkinson, M A
The Network for Pancreatic Organ donors with Diabetes (nPOD) programme was developed in response to an unmet research need for human pancreatic tissue obtained from individuals with type 1 diabetes mellitus and people at increased risk [i.e. autoantibody (AAb)-positive] for the disease. This necessitated the establishment of a type 1 diabetes-specific AAb screening platform for organ procurement organizations (OPOs). Assay protocols for commercially available enzyme-linked immunosorbent assays (elisas) determining AAb against glutamic acid decarboxylase (GADA), insulinoma-associated protein-2 (IA-2A) and zinc transporter-8 (ZnT8A) were modified to identify AAb-positive donors within strict time requirements associated with organ donation programmes. These rapid elisas were evaluated by the international islet AAb standardization programme (IASP) and used by OPO laboratories as an adjunct to routine serological tests evaluating donors for organ transplantation. The rapid elisas performed well in three IASPs (2011, 2013, 2015) with 98-100% specificity for all three assays, including sensitivities of 64-82% (GADA), 60-64% (IA-2A) and 62-68% (ZnT8A). Since 2009, nPOD has screened 4442 organ donors by rapid elisa; 250 (5·6%) were identified as positive for one AAb and 14 (0.3%) for multiple AAb with 20 of these cases received by nPOD for follow-up studies (14 GADA+, two IA-2A(+) , four multiple AAb-positive). Rapid screening for type 1 diabetes-associated AAb in organ donors is feasible, allowing for identification of non-diabetic, high-risk individuals and procurement of valuable tissues for natural history studies of this disease. © 2016 British Society for Immunology.
Introduction High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services. Methods This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply - side incentives on increasing access to maternal health services. The provider’s perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated. Results The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively. Conclusion Subsidizing maternal health care costs through demand and supply – side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda’s Gross Domestic Product (GDP) per capita of US$55` (2012), the incremental cost per additional delivery (US$23.9) represents about 5% of GDP per capita to save a mother and probably her new born. For many low income countries, this may not be
Shams, Kim; Cameo, Tamara; Fennoy, Ilene; Hassoun, Abeer A; Lerner, Shulamit E; Aranoff, Gaya S; Sopher, Aviva B; Yang, Christine; McMahon, Donald J; Oberfield, Sharon E
Aromatase inhibitors (AIs) have been used off-label to increase adult height in short adolescent males. Studies have shown that AIs increase the predicted adult height (PAH) while delaying bone age (BA) maturation. We sought to determine whether AI therapy increases PAH in boys with short stature or rapid pubertal progression, and to evaluate any untoward effects. The charts of 27 boys with BA ≥ 13 and short stature [height ≥ 2 standard deviation (SD) below the mean or ≥ 2 SD below mid-parental target height (MPTH)] or rapid pubertal progress, treated with anastrozole were reviewed. Outcome measures included anthropomorphic, hormonal, and metabolic data. The AI therapy averaged 21 months (range 14-30 months) for all, with Rx group 1 receiving height SDS, or BA/chronological age (CA). In Rx group 2, there was a small, nonsignificant increase in PAH, no change in height SDS, and a small decrease in BA/CA. Post-therapy PAH was different from MPTH in all and in both Rx groups 1 and 2, pheight, averaging 6.73 ± 1.40 cm less than MPTH and 1.91 ± 0.86 cm less than the pre-therapy PAH. Post-therapy, the initially decreased estradiol did not persist but mildly increased testosterone and decreased high-density lipoprotein were noted, as was an increase in hematocrit, and decrease in growth velocity. We suggest that although bone age progression may be slightly delayed with longer duration of therapy, an overall short-term AI therapy does not lead to a final height that is greater than the predicted pre-therapy height.
Reynolds, Sarah A; Ebben, Matthew R
Insomnia is a highly prevalent, often chronic condition, which is left untreated or not treated according to recommended guidelines in most cases. This results in high health and financial burdens to society. The cost of untreated insomnia and the prevailing reliance on sedative-hypnotic use as a first-line treatment are evaluated in this article. The cost-benefit potential of cognitive behavioral therapy for insomnia is also assessed. Copyright © 2016 Elsevier Inc. All rights reserved.
John D Rolston
Full Text Available Commercially available data acquisition systems for multielectrode recording from freely moving animals are expensive, often rely on proprietary software, and do not provide detailed, modifiable circuit schematics. When used in conjunction with electrical stimulation, they are prone to prolonged, saturating stimulation artifacts that prevent the recording of short-latency evoked responses. Yet electrical stimulation is integral to many experimental designs, and critical for emerging brain-computer interfacing and neuroprosthetic applications. To address these issues, we developed an easy-to-use, modifiable, and inexpensive system for multielectrode neural recording and stimulation. Setup costs are less than US$10,000 for 64 channels, an order of magnitude lower than comparable commercial systems. Unlike commercial equipment, the system recovers rapidly from stimulation and allows short-latency action potentials (<1 ms post-stimulus to be detected, facilitating closed-loop applications and exposing neural activity that would otherwise remain hidden. To illustrate this capability, evoked activity from microstimulation of the rodent hippocampus is presented. The system is modular, in banks of 16 channels, and flexible in usage: while primarily designed for in vivo use, it can be combined with commercial preamplifiers to record from in vitro multielectrode arrays. The system’s open-source control software, NeuroRighter, is implemented in C#, with an easy-to-use graphical interface. As C# functions in a managed code environment, which may impact performance, analysis was conducted to ensure comparable speed to C++ for this application. Hardware schematics, layout files, and software are freely available. Since maintaining wired headstage connections with freely moving animals is difficult, we describe a new method of electrode-headstage coupling using neodymium magnets.
Full Text Available Yunnan's biodiversity is under considerable pressure and subtropical evergreen broad-leaved forests in this area have become increasingly fragmented through agriculture, logging, planting of economic plants, mining activities and changing environment. The aims of the study are to investigate climate change-induced changes of subtropical evergreen broad-leaved forests in Yunnan and identify areas of current species richness centers for conservation preparation. Stacked species distribution models were created to generate ensemble forecasting of species distributions, alpha diversity and beta diversity for Yunnan's subtropical evergreen broad-leaved forests in both current and future climate scenarios. Under stacked species distribution models in rapid climate changes scenarios, changes of water-energy dynamics may possibly reduce beta diversity and increase alpha diversity. This point provides insight for future conservation of evergreen broad-leaved forest in Yunnan, highlighting the need to fully consider the problem of vegetation homogenization caused by transformation of water-energy dynamics.
Bridle, C; Palmer, S; Bagnall, A-M; Darba, J; Duffy, S; Sculpher, M; Riemsma, R
with tremor. Olanzapine as adjunct therapy to mood stabilisers may be more effective than placebo in reducing mania and improving global health, but it is associated with more dry mouth, somnolence, weight gain, increased appetite, tremor and speech disorder. There was little difference between these treatments and haloperidol in reducing mania, but haloperidol was associated with more extrapyramidal side-effects and negative implications for health-related quality of life. Intramuscular olanzapine and lorazepam were equally effective and safe in one very short (24 hour) trial. Valproate semisodium and carbamazepine were equally effective and safe in one small trial in children. Olanzapine may be more effective than valproate semisodium in reducing mania, but was associated with more dry mouth, increased appetite, oedema, somnolence, speech disorder, Parkinson-like symptoms and weight gain. Valproate semisodium was associated with more nausea than olanzapine. The results from the base-case analysis demonstrate that choice of optimal strategy is dependent on the maximum that the health service is prepared to pay per additional responder. For a figure of less than 7179 British pounds per additional responder, haloperidol is the optimal decision; for a spend in excess of this, it would be olanzapine. Under the most favourable scenario in relation to the costs of responders and non-responders beyond the 3-week period considered in the base-case analysis, the incremental cost-effectiveness ratio of olanzapine is reduced to 1236 British pounds. In comparison with placebo, quetiapine, olanzapine and valproate semisodium appear superior in reducing manic symptoms, but all drugs are associated with adverse events. In comparison with lithium, no significant differences were found between the three drugs in terms of effectiveness, and all were associated with adverse events. Several limitations of the cost-effectiveness analysis exist, which inevitably means that the results
out at the top of the late Miocene, early Mohnian: Bolivina aff hughesi, Rotalia becki, Suggrunda californica, Virgulina grandis, Virgulina ticensis, Bulimina ecuadorana, Denticula lauta and Nonion medio-costatum. Please see Appendix B, Fig. 1, Neogene Zones, p. 91 and Appendix C, chart 5, p. 99 By the use of Stratigraphy, employing both Paleontology and Lithology, we can increase hydrocarbon production, reduce operating costs and risks by the identification of the productive sections, and reduce environmental concerns by drilling less dry holes needlessly.
Sels, L; De Winne, S; Maes, J; Delmotte, J; Faems, D; Forrier, A
The majority of empirical studies on the HRM-performance link report a positive story. The costs associated with the productivity rise due to high performance work practices (HPWP) have been largely neglected. The purpose of this study is to develop a conceptual framework that maps both the
Chan, Randolph C. H.; Mak, Winnie W. S.; Pang, Ingrid H. Y.; Wong, Samuel Y. S.; Tang, Wai Kwong; Lau, Joseph T. F.; Woo, Jean; Lee, Diana T. F.; Cheung, Fanny M.
The present study examined whether, when, and how motivational messaging can boost the response rate of postal surveys for physicians based on Higgin's regulatory focus theory, accounting for its cost-effectiveness. A three-arm, blinded, randomized controlled design was used. A total of 3,270 doctors were randomly selected from the registration…
Mohr, Nicholas M; Harland, Karisa K; Shane, Dan M; Ahmed, Azeemuddin; Fuller, Brian M; Torner, James C
The objective of this study was to evaluate the impact of regionalization on sepsis survival, to describe the role of inter-hospital transfer in rural sepsis care, and to measure the cost of inter-hospital transfer in a predominantly rural state. Observational case-control study using statewide administrative claims data from 2005 to 2014 in a predominantly rural Midwestern state. Mortality and marginal costs were estimated with multivariable generalized estimating equations models and with instrumental variables models. A total of 18 246 patients were included, of which 59% were transferred between hospitals. Transferred patients had higher mortality and longer hospital length-of-stay than non-transferred patients. Using a multivariable generalized estimating equations (GEE) model to adjust for potentially confounding factors, inter-hospital transfer was associated with increased mortality (aOR 1.7, 95% CI 1.5-1.9). Using an instrumental variables model, transfer was associated with a 9.2% increased risk of death. Transfer was associated with additional costs of $6897 (95% CI $5769-8024). Even when limiting to only those patients who received care in the largest hospitals, transfer was still associated with $5167 (95% CI $3696-6638) in additional cost. The majority of rural sepsis patients are transferred, and these transferred patients have higher mortality and significantly increased cost of care. Copyright © 2016 Elsevier Inc. All rights reserved.
award; “pushing” potentially high-impact research reports (e.g., via overnight shipping) to selected practitioners and policy-makers; and most...integration of these two technologies within Phase IV of SHIPMAIN could result in substantial cost savings and decreased fleet cycle time via ...original Shipmain plan included: – 3D Terrestr s S ni g echnology ial La er can n T (3D TLS) – Collaborative Product Lifecycle Management (collab
Thorne, L M
Why are medical costs rising so rapidly? What are the factors involved that influence those costs? Does inflation affect health care costs? Can anything be done? The solutions to these complex issues are not clearly understood. It is clear, however, that the resolutions to these questions must be found quickly. If the causes of rising medical care costs are not promptly diagnosed and treated, we may find our economic health to be in critical condition. This paper attempts to better understand the reasons for increasing health care costs. The role that inflation plays relative to health care costs is investigated.
Halim, Murni; Rios-Solis, Leonardo; Micheletti, Martina; Ward, John M; Lye, Gary J
This work aims to establish microscale methods to rapidly explore bioprocess options that might be used to enhance bioconversion reaction yields: either by shifting unfavourable reaction equilibria or by overcoming substrate and/or product inhibition. As a typical and industrially relevant example of the problems faced we have examined the asymmetric synthesis of (2S,3R)-2-amino-1,3,4-butanetriol from l-erythrulose using the ω-transaminase from Chromobacterium violaceum DSM30191 (CV2025 ω-TAm) and methylbenzylamine as the amino donor. The first process option involves the use of alternative amino donors. The second couples the CV2025 ω-TAm with alcohol dehydrogenase and glucose dehydrogenase for removal of the acetophenone (AP) by-product by in situ conversion to (R)-1-phenylethanol. The final approaches involve physical in-situ product removal methods. Reduced pressure conditions, attained using a 96-well vacuum manifold were used to selectively increase evaporation of the volatile AP while polymeric resins were also utilised for selective adsorption of AP from the bioconversion medium. For the particular reaction studied here the most promising bioprocess options were use of an alternative amino donor, such as isopropylamine, which enabled a 2.8-fold increase in reaction yield, or use of a second enzyme system which achieved a 3.3-fold increase in yield.
Bonen, Arend; Jain, Swati S; Snook, Laelie A; Han, Xiao-Xia; Yoshida, Yuko; Buddo, Kathryn H; Lally, James S; Pask, Elizabeth D; Paglialunga, Sabina; Beaudoin, Marie-Soleil; Glatz, Jan F C; Luiken, Joost J F P; Harasim, Ewa; Wright, David C; Chabowski, Adrian; Holloway, Graham P
The mechanisms for diet-induced intramyocellular lipid accumulation and its association with insulin resistance remain contentious. In a detailed time-course study in rats, we examined whether a high-fat diet increased intramyocellular lipid accumulation via alterations in fatty acid translocase (FAT/CD36)-mediated fatty acid transport, selected enzymes and/or fatty acid oxidation, and whether intramyocellular lipid accretion coincided with the onset of insulin resistance. We measured, daily (on days 1-7) and/or weekly (for 6 weeks), the diet-induced changes in circulating substrates, insulin, sarcolemmal substrate transporters and transport, selected enzymes, intramyocellular lipids, mitochondrial fatty acid oxidation and basal and insulin-stimulated sarcolemmal GLUT4 and glucose transport. We also examined whether upregulating fatty acid oxidation improved glucose transport in insulin-resistant muscles. Finally, in Cd36-knockout mice, we examined the role of FAT/CD36 in intramyocellular lipid accumulation, insulin sensitivity and diet-induced glucose intolerance. Within 2-3 days, diet-induced increases occurred in insulin, sarcolemmal FAT/CD36 (but not fatty acid binding protein [FABPpm] or fatty acid transporter [FATP]1 or 4), fatty acid transport and intramyocellular triacylglycerol, diacylglycerol and ceramide, independent of enzymatic changes or muscle fatty acid oxidation. Diet-induced increases in mitochondria and mitochondrial fatty acid oxidation and impairments in insulin-stimulated glucose transport and GLUT4 translocation occurred much later (≥21 days). FAT/CD36 ablation impaired insulin-stimulated fatty acid transport and lipid accumulation, improved insulin sensitivity and prevented diet-induced glucose intolerance. Increasing fatty acid oxidation in insulin-resistant muscles improved glucose transport. High-fat feeding rapidly increases intramyocellular lipids (in 2-3 days) via insulin-mediated upregulation of sarcolemmal FAT/CD36 and fatty acid
Joiner, K S; Hamlin, G A; Lien, A R J; Bilgili, S F
Skeletal muscle development proceeds from early embryogenesis through marketing age in broiler chickens. While myofiber formation is essentially complete at hatching, myofiber hypertrophy can increase after hatch by assimilation of satellite cell nuclei into myofibers. As the diameter of the myofibers increases, capillary density peripheral to the myofiber is marginalized, limiting oxygen supply and subsequent diffusion into the myofiber, inducing microischemia. The superficial and deep pectoralis muscles constitute 25% of the total body weight in a market-age bird; thus compromise of those muscle groups can have profound economic impact on broiler production. We hypothesized that marginal capillary support relative to the hypertrophic myofibers increases the incidence of microischemia, especially in contemporary high-yield broilers under stressing conditions such as high environmental temperatures. We evaluated the following parameters in four different broiler strains at 39 and 53 days of age when reared under thermoneutral (20 to 25 C) versus hot (30 to 35 C) environmental conditions: capillary density, myofiber density and diameter, and degree of myodegeneration. Our data demonstrate that myofiber diameter significantly increased with age (P > or = 0.0001), while the absolute numbers of capillaries, blood vessels, and myofibers visible in five 400 x microscopic fields decreased (P > or = 0.0001). This is concomitant with marginalization of vascular support in rapidly growing myofibers. The myofiber diameter was significantly lower with hot environmental temperatures (P > or = 0.001); therefore, the absolute number of myofibers visible in five 400X microscopic fields was significantly higher. The incidence and subjective degree of myodegeneration characterized by loss of cross-striations, myocyte hyperrefractility, sarcoplasmic vacuolation, and nuclear pyknosis or loss also increased in hot conditions. Differences among strains were not observed.
Full Text Available Cellular edema (cell swelling is a principal component of numerous brain disorders including ischemia, cortical spreading depression, hyponatremia, and epilepsy. Cellular edema increases seizure-like activity in vitro and in vivo, largely through nonsynaptic mechanisms attributable to reduction of the extracellular space. However, the types of excitability changes occurring in individual neurons during the acute phase of cell volume increase remain unclear. Using whole-cell patch clamp techniques, we report that one of the first effects of osmotic edema on excitability of CA1 pyramidal cells is the generation of slow inward currents (SICs, which initiate after approximately 1 min. Frequency of SICs increased as osmolarity decreased in a dose-dependent manner. Imaging of real-time volume changes in astrocytes revealed that neuronal SICs occurred while astrocytes were still in the process of swelling. SICs evoked by cell swelling were mainly nonsynaptic in origin and NMDA receptor-dependent. To better understand the relationship between SICs and changes in neuronal excitability, recordings were performed in increasingly physiological conditions. In the absence of any added pharmacological reagents or imposed voltage clamp, osmotic edema induced excitatory postsynaptic potentials and burst firing over the same timecourse as SICs. Like SICs, action potentials were blocked by NMDAR antagonists. Effects were more pronounced in adult (8–20 weeks old compared with juvenile (P15–P21 mice. Together, our results indicate that cell swelling triggered by reduced osmolarity rapidly increases neuronal excitability through activation of NMDA receptors. Our findings have important implications for understanding nonsynaptic mechanisms of epilepsy in relation to cell swelling and reduction of the extracellular space.
Increasing daily steps through an Exercise Specialist-led group program in primary care may be a cost-effective approach towards improving daily physical activity among adults with type-2 diabetes. Alternative delivery strategies may be considered to improve the affordability of this model for primary care.
No dataset associated with this publication.This dataset is associated with the following publication:Augustine, S. Towards Universal Screening for Toxoplasmosis: Rapid, Cost-effective and Simultaneous Detection of Toxoplasma Anti-IgG, IgM and IgA Antibodies Using Very Small Serum Volumes. JOURNAL OF CLINICAL MICROBIOLOGY. American Society for Microbiology, Washington, DC, USA, 56(7): 1-2, (2016).
Jones, E; Pike, J; Marshall, T; Ye, X
Multiple sclerosis (MS) is a chronic progressive condition affecting the central nervous system. Progression of MS results in increased level of disability and most patients will eventually experience some degree of functional impairment and impaired mobility. Costs and burdens escalate as MS disability increases. However, there is a lack of recent data on the impact of MS disability on the cost and burden among patients in the US. Data for this study were drawn from a real world, cross-sectional survey undertaken between 2013 and 2014. Neurologists completed detailed patient report forms (PRF) for the most recent consulting patients with MS (age >18 years). Patient's perceptions of their diagnosis and health-related quality of life (HRQoL) were collected through a patient self-completion questionnaire (PSC). Regression analysis was used to evaluate the relationship between disability (determined by latest Expanded Disability Status Scale [EDSS] score) and current relapse and health care resource utilization, health care costs, HRQoL and work productivity. PRF data were collected for 715 patients (335 also completed a PSC). Patients with higher disability scores (EDSS 3-5 and >5 vs care related costs, including costs for physician consultations, hospitalizations and therapy (p care were $51,825, $57,889 and $67,116 for EDSS 5 groups, respectively; $51,692 and $58,648 for non-relapse and relapse groups, respectively. For MS patients in the US, health resource utilization and healthcare care costs increase with progression of disability. As the disability worsens, patients also exhibit diminished HRQoL and lower work productivity. There is a need for treatments that slow down or delay disability progression among MS patients.
Bruce C. V. Campbell
Full Text Available BackgroundEndovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which used CT-perfusion imaging selection.MethodsLarge vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS. Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$ reference year 2014.ResultsThere were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12–19. The median (IQR disability-weighted utility score at 90 days was 0.65 (0.00–0.91 in the alteplase-only versus 0.91 (0.65–1.00 in the endovascular group (p = 0.005. Modeled life expectancy was greater in the endovascular versus alteplase-only group (median 15.6 versus 11.2 years, p = 0.02. The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years [median (IQR 5.5 (3.2–8.7 versus 8.9 (4.7–13.8, p = 0.02] and more QALY gained [median (IQR 9.3 (4.2–13.1 versus 4.9 (0.3–8.5, p = 0.03]. Endovascular patients spent less time in hospital [median (IQR 5 (3–11 days versus 8 (5–14 days, p = 0.04] and rehabilitation [median (IQR 0 (0–28 versus 27 (0–65 days, p = 0.03]. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569, p = 0.008 offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515. The average saving per patient treated with thrombectomy was US$4
Ringe, J D; Farahmand, P
Almost 50 % of osteoporosis (OP) patients discontinue bisphosphonate (BP) therapy within 1-2 years after the start of their treatment. Denosumab's longer dosing interval with its administration every 6 months (Q6M) as a subcutaneous (sc) injection might result in a better real-life treatment adherence and persistence than weekly or monthly oral BP treatment regimen. The objectives of this open, investigator-initiated, prospective, observational, single-center study were to evaluate adherence with denosumab 60 mg sc every 6 months (Q6M) (Prolia(®)) injections in osteoporotic patients in a routine clinical care setting and to describe whether positive feedback to OP patients based on measured bone mineral density (BMD) increases and good safety profile have an impact on patients' real-life adherence. Results indicate that the rarity of adverse events and reduced dosage frequency together with the consistency of rapid and highly significant increases in BMD already after 6 months of denosumab therapy used as a positive reinforcement during doctor-patient interactions had a significant, positive impact on osteoporotic patient's adherence to continue with the 6-monthly sc denosumab injections.
and 23 controls for patients operated on apendicectomy and 20 cases and 20 controls for those operated on colectomy. In matching 2, the sample consisted on 17 pairs of cases and controls on apendicectomy and 14 pairs of cases and controls on colectomy. The infection increased the average length of stay between 7.7 days (matching 1 and 7.3 days (matching 2 in cases of infected apendicectomy and between 17.6 days (matching 1 and 15.4 days (matching 2 in cases of infected colectomy. The patients with apendicectomy infection presented an average cost three times higher than the ones not infected, both in matching 1 (2,998.60 versus 941.89 €, respectively; p < 0.0001 and in matching 2 (2,751.70 versus 870.81 €, respectively; p < 0.0001. Similar findings were observed in colectomy both in matching 1 (10,705.34 versus 2,600.55 €, respectively; p < 0.0001 and in matching 2 (9,081.12 versus 2,621.39 €, respectively; p < 0.0001. The average cost of surgical site infection oscillated between 2,056.71 € (matching 1 and 1,880.89 € (matching 2 in apendicectomy and between 8,140.79 € (matching 1 and 6,405.65 € (matching 2 in colectomy. Conclusions: Under the study conditions, the infection of surgical site determines the prolongation of the hospital stay in more than one week in apendicectomy and in more than two in colectomy, with an increase higher than 300% in the total direct cost.
Bishai, David; Sachathep, Karampreet; LeFevre, Amnesty; Thant, Hnin New Nwe; Zaw, Min; Aung, Tin; McFarland, Willi; Montagu, Dominic
This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL. The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices. Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods. Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted. Investing in developing a network of
Oginsky, Max F; Goforth, Paulette B; Nobile, Cameron W; Lopez-Santiago, Luis F; Ferrario, Carrie R
Urges to eat are influenced by stimuli in the environment that are associated with food (food cues). Obese people are more sensitive to food cues, reporting stronger craving and consuming larger portions after food cue exposure. The nucleus accumbens (NAc) mediates cue-triggered motivational responses, and activations in the NAc triggered by food cues are stronger in people who are susceptible to obesity. This has led to the idea that alterations in NAc function similar to those underlying drug addiction may contribute to obesity, particularly in obesity-susceptible individuals. Motivational responses are mediated in part by NAc AMPA receptor (AMPAR) transmission, and recent work shows that cue-triggered motivation is enhanced in obesity-susceptible rats after ‘junk-food' diet consumption. Therefore, here we determined whether NAc AMPAR expression and function is increased by ‘junk-food' diet consumption in obesity-susceptible vs -resistant populations using both outbred and selectively bred models of susceptibility. In addition, cocaine-induced locomotor activity was used as a general ‘read out' of mesolimbic function after ‘junk-food' consumption. We found a sensitized locomotor response to cocaine in rats that gained weight on a ‘junk-food' diet, consistent with greater responsivity of mesolimbic circuits in obesity-susceptible groups. In addition, eating ‘junk-food' increased NAc calcium-permeable-AMPAR (CP-AMPAR) function only in obesity-susceptible rats. This increase occurred rapidly, persisted for weeks after ‘junk-food' consumption ceased, and preceded the development of obesity. These data are considered in light of enhanced cue-triggered motivation and striatal function in obesity-susceptible rats and the role of NAc CP-AMPARs in enhanced motivation and addiction. PMID:27383008
Oginsky, Max F; Goforth, Paulette B; Nobile, Cameron W; Lopez-Santiago, Luis F; Ferrario, Carrie R
Urges to eat are influenced by stimuli in the environment that are associated with food (food cues). Obese people are more sensitive to food cues, reporting stronger craving and consuming larger portions after food cue exposure. The nucleus accumbens (NAc) mediates cue-triggered motivational responses, and activations in the NAc triggered by food cues are stronger in people who are susceptible to obesity. This has led to the idea that alterations in NAc function similar to those underlying drug addiction may contribute to obesity, particularly in obesity-susceptible individuals. Motivational responses are mediated in part by NAc AMPA receptor (AMPAR) transmission, and recent work shows that cue-triggered motivation is enhanced in obesity-susceptible rats after 'junk-food' diet consumption. Therefore, here we determined whether NAc AMPAR expression and function is increased by 'junk-food' diet consumption in obesity-susceptible vs -resistant populations using both outbred and selectively bred models of susceptibility. In addition, cocaine-induced locomotor activity was used as a general 'read out' of mesolimbic function after 'junk-food' consumption. We found a sensitized locomotor response to cocaine in rats that gained weight on a 'junk-food' diet, consistent with greater responsivity of mesolimbic circuits in obesity-susceptible groups. In addition, eating 'junk-food' increased NAc calcium-permeable-AMPAR (CP-AMPAR) function only in obesity-susceptible rats. This increase occurred rapidly, persisted for weeks after 'junk-food' consumption ceased, and preceded the development of obesity. These data are considered in light of enhanced cue-triggered motivation and striatal function in obesity-susceptible rats and the role of NAc CP-AMPARs in enhanced motivation and addiction.
Sun, Yan-Yan; Yang, Jing; Ji, Xiang
We used the many-lined sun skink (Mabuya multifasciata) as a model system to evaluate the energetic and locomotor costs of tail loss, and to examine whether tailless skinks compensate for the costs of tail loss by increasing feeding rate or digestive efficiency. We successively removed three tail segments from each of the 20 experimental skinks initially having intact tails. Energy content in each removed tail segment was measured, and swimming performance was measured for each experimental skink before and after each tail-removing treatment. Another independent sample of 19 skinks with intact tails were measured for swimming performance to serve as controls for successive measurements taken for the experimental skinks. Tailless experimental skinks and control skinks were then measured for food intake and digestive efficiency. Tail loss affected swimming speed, but the adverse influence was not significant until more than 55% of the tail (in length) was lost. Our data show that partial tail loss may not severely affect energy stores or locomotor performance in M. multifasciata. However, as tail breaks occurred more frequently in the proximal portion of the tail in skinks collected from the field, we conclude that caudal autotomy occurring in nature often incurs substantial energetic and locomotor costs. As tailless and tailed skinks did not differ in food intake, apparent digestive coefficient and assimilation efficiency, we conclude that tailless individuals do not compensate for the costs of tail loss by increasing feeding rate or digestive efficiency in M. multifasciata.
Full Text Available GABA is the major inhibitory neurotransmitter in the mammalian central nervous system that has been strongly implicated in the regulation of sleep. GABA transporter subtype 1 (GAT1 constructs high affinity reuptake sites for GABA and regulates GABAergic transmission in the brain. However, the role of GAT1 in sleep-wake regulation remains elusive. In the current study, we characterized the spontaneous sleep-wake cycle and responses to sleep deprivation in GAT1 knock-out (KO mice. GAT1 KO mice exhibited dominant theta-activity and a remarkable reduction of EEG power in low frequencies across all vigilance stages. Under baseline conditions, spontaneous rapid eye movement (REM sleep of KO mice was elevated both during the light and dark periods, and non-REM (NREM sleep was reduced during the light period only. KO mice also showed more state transitions from NREM to REM sleep and from REM sleep to wakefulness, as well as more number of REM and NREM sleep bouts than WT mice. During the dark period, KO mice exhibited more REM sleep bouts only. Six hours of sleep deprivation induced rebound increases in NREM and REM sleep in both genotypes. However, slow wave activity, the intensity component of NREM sleep was briefly elevated in WT mice but remained completely unchanged in KO mice, compared with their respective baselines. These results indicate that GAT1 plays a critical role in the regulation of REM sleep and homeostasis of NREM sleep.
Nichols, Brooke E; Sigaloff, Kim C E; Kityo, Cissy; Hamers, Raph L; Baltussen, Rob; Bertagnolio, Silvia; Jordan, Michael R; Hallett, Timothy B; Boucher, Charles A B; de Wit, Tobias F Rinke; van de Vijver, David A M C
Earlier antiretroviral therapy (ART) initiation reduces HIV-1 incidence. This benefit may be offset by increased transmitted drug resistance (TDR), which could limit future HIV treatment options. We analyze the epidemiological impact and cost-effectiveness of strategies to reduce TDR. We develop a deterministic mathematical model representing Kampala, Uganda, to predict the prevalence of TDR over a 10-year period. We then compare the impact on TDR and cost-effectiveness of: (1) introduction of pre-therapy genotyping; (2) doubling use of second-line treatment to 80% (50-90%) of patients with confirmed virological failure on first-line ART; and (3) increasing viral load monitoring from yearly to twice yearly. An intervention can be considered cost-effective if it costs less than three times the gross domestic product per capita per quality adjusted life year (QALY) gained, or less than $3420 in Uganda. The prevalence of TDR is predicted to rise from 6.7% (interquartile range [IQR] 6.2-7.2%) in 2014, to 6.8% (IQR 6.1-7.6%), 10.0% (IQR 8.9-11.5%) and 11.1% (IQR 9.7-13.0%) in 2024 if treatment is initiated at a CD4 HIV, the absolute numbers of patients infected with drug-resistant HIV is predicted to decrease. Increasing use of second-line treatment to all patients with confirmed failure on first-line therapy is a cost-effective approach to reduce TDR. Improving access to second-line ART is therefore a major priority.
Timothy C Marzullo
Full Text Available Although people are generally interested in how the brain functions, neuroscience education for the public is hampered by a lack of low cost and engaging teaching materials. To address this, we developed an open-source tool, the SpikerBox, which is appropriate for use in middle/high school educational programs and by amateurs. This device can be used in easy experiments in which students insert sewing pins into the leg of a cockroach, or other invertebrate, to amplify and listen to the electrical activity of neurons. With the cockroach leg preparation, students can hear and see (using a smartphone oscilloscope app we have developed the dramatic changes in activity caused by touching the mechanosensitive barbs. Students can also experiment with other manipulations such as temperature, drugs, and microstimulation that affect the neural activity. We include teaching guides and other resources in the supplemental materials. These hands-on lessons with the SpikerBox have proven to be effective in teaching basic neuroscience.
Dallat, Mary Anne T; Hunter, Ruth F; Tully, Mark A; Cairns, Karen J; Kee, Frank
Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer's perspective. Employees used a 'loyalty card' to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates. The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds. The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable "business model" which
Franck and Carmelita Troy in January 2007. Revised in May of 2007, this interim BCA, based on the data then available, offered an assessment of the...www.drivedemand.com/roipart1.html Franck, Raymond and Carmelita Troy, Agile Rapid Global Combat Support, Business Case Analysis, Version 1.0. Naval
Erickson, Paul W.
Even though there's been a slight reprieve in energy costs, the reality is that the cost of non-renewable energy is increasing, and state education budgets are shrinking. One way to keep energy and operations costs from overshadowing education budgets is to develop a 10-year energy audit plan to eliminate waste. First, facility managers should…
In this study, we investigated the effects of colistin resistance on virulence and fitness in hypermucoviscous (HV) Klebsiella pneumoniae sequence type 23 (ST23) strains. Colistin-resistant mutants were developed from three colistin-susceptible HV K. pneumoniae ST23 strains. The lipid A structures of strains were analyzed by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry. Changes in HV were investigated using the string test, and extracellular polysaccharide production was quantified. The expression levels of the phoQ, pmrD, pmrB, pbgP, magA, and p-rmpA2 genes, serum resistance, and biofilm-forming activity were determined. The fitness of colistin-resistant mutants compared to that of the parental strains was examined by determining the competitive index (CI). The colistin-resistant mutants exhibited reduced HV, which was accompanied by decreased formation of capsular polysaccharides (CPS) and reduced expression of genes (magA and p-rmpA2). While there was enhanced expression of pmrD and pbgP in all colistin-resistant derivatives, there were differences in the expression levels of phoQ and pmrB between strains. MALDI-TOF analysis detected the addition of aminoarabinose or palmitate to the lipid A moiety of lipopolysaccharide in the colistin-resistant derivatives. In addition, survival rates in the presence of normal human serum were decreased in the mutant strains, and CI values (0.01 to 0.19) indicated significant fitness defects in the colistin-resistant derivatives compared to the respective parental strains. In hypervirulent HV K. pneumoniae strains, the acquisition of colistin resistance was accompanied by reduced CPS production, impaired virulence, and a significant fitness cost. PMID:26282408
Shi, Wei; Zheng, Yifan; Taylor, André D.; Yu, Junsheng; Katz, Howard E.
Layer-by-layer deposited guanine and pentacene in organic field-effect transistors (OFETs) is introduced. Through adjusting the layer thickness ratio of guanine and pentacene, the tradeoff of two electronic parameters in OFETs, charge carrier mobility and current on/off ratio, was controlled. The charge mobility was enhanced by depositing pentacene over and between guanine layers and by increasing the proportion of pentacene in the layer-by-layer system, while the current on/off ratio was increased via the decreased off current induced by the guanine layers. The tunable device performance was mainly ascribed to the trap and dopant neutralizing properties of the guanine layers, which would decrease the density of free hydroxyl groups in the OFETs. Furthermore, the cost of the devices could be reduced remarkably via the adoption of low-cost guanine.
Faems, D.L.M.; de Visser, Matthias; Andries, Petra; van Looy, Bart; van Looy, Bart
Firms increasingly adopt an open innovation model in which they rely on technology alliances to complement and supplement their internal innovation efforts. Although previous studies provide in-depth insight into the impact of technology alliances on the innovation performance, they remain
Faems, Dries; de Visser, Matthias; Andries, Petra; Van Looy, Bart
Firms increasingly adopt an open innovation model in which they rely on technology alliances to complement and supplement their internal innovation efforts. Although previous studies provide in-depth insight into the impact of technology alliances on the innovation performance, they remain
Witjas-Paalberends, E Rosalie; Ferrara, Claudia; Scellini, Beatrice; Piroddi, Nicoletta; Montag, Judith; Tesi, Chiara; Stienen, Ger J M; Michels, Michelle; Ho, Carolyn Y; Kraft, Theresia; Poggesi, Corrado; van der Velden, Jolanda
The first mutation associated with hypertrophic cardiomyopathy (HCM) is the R403Q mutation in the gene encoding β-myosin heavy chain (β-MyHC). R403Q locates in the globular head of myosin (S1), responsible for interaction with actin, and thus motor function of myosin. Increased cross-bridge relaxation kinetics caused by the R403Q mutation might underlie increased energetic cost of tension generation; however, direct evidence is absent. Here we studied to what extent cross-bridge kinetics and energetics are related in single cardiac myofibrils and multicellular cardiac muscle strips of three HCM patients with the R403Q mutation and nine sarcomere mutation-negative HCM patients (HCMsmn). Expression of R403Q was on average 41 ± 4% of total MYH7 mRNA. Cross-bridge slow relaxation kinetics in single R403Q myofibrils was significantly higher (P < 0.0001) than in HCMsmn myofibrils (0.47 ± 0.02 and 0.30 ± 0.02 s(-1), respectively). Moreover, compared to HCMsmn, tension cost was significantly higher in the muscle strips of the three R403Q patients (2.93 ± 0.25 and 1.78 ± 0.10 μmol l(-1) s(-1) kN(-1) m(-2), respectively) which showed a positive linear correlation with relaxation kinetics in the corresponding myofibril preparations. This correlation suggests that faster cross-bridge relaxation kinetics results in an increase in energetic cost of tension generation in human HCM with the R403Q mutation compared to HCMsmn. Therefore, increased tension cost might contribute to HCM disease in patients carrying the R403Q mutation. © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society.
Santo, Antonio S; Roper, Jenevieve L; Dufek, Janet S; Mercer, John A
The purpose of this study was to determine if wearing rocker-bottom shoes with compliant midsoles (RB) influences muscle activity and metabolic cost of walking. Furthermore, we sought to determine if weight differences between shod conditions accounted for any potential change. Twenty-eight subjects (17 women, 11 men, age 22.8 ± 6.6 years; weight 72 ± 20 kg; height 170 ± 6.7 cm; percent body fat 23.0 ± 11.7) walked on a treadmill (0% grade) for 10 minutes at a self-selected speed plus 10% (1.3 ± 0.2 m·s) in each of the following laboratory-provided shoes: flat-bottomed shoe (W), flat-bottomed shoe weight-matched to RB (WM), and RB. Muscle activity of the right side biceps femoris (BF), rectus femoris (RF), gastrocnemius (GA), and tibalis anterior (TA) was recorded for 30 seconds at the beginning, middle, and ending of the 10-minute walk using an electromyography (EMG) system. The average (AVG) and root mean square (RMS) were calculated from full-wave rectified EMG data at each interval. The rate of oxygen consumption (V[Combining Dot Above]O2) was measured for 10 minutes during each condition. A 3 (shoe) × 3 (time) repeated-measures analysis of variance (ANOVA) was used to compare each EMG-dependent variable (AVG and RMS EMG of each muscle), and repeated measures ANOVA was used to test V[Combining Dot Above]O2. Muscle activity (for any muscle) was not influenced by the interaction of shoe and time (p > 0.05). The AVG and RMS for RF, BF, and GA, including V[Combining Dot Above]O2, were not different among shod conditions (W: 9.7 ± 0.6 ml·kg·min; WM: 10.0 ± 0.5 ml·kg·min; RB: 10.1 ± 0.5 ml·kg·min), whereas TA AVG and RMS were lower during RB (p shoe despite there being the rocker-profile design and mass differences.
Dennis J. Petrie
Full Text Available Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.
Dageforde, Leigh Anne; Feurer, Irene D; Pinson, C Wright; Moore, Derek E
The aim of this study was to evaluate the cost-effectiveness in liver transplantation (LT) of utilizing organs donated after cardiac death (DCD) compared with organs donated after brain death (DBD). A Markov-based decision analytic model was created to compare two LT waitlist strategies distinguished by organ type: (i) DBD organs only, and (ii) DBD and DCD organs. The model simulated outcomes for patients over 10 years with annual cycles through one of four health states: survival; ischaemic cholangiopathy; retransplantation, and death. Baseline values and ranges were determined from an extensive literature review. Sensitivity analyses tested model strength and parameter variability. Overall survival is decreased, and biliary complications and retransplantation are increased in recipients of DCD livers. Recipients of DBD livers gained 5.6 quality-adjusted life years (QALYs) at a cost of US$69 000/QALY, whereas recipients on the DBD + DCD LT waitlist gained 6.0 QALYs at a cost of US$61 000/QALY. The DBD + DCD organ strategy was superior to the DBD organ-only strategy. The extension of life and quality of life provided by DCD LT to patients on the waiting list who might otherwise not receive a liver transplant makes the continued use of DCD livers cost-effective. © 2012 International Hepato-Pancreato-Biliary Association.
Kanomi, Ryuzo; Deguchi, Toru; Kakuno, Eriko; Takano-Yamamoto, Teruko; Roberts, W Eugene
To assess the three-dimensional (3D) skeletal response to a standardized 5 mm of rapid maxillary expansion (RME) in growing children (6-15 years) with maxillary width deficiency and crowding. A bonded appliance was used prior to the eruption of the maxillary first premolars (Mx4s), and a banded appliance was used thereafter. A consecutive sample of 89 patients (29 boys and 60 girls) from a large pediatric dentistry and orthodontics practice was divided into four groups: 1) 6-8 years old (n = 26), 2) 9-11 years old with unerupted Mx4s (n = 21), 3) 9-11 years with erupted Mx4s (n = 23), and 4) 12-15 years (n = 19). For all patients, the 3D evaluation of dental and skeletal effects was performed with cone-beam computed tomography (CBCT). For both appliances in all patients, CBCT confirmed a triangular pattern of expansion in both the frontal and sagittal planes. Overall, both appliances produced significant maxillary expansion (>80% of the 5-mm activation), but older children showed a progressively more dental (less skeletal) response. Comparison of the two types of expanders in the crossover sample, children aged 9-11 years, showed that the bonded RME produced the most efficient skeletal expansion in the preadolescent sample. Increased maxillary width at the level of the zygomaticomaxillary suture was the best indicator for development of maxillary arch circumference. Development-dependent appliances (bonded RPE before Mx4s erupt, and a banded device thereafter) provided optimal RME treatment for all children from age 6-15 years.
Andrei V Derbenev
Full Text Available Glucocorticoids influence vagal parasympathetic output to the viscera via mechanisms that include modulation of neural circuitry in the dorsal vagal complex, a principal autonomic regulatory center. Glucocorticoids can modulate synaptic neurotransmitter release elsewhere in the brain by inducing release of retrograde signalling molecules. We tested the hypothesis that the glucocorticoid agonist dexamethasone (DEX modulates GABA release in the rat dorsal motor nucleus of the vagus (DMV. Whole-cell patch-clamp recordings revealed that DEX (1-10 µM rapidly (i.e. within three minutes increased the frequency of tetrodotoxin-resistant, miniature IPSCs (mIPSCs in 67% of DMV neurons recorded in acutely prepared slices. Glutamate-mediated mEPSCs were also enhanced by DEX (10 µM, and blockade of ionotropic glutamate receptors reduced the DEX effect on mIPSC frequency. Antagonists of type I or II corticosteroid receptors blocked the effect of DEX on mIPSCs. The effect was mimicked by application of the membrane-impermeant BSA-conjugated DEX, and intracellular blockade of G protein function with GDP βS in the recorded cell prevented the effect of DEX. The enhancement of GABA release was blocked by the TRPV1 antagonists, 5'-iodoresiniferatoxin or capsazepine, but was not altered by the cannabinoid type 1 receptor antagonist AM251. The DEX effect was prevented by blocking fatty acid amide hydrolysis or by inhibiting anandamide transport, implicating involvement of the endocannabinoid system in the response. These findings indicate that DEX induces an enhancement of GABA release in the DMV, which is mediated by activation of TRPV1 receptors on afferent terminals. The effect is likely induced by anandamide or other 'endovanilloid', suggesting activation of a local retrograde signal originating from DMV neurons to enhance synaptic inhibition locally in response to glucocorticoids.
Hoekstra, Miriam; Schoorl, Michiel A; van der Horst, Iwan C C; Vogelzang, Mathijs; Wietasch, J K Götz; Zijlstra, Felix; Nijsten, Maarten W N
Early delivery of calories is important in critically ill patients, and the administration of parenteral nutrition (PN) is sometimes required to achieve this goal. However, PN can induce acute hyperglycemia, which is associated with adverse outcome. We hypothesized that initiation of PN using a rapid "step-up" approach, coupled with a computerized insulin-dosing protocol, would result in a desirable caloric intake within 24 hours without causing hyperglycemia. In our surgical intensive care unit (ICU), glucose is regulated by a nurse-centered computerized glucose regulation program. When adequate enteral feeding was not possible, PN was initiated according to a simple step-up rule at an infusion rate of 10 mL/h (approximately 10 kcal/h) and subsequently increased by steps of 10 mL/h every 4 hours, provided glucose was up period and for 24 hours after achieving target feeding. In all 23 consecutive patients requiring PN, mean intake was 1 kcal/kg/h within 24 hours. Of the 280 glucose samples during the 48-hour study period, mean ± standard deviation glucose level was 7.4 ± 1.4 mmol/L. Only 4.5% of glucose measurements during the step-up period were transiently ≥10 mmol/L. After initiating PN, the insulin requirement rose from 1.1 ± 1.5 units/h to 2.9 ± 2.5 units/h (P initiation of PN using a step-up approach coupled with computerized glucose control resulted in adequate caloric intake within 24 hours while maintaining adequate glycemic control.
Warren, David R.; Edwards, Lee; Beard, James; Wyatt, Terry
The space shuttle is the only U.S. launch system capable of carrying people to and from space. It has operated for over 10 years and is likely to be used well into the next century. As the shuttle ages, NASA will be faced with increased need to update and replace various components due to obsolescence or to enhance safety. A review is presented of the shuttle program to determine (1) the assumptions NASA has made regarding the length of time the current shuttle fleet will be in operation and (2) NASA's processes and criteria for selecting needed safety and obsolescence upgrades.
Leite, Eliane D.; Barbosa, Felipe G. de; Szarf, Gilberto; Lederman, Henrique M. [Universidade Federal de Sao Paulo, Department of Diagnostic Imaging, Sao Paulo (Brazil); Seber, Adriana; Ginani, Valeria C.; Carlesse, Fabianne C.; Gouvea, Roseane V.; Zecchin, Victor G.; Carvalho, Cinthya R. [Universidade Federal de Sao Paulo, Division of Pediatric Oncology, Department of Pediatrics, Sao Paulo (Brazil)
Patients undergoing bone marrow transplant (BMT) are at risk for infectious complications, including those of the sinus. Central nervous system (CNS) abnormalities related to the chemotherapy or radiation that the patient received for the treatment of underlying malignancy or to transplant-related effects are also commonly seen. The only effective way to differentiate pre- and post-transplant causes is to have a baseline evaluation prior to the admission for transplant. The current method used to evaluate these patients is head CT. However, CT is not accurate to demonstrate CNS abnormalities and exposes the patient to radiation. MRI, despite better sensitivity for white matter abnormalities, has not been routinely used because of the higher cost and longer duration of the exam. Therefore, we designed a fast, low-cost and radiation-free MRI-based protocol to simultaneously evaluate sinus and brain abnormalities. (orig.)
Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.
Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro
The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.
Thaden, Joshua T; Li, Yanhong; Ruffin, Felicia; Maskarinec, Stacey A; Hill-Rorie, Jonathan M; Wanda, Lisa C; Reed, Shelby D; Fowler, Vance G
The clinical and economic impacts of bloodstream infections (BSI) due to multidrug-resistant (MDR) Gram-negative bacteria are incompletely understood. From 2009 to 2015, all adult inpatients with Gram-negative BSI at our institution were prospectively enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical outcomes and inpatient costs associated with the MDR phenotype were identified. Among 891 unique patients with Gram-negative BSI, 292 (33%) were infected with MDR bacteria. In an adjusted analysis, only history of Gram-negative infection was associated with MDR BSI versus non-MDR BSI (odds ratio, 1.60; 95% confidence interval [CI], 1.19 to 2.16; P = 0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] versus 0.2% [1/599]; P = 0.02) and longer hospital stay (median, 10.0 versus 8.0 days; P = 0.0005). Unadjusted rates of in-hospital mortality did not significantly differ between MDR (26.4% [77/292]) and non-MDR (21.7% [130/599]) groups (P = 0.12). Unadjusted mean costs were 1.62 times higher in MDR than in non-MDR BSI ($59,266 versus $36,452; P = 0.003). This finding persisted after adjustment for patient factors and appropriate empirical antibiotic therapy (means ratio, 1.18; 95% CI, 1.03 to 1.36; P = 0.01). Adjusted analysis of patient subpopulations revealed that the increased cost of MDR BSI occurred primarily among patients with hospital-acquired infections (MDR means ratio, 1.41; 95% CI, 1.10 to 1.82; P = 0.008). MDR Gram-negative BSI are associated with recurrent BSI, longer hospital stays, and increased mean inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account for the increased cost. Copyright © 2017 American Society for Microbiology.
The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...
Full Text Available Abstract Background Although the percentage of women who initiate breast cancer screening is rising, the rate of continued adherence is poor. The purpose of this study was to examine the effectiveness and cost-effectiveness of a tailored print intervention compared with a non-tailored print intervention for increasing the breast cancer screening rate among a non-adherent population. Methods In total, 1859 participants aged 51–59 years (except those aged 55 years were recruited from a Japanese urban community setting. Participants were randomly assigned to receive either a tailored print reminder (tailored intervention group or non-tailored print reminder (non-tailored intervention group. The primary outcome was improvement in the breast cancer screening rate. The screening rates and cost-effectiveness were examined for each treatment group (tailored vs. non-tailored and each intervention subgroup during a follow-up period of five months. All analyses followed the intention-to-treat principle. Results The number of women who underwent a screening mammogram following the reminder was 277 (19.9% in the tailored reminder group and 27 (5.8% in the non-tailored reminder group. A logistic regression model revealed that the odds of a woman who received a tailored print reminder undergoing mammography was 4.02 times those of a women who had received a non-tailored print reminder (95% confidence interval, 2.67–6.06. The cost of one mammography screening increase was 2,544 JPY or 30 USD in the tailored intervention group and 4,366 JPY or 52 USD in the non-tailored intervention group. Conclusions Providing a tailored print reminder was an effective and cost-effective strategy for improving breast cancer screening rates among non-adherent women.
Beatriz eQuiñones; Swimley, Michelle S.; Koh-Eun eNarm; Patel, Ronak N.; Cooley, Michael B.; Mandrell, Robert E.
Shiga toxin-producing Escherichia coli (STEC) is a leading cause of foodborne illness worldwide. The present study developed the use of DNA microarrays with the ampliPHOX colorimetric method to rapidly detect and genotype STEC strains. A low-density 30-mer oligonucleotide DNA microarray was designed to target O-antigen gene clusters of eleven E. coli serogroups (O26, O45, O91, O103, O104, O111, O113, O121, O128, O145 and O157) that have been associated with the majority of STEC infections. ...
Peterson, Kimberly; Dieperink, Eric; Anderson, Johanna; Boundy, Erin; Ferguson, Lauren; Helfand, Mark
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.
Kim, Hyun; Malatesta, Theresa M; Anné, Pramila R; McAna, John; Bar-Ad, Voichita; Dicker, Adam P; Den, Robert B
Board certified radiation oncologists and medical physicists are required to earn self-assessment module (SAM) continuing medical education (CME) credit, which may require travel costs or usage fees. Data indicate that faculty participation in resident teaching activities is beneficial to resident education. Our hypothesis was that providing the opportunity to earn SAM credit in resident didactics would increase faculty participation in and improve resident education. SAM applications, comprising CME certified category 1 resident didactic lectures and faculty-generated questions with respective answers, rationales, and references, were submitted to the American Board of Radiology for formal review. Surveys were distributed to assess main academic campus physician, affiliate campus physician, physicist, and radiation oncology resident impressions regarding the quality of the lectures. Survey responses were designed in Likert-scale format. Sign-test was performed with P didactics (P = .004). Residents reported an increased amount of time required to prepare lectures (P = .008). We are the first department, to our knowledge, to offer SAM credit to clinical faculty for participation in resident-generated didactics. Offering SAM credit at resident lectures is a cost-effective alternative to purchasing SAM resources, increases faculty attendance, and may improve the quality of radiation oncology resident education. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Maeng, Daniel; Pitcavage, James
Background/Aims Employers have recently seen rapid increases in their cost of providing health insurance benefits for their employees, partly because the traditional health insurance benefit design...
Wang, Ying; Liu, Xianhua; Wang, Meiyu; Zhang, Pingping; Zong, Yanping; Zhang, Qiufeng
The biochemical oxygen demand (BOD) is widely used for the evaluation of water and wastewater quality. However, the conventional method to measure BOD is time-consuming and requires complicated processes. In this study, a Microbial fuel cell (MFC)-based BOD sensor was developed by using low-cost activated carbon as the cathode catalyst. The sensor was calibrated with an aerated nutrient medium containing sodium acetate as the BOD source. When the sensor was operated with an external resistance of 1 K Ω, linear correlation (R2 = 0.9965) was obtained for BOD concentrations ranging from 80 to 1280 mg/L in a reaction time of 50 h. Besides acetate, glucose/glutamic acid (GGA) and ethanol could also be analyzed by the sensor. In a low concentration range (200 mg/L), the relationship between GGA solution concentration and output voltage was in accord with Monod growth kinetics.
Mattace-Raso Francesco US
Full Text Available Background Fall incidents represent an increasing public health problem in aging societies worldwide. A major risk factor for falls is the use of fall-risk increasing drugs. The primary aim of the study is to compare the effect of a structured medication assessment including the withdrawal of fall-risk increasing drugs on the number of new falls versus 'care as usual' in older adults presenting at the Emergency Department after a fall. Methods/Design A prospective, multi-center, randomized controlled trial will be conducted in hospitals in the Netherlands. Persons aged ≥65 years who visit the Emergency Department due to a fall are invited to participate in this trial. All patients receive a full geriatric assessment at the research outpatient clinic. Patients are randomized between a structured medication assessment including withdrawal of fall-risk increasing drugs and 'care as usual'. A 3-monthly falls calendar is used for assessing the number of falls, fallers and associated injuries over a one-year follow-up period. Measurements will be at three, six, nine, and twelve months and include functional outcome, healthcare consumption, socio-demographic characteristics, and clinical information. After twelve months a second visit to the research outpatient clinic will be performed, and adherence to the new medication regimen in the intervention group will be measured. The primary outcome will be the incidence of new falls. Secondary outcome measurements are possible health effects of medication withdrawal, health-related quality of life (Short Form-12 and EuroQol-5D, costs, and cost-effectiveness of the intervention. Data will be analyzed using an intention-to-treat analysis. Discussion The successful completion of this trial will provide evidence on the effectiveness of withdrawal of fall-risk increasing drugs in older patients as a method for falls reduction. Trial Registration The trial is registered in the Netherlands Trial Register (NTR1593
Full Text Available Arsenic is naturally found in surface and ground waters and the inorganic forms of arsenic are the most toxic forms. The adverse health effects of arsenic may involve the respiratory, gastrointestinal, cardiovascular, nervous, and haematopoietic systems. Arsenic contamination in drinking water is a global problem widely seen in Bangladesh and West Bengal of the Indian sub continent. As there is a great demand for field test kits due to the anticipated reduction of the US EPA arsenic standard from 50ppb to 10ppb a field kit which offers rapid, simple and safe method for precise estimation of arsenic at 10ppb in drinking water samples is developed. Field methods, based on the mercuric-bromide-stain, consist of three different major parts, which are carried out stepwise. The first part of the procedure is to remove serious interference caused by hydrogen sulphide. In commercially available kits either the sulphide is oxidized to sulphate and the excess oxidizing reagent removed prior to the hydride generation step or, the hydrogen sulphide is filtered out by passing the gas stream through a filter impregnated with lead acetate during the hydride generation step. The present method employs cupric chloride in combination with ferric chloride or FentonÃ¢Â€Â™s reagent for the removal of hydrogen sulphide, which is rapid, simple and more efficient. Other interferences at this step of the analyses are normally not expected for drinking water analysis. In the second step, the generation of the arsine gas involves the classical way of using zinc metal and hydrochloric acid, which produce the Ã¢Â€Â˜nascentÃ¢Â€Â™ hydrogen, which is the actual reducing agent. Hydrochloric acid can be replaced by sulfamic acid, which is solid and avoids a major disadvantage of having to handle a corrosive liquid in the field. The arsine gas produces a yellowish spot on the reagent paper. Depending on the arsenic content, either, Yellow Ã¢Â€Â“ H
Audrey, Suzanne; Cooper, Ashley R; Hollingworth, William; Metcalfe, Chris; Procter, Sunita; Davis, Adrian; Campbell, Rona; Gillison, Fiona; Rodgers, Sarah E
Physical inactivity increases the risk of many chronic diseases including coronary heart disease, type 2 diabetes and some cancers. It is recommended that adults should undertake at least 150 minutes of moderate intensity physical activity throughout the week but many adults do not achieve this. An opportunity for working adults to accumulate the recommended activity levels is through the daily commute. Employees will be recruited from workplaces in south-west England and south Wales. In the intervention arm, workplace Walk-to-Work promoters will be recruited and trained. Participating employees will receive Walk-to-Work materials and support will be provided through four contacts from the promoters over 10 weeks. Workplaces in the control arm will continue with their usual practice. The intervention will be evaluated by a cluster randomized controlled trial including economic and process evaluations. The primary outcome is daily minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes are: overall physical activity; sedentary time; modal shift away from private car use during the commute; and physical activity/MVPA during the commute. Accelerometers, GPS receivers and travel diaries will be used at baseline and one year follow-up. Questionnaires will be used at baseline, immediately post intervention, and one year follow-up. The process evaluation will examine the context, delivery and response to the intervention from the perspectives of employers, Walk-to-Work promoters and employees using questionnaires, descriptive statistics, fieldnotes and interviews. A cost-consequence study will include employer, employee and health service costs and outcomes. Time and consumables used in implementing the intervention will be measured. Journey time, household commuting costs and expenses will be recorded using travel diaries to estimate costs to employees. Presenteeism, absenteeism, employee wellbeing and health service use will be recorded. Compared
Rossi, Edoardo; Kant, Michael A.; von Rohr, Philipp Rudolf; Saar, Martin O.
The exploitation of deep geothermal resources for energy production relies on finding cost effective solutions to increase the drilling performance in hard rocks. Conventional rotary drilling techniques, based on mechanical rock exportation, result in high rates of drilling tool wearing, causing significant costs. Additionally, rotary drilling results in low drilling speeds in the typically hard crystalline basement rocks targeted for enhanced geothermal energy utilization technologies. Furthermore, even lower overall drilling rates result, when considering tripping times required to exchange worn drill tools. Therefore, alternative drilling techniques, such as hammering, thermal drilling, plasma drilling, and jetting processes are widely investigated in order to provide cost-effective alternatives to conventional drilling methods. A promising approach, that combines conventional rotary and thermal drilling techniques, is investigated in the present work. Here, the rock material is thermally weakened before being exported by conventional cutters. Heat is locally provided by a flame, which moves over the rock surface, heat-treating the material. Besides reducing the rock strength, an in-depth smoothening effect of the mechanical rock properties is observed due to the thermal treatment. This results in reduced rates of drill bit wearing and higher rates of penetration, which in turn decreases drilling costs significantly, particularly for deep-drilling projects. Due to the high heating rates, rock-hardening, commonly observed at moderate temperatures, can be avoided. The flame action can be modelled as a localized, high heat transfer coefficient flame treatment, which results in orders of magnitude higher heating rates than conventional oven treatments. Therefore, we analyse rock strength variations after different maximum temperatures, flame-based heating rates, and rock confinement pressures. The results show that flame treatments lead to a monotonous decrease of
Kreizinger, Zsuzsa; Sulyok, Kinga Mária; Pásztor, Alexandra; Erdélyi, Károly; Felde, Orsolya; Povazsán, János; Kőrösi, László; Gyuranecz, Miklós
Mycoplasma synoviae infection in chickens and turkeys can cause respiratory disease, infectious synovitis and eggshell apex abnormality; thus it is an economically important pathogen. Control of M. synoviae infection comprises eradication, medication or vaccination. The differentiation of the temperature sensitive (ts+) MS-H vaccine strain from field isolates is crucial during vaccination programs. Melt-curve and agarose gel based mismatch amplification mutation assays (MAMA) are provided in the present study to distinguish between the ts+ MS-H vaccine strain, its non-temperature sensitive re-isolates and wild-type M. synoviae isolates based on the single nucleotide polymorphisms at nt367 and nt629 of the obg gene. The two melt-MAMAs and the two agarose-MAMAs clearly distinguish the ts+ MS-H vaccine strain genotype from its non-temperature sensitive re-isolate genotype and wild-type M. synoviae isolate genotype, and no cross-reactions with other Mycoplasma species infecting birds occur. The sensitivity of the melt-MAMAs and agarose-MAMAs was 103 and 104 copy numbers, respectively. The assays can be performed directly on clinical samples and they can be run simultaneously at the same annealing temperature. The assays can be performed in laboratories with limited facilities, using basic real-time PCR machine or conventional thermocycler coupled with agarose gel electrophoresis. The advantages of the described assays compared with previously used methods are simplicity, sufficient sensitivity, time and cost effectiveness and specificity. PMID:26207635
Michiel Ras; Debbie Verbeek-Oudijk; Evelien Eggink
Original title: Lasten onder de loep The Dutch government spends almost 7 billion euros each year on care for people with intellectual disabilities, and these costs are rising steadily. This report analyses what underlies the increase in costs that occurred between 2007 and 2011. Was
Krych, Łukasz; Kot, Witold; Bendtsen, Katja M B; Hansen, Axel K; Vogensen, Finn K; Nielsen, Dennis S
The Dextran Sulfate Sodium (DSS) induced colitis mouse model is commonly used to investigate human inflammatory bowel disease (IBD). Nucleic acid extracts originating from these animals are often contaminated with DSS, which is a strong inhibitor of many enzymatic based molecular biology reactions including PCR and reverse-transcription (RT). Methods for removing DSS from nucleic acids extracts exist for RNA, but no effective protocol for DNA or cDNA is currently available. However, spermine has previously been shown to be an effective agent for counteracting DSS inhibition of polynucleotide kinase, which led to the hypothesis, that spermine could be used to counteract DSS inhibition of PCR and RT. We investigated the means of adding spermine in an adequate concentration to PCR based protocols (including qPCR, two-step RT-qPCR, and amplicon sequencing library preparation) to remove DSS inhibition. Within the range up to 0.01g/L, spermine can be added to PCR/qPCR or RT prophylactically without a significant reduction of reaction efficiency. Addition of spermine at the concentration of 0.08g/L can be used to recover qualitative PCR signal inhibited by DSS in concentrations up to 0.32g/L. For optimal quantitative analysis, the concentration of spermine requires fine adjustment. Hence, we present here a simple fluorometric based method for adjusting the concentration of spermine ensuring an optimal efficiency of the reaction exposed to an unknown concentration of DSS. In conclusion, we demonstrate a cost effective and easy method to counteract DSS inhibition in PCR and two-step RT-qPCR. Fixed or fine-tuned concentrations of spermine can be administered depending on the qualitative or quantitative character of the analysis. Copyright © 2017 Elsevier B.V. All rights reserved.
Newmeyer, Matthew N.; Concheiro, Marta; Huestis, Marilyn A.
Methamphetamine is a widely abused psychostimulant containing a chiral center. Consumption of over-the-counter and prescription medications may yield positive amphetamines results, but chiral separation of l- and d- methamphetamine and its metabolite amphetamine can help determine whether the source was licit or illicit. We present the first LC-MS/MS method with precolumn derivatization for methamphetamine and amphetamine chiral resolution in plasma and oral fluid collected with the Oral-Eze® and Quantisal™ devices. To 0.5 mL plasma, 0.75 mL Oral-Eze, or 1 mL Quantisal specimen racemic d11-methamphetamine and amphetamine internal standards were added, followed by protein precipitation. Samples were centrifuged and supernatants loaded onto pre-conditioned Phenomenex® Strata™-XC Polymeric Strong Cation solid phase extraction columns. After washing, analytes were eluted with 5% ammonium hydroxide in methanol. The eluate was evaporated to dryness and reconstituted in water. Derivatization was performed with 1-fluoro-2,4-dinitrophenyl-5-l-alanineamide (Marfey's reagent) and heating at 45°C for 1 h. Derivatized enantiomer separations were performed under isocratic conditions (methanol:water, 60:40) with a Phenomenex® Kinetex® 2.6 μm C18 column. Analytes were identified and quantified by two MRM transitions and their ratio on a 3200 QTrap (AB Sciex) mass spectrometer in ESI negative mode. In all three matrices, the method was linear for all enantiomers from 1-500 μg/L, with imprecision and accuracy of ≤11.3% and 85.3-108%, respectively. Extraction efficiencies ranged from 67.4-117% and matrix effects from -17.0-468%, with variation always ≤19.1%. Authentic plasma and OF specimens were collected from an IRB-approved study that included controlled Vicks® VapoInhaler™ administration. The present method is sensitive, selective, economic and rapid (separations accomplished in <10 min), and improves methamphetamine result interpretation. PMID:25065924
Newmeyer, Matthew N; Concheiro, Marta; Huestis, Marilyn A
Methamphetamine is a widely abused psychostimulant containing a chiral center. Consumption of over-the-counter and prescription medications may yield positive amphetamines results, but chiral separation of l- and d-methamphetamine and its metabolite amphetamine can help determine whether the source was licit or illicit. We present the first LC-MS/MS method with precolumn derivatization for methamphetamine and amphetamine chiral resolution in plasma and oral fluid collected with the Oral-Eze(®) and Quantisal™ devices. To 0.5mL plasma, 0.75mL Oral-Eze, or 1mL Quantisal specimen racemic d11-methamphetamine and amphetamine internal standards were added, followed by protein precipitation. Samples were centrifuged and supernatants loaded onto pre-conditioned Phenomenex(®) Strata™-XC Polymeric Strong Cation solid phase extraction columns. After washing, analytes were eluted with 5% ammonium hydroxide in methanol. The eluate was evaporated to dryness and reconstituted in water. Derivatization was performed with 1-fluoro-2,4-dinitrophenyl-5-l-alanineamide (Marfey's reagent) and heating at 45°C for 1h. Derivatized enantiomer separations were performed under isocratic conditions (methanol:water, 60:40) with a Phenomenex(®) Kinetex(®) 2.6μm C18 column. Analytes were identified and quantified by two MRM transitions and their ratio on a 3200 QTrap (AB Sciex) mass spectrometer in ESI negative mode. In all three matrices, the method was linear for all enantiomers from 1 to 500μg/L, with imprecision and accuracy of ≤11.3% and 85.3-108%, respectively. Extraction efficiencies ranged from 67.4 to 117% and matrix effects from -17.0 to 468%, with variation always ≤19.1%. Authentic plasma and OF specimens were collected from an IRB-approved study that included controlled Vicks(®) VapoInhaler™ administration. The present method is sensitive, selective, economic and rapid (separations accomplished in <10min), and improves methamphetamine result interpretation. Published
Leslie, James C.
Recognizing the potential benefits, the oil exploration and production industry began to experiment with the field use of composite materials in the last half of the 1900's. Gradually, the inherent reluctance to move "unproven materials" into full operational applications is being overcome. Now, the increased price of crude and the need to locate and produce more oil and gas and to reduce associated costs are forcing an accelerated acceptance and use of composite materials in these operations. As a result, the cost of building, servicing, and maintaining drilling rigs and pipe lines is being reduced. "Thought to be depleted" oil and gas deposits are being revitalized. Technology currently in development and/or in the process of field trial demonstration are showing promise to provide enabling capability for obtaining greater reach in both extended reach and deep water drilling. Smart drill pipes and coiled tubing, able to provide both real-time communication from well head to drill bit and to similarly provide down hole power, have been demonstrated. This paper presents a summary of the current state of the use of composites in the Oil Patch and discusses areas of technology development which must be brought to fruition in order for the oil industry the reap full benefit, such as has been accomplished by the aerospace industry.
Zhu, Xing; He, Bin; Zhao, Changwen; Fan, Rong; Zhang, Lihua; Wang, Guan; Ma, Yuhong; Yang, Wantai
The main limitation preventing the use of enzymatic cellulosic ethanol in industrial production is its higher cost which is mainly due to the elevated price of β-glucosidase (BG). Herein, we report on a simple strategy for the in-situ encapsulation of BG for repeated cellulosic ethanol production. In this strategy, BG was net-immobilized into a poly(ethylene glycol) (PEG) net-cloth layer on a PP nonwoven fabric by way of the visible light-induced surface controlled/living graft cross-linking polymerization. The visible light and mild reaction conditions could ensure the activity retention of BG during immobilization, while the non-swelling uniform net-mesh formed by living cross-linking polymerization could prevent the leakage of BG effectively (at the immobilization rate of more than 98.6% and the leakage rate of only 0.4%). When the BG-loaded fabric was used in combination with free cellulase (CEL), the results of the catalytic reaction demonstrated that these BG-loaded fabrics could not only give a 40% increase in cellulose conversions but also be reused for more than fifteen batches without losing the activity. These BG-loaded fabrics with characteristics including easy separation, excellent operation stability, a low cost of the polymeric matrix and a simple fabrication process are particularly interesting for a future bio-fuel production strategy.
Zhu, Xing; He, Bin; Zhao, Changwen; Fan, Rong; Zhang, Lihua; Wang, Guan; Ma, Yuhong; Yang, Wantai
The main limitation preventing the use of enzymatic cellulosic ethanol in industrial production is its higher cost which is mainly due to the elevated price of β-glucosidase (BG). Herein, we report on a simple strategy for the in-situ encapsulation of BG for repeated cellulosic ethanol production. In this strategy, BG was net-immobilized into a poly(ethylene glycol) (PEG) net-cloth layer on a PP nonwoven fabric by way of the visible light-induced surface controlled/living graft cross-linking polymerization. The visible light and mild reaction conditions could ensure the activity retention of BG during immobilization, while the non-swelling uniform net-mesh formed by living cross-linking polymerization could prevent the leakage of BG effectively (at the immobilization rate of more than 98.6% and the leakage rate of only 0.4%). When the BG-loaded fabric was used in combination with free cellulase (CEL), the results of the catalytic reaction demonstrated that these BG-loaded fabrics could not only give a 40% increase in cellulose conversions but also be reused for more than fifteen batches without losing the activity. These BG-loaded fabrics with characteristics including easy separation, excellent operation stability, a low cost of the polymeric matrix and a simple fabrication process are particularly interesting for a future bio-fuel production strategy.
Lai, Ning-Sheng; Tsai, Tzung-Yi; Li, Chung-Yi; Koo, Malcolm; Yu, Chia-Li; Lu, Ming-Chi
To investigate the frequency and costs associated with ambulatory medical care utilization over an 8-year period in patients prior to the diagnosis of rheumatoid arthritis (RA). We used Taiwan's National Health Insurance Research Database to identify 691 newly diagnosed RA cases between 2005 and 2010. We selected 1,382 controls without RA, frequency matched by sex, age, and the catastrophic illness certificate application year of the cases. The frequency and costs of ambulatory medical care utilization between the RA patients and controls were compared using the 2-sample Kolmogorov-Smirnov test. The median frequency of ambulatory medical care utilization was significantly higher in RA patients compared with controls (29 versus 13; P ambulatory medical care utilization in RA patients increased annually over the study period, from a median of $212 eight years preceding diagnosis to $798 one year preceding diagnosis. Frequency of ambulatory medical care utilization due to diseases of the musculoskeletal system and connective tissue (P ambulatory care utilization among RA patients in Taiwan preceding diagnosis of RA. Copyright © 2014 by the American College of Rheumatology.
Christiansen, Nina; Nielsen, Lene; Jakobsen, Lotte
Resistance to ciprofloxacin in Escherichia coli from urinary tract infections (UTI) in Denmark is increasing parallel to increased use of fluoroquinolones both in Denmark and in other European countries. The objective was to investigate the occurrence of ciprofloxacin resistance mechanisms...
Eakin, Cynthia; Fischer, Katrina
Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425
Peter Hilsenrath PhD
Full Text Available Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers.
Continuing educators need additional strategies for developing new programming that can both reduce the time to market and lower the cost of development. Rapid prototyping, a time-compression technique adapted from the high technology industry, represents one such strategy that merits renewed evaluation. Although in higher education rapid…
Hosking, Jay G; Lam, Fred C W; Winstanley, Catharine A
Successful decision making in our daily lives requires weighing an option's costs against its associated benefits. The neuromodulator acetylcholine underlies both the etiology and treatment of a number of illnesses in which decision making is perturbed, including Alzheimer's disease, attention-deficit/hyperactivity disorder, and schizophrenia. Nicotine acts on the cholinergic system and has been touted as a cognitive enhancer by both smokers and some researchers for its attention-boosting effects; however, it is unclear whether treatments that have a beneficial effect on attention would also have a beneficial effect on decision making. Here we utilize the rodent Cognitive Effort Task (rCET), wherein animals can choose to allocate greater visuospatial attention for a greater reward, to examine cholinergic contributions to both attentional performance and choice based on attentional demand. Following the establishment of baseline behavior, four drug challenges were administered: nicotine, mecamylamine, scopolamine, and oxotremorine (saline plus three doses for each). As per previous rCET studies, animals were divided by their baseline preferences, with "worker" rats choosing high-effort/high-reward options more than their "slacker" counterparts. Nicotine caused slackers to choose even fewer high-effort trials than at baseline, but had no effect on workers' choice. Despite slackers' decreased willingness to expend effort, nicotine improved their attentional performance on the task. Nicotine also increased measures of motor impulsivity in all animals. In contrast, scopolamine decreased animals' choice of high-effort trials, especially for workers, while oxotremorine decreased motor impulsivity for all animals. In sum, the cholinergic system appears to contribute to decision making, and in part these contributions can be understood as a function of individual differences. While nicotine has been considered as a cognitive enhancer, these data suggest that its modest
Hosking, Jay G.; Lam, Fred C. W.; Winstanley, Catharine A.
Successful decision making in our daily lives requires weighing an option’s costs against its associated benefits. The neuromodulator acetylcholine underlies both the etiology and treatment of a number of illnesses in which decision making is perturbed, including Alzheimer’s disease, attention-deficit/hyperactivity disorder, and schizophrenia. Nicotine acts on the cholinergic system and has been touted as a cognitive enhancer by both smokers and some researchers for its attention-boosting effects; however, it is unclear whether treatments that have a beneficial effect on attention would also have a beneficial effect on decision making. Here we utilize the rodent Cognitive Effort Task (rCET), wherein animals can choose to allocate greater visuospatial attention for a greater reward, to examine cholinergic contributions to both attentional performance and choice based on attentional demand. Following the establishment of baseline behavior, four drug challenges were administered: nicotine, mecamylamine, scopolamine, and oxotremorine (saline plus three doses for each). As per previous rCET studies, animals were divided by their baseline preferences, with “worker” rats choosing high-effort/high-reward options more than their “slacker” counterparts. Nicotine caused slackers to choose even fewer high-effort trials than at baseline, but had no effect on workers’ choice. Despite slackers’ decreased willingness to expend effort, nicotine improved their attentional performance on the task. Nicotine also increased measures of motor impulsivity in all animals. In contrast, scopolamine decreased animals’ choice of high-effort trials, especially for workers, while oxotremorine decreased motor impulsivity for all animals. In sum, the cholinergic system appears to contribute to decision making, and in part these contributions can be understood as a function of individual differences. While nicotine has been considered as a cognitive enhancer, these data suggest
Jay G Hosking
Full Text Available Successful decision making in our daily lives requires weighing an option's costs against its associated benefits. The neuromodulator acetylcholine underlies both the etiology and treatment of a number of illnesses in which decision making is perturbed, including Alzheimer's disease, attention-deficit/hyperactivity disorder, and schizophrenia. Nicotine acts on the cholinergic system and has been touted as a cognitive enhancer by both smokers and some researchers for its attention-boosting effects; however, it is unclear whether treatments that have a beneficial effect on attention would also have a beneficial effect on decision making. Here we utilize the rodent Cognitive Effort Task (rCET, wherein animals can choose to allocate greater visuospatial attention for a greater reward, to examine cholinergic contributions to both attentional performance and choice based on attentional demand. Following the establishment of baseline behavior, four drug challenges were administered: nicotine, mecamylamine, scopolamine, and oxotremorine (saline plus three doses for each. As per previous rCET studies, animals were divided by their baseline preferences, with "worker" rats choosing high-effort/high-reward options more than their "slacker" counterparts. Nicotine caused slackers to choose even fewer high-effort trials than at baseline, but had no effect on workers' choice. Despite slackers' decreased willingness to expend effort, nicotine improved their attentional performance on the task. Nicotine also increased measures of motor impulsivity in all animals. In contrast, scopolamine decreased animals' choice of high-effort trials, especially for workers, while oxotremorine decreased motor impulsivity for all animals. In sum, the cholinergic system appears to contribute to decision making, and in part these contributions can be understood as a function of individual differences. While nicotine has been considered as a cognitive enhancer, these data suggest
Kliebenstein, James B.; Hurley, Sean P.; Larson, Ben; Honeyman, Mark
Niche markets of agricultural products are experiencing rapid growth. One such market is organic pork. Organic production typically demands specific production conditions that can be cost increasing. This study evaluates the cost of organic pork production, seasonal differences in costs, and premiums necessary to induce continuous organic pork production. In the past few years, niche marketing has been a rapidly growing phenomenon in agriculture. One area that has experienced dramatic growth ...
Nguyen, Phuong Hong; Headey, Derek; Frongillo, Edward A; Tran, Lan Mai; Rawat, Rahul; Ruel, Marie T; Menon, Purnima
nutritional change in intervention and comparison areas. Improvements in underlying determinants explained rapid improvements in HAZs between 2010 and 2014 in Bangladesh and Vietnam.
Ahmed, Asma; Mukherjee, Sambuddho; Deobagkar, Mukta; Naik, Tanushree; Nandi, Dipankar
The identification of small molecules that affect T cell activation is an important area of research. Three molecules that regulate plant growth and differentiation, but not their structurally similar analogs, were identified to enhance primary mouse CD4(+) T cell activation in conjunction with soluble anti-CD3 stimulation: Indoleacetic acid (natural plant auxin), 1-Napthaleneacetic acid (synthetic plant auxin) and 2,4-Dichlorophenoxyacetic acid (synthetic plant auxin and herbicide). These effects are distinct in comparison to Curcumin, the well known phenolic immunomodulator, which lowers T cell activation. An investigation into the mechanisms of action of the three plant growth regulators revealed a rapid induction of reactive oxygen species (ROS), mainly comprising H(2)O(2). In addition, these three molecules synergize with soluble anti-CD3 signaling to enhance intracellular Ca(2+) concentrations [Ca(2+)](i), leading to greater T cell activation, e.g. induction of CD25 and IL-2. Enhanced production of TNFα and IFNγ by CD4(+) T cells is also observed upon plant growth regulator treatment with soluble anti-CD3. Interestingly, maximal IL-2 production and CD4(+) T cell cycle progression are observed upon activation with soluble anti-CD3 and phorbol 12-myristate 13-acetate (PMA), a phorbol ester. Additionally, stimulation with PMA and Ionomcyin (a Ca(2+) ionophore), which activates T cells by circumventing the TCR, and plant growth regulators also demonstrated the role of the strength of signal (SOS): T cell cycle progression is enhanced with gentle activation conditions but decreased with strong activation conditions. This study demonstrates the direct effects of three plant growth regulators on CD4(+) T cell activation and cycling. Copyright © 2010 Elsevier B.V. All rights reserved.
Estifanos Biru Shargie
Full Text Available Following recent large scale-up of malaria control interventions in Ethiopia, this study aimed to compare ownership and use of long-lasting insecticidal nets (LLIN, and the change in malaria prevalence using two population-based household surveys in three regions of the country. Each survey used multistage cluster random sampling with 25 households per cluster. Household net ownership tripled from 19.6% in 2006 to 68.4% in 2007, with mean LLIN per household increasing from 0.3 to 1.2. Net use overall more than doubled from 15.3% to 34.5%, but in households owning LLIN, use declined from 71.7% to 48.3%. Parasitemia declined from 4.1% to 0.4%. Large scale-up of net ownership over a short period of time was possible. However, a large increase in net ownership was not necessarily mirrored directly by increased net use. Better targeting of nets to malaria-risk areas and sustained behavioural change communication are needed to increase and maintain net use.
It is known that statistically significant (positive) results are more likely to be published than non-significant (negative) results. However, it has been unclear whether any increasing prevalence of positive results is stronger in the “softer” disciplines (social sciences) than in the “harder” disciplines (physical sciences), and whether the prevalence of negative results is decreasing over time. Using Scopus, we searched the abstracts of papers published between 1990 and 2013, and measured longitudinal trends of multiple expressions of positive versus negative results, including p-values between 0.041 and 0.049 versus p-values between 0.051 and 0.059, textual reporting of “significant difference” versus “no significant difference,” and the reporting of p 0.05. We found no support for a “hierarchy of sciences” with physical sciences at the top and social sciences at the bottom. However, we found large differences in reporting practices between disciplines, with p-values between 0.041 and 0.049 over 1990–2013 being 65.7 times more prevalent in the biological sciences than in the physical sciences. The p-values near the significance threshold of 0.05 on either side have both increased but with those p-values between 0.041 and 0.049 having increased to a greater extent (2013-to-1990 ratio of the percentage of papers = 10.3) than those between 0.051 and 0.059 (ratio = 3.6). Contradictorily, p 0.05 (ratios = 1.4 and 4.8, respectively), while the use of “significant difference” has shown only a modest increase compared to “no significant difference” (ratios = 1.5 and 1.1, respectively). We also compared reporting of significance in the United States, Asia, and Europe and found that the results are too inconsistent to draw conclusions on cross-cultural differences in significance reporting. We argue that the observed longitudinal trends are caused by negative factors, such as an increase of questionable research practices, but also by
Jewell, B.S.; Rowden, S.C.
According to studies by Cinco Marine Services Ltd., compliance of owners of existing crude oil tankers with the IMCO pollution prevention regulations proposed in the 1978 convention will require selecting one of three types of conversion. The first, the CBT conversion, requires ballast water to be carried in cargo tanks designated solely for carrying clean ballast, and for tankers over 40,000 dwt, it is intended as an interim measure only; these requirements are in Regulation 13A and Resolution 14 of the MARPOL Protocol. The second type, the SBT conversion, embraces the segregation of ballast tanks and their piping and pumping systems from cargo and fuel tanks and systems; certain requirements for this conversion are in Regulation 13. The third conversion, providing for tank washing with crude oil and the basic requirements, are in Regulation 13B and Resolution 15 of the MARPOL Protocol. The conversions, the associated requirements, their economic and other implications, the increased transportation cost that will result, and the requirements of MARPOL 1973 and SOLAS 1974 and their respective protocols are discussed.
Saramago, Pedro; Cooper, Nicola J; Sutton, Alex J; Hayes, Mike; Dunn, Ken; Manca, Andrea; Kendrick, Denise
The UK has one of the highest rates for deaths from fire and flames in children aged 0-14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of 'functioning' smoke alarms and consequently for the prevention of fire-related injuries in children in the UK. We carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection. Education and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household. Assessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.
Full Text Available Aims: This study aims to evaluate the implementation of a rapid response treatment protocol for patients presenting with acute onset ischemic stroke. Improvements of routines surrounding the admission and treatment of patients with intravenous thrombolysis (IVT, such as door-to-needle (DTN times, and increasing the numbers of patients treated are discussed. Methods: We conducted a retrospective analysis of all patients (n = 320 treated with IVT for acute onset ischemic stroke at the Stavanger University Hospital, Norway, between 2003 and 2012. In 2009, a succession of changes to pre- and intra-hospital routines were made as well as an improvement in the education of primary health care physicians, nurses and paramedics involved in the treatment of acute onset stroke patients (rapid response treatment protocol. Analyses of DTN times, onset-to-needle times and the number of patients treated per year were carried out to ascertain the effect of the changes made. The primary aim was to analyze DTN times to look for any changes, and the secondary aim was to analyze changes in the number of patients treated per year. Results: In the years after the implementation of the rapid treatment protocol, we saw an improvement in the median DTN time with a decrease from 73 to 50 min in the first year (p = 0.03, a decrease of 45 min in the second year (p = 0.01 and a decrease of 31 min in the third year (p Conclusions: The implementation of the rapid treatment protocol for acute onset ischemic stroke patients led to a significant decrease in the DTN time at our center. These improvements also produced an increase in the number of patients treated per year. The extension of the therapeutic window from 3 to 4.5 h for the use of intravenous recombinant tissue plasminogen activator also played a role in the increased treatment numbers.
Bortz, D M; Mikkelsen, J D; Bruno, J P
that inhibited (threo-beta-benzyl-oxy-aspartate (TβOA), 100.0μM) or facilitated (ceftriaxalone, 200mg/kg, i.p.) excitatory amino acid transporters. TβOA slowed both the clearance (s) and rate of clearance (μM/s) by 10-fold, particularly at the mid-late stages of the return to baseline. Ceftriaxone reduced......The ability of local infusions of the alpha 7 nicotinic acetycholine receptor (α7 nAChR) partial agonist SSR180711 to evoke glutamate release in prefrontal cortex was determined in awake rats using a microelectrode array. Infusions of SSR180711 produced dose-dependent increases in glutamate levels...
Hock L Tay
Full Text Available Pathogenic bacterial infections of the lung are life threatening and underpin chronic lung diseases. Current treatments are often ineffective potentially due to increasing antibiotic resistance and impairment of innate immunity by disease processes and steroid therapy. Manipulation miRNA directly regulating anti-microbial machinery of the innate immune system may boost host defence responses. Here we demonstrate that miR-328 is a key element of the host response to pulmonary infection with non-typeable haemophilus influenzae and pharmacological inhibition in mouse and human macrophages augments phagocytosis, the production of reactive oxygen species, and microbicidal activity. Moreover, inhibition of miR-328 in respiratory models of infection, steroid-induced immunosuppression, and smoke-induced emphysema enhances bacterial clearance. Thus, miRNA pathways can be targeted in the lung to enhance host defence against a clinically relevant microbial infection and offer a potential new anti-microbial approach for the treatment of respiratory diseases.
Tay, Hock L; Kaiko, Gerard E; Plank, Maximilian; Li, JingJing; Maltby, Steven; Essilfie, Ama-Tawiah; Jarnicki, Andrew; Yang, Ming; Mattes, Joerg; Hansbro, Philip M; Foster, Paul S
Pathogenic bacterial infections of the lung are life threatening and underpin chronic lung diseases. Current treatments are often ineffective potentially due to increasing antibiotic resistance and impairment of innate immunity by disease processes and steroid therapy. Manipulation miRNA directly regulating anti-microbial machinery of the innate immune system may boost host defence responses. Here we demonstrate that miR-328 is a key element of the host response to pulmonary infection with non-typeable haemophilus influenzae and pharmacological inhibition in mouse and human macrophages augments phagocytosis, the production of reactive oxygen species, and microbicidal activity. Moreover, inhibition of miR-328 in respiratory models of infection, steroid-induced immunosuppression, and smoke-induced emphysema enhances bacterial clearance. Thus, miRNA pathways can be targeted in the lung to enhance host defence against a clinically relevant microbial infection and offer a potential new anti-microbial approach for the treatment of respiratory diseases.
Full Text Available This paper reports on an increase of ozone event observed over Kerguelen (49.4° S, 70.3° E in relationship with large-scale isentropic transport. This is evidenced by ground-based observations (co-localised radiosonde and SAOZ experiments together with satellite global observations (Aura/MLS assimilated into MOCAGE, a Méteo-France model.
The study is based on the analyses of the first ozonesonde experiment never recorded at the Kerguelen site within the framework of a French campaign called ROCK that took place from April to August 2008.
Comparisons and interpretations of the observed event are supported by co-localised SAOZ observations, by global mapping of tracers (O3, N2O and columns of O3 from Aura/MLS and Aura/OMI experiments, and by model simulations of Ertel Potential Vorticity initialised by the ECMWF (European Centre for Medium-Range Weather Forecasts data reanalyses.
Satellite and ground-based observational data revealed a consistent increase of ozone in the local stratosphere by mid-April 2008. Additionally, Ozone (O3 and nitrous oxide (N2O profiles obtained during January–May 2008 using the Microwave Limb Sounder (MLS aboard the Aura satellite are assimilated into MOCAGE (MOdèle de Chimie Atmosphérique à Grande Echelle, a global three-dimensional chemistry transport model of Météo-France. The assimilated total O3 values are consistent with SAOZ ground observations (within ±5%, and isentropic distributions of O3 match well with maps of advected potential vorticity (APV derived from the MIMOSA model, a high-resolution advection transport model, and from the ECMWF reanalysis.
The event studied seems to be related to the isentropic transport of air masses that took place simultaneously in the lower- and middle-stratosphere, respectively from the polar region and from the tropics to the mid-latitudes.
Full Text Available Abstract Background Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design Study candidates (n = 1500 will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600 will be randomised into the study. These participants will receive either a "mini booster" (n = 200, "full booster" (n = 200 or no booster (n = 200. The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it
Enosse, Sonia; Magnussen, Pascal; Abacassamo, Fatima; Gómez-Olivé, Xavier; Rønn, Anita M; Thompson, Ricardo; Alifrangis, Michael
In late 2002, the health authorities of Mozambique implemented sulphadoxine-pyrimethamine (SP)/amodiaquine (AQ) as first-line treatment against uncomplicated falciparum malaria. In 2004, this has been altered to SP/artesunate in line with WHO recommendations of using Artemisinin Combination Therapies (ACTs), despite the fact that all the neighbouring countries have abandoned SP-drug combinations due to high levels of SP drug resistance. In the study area, one year prior to the change to SP/AQ, SP alone was used to treat uncomplicated malaria cases. The study described here investigated the immediate impact of the change to SP on the frequency of SP and CQ resistance-related haplotypes in the Plasmodium falciparum genes Pfdhfr, Pfdhps and Pfcrt before and a year after the introduction of SP. Samples were collected during two cross sectional surveys in early 2002 and 2003 involving 796 and 692 children one year or older and adults randomly selected living in Maciana, an area located in Manhiça district, Southern Mozambique. Out of these, 171 and 173 P. falciparum positive samples were randomly selected to measure the frequency of resistance- related haplotypes in Pfdhfr, Pfdhps and Pfcrt based on results obtained by nested PCR followed by sequence-specific oligonucleotide probe (SSOP)-ELISA. The frequency of the SP-resistance associated Pfdhps double mutant (SGEAA) haplotype increased significantly from 14% to 35% (P drug, Coartem.
Full Text Available Purpose. In Korea, it has been estimated that the number of the single-household elderly increased 45% from 2005 to 2010. This research was conducted to provide empirical resources for development of a community mental health program by an explorative investigation on depression, coping mechanism, and life satisfaction of a single-household elderly population. Design and Methods. This research applied a descriptive survey research design. Participants were 225 single-household elderlies residing in Seoul, Korea. The geriatric depression scale and the satisfaction with life scale were used to check the level of depression and life satisfaction of the participants. Results. Results showed that 46.3 percent of the participants were categorized as having light-to-severe level of depression, and 80.5 percent of the participants responded that they were dissatisfied with their lives. This research demonstrated that the level of depression and life satisfaction of the Korean single-household elderly is statistically significantly related to age and gender as well as coping resources and human resources. Implications. Current public health services in Korea for the single-household elderly are still lacking and require active support, intervention, and research to provide effective programs and services. Case management, counseling, and various programs based on Korean culture including support from family members and community-based assistance are recommended to help the vulnerable population.
Sriyani, Kumarasinghe A; Wasalathanthri, Sudharshani; Hettiarachchi, Priyadharshika; Prathapan, Shamini
To identify the socio demographic, life style and foot examination related predictors of diabetic foot and leg ulcers with a view to develop a screening tool appropriate for the use in an outpatient setting. This cross sectional study included type 2 diabetes mellitus (DM) patients; 88 subjects with leg and foot ulcers and 80 non ulcer controls. Socio demographic data and life style factors were documented. Foot was examined for skin changes and structural abnormalities. Distal peripheral neuropathy was assessed by pressure sense, vibration sense and joint position sense. Multivariate analysis by logistic regression was used to determine the significant predictors in screening for foot ulcers. Education of grade 6 and below (OR--1.41, 95% CI; 1.03-4.68), low income (OR--23.3, 95% CI; 1.5-34.0), impaired vibration sense (OR--24.79, 95% CI; 9.3-66.2), abnormal monofilament test on first (OR--1.69, 95% CI; 1.36-16.6), third (OR--3.4, 95% CI; 1.1-10.6) and fifth (OR--1.8, 95% CI; 1.61-12.6) toes are found to be predictors of increased risk whereas incidental diagnosis of DM (OR--0.03, 95% CI; 0.003-0.28), wearing covered shoes (OR--0.003, 95% CI; 0.00-0.28), presence of normal skin color (OR--0.01, 95% CI; 0.001-0.14) and normal monofilament test on first metatarsal head (OR--0.10, 95% CI; 0.00-0.67) are protective factors for ulcers. Ten independent risk and protective factors identified in this study are proposed as a simple screening tool to predict the risk of developing leg and foot ulcers in patients with DM.
Kumarasinghe A Sriyani
Full Text Available OBJECTIVE: To identify the socio demographic, life style and foot examination related predictors of diabetic foot and leg ulcers with a view to develop a screening tool appropriate for the use in an outpatient setting. RESEARCH DESIGN AND METHODS: This cross sectional study included type 2 diabetes mellitus (DM patients; 88 subjects with leg and foot ulcers and 80 non ulcer controls. Socio demographic data and life style factors were documented. Foot was examined for skin changes and structural abnormalities. Distal peripheral neuropathy was assessed by pressure sense, vibration sense and joint position sense. Multivariate analysis by logistic regression was used to determine the significant predictors in screening for foot ulcers. RESULTS: Education of grade 6 and below (OR--1.41, 95% CI; 1.03-4.68, low income (OR--23.3, 95% CI; 1.5-34.0, impaired vibration sense (OR--24.79, 95% CI; 9.3-66.2, abnormal monofilament test on first (OR--1.69, 95% CI; 1.36-16.6, third (OR--3.4, 95% CI; 1.1-10.6 and fifth (OR--1.8, 95% CI; 1.61-12.6 toes are found to be predictors of increased risk whereas incidental diagnosis of DM (OR--0.03, 95% CI; 0.003-0.28, wearing covered shoes (OR--0.003, 95% CI; 0.00-0.28, presence of normal skin color (OR--0.01, 95% CI; 0.001-0.14 and normal monofilament test on first metatarsal head (OR--0.10, 95% CI; 0.00-0.67 are protective factors for ulcers. CONCLUSIONS: Ten independent risk and protective factors identified in this study are proposed as a simple screening tool to predict the risk of developing leg and foot ulcers in patients with DM.
Walker, Michael E. [Illinois Inst. of Technology, Chicago, IL (United States). Dept. of Chemical and Biological Engineering; Theregowda, Ranjani B. [Carnegie Mellon Univ., Pittsburgh, PA (United States). Dept of Civil and Mechanical Engineering; Safari, Iman [Illinois Inst. of Technology, Chicago, IL (United States). Dept. of Chemical and Biological Engineering; Abbasian, Javad [Illinois Inst. of Technology, Chicago, IL (United States). Dept. of Chemical and Biological Engineering; Arastoopour, Hamid [Illinois Inst. of Technology, Chicago, IL (United States). Dept. of Chemical and Biological Engineering; Dzombak, David A. [Carnegie Mellon Univ., Pittsburgh, PA (United States). Dept of Civil and Mechanical Engineering; Hsieh, Ming-Kai [Tamkang Univ., Taipei (Taiwan). Waer Resources Management and Policy Research Center; Miller, David C. [National Energy Technology Lab. (NETL), Morgantown, WV (United States)
A methodology is presented to calculate the total combined cost (TCC) of water sourcing, water treatment and condenser fouling in the recirculating cooling systems of thermoelectric power plants. The methodology is employed to evaluate the economic viability of using treated municipal wastewater (MWW) to replace the use of freshwater as makeup water to power plant cooling systems. Cost analyses are presented for a reference power plant and five different tertiary treatment scenarios to reduce the scaling tendencies of MWW. Results indicate that a 550 MW sub-critical coal fired power plant with a makeup water requirement of 29.3 ML/day has a TCC of $3.0 - 3.2 million/yr associated with the use of treated MWW for cooling. (All costs USD 2009). This translates to a freshwater conservation cost of $0.29/kL, which is considerably lower than that of dry air cooling technology, $1.5/kL, as well as the 2020 conservation cost target set by the U.S. Department of Energy, $0.74/kL. Results also show that if the available price of freshwater exceeds that of secondary-treated MWW by more than $0.13-0.14/kL, it can be economically advantageous to purchase secondary MWW and treat it for utilization in the recirculating cooling system of a thermoelectric power plant.
The scenario of waste management in many Nigerian cities has been complicated by the non segregation of healthcare wastes from domestic wastes in many healthcare facilities (HCFs). Incidentally, the healthcare facilities have soared in numbers over a 50 - year period in all the six geopolitical zones of Nigeria.
Clargo, N.M.; Salt, L.; Thomas, H.; de Baar, H.J.W.
The CO2 system in the North Sea over the 2001-2011 decade was investigated using four comprehensive basin-wide datasets covering the late summer periods of 2001, 2005, 2008 and 2011. We find that rises in surface water DIC and pCO2 exceeded concurrent rises in atmospheric pCO2, which we attribute
It is shown that urban sprawl and the abuses of technological industries result in substantial environmental and economic costs at the expense of center city locations and populations. Socioeconomic deterioration and modification of the biosphere triggers climatic and environmental changes leading to ecosystem damage and destruction, health consequences and international conflict.
İlker KIYMETLİ ŞEN
Full Text Available In recent years, enterprises are required to reconsider the management of logistics activities as a result of developments such as increasing competition, rapid technological development, and the shortening of product life cycles. As a result of globalization, costs of logistics activities have also increased depending on changes in the quality and quantity of logistics activities. According to research on logistics activities, the physical distribution costs of enterprises may reach up to 30% of sales. For this reason, the management of logistics operations and control of costs caused by these activities is a necessity. The increase in costs negatively impact on the financial performance of enterprises, cash flows, profitability and so value of the shares. The aim of this study was to describe the structure of logistics costs and logistics activities to explain the methods used in costing. For this purpose, many studies in the literature were investigated. The aim of this study was to describe the structure of logistics costs and logistics activities to explain the methods used in costing. For this purpose, many studies in the literature were investigated.
Rosenzweig, Emily Quinn
In the present study I developed and evaluated the effects of two interventions designed to target students' motivation to learn in an introductory college physics course. One intervention was designed to improve students' perceptions of utility value and the other was designed to reduce students' perceptions of cost. Utility value and cost both are central constructs from Eccles and colleagues' expectancy-value theory of motivation (Eccles-Parsons et al., 1983). Students (N = 148) were randomly assigned to receive the cost intervention, the utility value intervention, or one of two control conditions. Compared to a survey control condition, neither intervention impacted overall students' motivation, measured at 3 time points over the semester, or their course outcomes. In moderation analyses, neither intervention impacted any students' perceptions of utility value. However, both interventions impacted some students' perceptions of cost, competence-related beliefs, and course outcomes positively while impacting these variables for other students negatively. The cost intervention benefitted consistently and in different ways students who had low baseline competence-related beliefs, low prior achievement, strong malleable beliefs about intelligence, or who were female. However, the intervention showed consistent undermining effects on motivation and/or achievement for students with strong fixed beliefs about intelligence. The utility value intervention benefitted consistently the course outcomes of students who had low baseline competence-related beliefs, low prior achievement, or who were female. The intervention showed less consistent undermining effects on motivation for students with strong fixed beliefs about intelligence, high baseline competence-related beliefs, or high prior achievement. Prior researchers have shown that utility value interventions improve course outcomes for some students who are at risk for underachievement. The present study extends prior
Arlinger, John; Brunberg, Bengt; Eriksson, Mats; Thor, Magnus [Forestry Research Inst. of Sweden, Uppsala (Sweden)
The work has been carried on in three steps: (1) Mapping of the present quality of forest fuels at heating and cogeneration utilities and pellets producers, (2) Calculation of gross supply of forest fuels in three forestry administrations at AssiDomaen in southern, central and northern Sweden, and (3) Analysis of costs and raw material utilization in three forestry administrations at AssiDomaen in southern, central and northern Sweden. A very detailed description of the results is given in three appendixes.
Hosking, Jay G.; Lam, Fred C. W.; Winstanley, Catharine A
Successful decision making in our daily lives requires weighing an option's costs against its associated benefits. The neuromodulator acetylcholine underlies both the etiology and treatment of a number of illnesses in which decision making is perturbed, including Alzheimer's disease, attention-deficit/hyperactivity disorder, and schizophrenia. Nicotine acts on the cholinergic system and has been touted as a cognitive enhancer by both smokers and some researchers for its attention-boosting eff...
To avoid high tooling costs in product development, a rapid prototyping process chain has been established that enables rapid manufacturing of ceramic microcomponents from functional models to small lot series within a short time. This process chain combines the fast and inexpensive supply of master models by rapid ...
Javelin, a Lone Peak Engineering Inc. Company has introduced the SteamRoller(TM) System as a commercial product. The system was designed by Javelin during a Phase II NASA funded small commercial product. The purpose of the invention was to allow automated-feed of flexible ceramic tapes to the Laminated Object Manufacturing rapid prototyping equipment. The ceramic material that Javelin was working with during the Phase II project is silicon nitride. This engineered ceramic material is of interest for space-based component.
'aide d'abaques. Conçue pour être appliquée lors des étapes préliminaires du développement d'un procédé, ou pour l'obtention d'une évaluation rapide, la Méthode des Modules Fonctionnels s'est avérée suffisamment précise pour être aussi utilisée dans l'estimation du coût d'équipements préalablement dimensionnés. The application of statistical multivariate data analysismethods to a wide range of data samples, obtained either directly from private information sources or from a sizing and detailed-estimation software, has led to the development of a new method for the quick evaluation of the cost of an investment. This method is called the Functional Module Method. In the past, several so-called modular design procedures have been proposed. In the present case, however, this is the first attempt known in the field of the use of techniques such as principal-components analysis, principal factor analysis by distance table and multiple linear regression, to develop a modular structure for estimating the cost of an investment. These changes compared to the modular procedure, which has been used to date by the IFP Project Evaluation Department (Manuel d'évaluation économique des procédés, Editions Technip, Paris, 1976, concern the definition and organization of modules capable of being identified in any chemical processing plant. The functional approach in this lcase is based on the unit operating concept of chemical engineering and no longer on a pre-specified equipment basis, for example, so that the so-called functional modules can be created. All that needs to be used is a process flowsheet indicating the principal pieces of equipment; the nature of the products processed; a material balance that is at least overall, and if possible that. is detailed for the essential lines; the mean operating conditions. The results may be obtained either via equations capable of being programmed on a pocket calculator or by using charts, as is described here. The
Application Anti Microbial Activity Test and Direct Inoculation of Urinary Specimen Test to Increase the Quality of Results and Decrease the Production Cost in Clinical Microbiology Laboratory, Sanglah General Hospital Hospital, Bali-Indonesia
Full Text Available Objective: Urinary tract infection (UTI is the most common bacterial infection in general practice and in hospitals. Fast and accurate urine culture and sensitivity test are needed for adequate therapy. Anti Microbial Activity test (AMA test that is used to detect the presence of antibiotics in urine specimens is not commonly used in clinical microbiology laboratories. Some laboratories are still using indirect inoculation technique using enriched media before inoculating onto the agar media. The aim of this research is to compare results of urinary examination of direct inoculation technique with AMA test with indirect inoculation technique without AMA test.Methods: A number of 210 urine specimens were collected in Clinical Microbiology Laboratory at Sanglah General Hospital within a time period between 16 June until 16 July 2009.Results: Antibiotics were detected in 40% of the urinary specimens; whereas 48.1% showed no evidence of UTI, that is negative AMA test and sterile urinary culture or colony growth < 105 CFU/ml. Only 11.9% of the specimens indicates urinary tract infections. The examination can be completed within 2-3 days which is shorter than indirect inoculation test which require 5-7 days. Direct inoculation technique can reduce the cost of production three-fold the costs require for an indirect inoculation test.Conclusions: Application of AMA test and direct inoculation technique can give results more rapidly, reliable and useful for clinicians. This also decrease the laboratory’s cost of production.
Full Text Available This article deals with methodological issues connected with least-cost path (LCP calculations in archaeology. The number of LCP studies in archaeology has increased rapidly during the last couple of years, but not all of the approaches applied are based on an appropriate model and implementation. M