20 CFR 404.278 - Additional cost-of-living increase.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Additional cost-of-living increase. 404.278... DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.278 Additional cost-of-living increase. (a) General. In addition to the cost-of-living increase explained in...

20 CFR 228.60 - Cost-of-living increase.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Cost-of-living increase. 228.60 Section 228... COMPUTATION OF SURVIVOR ANNUITIES The Tier II Annuity Component § 228.60 Cost-of-living increase. The tier II... tier II component at the time the survivor annuity begins, all cost-of-living increases that were...

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

Science.gov (United States)

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

2018-06-01

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

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

Science.gov (United States)

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

2018-06-01

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

Cost of increasing access to artemisinin combination therapy: the Cambodian experience

Directory of Open Access Journals (Sweden)

Socheat Duong

2008-05-01

Full Text Available Abstract Background Malaria-endemic countries are switching antimalarial drug policy from cheap ineffective monotherapies to artemisinin combination therapies (ACTs for the treatment of Plasmodium falciparum malaria and the global community are considering setting up a global subsidy to fund their purchase. However, in order to ensure that ACTs are correctly used and are accessible to the poor and remote communities who need them, specific interventions will be necessary and the additional costs need to be considered. Methods This paper presents an incremental cost analysis of some of these interventions in Cambodia, the first country to change national antimalarial drug policy to an ACT of artesunate and mefloquine. These costs include the cost of rapid diagnostic tests (RDTs, the cost of blister-packaging the drugs locally and the costs of increasing access to diagnosis and treatment to remote communities through malaria outreach teams (MOTs and Village Malaria Workers (VMW. Results At optimum productive capacity, the cost of blister-packaging cost under $0.20 per package but in reality was significantly more than this because of the low rate of production. The annual fixed cost (exclusive of RDTs and drugs per capita of the MOT and VMW schemes was $0.44 and $0.69 respectively. However because the VMW scheme achieved a higher rate of coverage than the MOT scheme, the cost per patient treated was substantially lower at $5.14 compared to $12.74 per falciparum malaria patient treated. The annual cost inclusive of the RDTs and drugs was $19.31 for the MOT scheme and $11.28 for the VMW scheme given similar RDT positivity rates of around 22% and good provider compliance to test results. Conclusion In addition to the cost of ACTs themselves, substantial additional investments are required in order to ensure that they reach the targeted population via appropriate delivery systems and to ensure that they are used appropriately. In addition, differences

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

Directory of Open Access Journals (Sweden)

Kamfai Chan

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

E-learning: controlling costs and increasing value.

Science.gov (United States)

Walsh, Kieran

2015-04-01

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.

Rapid, low-cost, image analysis through video processing

International Nuclear Information System (INIS)

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

1976-01-01

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

Rapid and Low-cost Prototyping of Medical Devices Using 3D Printed Molds for Liquid Injection Molding

Science.gov (United States)

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

2014-01-01

Biologically inert elastomers such as silicone are favorable materials for medical device fabrication, but forming and curing these elastomers using traditional liquid injection molding processes can be an expensive process due to tooling and equipment costs. As a result, it has traditionally been impractical to use liquid injection molding for low-cost, rapid prototyping applications. We have devised a method for rapid and low-cost production of liquid elastomer injection molded devices that utilizes fused deposition modeling 3D printers for mold design and a modified desiccator as an injection system. Low costs and rapid turnaround time in this technique lower the barrier to iteratively designing and prototyping complex elastomer devices. Furthermore, CAD models developed in this process can be later adapted for metal mold tooling design, enabling an easy transition to a traditional injection molding process. We have used this technique to manufacture intravaginal probes involving complex geometries, as well as overmolding over metal parts, using tools commonly available within an academic research laboratory. However, this technique can be easily adapted to create liquid injection molded devices for many other applications. PMID:24998993

Collateral damage: rapid exposure-induced evolution of pesticide resistance leads to increased susceptibility to parasites.

Science.gov (United States)

Jansen, Mieke; Stoks, Robby; Coors, Anja; van Doorslaer, Wendy; de Meester, Luc

2011-09-01

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).

Low-Cost Rotating Experimentation in Compressor Aerodynamics Using Rapid Prototyping

Directory of Open Access Journals (Sweden)

Mathias Michaud

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Grace Wong

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

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

CSIR Research Space (South Africa)

Hugo, S

2013-10-01

Full Text Available can be achieved. This work provides a complete centrifugal microfluidic platform and the building blocks on which to develop a variety of microfluidic applications and potential products rapidly and at a low cost. ... stream_source_info Hugo_2015_ABSTRACT.pdf.txt stream_content_type text/plain stream_size 1281 Content-Encoding UTF-8 stream_name Hugo_2015_ABSTRACT.pdf.txt Content-Type text/plain; charset=UTF-8 Rapid Product Development...

Public financing of the Medicare program will make its uniform structure increasingly costly to sustain.

Science.gov (United States)

Baicker, Katherine; Shepard, Mark; Skinner, Jonathan

2013-05-01

The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the "one-size-fits-all" Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity.

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

Science.gov (United States)

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

2018-01-01

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

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

Directory of Open Access Journals (Sweden)

Marco A. Rendón-Medina

2018-01-01

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

20 CFR 404.271 - When automatic cost-of-living increases apply.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When automatic cost-of-living increases apply... AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.271 When automatic cost-of-living increases apply. Besides increases in the primary insurance amounts...

[Electrical acupoint stimulation increases athletes' rapid strength].

Science.gov (United States)

Yang, Hua-yuan; Liu, Tang-yi; Kuai, Le; Gao, Ming

2006-05-01

To search for a stimulation method for increasing athletes' performance. One hundred and fifty athletes were randomly divided into a trial group and a control group, 75 athletes in each group. Acupoints were stimulated with audio frequency pulse modulated wave and multi-blind method were used to investigate effects of the electric stimulation of acupoints on 30-meter running, standing long jumping and Cybex isokinetic testing index. The acupoint electric stimulation method could significantly increase athlete's performance (P < 0.05), and the biomechanical indexes, maximal peak moment of force (P < 0.05), force moment accelerating energy (P < 0.05) and average power (P < 0.05). Electrical acupoint stimulation can enhance athlete's rapid strength.

New plant construction cost and schedule

International Nuclear Information System (INIS)

Akins, M. J.

2009-01-01

The presentation covers the following topics: cost structure; capital costs; variation of capital costs; trends in power plant construction; studies of costs completion; periods and risks. Nuclear plant costs have recently risen so rapidly that vendors are not willing to publicly commit to cost estimates: ∼ $2000/Kw overnight costs in 2006 in the US market > $4000/Kw and in 2008 in the US market > $6000/Kw in 2008 in emerging markets. There is vendors pricing uncertainty. Current contract models may not apply. Current construction projects have problems: Olkiluoto-3 is reported to be 50% over budget and two years behind schedule, increasing perceptions that nuclear costs will continue to increase rapidly; Price of materials is a big volatile unknown, which may decrease Labor could become more available due to limited number of new projects; Lack of debt/credit to finance new project may decrease demand of new construction

Costs and cost-effectiveness of periviable care.

Science.gov (United States)

Caughey, Aaron B; Burchfield, David J

2014-02-01

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

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

Science.gov (United States)

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

2015-11-01

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

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

Science.gov (United States)

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

2016-04-01

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

20 CFR 225.43 - PIA's subject to cost-of-living increases.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false PIA's subject to cost-of-living increases... RETIREMENT ACT PRIMARY INSURANCE AMOUNT DETERMINATIONS Cost-of-Living Increases § 225.43 PIA's subject to cost-of-living increases. The Retirement Tier I, Overall Minimum, Survivor Tier I, Employee RIB and RLS...

20 CFR 225.44 - When a cost-of-living increase is payable.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false When a cost-of-living increase is payable... RETIREMENT ACT PRIMARY INSURANCE AMOUNT DETERMINATIONS Cost-of-Living Increases § 225.44 When a cost-of-living increase is payable. A cost-of-living increase is payable beginning with December of the year for...

Corruption Significantly Increases the Capital Cost of Power Plants in Developing Contexts

Directory of Open Access Journals (Sweden)

Kumar Biswajit Debnath

2018-03-01

Full Text Available Emerging economies with rapidly growing population and energy demand, own some of the most expensive power plants in the world. We hypothesized that corruption has a relationship with the capital cost of power plants in developing countries such as Bangladesh. For this study, we analyzed the capital cost of 61 operational and planned power plants in Bangladesh. Initial comparison study revealed that the mean capital cost of a power plant in Bangladesh is twice than that of the global average. Then, the statistical analysis revealed a significant correlation between corruption and the cost of power plants, indicating that higher corruption leads to greater capital cost. The high up-front cost can be a significant burden on the economy, at present and in the future, as most are financed through international loans with extended repayment terms. There is, therefore, an urgent need for the review of the procurement and due diligence process of establishing power plants, and for the implementation of a more transparent system to mitigate adverse effects of corruption on megaprojects.

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

KAUST Repository

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

2016-01-01

and cost-effective automatic yeast analysis platform (AYAP), which can rapidly measure cell concentration and viability. AYAP is based on digital in-line holography and on-chip microscopy and rapidly images a large field-of-view of 22.5 mm2. This lens

20 CFR 404.273 - When are automatic cost-of-living increases effective?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When are automatic cost-of-living increases..., SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.273 When are automatic cost-of-living increases effective? We make automatic cost-of-living...

Increased corrosion resistance of the AZ80 magnesium alloy by rapid solidification.

Science.gov (United States)

Aghion, E; Jan, L; Meshi, L; Goldman, J

2015-11-01

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.

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

Science.gov (United States)

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

2017-04-01

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

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

Directory of Open Access Journals (Sweden)

Kuang-Li Lee

2017-07-01

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

The Hepatitis C Genotype 1 Paradox: Cost per Treatment Is Increasing, but Cost per Cure Is Decreasing

Directory of Open Access Journals (Sweden)

Stephen D Shafran

2015-01-01

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.

The hepatitis C genotype 1 paradox: cost per treatment is increasing, but cost per cure is decreasing.

Science.gov (United States)

Shafran, Stephen D

2015-01-01

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.

Mechanisms Underlying Early Rapid Increases in Creatinine in Paraquat Poisoning

Science.gov (United States)

Mohamed, Fahim; Endre, Zoltan; Jayamanne, Shaluka; Pianta, Timothy; Peake, Philip; Palangasinghe, Chathura; Chathuranga, Umesh; Jayasekera, Kithsiri; Wunnapuk, Klintean; Shihana, Fathima; Shahmy, Seyed; Buckley, Nicholas

2015-01-01

Background Acute kidney injury (AKI) is common after severe paraquat poisoning and usually heralds a fatal outcome. The rapid large increases in serum creatinine (Cr) exceed that which can be explained by creatinine kinetics based on loss of glomerular filtration rate (GFR). Methods and Findings This prospective multi-centre study compared the kinetics of two surrogate markers of GFR, serum creatinine and serum cystatin C (CysC), following paraquat poisoning to understand and assess renal functional loss after paraquat poisoning. Sixty-six acute paraquat poisoning patients admitted to medical units of five hospitals were included. Relative changes in creatinine and CysC were monitored in serial blood and urine samples, and influences of non-renal factors were also studied. Results Forty-eight of 66 patients developed AKI (AKIN criteria), with 37 (56%) developing moderate to severe AKI (AKIN stage 2 or 3). The 37 patients showed rapid increases in creatinine of >100% within 24 hours, >200% within 48 hours and >300% by 72 hours and 17 of the 37 died. CysC concentration increased by 50% at 24 hours in the same 37 patients and then remained constant. The creatinine/CysC ratio increased 8 fold over 72 hours. There was a modest fall in urinary creatinine and serum/urine creatinine ratios and a moderate increase in urinary paraquat during first three days. Conclusion Loss of renal function contributes modestly to the large increases in creatinine following paraquat poisoning. The rapid rise in serum creatinine most probably represents increased production of creatine and creatinine to meet the energy demand following severe oxidative stress. Minor contributions include increased cyclisation of creatine to creatinine because of acidosis and competitive or non-competitive inhibition of creatinine secretion. Creatinine is not a good marker of renal functional loss after paraquat poisoning and renal injury should be evaluated using more specific biomarkers of renal injury

Multiple drug cost containment policies in Michigan's Medicaid program saved money overall, although some increased costs.

Science.gov (United States)

Kibicho, Jennifer; Pinkerton, Steven D

2012-04-01

Michigan's Medicaid program implemented four cost containment policies--preferred drug lists, joint and multistate purchasing arrangements, and maximum allowable cost--during 2002-04. The goal was to control growth of drug spending for beneficiaries who were enrolled in both Medicaid and Medicare and taking antihypertensive or antihyperlipidemic prescription drugs. We analyzed the impact of each policy while holding the effect of all other policies constant. Preferred drug lists increased both preferred and generic drugs' market share and reduced daily cost--the cost per day for each prescription provided to a beneficiary. In contrast, the maximum allowable cost policy increased daily cost and was the only policy that did not generate cost savings. The joint and multistate arrangements did not affect daily cost. Despite these policy trade-offs, the cumulative effect was a 10 percent decrease in daily cost and a total cost savings of $46,195 per year. Our findings suggest that policy makers need to evaluate the impact of multiple policies aimed at restraining drug spending, and further evaluate the policy trade-offs, to ensure that scarce public dollars achieve the greatest return for money spent.

Impact of increased fuel costs and inflation on the cost of desalting sea water and brackish waters

International Nuclear Information System (INIS)

Reed, S.A.

1976-01-01

The combined increases in the cost of fuel, equipment, and money during the past four years have had a marked impact on the cost of desalting saline waters. The current costs of desalting seawater by distillation and reverse osmosis and brackish waters by reverse osmosis and electrodialysis as a function of plant size and feedwater chemistry are estimated. Typically, distillation plant capital costs have increased from dollar 1 per daily gallon to dollar 3 per daily gallon for large plants (100 Mgd) and from approximately dollar 1.40 per daily gallon to approximately dollar 5 per daily gallon per plant sizes of 5 Mgd or less. Consequently, water costs are now ranging from dollar 3 to dollar 4 per 1000 gal when oil is used to generate steam. Similarly, the costs of desalting inland brackish waters using reverse osmosis or electrodialysis have increased significantly

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

Science.gov (United States)

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

2010-09-01

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

Rapid increases in tropospheric ozone production and export from China

NARCIS (Netherlands)

Verstraeten, W.W.; Neu, J.L.; Williams, J.E.; Bowman, K.W.; Worden, J.R.; Boersma, K.F.

2015-01-01

Rapid population growth and industrialization have driven substantial increases in Asian ozone precursor emissions over the past decade1, with highly uncertain impacts on regional and global tropospheric ozone levels. According to ozonesonde measurements2, 3, tropospheric ozone concentrations at two

Cost update: Technology, safety, and costs of decommissioning reference independent spent fuel storage installations

International Nuclear Information System (INIS)

Miles, T.L.

1994-07-01

The cost estimates originally developed in NUREG/CR-2210 for decommissioning five conceptual Independent Spent Fuel Storage Installations (ISFSIs) and their supporting ancillaries (hot cell and transporter) are updated from 1981 to 1993 dollars. The costs for labor and materials increased approximately at the rate of inflation, the cost of energy increased more slowly than the rate of inflation, and the cost of low-level radioactive waste disposal increased much more rapidly than the rate of inflation. A methodology and a formula are presented for estimating the cost of decommissioning the ISFSIs at some future time, based on these current cost estimates. The formula contains essentially the same elements as the formula given in 10 CFR 50.75 for escalating the decommissioning costs for nuclear power reactors to some future time

[Relating costs to activities in hospitals. Use of internal cost accounting].

Science.gov (United States)

Stavem, K

1995-01-10

During the last few years hospital cost accounting has become widespread in many countries, in parallel with increasing cost pressure, greater competition and new financing schemes. Cost accounting has been used in the manufacturing industry for many years. Costs can be related to activities and production, e.g. by the costing of procedures, episodes of care and other internally defined cost objectives. Norwegian hospitals have lagged behind in the adoption of cost accounting. They ought to act quickly if they want to be prepared for possible changes in health care financing. The benefits can be considerable to a hospital operating in a rapidly changing health care environment.

Africa: rapid population increase retards development.

Science.gov (United States)

1993-10-01

The Organization of African Unity (OAU), the African Development Bank (ADB) and the UN Economic Commission for Africa (ECA) have criticized African governments for not taking the problem of unchecked population growth seriously enough. "Until recently most African governments did not view rapid population growth as a matter for concern," said the OAU assistant secretary-general for political affairs, Machivenyika Mapuranga, at a seminar on 'population and development'. The OAU estimates that an annual average population increase of 3.1% far outstrips Africa's economic growth, which in 1992 was less than 1%. Mapuranga acknowledged that cutting the population increase is an uphill struggle, especially among rural communities. African agriculture is largely labor intensive, sustained by smallholders, which encourages farmers to have more children. Like other wage earners, African farmers look to support from their family when they grow old and, for that reason, the number of children also counts. But with agricultural production growing at an average annual rate of 2.5%, self-sufficiency in food remains an elusive goal. Cities in sub-Saharan Africa are growing much faster than the overall rate of population increase of 3.1% per year. Between 1980 and 1988 the region's urban population increased at the rate of 6.9% a year. Urban areas now account for nearly 30% of the sub-Saharan Africa population, currently put at 680 million. By 2025, approximately 700 million people are expected to live in urban areas. Despite migration to towns, the rural population is expected to rise more than 68%, reaching over 590 million. full text

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

Science.gov (United States)

Morgan, Margie Ann

2009-02-01

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

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

Science.gov (United States)

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

2013-04-07

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

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

Directory of Open Access Journals (Sweden)

Patricia C Lopes

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

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

Science.gov (United States)

Sone, Satoru; Takagi, Ryo

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

A rapid cosmic-ray increase in BC 3372-3371 from ancient buried tree rings in China.

Science.gov (United States)

Wang, F Y; Yu, H; Zou, Y C; Dai, Z G; Cheng, K S

2017-11-14

Cosmic rays interact with the Earth's atmosphere to produce 14 C, which can be absorbed by trees. Therefore, rapid increases of 14 C in tree rings can be used to probe previous cosmic-ray events. By this method, three 14 C rapidly increasing events have been found. Plausible causes of these events include large solar proton events, supernovae, or short gamma-ray bursts. However, due to the lack of measurements of 14 C by year, the occurrence frequency of such 14 C rapidly increasing events is poorly known. In addition, rapid increases may be hidden in the IntCal13 data with five-year resolution. Here we report the result of 14 C measurements using an ancient buried tree during the period between BC 3388 and 3358. We found a rapid increase of about 9‰ in the 14 C content from BC 3372 to BC 3371. We suggest that this event could originate from a large solar proton event.

Cost Accounting as a Tool for Increasing Cost Transparency in Selective Hepatic Transarterial Chemoembolization.

Science.gov (United States)

Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V

2015-12-01

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.

20 CFR 404.275 - How is an automatic cost-of-living increase calculated?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How is an automatic cost-of-living increase..., SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.275 How is an automatic cost-of-living increase calculated? (a) Increase based on the CPI. We...

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

Science.gov (United States)

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

2018-02-01

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

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

Science.gov (United States)

Smith, Patricia L; McSweeney, Jean

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

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

Science.gov (United States)

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

2018-03-15

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

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

Science.gov (United States)

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

2003-05-01

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

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

Directory of Open Access Journals (Sweden)

Stürenburg, Enno

2009-07-01

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

Concepts of increasing productivity and reducing the processing cost of machine parts

Directory of Open Access Journals (Sweden)

О. С. Кленов

2017-06-01

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

Metabolic and respiratory costs of increasing song amplitude in zebra finches.

Directory of Open Access Journals (Sweden)

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.

20 CFR 226.13 - Cost-of-living increase in employee vested dual benefit.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Cost-of-living increase in employee vested... Annuity § 226.13 Cost-of-living increase in employee vested dual benefit. If the employee's annuity begins June 1, 1975 or later, a cost-of-living increase is added to the total vested dual benefit amount. This...

Insight into the Physical and Dynamical Processes that Control Rapid Increases in Total Flash Rate

Science.gov (United States)

Schultz, Christopher J.; Carey, Lawrence D.; Schultz, Elise V.; Blakeslee, Richard J.; Goodman, Steven J.

2015-01-01

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.

Evaluation of ways and procedures to reduce construction cost and increase competition.

Science.gov (United States)

2009-01-01

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 ...

Increasing value in plagiocephaly care: a time-driven activity-based costing pilot study.

Science.gov (United States)

Inverso, Gino; Lappi, Michael D; Flath-Sporn, Susan J; Heald, Ronald; Kim, David C; Meara, John G

2015-06-01

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.

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

Science.gov (United States)

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

2014-10-01

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

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

Science.gov (United States)

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

2005-07-01

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

12 CFR 1206.4 - Increased costs of regulation.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Increased costs of regulation. 1206.4 Section 1206.4 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ORGANIZATION AND OPERATIONS ASSESSMENTS § 1206... regulation of a Regulated Entity due to its classification as other than adequately capitalized, or as a...

20 CFR 225.41 - How a cost-of-living increase is determined and applied.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How a cost-of-living increase is determined... RAILROAD RETIREMENT ACT PRIMARY INSURANCE AMOUNT DETERMINATIONS Cost-of-Living Increases § 225.41 How a cost-of-living increase is determined and applied. Depending on the condition of the social security...

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

International Nuclear Information System (INIS)

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

2002-01-01

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

Cost update: Technology, safety, and costs of decommissioning a reference uranium fuel fabrication plant

International Nuclear Information System (INIS)

Miles, T.L.; Liu, Y.

1994-06-01

The cost estimates originally developed in NUREG/CR-1266 for commissioning a reference low-enrichment uranium fuel fabrication plant are updated from 1978 to early 1993 dollars. During this time, the costs for labor and materials increased approximately at the rate of inflation, the cost of energy increased more slowly than the rate of inflation, and the cost of low-level radioactive waste disposal increased much more rapidly than the rate of inflation. The results of the analysis indicate that the estimated costs for the immediate dismantlement and decontamination for unrestricted facility release (DECON) of the reference plant have increased from the mid-1978 value of $3.57 million to $8.08 million in 1993 with in-compact low-level radioactive waste disposal at the US Ecoloay facility near Richland, Washington. The cost estimate rises to $19.62 million with out-of-compact radioactive waste disposal at the Chem-Nuclear facility near Barnwell, South Carolina. A methodology and a formula are presented for estimating the cost of decommissioning the reference uranium fuel fabrication plant at some future time, based on these early 1993 cost estimates. The formula contains essentially the same elements as the formula given in 10 CFR 50.75 for escalating the decommissioning costs for nuclear power reactors to some future time

Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients.

Science.gov (United States)

van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W; Pols, Huibert A P; van der Cammen, Tischa J M

2008-01-01

Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. Within a common geriatric outpatient population, patients with a history of falls were assessed for falls risk (n = 139). Fall-risk-increasing drugs were withdrawn when appropriate (n = 75). All participants had a 2-month follow-up for fall incidents. The number of prevented falls was calculated using a loglinear regression model. The savings on health expenditures as a result of prevented injuries (estimated from a literature review) and reduced consumption of pharmaceuticals were compared with the intervention costs. After adjustment for confounders, drug withdrawal resulted in a falls risk reduction of 0.89 (95% CI 0.33, 0.98) per patient compared with the non-withdrawal group. Net cost savings were euro1691 (95% CI 662, 2181) per patient in the cohort. This resulted in a cost saving of euro491 (95% CI 465, 497) per prevented fall. Withdrawal of fall-risk-increasing drugs generates significant cost savings. Extrapolation of these findings to a national scale results in an estimated reduction of euro60 million in healthcare expenditures, that is, 15% of fall-related health costs.

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

Directory of Open Access Journals (Sweden)

Daniel E Winetsky

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

Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand.

Directory of Open Access Journals (Sweden)

Tony Blakely

2015-07-01

Full Text Available 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.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.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 burden and health inequalities, they will also

Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand

Science.gov (United States)

Blakely, Tony; Cobiac, Linda J.; Cleghorn, Christine L.; Pearson, Amber L.; van der Deen, Frederieke S.; Kvizhinadze, Giorgi; Nghiem, Nhung; McLeod, Melissa; Wilson, Nick

2015-01-01

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

Delayed otolaryngology referral for voice disorders increases health care costs.

Science.gov (United States)

Cohen, Seth M; Kim, Jaewhan; Roy, Nelson; Courey, Mark

2015-04-01

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.

78 FR 68133 - Cost-of-Living Increases and Other Determinations for 2014; Correction

Science.gov (United States)

2013-11-13

... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2013-0057] Cost-of-Living Increases and Other Determinations for 2014; Correction AGENCY: Social Security Administration. ACTION: Notice; Correction. SUMMARY..., concerning the cost-of-living increase in Social Security benefits effective December 2013. The document...

Economical Feedback of Increasing Fuel Enrichment on Electricity Cost for VVER-1000

Directory of Open Access Journals (Sweden)

Mohammed Saad Dwiddar

2015-08-01

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.

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

Science.gov (United States)

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

2007-09-01

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

Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

Science.gov (United States)

Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

2017-01-01

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.

Cost-effectiveness of policies aimed at increasing organ donation: the case of Chile.

Science.gov (United States)

Domínguez, J; Harrison, R; Atal, R; Larraín, L

2013-01-01

In this article we present an economic evaluation of policies aimed at increasing deceased organ donation in Chile, a developing country that has low donation rates; it had 5.4 donors per million people (pmp) in 2010. Expert opinions of leading participants in donation and transplantation were analyzed, resulting in a set of local policies aimed at increasing donation rates. Using previous results of reported cost savings of increasing kidney transplantation in Chile, we estimated the net benefits of these policies, as a function of additional donors. The main problem of the Chilean system seems to be the low capability to identify potential donors and a deficit in intensive care unit (ICU) beds. Among considered policies central to increase donation are the following: increasing human and capital resources dedicated to identifying potential donors, providing ICU beds from private centers, and developing an online information system that facilitates procurement coordination and the evaluation of performance at each hospital. Our results show that there is a linear relationship between cost savings and incremental donors pmp. For example, if these policies are capable of elevating donation rates in Chile by 6 donors pmp net estimated cost savings are approximately US $1.9 million. Likewise, considering the effect on patients' quality of life, savings would amount to around $15.0 million dollars per year. Our estimates suggest that these policies have a large cost-saving potential. In fact, considering implementation costs, cost reduction is positive after 4 additional donors pmp, and increasing afterward. Copyright © 2013 Elsevier Inc. All rights reserved.

Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? Evidence from a computer simulation model.

Science.gov (United States)

Braithwaite, R Scott; Omokaro, Cynthia; Justice, Amy C; Nucifora, Kimberly; Roberts, Mark S

2010-02-16

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 (value services ($100,000-$300,000 per life-year or unknown), and would be increased for 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

Rapid Increase of Genetically Diverse Methicillin-Resistant Staphylococcus aureus, Copenhagen, Denmark

DEFF Research Database (Denmark)

Bartels, Mette Damkjær; Boye, Kit; Larsen, Anders Rhod

2007-01-01

In Copenhagen, methicillin-resistant Staphylococcus aureus (MRSA) accounted for <15 isolates per year during 1980-2002. However, since 2003 an epidemic increase has been observed, with 33 MRSA cases in 2003 and 110 in 2004. We analyzed these 143 cases epidemiologically and characterized isolates ...... and soft tissue infections dominated. CO-MRSA with diverse genetic backgrounds is rapidly emerging in a low MRSA prevalence area. Udgivelsesdato: October...

Benefits and costs of increased levels of corticosterone in seabird chicks

Science.gov (United States)

Kitaysky, A.S.; Kitaiskaia, E.V.; Piatt, John F.; Wingfield, J.C.

2003-01-01

Seabird chicks respond to food shortages by increasing corticosterone (cort) secretion, which is probably associated with fitness benefits and costs. To examine this, we experimentally increased levels of circulating cort in captive black-legged kittiwake chicks fed ad libitum. We found that cort-implanted chicks begged more frequently and were more aggressive compared to controls. These behavioral modifications must be beneficial to chicks as they facilitate acquisition of food from the parents and might trigger brood reduction and reduced competition for food. Cort-implanted chicks also increased food intake; however, their growth rates were similar to controls. To examine the costs of chronically increased circulating levels of cort, we removed cort implants and, after a 10-day recovery period, tested cognitive abilities of young kittiwakes. We found that the ability of kittiwakes to associate a visual cue with the presence of food in a choice situation was compromised by the experimental elevation of cort during development. To examine the long-term costs of increased levels of cort, 8 months later we tested the performance of the same individuals in a spatial task requiring them to make a detour around a barrier in order to escape from an enclosure. Individuals treated with cort during development took significantly more time to solve this task compared to controls. The results of this study suggest that the adrenocortical response of a developing bird to environmental stressors is associated with both benefits (increased food intake, foraging behavior, and aggression) and costs (low growth efficiency and compromised cognitive abilities later in life). This provides an evolutionary framework for relating juvenile physiological traits to fitness of birds in subsequent life-history stages. ?? 2003 Elsevier Science (USA). All rights reserved.

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

Science.gov (United States)

Caldwell, Chip

2006-10-01

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

Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? Evidence from a computer simulation model.

Directory of Open Access Journals (Sweden)

R Scott Braithwaite

2010-02-01

Full Text Available 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 ($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 from

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

DEFF Research Database (Denmark)

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

2017-01-01

was a cost-effectiveness analysis of the introduction of malaria rapid diagnostic tests (mRDTs) performed by CHWs in two areas of moderate-to-high and low malaria transmission in rural Uganda. CHWs were trained to perform mRDTs and treat children with artemisinin-based combination therapy (ACT......) in the intervention arm while CHWs offered treatment based on presumptive diagnosis in the control arm. Data on the proportion of children with fever 'appropriately treated for malaria with ACT' were captured from a randomised trial. Health sector costs included: training of CHWs, community sensitisation, supervision...

20 CFR 228.40 - Cost of living increase applicable to the tier I annuity component.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Cost of living increase applicable to the... § 228.40 Cost of living increase applicable to the tier I annuity component. The tier I annuity... the Federal Register annually. The cost-of-living increase is payable beginning with the benefit for...

Climate change and electricity consumption-Witnessing increasing or decreasing use and costs?

International Nuclear Information System (INIS)

Pilli-Sihvola, Karoliina; Aatola, Piia; Ollikainen, Markku; Tuomenvirta, Heikki

2010-01-01

Climate change affects the need for heating and cooling. This paper examines the impact of gradually warming climate on the need for heating and cooling with an econometric multivariate regression model for five countries in Europe along the south-north line. The predicted changes in electricity demand are then used to analyze how climate change impacts the cost of electricity use, including carbon costs. Our main findings are, that in Central and North Europe, the decrease in heating due to climate warming, dominates and thus costs will decrease for both users of electricity and in carbon markets. In Southern Europe climate warming, and the consequential increase in cooling and electricity demand, overcomes the decreased need for heating. Therefore costs also increase. The main contributors are the role of electricity in heating and cooling, and the climatic zone.

20 CFR 225.42 - Notice of the percentage amount of a cost-of-living increase.

Science.gov (United States)

2010-04-01

... THE RAILROAD RETIREMENT ACT PRIMARY INSURANCE AMOUNT DETERMINATIONS Cost-of-Living Increases § 225.42 Notice of the percentage amount of a cost-of-living increase. The percentage amount of the cost-of-living... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Notice of the percentage amount of a cost-of...

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

Science.gov (United States)

Ratner, Jacqueline; Pyle, David; Mather, Tamsin

2014-05-01

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

Impact of Cost-Sharing Increases on Continuity of Specialty Drug Use: A Quasi-Experimental Study.

Science.gov (United States)

Li, Pengxiang; Hu, Tianyan; Yu, Xinyan; Chahin, Salim; Dahodwala, Nabila; Blum, Marissa; Pettit, Amy R; Doshi, Jalpa A

2017-07-24

To examine the impact of cost-sharing increases on continuity of specialty drug use in Medicare beneficiaries with multiple sclerosis (MS) or rheumatoid arthritis (RA). Five percent Medicare claims data (2007-2010). Quasi-experimental study examining changes in specialty drug use among a group of Medicare Part D beneficiaries without low-income subsidies (non-LIS) as they transitioned from a 5 percent cost-sharing preperiod to a ≥25 percent cost-sharing postperiod, as compared to changes among a disease-matched contemporaneous control group of patients eligible for full low-income subsidies (LIS), who faced minor cost sharing (≤$6.30 copayment) in both the pre- and postperiods. Key variables were extracted from Medicare data. Relative to the LIS group, the non-LIS group had a greater increase in incidence of 30-day continuous gaps in any Part D treatment from the lower cost-sharing period to the higher cost-sharing period (MS, absolute increase = 10.1 percent, OR = 1.61, 95% CI 1.19-2.17; RA, absolute increase = 21.9 percent, OR = 2.75, 95% CI 2.15-3.51). The increase in Part D treatment gaps was not offset by increased Part B specialty drug use. Cost-sharing increases due to specialty tier-level cost sharing were associated with interruptions in MS and RA specialty drug treatments. © Health Research and Educational Trust.

Fuel cycle cost considerations of increased discharge burnups

International Nuclear Information System (INIS)

Scherpereel, L.R.; Frank, F.J.

1982-01-01

Evaluations are presented that indicate the attainment of increased discharge burnups in light water reactors will depend on economic factors particular to individual operators. In addition to pure resource conserving effects and assuming continued reliable fuel performance, a substantial economic incentive must exist to justify the longer operating times necessary to achieve higher burnups. Whether such incentive will exist or not will depend on relative price levels of all fuel cycle cost components, utility operating practices, and resolution of uncertainties associated with the back-end of the fuel cycle. It is concluded that implementation of increased burnups will continue at a graduated pace similar to past experience, rather than finding universal acceptance of particular increased levels at any particular time

The management of aldosterone-producing adrenal adenomas--does adrenalectomy increase costs?

Science.gov (United States)

Reimel, Bethann; Zanocco, Kyle; Russo, Mark J; Zarnegar, Rasa; Clark, Orlo H; Allendorf, John D; Chabot, John A; Duh, Quan-Yang; Lee, James A; Sturgeon, Cord

2010-12-01

Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156% to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6% of PHA patients have resectable APA. Resection of APAs was the least costly treatment strategy in this decision analysis model. Copyright © 2010 Mosby, Inc. All rights reserved.

Costs of living for juvenile Chinook salmon (Oncorhynchus tshawytscha) in an increasingly warming and invaded world

Science.gov (United States)

Kuehne, Lauren M.; Olden, Julian D.; Duda, Jeffrey J.

2012-01-01

Rapid environmental change in freshwater ecosystems has created a need to understand the interactive effects of multiple stressors, with temperature and invasive predators identified as key threats to imperiled fish species. We tested the separate and interactive effects of water temperature and predation by non-native smallmouth bass (Micropterus dolomieu) on the lethal (mortality) and sublethal (behavior, physiology, and growth) effects for juvenile Chinook salmon (Oncorhynchus tshawytscha) in seminatural stream channel experiments. Over 48 h trials, there was no difference in direct predation with warmer temperatures, but significant interactive effects on sublethal responses of juvenile salmon. Warmer temperatures resulted in significantly stronger and more variable antipredator responses (surface shoaling and swimming activity), while physiological indicators (plasma glucose, plasma cortisol) suggested suppression of physiological mechanisms in response to the combined stressors. These patterns corresponded with additive negative growth in predation, temperature, and combined treatments. Our results suggest that chronic increases in temperature may not increase direct predation over short periods, but can result in significant sublethal costs with negative implications for long-term development, disease resistance, and subsequent size-selective mortality of Pacific salmon.

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey.

Science.gov (United States)

Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

2016-01-01

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.

Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients

NARCIS (Netherlands)

van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W.; Pols, Huibert A. P.; van der Cammen, Tischa J. M.

2008-01-01

BACKGROUND: Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. METHOD: Within a common geriatric outpatient

Capital-cost behavior: is nuclear different

International Nuclear Information System (INIS)

Lotze, C.D.; Riordan, B.J.

1978-01-01

The capital costs of coal-fired and nuclear power plants are found to be comparable when costs for pollution control are included. Trends in capital costs reveal a similar rate gain that retains the same economic balance. Graphs of selected cost indices are used to show that the rapid increase in direct construction costs is not unique to nuclear plants, those of hydroelectric plants as well as coal-fired having the same pattern. Comparisons of indirect capital costs, based on analyses of direct capital and total capital costs, show estimated average growth rates of total costs to be 14% for coal and 13.6% for nuclear, while direct cost growth rates are 10.2% and 10.4%. The economics of market competition can be expected to push alternative energy source projects into balance

FY 1997 cost savings report

International Nuclear Information System (INIS)

Sellards, J.B.

1998-01-01

With the end of the cold war, funding for the Environmental Management program increased rapidly as nuclear weapons production facilities were shut down, cleanup responsibilities increased, and facilities were transferred to the cleanup program. As funding for the Environmental Management (EM) program began to level off in response to Administration and Congressional efforts to balance the Federal budget, the program redoubled its efforts to increase efficiency and get more productivity out of every dollar. Cost savings and enhanced performance are an integral pair of Hanford Site operations. FY1997 was the third year of a cost savings program that was initially defined in FY 1995. The definitions and process remained virtually the same as those used in FY 1996

Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital

Directory of Open Access Journals (Sweden)

Mishra Vinod

2012-08-01

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

The Great Recession And Increased Cost Sharing In European Health Systems.

Science.gov (United States)

Palladino, Raffaele; Lee, John Tayu; Hone, Thomas; Filippidis, Filippos T; Millett, Christopher

2016-07-01

European health systems are increasingly adopting cost-sharing models, potentially increasing out-of-pocket expenditures for patients who use health care services or buy medications. Government policies that increase patient cost sharing are responding to incremental growth in cost pressures from aging populations and the need to invest in new health technologies, as well as to general constraints on public expenditures resulting from the Great Recession (2007-09). We used data from the Survey of Health, Ageing and Retirement in Europe to examine changes from 2006-07 to 2013 in out-of-pocket expenditures among people ages fifty and older in eleven European countries. Our results identify increases both in the proportion of older European citizens who incurred out-of-pocket expenditures and in mean out-of-pocket expenditures over this period. We also identified a significant increase over time in the percentage of people who incurred catastrophic health expenditures (greater than 30 percent of the household income) in the Czech Republic, Italy, and Spain. Poorer populations were less likely than those in the highest income quintile to incur an out-of-pocket expenditure and reported lower mean out-of-pocket expenditures, which suggests that measures are in place to provide poorer groups with some financial protection. These findings indicate the substantial weakening of financial protection for people ages fifty and older in European health systems after the Great Recession. Project HOPE—The People-to-People Health Foundation, Inc.

Risk Factors Associated with Mortality and Increased Drug Costs in Nonvariceal Upper Gastrointestinal Bleeding.

Science.gov (United States)

Lu, Mingliang; Sun, Gang; Zhang, Xiu-li; Zhang, Xiao-mei; Liu, Qing-sen; Huang, Qi-yang; Lau, James W Y; Yang, Yun-sheng

2015-06-01

To determine risk factors associated with mortality and increased drug costs in patients with nonvariceal upper gastrointestinal bleeding. We retrospectively analyzed data from patients hospitalized with nonvariceal upper gastrointestinal bleeding between January 2001-December 2011. Demographic and clinical characteristics and drug costs were documented. Univariate analysis determined possible risk factors for mortality. Statistically significant variables were analyzed using a logistic regression model. Multiple linear regression analyzed factors influencing drug costs. p study included data from 627 patients. Risk factors associated with increased mortality were age > 60, systolic blood pressurebleeding rate is 11.20% and mortality is 5.74%. The mortality risk in patients with comorbidities was higher than in patients without comorbidities, and was higher in patients requiring blood transfusion than in patients not requiring transfusion. Rebleeding was associ-ated with mortality. Rebleeding, blood transfusion, and prolonged hospital stay were associated with increased drug costs, whereas bleeding from lesions in the esophagus and duodenum was associated with lower drug costs.

The impact of unit cost reductions on gross profit: Increasing or decreasing returns?

Directory of Open Access Journals (Sweden)

Ely Dahan

2011-09-01

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.

An Analysis of Army Rapid Acquisition

Science.gov (United States)

2015-09-01

measuring its bottom-line impacts enables managers to increase the productivity of these critical assets.”16 If we determine that the current rapid...readiness-requirements/. 111 William Beaver , “Mantech Awarded $61M for Contractor Logistics Sustainment Support Services,” Danger Zone Jobs (blog...could be quickly produced and fielded.”120  Stable and Available Funding. MRAP “was able to avoid negative cost and schedule impacts that are

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

Directory of Open Access Journals (Sweden)

Patrick W. Fedick

2018-03-01

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

Effect of increased regulation on capital costs and manual labor requirements of nuclear power plants

International Nuclear Information System (INIS)

Paik, S.; Schriver, W.R.

1981-01-01

An attempt is made to explain the impact of increasing governmental regulation on capital costs and labor requirements for constructing light water reactor (LWR) electric power plants. The principal factors contributing to these increases are: (1) market conditions and (2) increased regulation. General market conditions include additional costs attributable to price inflation of equipment, material, labor, and the increased cost of money. The central objective of this work is to estimate the impact of increasing regulation on plant costs and, conversely, on output. To do this it is necessary to isolate two opposing sets of forces which have been in operation during the period of major regulatory expansion: learning based upon plant design experience and economies of scale with increasing size (generating capacity) of newer plants. Conceptual models are specified to capture the independent effects of increasing regulation, learning, and economies of scale. Empirical results were obtained by estimating the models on data collected from industry experience during the 1967-1980 period. 23 refs

42 CFR 413.40 - Ceiling on the rate of increase in hospital inpatient costs.

Science.gov (United States)

2010-10-01

... October 1, 2002, is the percentage increase projected by the hospital market basket index. (4) Target... target amount for the previous cost reporting period, updated by the market basket percentage increase... each cost reporting period, the ceiling is determined by multiplying the updated target amount, as...

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

Science.gov (United States)

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

2017-07-17

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

The cost-effectiveness of using payment to increase living donor kidneys for transplantation.

Science.gov (United States)

Barnieh, Lianne; Gill, John S; Klarenbach, Scott; Manns, Braden J

2013-12-01

For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.

Rapid Prototyping Laboratory

Data.gov (United States)

Federal Laboratory Consortium — The ARDEC Rapid Prototyping (RP) Laboratory was established in December 1992 to provide low cost RP capabilities to the ARDEC engineering community. The Stratasys,...

Fitness cost of resistance to Bt cotton linked with increased gossypol content in pink bollworm larvae.

Directory of Open Access Journals (Sweden)

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.

Effect of increasing energy cost on arm coordination in elite sprint swimmers.

Science.gov (United States)

Komar, J; Leprêtre, P M; Alberty, M; Vantorre, J; Fernandes, R J; Hellard, P; Chollet, D; Seifert, L

2012-06-01

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 (pstroke index did not change significantly with the speed increments (pstroke 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.

Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

Science.gov (United States)

Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

2015-04-01

Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

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

KAUST Repository

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

2011-01-01

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

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

KAUST Repository

Li, Huawei

2011-11-01

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

Exogenous Testosterone Rapidly Increases Aggressive Behavior in Dominant and Impulsive Men.

Science.gov (United States)

Carré, Justin M; Geniole, Shawn N; Ortiz, Triana L; Bird, Brian M; Videto, Amber; Bonin, Pierre L

2017-08-15

Although traditional wisdom suggests that baseline levels of testosterone (T) promote aggressive behavior, decades of research have produced findings that have been largely weak and inconsistent. However, more recent experimental work suggests that exogenous administration of T rapidly potentiates amygdala and hypothalamus responses to angry facial expressions. Notably, these brain regions are rich in androgen receptors and play a key role in modulating aggressive behavior in animal models. The present experiment extends this work by examining whether acutely increasing T potentiates aggressive behavior in men. In a double-blind, placebo-controlled, between-subject design, healthy adult men (n = 121) were administered either T or placebo, and subsequently engaged in a well-validated decision-making game that measures aggressive behavior in response to social provocation. In light of prior correlational research, we also assessed the extent to which T's effects on aggressive behavior would depend on variability in trait dominance and/or trait self-control. Exogenous T on its own did not modulate aggressive behavior. However, T's effects on aggression were strongly influenced by variation in trait dominance and trait self-control. Specifically, T caused an increase in aggressive behavior, but only among men scoring relatively high in trait dominance or low in trait self-control. These findings are the first to demonstrate that T can rapidly (within 60 minutes) potentiate aggressive behavior, but only among men with dominant or impulsive personality styles. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016

Science.gov (United States)

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.

2017-01-01

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

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016.

Science.gov (United States)

Li, Rui; 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

2017-01-01

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.

48 CFR 1552.217-74 - Option for increased quantity-cost-plus-award-fee contract.

Science.gov (United States)

2010-10-01

... quantity-cost-plus-award-fee contract. 1552.217-74 Section 1552.217-74 Federal Acquisition Regulations... Texts of Provisions and Clauses 1552.217-74 Option for increased quantity—cost-plus-award-fee contract. As prescribed in 1517.208(e), insert this contract clause in cost-plus-award-fee term contracts when...

A METHOD OF THE MINIMIZING OF THE TOTAL ACQUISITIONS COST WITH THE INCREASING VARIABLE DEMAND

Directory of Open Access Journals (Sweden)

ELEONORA IONELA FOCȘAN

2015-12-01

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.

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

KAUST Repository

Feizi, Alborz

2016-09-24

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

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

Science.gov (United States)

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

2016-11-01

Monitoring yeast cell viability and concentration is important in brewing, baking and biofuel production. However, existing methods of measuring viability and concentration are relatively bulky, tedious and expensive. Here we demonstrate a compact and cost-effective automatic yeast analysis platform (AYAP), which can rapidly measure cell concentration and viability. AYAP is based on digital in-line holography and on-chip microscopy and rapidly images a large field-of-view of 22.5 mm 2 . This lens-free microscope weighs 70 g and utilizes a partially-coherent illumination source and an opto-electronic image sensor chip. A touch-screen user interface based on a tablet-PC is developed to reconstruct the holographic shadows captured by the image sensor chip and use a support vector machine (SVM) model to automatically classify live and dead cells in a yeast sample stained with methylene blue. In order to quantify its accuracy, we varied the viability and concentration of the cells and compared AYAP's performance with a fluorescence exclusion staining based gold-standard using regression analysis. The results agree very well with this gold-standard method and no significant difference was observed between the two methods within a concentration range of 1.4 × 10 5 to 1.4 × 10 6 cells per mL, providing a dynamic range suitable for various applications. This lensfree computational imaging technology that is coupled with machine learning algorithms would be useful for cost-effective and rapid quantification of cell viability and density even in field and resource-poor settings.

The price of information: Increased inspection costs reduce the confirmation bias in visual search.

Science.gov (United States)

Rajsic, Jason; Wilson, Daryl E; Pratt, Jay

2018-04-01

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.

Price-Transparency and Cost Accounting

Science.gov (United States)

Eakin, Cynthia; Fischer, Katrina

2015-01-01

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

Price-Transparency and Cost Accounting

Directory of Open Access Journals (Sweden)

Peter Hilsenrath PhD

2015-04-01

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.

Rapid increase in cystic volume of an anaplastic astrocytoma misdiagnosed as neurocysticercosis: A case report

Science.gov (United States)

Li, Hong-Jiang; Han, Hong-Xiu; Feng, Dong-Fu

2016-01-01

Reports describing a rapid increase in the cystic volume of anaplastic astrocytoma (AA) in a short time frame are rare. The present study reports the case of a 68-year-old male who was admitted to the No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine (Shanghai, China), with a small cystic brain lesion and positive immunological testing for cysticercosis. Head magnetic resonance imaging (MRI) showed a cystic lesion, 6 mm in diameter, in the left frontal lobe. Neurocysticercosis was suspected and the patient was treated with a clinical trial of albendazole and steroids. A period of 25 days later, the patient's condition had deteriorated, and MRI revealed a cystic lesion in the left frontal lobe; thereafter, the cystic lesion was removed and a diagnosis of AA was established. The tumor was soft, ivory white and gelatinous due to myxoid degeneration. In this case, tumor-related angiogenesis and microvascular extravasation (blood-brain barrier disruption) may have been the main cause of the rapid increase in the cystic volume in such a short time frame. The similarity of the glioma and cysticercus antigens may have been the cause of the positive reactions in the cystic fluid. The present study reports the rare occurrence of a rapid increase of cystic volume and potential diagnostic difficulties. PMID:27698865

High laboratory cost predicted per tuberculosis case diagnosed with increased case finding without a triage strategy.

Science.gov (United States)

Dunbar, R; Naidoo, P; Beyers, N; Langley, I

2017-09-01

Cape Town, South Africa. To model the effects of increased case finding and triage strategies on laboratory costs per tuberculosis (TB) case diagnosed. We used a validated operational model and published laboratory cost data. We modelled the effect of varying the proportion with TB among presumptive cases and Xpert cartridge price reductions on cost per TB case and per additional TB case diagnosed in the Xpert-based vs. smear/culture-based algorithms. In our current scenario (18.3% with TB among presumptive cases), the proportion of cases diagnosed increased by 8.7% (16.7% vs. 15.0%), and the cost per case diagnosed increased by 142% (US$121 vs. US$50). The cost per additional case diagnosed was US$986. This would increase to US$1619 if the proportion with TB among presumptive cases was 10.6%. At 25.9-30.8% of TB prevalence among presumptive cases and a 50% reduction in Xpert cartridge price, the cost per TB case diagnosed would range from US$50 to US$59 (comparable to the US$48.77 found in routine practice with smear/culture). The operational model illustrates the effect of increased case finding on laboratory costs per TB case diagnosed. Unless triage strategies are identified, the approach will not be sustainable, even if Xpert cartridge prices are reduced.

Corticosterone rapidly increases thorns of CA3 neurons via synaptic/extranuclear glucocorticoid receptor in rat hippocampus

Directory of Open Access Journals (Sweden)

Miyuki eYoshiya

2013-11-01

Full Text Available Modulation of synapses under acute stress is attracting much attention. Exposure to acute stress induces corticosterone (CORT secretion from the adrenal cortex, resulting in rapid increase of CORT levels in plasma and the hippocampus. We tried to test whether rapid CORT effects involve activation of essential kinases as non-genomic processes.We demonstrated rapid effects (~ 1 h of CORT on the density of thorns, by imaging Lucifer Yellow-injected neurons in adult male rat hippocampal slices. Thorns of thorny excrescences of CA3 hippocampal neurons are post-synaptic regions whose presynaptic partners are mossy fiber terminals. The application of CORT at 100, 500 and 1000 nM induced a rapid increase in the density of thorns in the stratum lucidum of CA3 pyramidal neurons. Co-administration of RU486, an antagonist of glucocorticoid receptor (GR, abolished the effect of CORT. Blocking a single kinase, including MAPK, PKA or PKC, suppressed CORT-induced enhancement of thorn-genesis. On the other hand, GSK-3β was not involved in the signaling of thorn-genesis. Blocking AMPA receptors suppressed the CORT effect. Expression of CA3 synaptic/extranuclear GR was demonstrated by immunogold electron microscopic analysis. From these results, stress levels of CORT (100-1000 nM might drive the rapid thorn-genesis via synaptic/extranuclear GR and multiple kinase pathways, although a role of nuclear GRs cannot be completely excluded.

Healthcare costs for new technologies

International Nuclear Information System (INIS)

Goyen, Mathias; Debatin, Joerg F.

2009-01-01

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

Healthcare costs for new technologies

Energy Technology Data Exchange (ETDEWEB)

Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

2009-03-15

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

Faith community nursing: real care, real cost savings.

Science.gov (United States)

Yeaworth, Rosalee C; Sailors, Ronnette

2014-01-01

At a time when healthcare costs are increasing more than other aspects of the economy, churches are stepping up to help fill needs through congregational health ministries. Faith Community Nursing (FCN) is a rapidly growing health service in the churches of many denominations. This article documents healthcare services and financial savings provided by FCNs and health ministries, showing the critical role faith community nursing can play in containing healthcare costs.

Downsizing a database platform for increased performance and decreased costs

Energy Technology Data Exchange (ETDEWEB)

Miller, M.M.; Tolendino, L.F.

1993-06-01

Technological advances in the world of microcomputers have brought forth affordable systems and powerful software than can compete with the more traditional world of minicomputers. This paper describes an effort at Sandia National Laboratories to decrease operational and maintenance costs and increase performance by moving a database system from a minicomputer to a microcomputer.

Increased accuracy of cost-estimation using product configuration systems

DEFF Research Database (Denmark)

Rasmussen, Jeppe Bredahl; Hvam, Lars; Mortensen, Niels Henrik

This article describes an approach for utilizing Product Configuration Systems (PCS) for quantifying project costs in project-based companies. It presents a case study demonstrating a method of quantifying costs in a way that makes it possible to configure cost- and time estimates. Piecework costs......, material costs and sub-supplier costs are used as principle cost elements and linked to structural and process elements to facilitate configuration. The cost data are used by the PCS to generate fast and accurate cost-estimates, quotations, time estimates and cost summaries. The described cost...... quantification principles have been used in a Scandinavian SME (Small and Medium-sized Enterprise) since the 90’s, but have since 2011 been adopted to be used in a configuration system. A longitudinal case study was conducted to compare cost and time-estimation accuracy before and after implementation. We...

Cost escalation in nuclear power

International Nuclear Information System (INIS)

Montomery, W.D.; Quirk, J.P.

1978-01-01

This report is concerned with the escalation of capital costs of nuclear central station power plants between the early 1960s and the present. The report presents an historical overview of the development of the nuclear power industry and cost escalation in the industry, using existing data on orders and capital costs. New data are presented on regulatory delays in the licensing process, derived from a concurrent study being carried on in the Social Science group at Caltech. The conclusions of the study are that nuclear capital costs have escalated more rapidly than the GNP deflator or the construction industry price index. Prior to 1970, cost increases are related to bottleneck problems in the nuclear construction and supplying industries and the regulatory process; intervenors play only a minor role in cost escalation. After 1970, generic changes introduced into the licensing process by intervenors (including environmental impact reviews, antitrust reviews, more stringent safety standards) dominate the cost escalation picture, with bottlenecks of secondary importance. Recent increases in the time from application for a construction permit to commercial operation are related not only to intervenor actions, but also to suspensions, cancellations or postponements of construction by utilities due to unfavorable demand or financing conditions

Cost-effectiveness of increasing bisphosphonates adherence for osteoporosis in community pharmacies

NARCIS (Netherlands)

Van Boven, J.F.M.; Oosterhof, P.; Hiddink, E.G.; Stuurman-Bieze, A.G.G.; Postma, M.J.; Vegter, S.

2011-01-01

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

Non-linear increase of respiratory diseases and their costs under severe air pollution.

Science.gov (United States)

Shen, Ying; Wu, Yiyun; Chen, Guangdi; Van Grinsven, Hans J M; Wang, Xiaofeng; Gu, Baojing; Lou, Xiaoming

2017-05-01

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.

20 CFR 404.277 - When does the frozen minimum primary insurance amount increase because of cost-of-living...

Science.gov (United States)

2010-04-01

... insurance amount increase because of cost-of-living adjustments? 404.277 Section 404.277 Employees' Benefits... Primary Insurance Amounts Cost-Of-Living Increases § 404.277 When does the frozen minimum primary insurance amount increase because of cost-of-living adjustments? (a) What is the frozen minimum primary...

Cost-effectiveness of increasing access to mammography through mobile mammography for older women.

Science.gov (United States)

Naeim, Arash; Keeler, Emmett; Bassett, Lawrence W; Parikh, Jay; Bastani, Roshan; Reuben, David B

2009-02-01

To compare the costs of mobile and stationary mammography and examine the incremental cost-effectiveness of using mobile mammography to increase screening rates. A cost-effectiveness analysis was performed using effectiveness data from a randomized clinical trial and modeling of costs associated with the mobile mammography intervention. The trial involved 60 community-based meal sites, senior centers, and clubs. Four hundred ninety-nine individuals were enrolled in the study, of whom 463 had outcome data available for analysis. Costs were calculated for stationary and mobile mammography, as well as costs due to differences in technology and film versus digital. Incremental cost-effectiveness (cost per additional screen) was modeled, and sensitivity analysis was performed by altering efficiency (throughput) and effectiveness based on subgroup data from the randomized trial. The estimated annual costs were $435,162 for a stationary unit, $539,052 for a mobile film unit, and $456, 392 for a mobile digital unit. Assuming mobile units are less efficient (50% annual volume), the cost per screen was $41 for a stationary unit, $86 for a mobile film unit, and $102 for a mobile digital unit. The incremental cost per additional screen were $207 for a mobile film unit and $264 for a mobile digital unit over a stationary unit. Although mobile mammography is a more effective way to screen older women, the absolute cost per screen of mobile units is higher, whereas the reimbursement is no different. Financial barriers may impede the widespread use of this approach.

Cost Engineering Techniques and Their Applicability for Cost Estimation of Organic Rankine Cycle Systems

Directory of Open Access Journals (Sweden)

Sanne Lemmens

2016-06-01

Full Text Available The potential of organic Rankine cycle (ORC systems is acknowledged by both considerable research and development efforts and an increasing number of applications. Most research aims at improving ORC systems through technical performance optimization of various cycle architectures and working fluids. The assessment and optimization of technical feasibility is at the core of ORC development. Nonetheless, economic feasibility is often decisive when it comes down to considering practical instalments, and therefore an increasing number of publications include an estimate of the costs of the designed ORC system. Various methods are used to estimate ORC costs but the resulting values are rarely discussed with respect to accuracy and validity. The aim of this paper is to provide insight into the methods used to estimate these costs and open the discussion about the interpretation of these results. A review of cost engineering practices shows there has been a long tradition of industrial cost estimation. Several techniques have been developed, but the expected accuracy range of the best techniques used in research varies between 10% and 30%. The quality of the estimates could be improved by establishing up-to-date correlations for the ORC industry in particular. Secondly, the rapidly growing ORC cost literature is briefly reviewed. A graph summarizing the estimated ORC investment costs displays a pattern of decreasing costs for increasing power output. Knowledge on the actual costs of real ORC modules and projects remains scarce. Finally, the investment costs of a known heat recovery ORC system are discussed and the methodologies and accuracies of several approaches are demonstrated using this case as benchmark. The best results are obtained with factorial estimation techniques such as the module costing technique, but the accuracies may diverge by up to +30%. Development of correlations and multiplication factors for ORC technology in particular is

Cost analysis and cost justification of automated data processing in the clinical laboratory.

Science.gov (United States)

Westlake, G E

1983-03-01

Prospective cost analysis of alternative data processing systems can be facilitated by proper selection of the costs to be analyzed and realistic appraisal of the effect on staffing. When comparing projects with dissimilar cash flows, techniques such as analysis of net present value can be helpful in identifying financial benefits. Confidence and accuracy in prospective analyses will increase as more retrospective studies are published. Several accounts now in the literature describe long-term experience with turnkey laboratory information systems. Acknowledging the difficulty in longitudinal studies, they all report favorable effects on labor costs and recovery of lost charges. Enthusiasm is also expressed for the many intangible benefits of the systems. Several trends suggest that cost justification and cost effectiveness will be more easily demonstrated in the future. These are the rapidly decreasing cost of hardware (with corresponding reduction in service costs) and the entry into the market of additional systems designed for medium to small hospitals. The effect of broadening the sales base may be lower software prices. Finally, operational and executive data management and reporting are destined to become the premier extensions of the LIS for cost justification. Aptly applied, these facilities can promote understanding of costs, control of costs, and greater efficiency in providing laboratory services.

Economic costs attributable to smoking in Hong Kong in 2011: a possible increase from 1998.

Science.gov (United States)

Chen, Jing; McGhee, Sarah; Lam, Tai Hing

2017-11-15

Reduction in smoking prevalence does not necessarily reduce the costs of smoking as evidence shows in developed countries. We provide up-to-date estimates for direct and indirect costs attributable to smoking in Hong Kong in 2011 and compare with our 1998 estimates. We took a societal perspective to include lives and life years lost, health care costs and time lost from work in the costing. We followed guidelines on estimating costs of active smoking for those aged 35 years or above (35+) and costs due to SHS exposure for 35+, infants aged 12 months and under and children aged 15 and below. All costs are in US$. We estimated that 6154 deaths among 35+ in Hong Kong in 2011 were attributable to active smoking, an increase of 10% from 1998. Besides, 672 deaths were attributable to SHS exposure, i.e. 10% of the total 6826 smoking-attributable deaths. The estimate of productive life lost due to deaths from active smoking by those aged under 65 years in 2011 was $166 million, an increase of about 4% over the estimate in 1998. Our conservative estimate of the annual tobacco-related disease cost in 2011 was $716 million which accounted for 0.3% of GDP. If we added the value of attributable lives lost, the annual cost would be $4.7 billion. Despite the reduction in smoking prevalence, smoking-attributable disease still imposes a substantial economic burden on Hong Kong society. These findings support more stringent and effective tobacco control legislation, polices and measures. Current evidence shows reduction in smoking prevalence does not necessarily reduce the economic costs of smoking. Most studies in developed countries employed a societal perspective, including costs of productivity loss and indirect costs, but not all studies estimated costs associated with second-hand smoking (SHS). The present study estimated the total costs of smoking in Hong Kong including direct and indirect costs attributable to active smoking and to SHS exposure. Our study confirms the

Increased Patient Cost-Sharing, Weak US Economy, and Poor Health Habits: Implications for Employers and Insurers.

Science.gov (United States)

Haren, Melinda C; McConnell, Kirk; Shinn, Arthur F

2009-04-01

Many healthcare stakeholders, including insurers and employers, agree that growth in healthcare costs is inevitable. But the current trend toward further cost-shifting to employees and other health plan members is unsustainable. In 2008, the Zitter Group conducted a large national study on the relationship between insurers and employers, to understand how these 2 healthcare stakeholders interact in the creation of health benefit design. The survey results were previously summarized and discussed in the February/March 2009 issue of this journal. The present article aims to assess the implications of those results in the context of the growing tendency to increase patient cost-sharing, a weak US economy, and poor health habits. Increasing cost-sharing is a blunt instrument: although it may reduce utilization of frivolous services, it may also result in individuals forgoing medically necessary care. Increases in deductibles will lead to an overall decrease in optimal care-seeking behavior as families juggle healthcare costs with a weak economy and stagnating wages.

Cost-effectiveness of increasing cervical cancer screening coverage in the Middle East: An example from Lebanon.

Science.gov (United States)

Sharma, Monisha; Seoud, Muhieddine; Kim, Jane J

2017-01-23

Most cervical cancer (CC) cases in Lebanon are detected at later stages and associated with high mortality. There is no national organized CC screening program so screening is opportunistic and limited to women who can pay out-of-pocket. Therefore, a small percentage of women receive repeated screenings while most are under-or never screened. We evaluated the cost-effectiveness of increasing screening coverage and extending intervals. We used an individual-based Monte Carlo model simulating HPV and CC natural history and screening. We calibrated the model to epidemiological data from Lebanon, including CC incidence and HPV type distribution. We evaluated cytology and HPV DNA screening for women aged 25-65years, varying coverage from 20 to 70% and frequency from 1 to 5years. At 20% coverage, annual cytologic screening reduced lifetime CC risk by 14% and had an incremental cost-effectiveness ratio of I$80,670/year of life saved (YLS), far exceeding Lebanon's gross domestic product (GDP) per capita (I$17,460), a commonly cited cost-effectiveness threshold. By comparison, increasing cytologic screening coverage to 50% and extending screening intervals to 3 and 5years provided greater CC reduction (26.1% and 21.4, respectively) at lower costs compared to 20% coverage with annual screening. Screening every 5years with HPV DNA testing at 50% coverage provided greater CC reductions than cytology at the same frequency (23.4%) and was cost-effective assuming a cost of I$18 per HPV test administered (I$12,210/YLS); HPV DNA testing every 4years at 50% coverage was also cost-effective at the same cost per test (I$16,340). Increasing coverage of annual cytology was not found to be cost-effective. Current practice of repeated cytology in a small percentage of women is inefficient. Increasing coverage to 50% with extended screening intervals provides greater health benefits at a reasonable cost and can more equitably distribute health gains. Novel HPV DNA strategies offer greater

Software Cuts Homebuilding Costs, Increases Energy Efficiency

Science.gov (United States)

2015-01-01

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.

Increase the Performance of Companies in the Energy Sector by Implementing the Activity-Based Costing

OpenAIRE

Letitia-Maria Rof; Sorinel Capusneanu

2015-01-01

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 ...

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

Science.gov (United States)

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

2017-11-01

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

Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less.

Science.gov (United States)

Torres-Rueda, Sergio; Wambura, Mwita; Weiss, Helen A; Plotkin, Marya; Kripke, Katharine; Chilongani, Joseph; Mahler, Hally; Kuringe, Evodius; Makokha, Maende; Hellar, Augustino; Schutte, Carl; Kazaura, Kokuhumbya J; Simbeye, Daimon; Mshana, Gerry; Larke, Natasha; Lija, Gissenge; Changalucha, John; Vassall, Anna; Hayes, Richard; Grund, Jonathan M; Terris-Prestholt, Fern

2018-03-19

Although voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition, demand for services is lower among men in most at-risk age groups (ages 20-34 years). A randomised controlled trial was conducted to assess the effectiveness of locally-tailored demand creation activities (including mass media, community mobilisation and targeted service delivery) in increasing uptake of campaign-delivered VMMC among men aged 20-34 years. We conducted an economic evaluation to understand the intervention's cost and cost-effectiveness. Tanzania (Njombe and Tabora regions). Cost data were collected on surgery, demand creation activities and monitoring and supervision related to VMMC implementation across clusters in both trial arms, as well as start-up activities for the intervention arm. The Decision Makers' Program Planning Tool was used to estimate the number of HIV infections averted and related cost savings given total VMMCs per cluster. Disability-adjusted life years were calculated and used to estimate incremental cost-effectiveness ratios. Client load was higher in the intervention arms than in the control arms: 4394 v. 2901, respectively, in Tabora and 1797 v. 1025 in Njombe. Despite additional costs of tailored demand creation, demand increased more than proportionally: mean costs per VMMC in the intervention arms were $62 in Tabora and $130 in Njombe, and in the control arms $70 and $191, respectively. More infections were averted in the intervention arm than in the control arm in Tabora (123 v. 67, respectively) and in Njombe (164 v. 102, respectively). The intervention dominated the control as it was both less costly and more effective. Cost-savings were observed in both regions stemming from the antiretroviral treatment costs averted as a result of the VMMCs performed. Spending more to address local preferences as a way to increase uptake of VMMC can be cost-saving.This is an open access article distributed under the terms of the Creative Commons

Wellsite computers--their increasing role in drilling operations

International Nuclear Information System (INIS)

Keenan, P.G.; Dyson, P.M.

1981-01-01

The increasing expense and complexity of exploration drilling, coupled with rapid advances in computer and microprocessor technology, have led to the development of computer-assisted wellsite logging units from their humble beginnings as simple hot wire gas detectors. The main applications of this technology can be recognized in the following areas: (a) Safety of wellsite personnel, rig and downhole equipment. (b) Increased drilling efficiency with the resultant time and cost savings. (c) Simulation of possible events allowing comparisons between actual and expected data to assist decision making at the wellsite. (d) Storage of data on tape/disk to allow rapid retrieval of data for postwell analysis and report production. 6 refs

How Rapid is Rapid Prototyping? Analysis of ESPADON Programme Results

Directory of Open Access Journals (Sweden)

Ian D. Alston

2003-05-01

Full Text Available New methodologies, engineering processes, and support environments are beginning to emerge for embedded signal processing systems. The main objectives are to enable defence industry to field state-of-the-art products in less time and with lower costs, including retrofits and upgrades, based predominately on commercial off the shelf (COTS components and the model-year concept. One of the cornerstones of the new methodologies is the concept of rapid prototyping. This is the ability to rapidly and seamlessly move from functional design to the architectural design to the implementation, through automatic code generation tools, onto real-time COTS test beds. In this paper, we try to quantify the term “rapid” and provide results, the metrics, from two independent benchmarks, a radar and sonar beamforming application subset. The metrics show that the rapid prototyping process may be sixteen times faster than a conventional process.

Renewable energies: the cost of intermittency

International Nuclear Information System (INIS)

Crassous, Renaud; Roques, Fabien

2013-01-01

The authors indicate the different adaptations which will be required for the electric system to cope with the intermittency of solar and wind energy production, and propose an approximate assessment of the associated costs. Different types of adaptation are addressed: secure production in case of absence of wind or sun (electricity imports, construction of additional power stations), use of more flexible production means (gas turbines), grid extensions (connection to offshore production sites, routing of production one part of the country to the other). They think that beyond a 20 per cent share for renewable energies, these costs could rapidly increase

Dietary changes needed to reach nutritional adequacy without increasing diet cost according to income: An analysis among French adults.

Directory of Open Access Journals (Sweden)

Matthieu Maillot

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.

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

Science.gov (United States)

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

2015-02-05

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

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

Directory of Open Access Journals (Sweden)

Lue-Ping Zhao

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

The Tolerability and Efficacy of Rapid Infliximab Infusions in Patients with Inflammatory Bowel Disease.

Science.gov (United States)

Qazi, Taha; Shah, Bhavesh; El-Dib, Mohammed; Farraye, Francis A

2016-02-01

Few studies have assessed the loss of efficacy or patient and caregiver satisfaction with rapid infliximab infusions. The aim of this study is to assess the tolerability, loss of efficacy and to describe the impact on resource utilization and patient satisfaction in rapid infliximab infusions. Subjects with inflammatory bowel disease receiving rapid infliximab infusions were included in the study. Subjects received maintenance infusions from June 2011 to June 2013. Incidence of adverse reactions and the total number of rapid infliximab infusions were recorded. Efficacy was compared to published studies evaluating the long-term efficacy of infliximab infusions. Patient satisfaction was addressed through a survey following the implementation of the rapid infusion protocol. Seventy-five subjects with IBD were included in the study. Five hundred and twenty-two rapid infliximab infusions were provided to patients. There were no acute or delayed infusion reactions. Ten subjects (13 %) required either a dose escalation or interval adjustment between infliximab infusions. A majority of patients reported increased satisfaction with 1-h infliximab infusions, and 97 % of surveyed patients opted to continue rapid infusions. The rapid infliximab infusion protocol increased infusion unit efficiency by increasing capacity by 15 %. Cost savings in the elimination of nursing time translated to approximately $108,150 savings at our institution. Rapid infliximab infusions do not appear to increase the risk of loss of response compared to historical studies of long-term infliximab efficiency. A rapid infliximab infusion protocol improved efficiency in our infusion unit and increased patient and nursing satisfaction.

Relational Benefits & Costs in Social Media Brand Pages

OpenAIRE

Tsimonis, Georgios; Dimitriadis, Sergios

2014-01-01

Attracted by the rapid penetration of social media into society, firms are increasingly using them to offer interactive services to their customers, and to create or enhance their relationships with them. As the number of consumers who join brand pages on social media platforms raises, it brings to the front a new question: What relational benefits and costs arise from customer interactions with brands in social media? Thus, this study is an attempt to identify what benefits and costs users p...

Increased length of stay and costs associated with weekend admissions for failure to thrive.

Science.gov (United States)

Thompson, Rachel T; Bennett, William E; Finnell, S Maria E; Downs, Stephen M; Carroll, Aaron E

2013-03-01

To evaluate whether admission day of the week affects the length of stay (LOS) and health care costs for failure to thrive (FTT) admissions. Administrative data were obtained for all children aged <2 years (N = 23 332) with a primary admission diagnosis of FTT from 2003-2011 from 42 freestanding US hospitals. Demographic characteristics, day of admission, LOS, costs per stay, number of discharge diagnoses, primary discharge diagnoses, primary procedure code, number of radiologic and laboratory units billed during admission were obtained for each admission. Linear regression and zero-truncated Poisson regression were used for analysis. Weekend admission was significantly correlated with increased LOS and increased average cost (P < .002). This finding was also true for children with both admission and discharge diagnoses of FTT (P < .001). The number of procedures for children admitted on the weekend was not significantly different compared with children admitted on the weekdays (incident rate ratio [IRR]:1.04 [95% confidence interval (CI): 0.99-1.09]). However, weekend admissions did have more radiologic studies (IRR: 1.13 [95% CI: 1.10-1.16]) and laboratory tests (IRR: 1.39 [95% CI: 1.38-1.40]) performed. If one-half of weekend admissions in 2010 with both admission and discharge diagnoses of FTT were converted to Monday admissions, total savings in health care dollars for 2010 would be $534, 145. Scheduled FTT admissions on weekends increased LOS and health care costs compared with weekday admissions of similar levels of complexity. Reduction in planned weekend admissions for FTT could significantly reduce health care costs.

Hospital Merger Increased Medicare and Medicaid Payments for Capital Costs.

Science.gov (United States)

1983-12-22

15 provisions relating to depreciation and appraisals, i.e., the very subjects addressed by the draft report, expressly incorporate GAAP . For example...the historical cost for depreciation purposes of "owned" assets and, as stated be- fore, (see p. 54) places limitations on the use of GAAP for es...increased because of the acquisition by a net amount of about $55 million attributable to changes in interest, depreciation , and home office expenses. A

Ablation - breakthrough technology to reduce uranium mining cost and increase resources

International Nuclear Information System (INIS)

Scriven, D.

2014-01-01

Ablation Technologies, LLC has developed and patented a revolutionary mining technology termed “ablation”. Ablation is a process using only mechanical forces to upgrade sandstone uranium ores. Uranium bearing sandstone orebodies are formed from a uranium enriched solution flowing through an aquifer until it reached some type of a “red/ox” zone forcing the uranium and other heavy metals to come out of solution. The precipitate forms a thin coating on the sand grains and fills the interstitial space between the sand grains but does no penetrate the sand grains. The ablation process knocks the precipitate off the sand grains using the forces of abrasion, elastic compression and rebounding, much like a mud coated tennis ball will sheds the mud when bounced off the ground, and to some extent, sonic waves. This produces a product which collectively is exactly the same as the ore going in but with all the individual components separated. This allows for disgressionary separation, the most important of which is screening. The uranium and heavy metals report to the finer fractions of the material, typically less than 250 mesh. The larger fractions contain less than five percent of the uranium but 90 to 95 percent of the mass. The advantages of making an enriched ore are numerous: • Reduce haulage costs from 90 to 95 percent. • Reduce milling costs by reducing material handling costs, acid consumption and tailings disposal costs. • In addition to reducing overall mining and milling costs, the overall recovery of the recourse is increased because the ablation process is so inexpensive, if the material has to be mined it will be ablated and screened. This basically means ore control is significantly reduced, cutoff grade goes to practically zero and overall resource recovery is significantly increased. • Environmentally, the two major advantages are reduced tailings requirements at the mill site and cleaner waste dumps at the mine site. This paper will show

Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics.

Science.gov (United States)

Lecher, Shirley Lee; Shrestha, Ram K; Botts, Linda W; Alvarez, Jorge; Moore, James H; Thomas, Vasavi; Weidle, Paul J

2015-01-01

To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting. Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics. The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction. Pharmacists and retail clinic staff. HIV rapid testing. The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising. The six sites trained 22 staff to implement HIV testing. A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. Median pretest counseling time was 2 minutes. Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. The average cost per person tested was an estimated $47.21. When we considered only recurrent costs, the average cost per person tested was $32.17. Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the

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

Science.gov (United States)

Apor, Péter

2010-05-09

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

Climate-based policies may increase life-cycle social costs of vehicle fleet operation

International Nuclear Information System (INIS)

Emery, Isaac; Mbonimpa, Eric; Thal, Alfred E.

2017-01-01

Sustainability guidelines and regulations in the United States often focus exclusively on carbon or petroleum reductions. Though some of these policies have resulted in substantial progress toward their goals, the effects of these efforts on other social and environmental externalities are often ignored. In this study, we examine the life-cycle air pollutant emissions for alternative fuel and vehicle purchase scenarios at a military installation near a typical urban area in the United States (U.S.). We find that scenarios which minimize petroleum use or greenhouse gas emissions do not concomitantly minimize criteria air pollutant emissions. We also employ social cost methodologies to quantify economic externalities due to climate change and health-related air pollutant impacts. Accounting for the social costs of climate change and air pollution from vehicle use reveals that criteria air pollutants may have a greater total impact than greenhouse gas emissions in locations similar to the urban area examined in this study. Use of first-generation biofuels, particularly corn grain ethanol, may reduce net petroleum use at the cost of increased total health impacts. More comprehensive policies may be needed to ensure that sustainability policies result in a net benefit to society. - Highlights: • U.S. energy and transportation policies focus on petroleum use and greenhouse gases. • Use of corn ethanol at a military base in Ohio, U.S. increases total social costs vs. gasoline. • Renewable electricity provides cost-effective climate and health protection. • DOD strategy to improve energy security may damage Americans' health. • More inclusive policies needed to protect health and climate.

76 FR 66111 - Cost-of-Living Increase and Other Determinations for 2012

Science.gov (United States)

2011-10-25

... visit our Internet site, Social Security Online, at http://www.socialsecurity.gov . SUPPLEMENTARY... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2011-0075] Cost-of-Living Increase and Other Determinations for 2012 AGENCY: Social Security Administration. ACTION: Notice. SUMMARY: Under title II of the...

CERN reacts to increased costs to completion of the LHC

CERN Multimedia

2002-01-01

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...

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

Directory of Open Access Journals (Sweden)

A. Calantropio

2017-11-01

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

75 FR 65696 - Cost-of-Living Increase and Other Determinations for 2011

Science.gov (United States)

2010-10-26

... eligibility or claiming benefits, call 1-800-772-1213, or visit our Internet site, Social Security Online, at... SOCIAL SECURITY ADMINISTRATION Office of the Commissioner [Docket No. SSA-2010-0054] Cost-of-Living Increase and Other Determinations for 2011 AGENCY: Social Security Administration. ACTION: Notice...

Increased care demand and medical costs after falls in nursing homes: A Delphi study.

Science.gov (United States)

Sterke, Carolyn Shanty; Panneman, Martien J; Erasmus, Vicki; Polinder, Suzanne; van Beeck, Ed F

2018-04-21

To estimate the increased care demand and medical costs caused by falls in nursing homes. There is compelling evidence that falls in nursing homes are preventable. However, proper implementation of evidence-based guidelines to prevent falls is often hindered by insufficient management support, staff time and funding. A three-round Delphi study. A panel of 41 experts, all working in nursing homes in the Netherlands, received three online questionnaires to estimate the extra hours of care needed during the first year after the fall. This was estimated for ten falls categories with different levels of injury severity, in three scenarios, that is a best-case, a typical-case and a worst-case scenario. We calculated the costs of falls by multiplying the mean amount of extra hours that the participants spent on the care for a resident after a fall with their hourly wages. In case of a noninjurious fall, the extra time spent on the faller is on average almost 5 hr, expressed in euros that add to € 193. The extra staff time and costs of falls increased with increasing severity of injury. In the case of a fracture of the lower limb, the extra staff time increased to 132 hr, expressed in euros that is € 4,604. In the worst-case scenario of a fracture of the lower limb, the extra staff time increased to 284 hr, expressed in euros that is € 10,170. Falls in nursing homes result in a great deal of extra staff time spent on care, with extra costs varying between € 193 for a noninjurious fall and € 10,170 for serious falls. This study could aid decision-making on investing in appropriate implementation of falls prevention interventions in nursing homes. © 2018 John Wiley & Sons Ltd.

Employee responses to health insurance premium increases.

Science.gov (United States)

Goldman, Dana P; Leibowitz, Arleen A; Robalino, David A

2004-01-01

To determine the sensitivity of employees' health insurance decisions--including the decision to not choose health maintenance organization or fee-for-service coverage--during periods of rapidly escalating healthcare costs. A retrospective cohort study of employee plan choices at a single large firm with a "cafeteria-style" benefits plan wherein employees paid all the additional cost of purchasing more generous insurance. We modeled the probability that an employee would drop coverage or switch plans in response to employee premium increases using data from a single large US company with employees across 47 states during the 3-year period of 1989 through 1991, a time of large premium increases within and across plans. Premium increases induced substantial plan switching. Single employees were more likely to respond to premium increases by dropping coverage, whereas families tended to switch to another plan. Premium increases of 10% induced 7% of single employees to drop or severely cut back on coverage; 13% to switch to another plan; and 80% to remain in their existing plan. Similar figures for those with family coverage were 11%, 12%, and 77%, respectively. Simulation results that control for known covariates show similar increases. When faced with a dramatic increase in premiums--on the order of 20%--nearly one fifth of the single employees dropped coverage compared with 10% of those with family coverage. Employee coverage decisions are sensitive to rapidly increasing premiums, and single employees may be likely to drop coverage. This finding suggests that sustained premium increases could induce substantial increases in the number of uninsured individuals.

Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon.

Science.gov (United States)

Wright, Bill J; Garcia-Alexander, Ginny; Weller, Margarette A; Baicker, Katherine

2017-05-01

Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a population whose members had already expressed interest in obtaining coverage, but the effects were more persistent in low-income populations whose members were already enrolled in other state assistance programs but had not expressed interest in health insurance. The effects were similar across different demographic groups. Our results suggest that improving the design of enrollment processes and using low-cost mass-outreach efforts have the potential to substantially increase insurance coverage of vulnerable populations. Project HOPE—The People-to-People Health Foundation, Inc.

Preventive health screenings and health consultations in primary care increase life expectancy without increasing costs

DEFF Research Database (Denmark)

Rasmussen, Susanne R; Thomsen, Janus Laust; Kilsmark, Janni

2007-01-01

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...... 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...... in average direct (3,255 euro (3,703 euro) versus 4,186 euro) and total costs (10,409 euro (9,399 euro) versus 10,667 euro). The effect in group B is, however, better than in group A with no significant differences in costs. The results are insensitive to a range of assumptions regarding costs, effects...

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

Science.gov (United States)

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

2017-11-01

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

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

Science.gov (United States)

Yasumitsu, Hidetaro

2017-01-01

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

Increasing coal-fired power generation efficiency to reduce electric cost and environmental emissions

International Nuclear Information System (INIS)

Torrens, I.M.; Stenzel, W.C.

1997-01-01

New generating capacity required globally between 1993 and 2010 is estimated to be around 1500 GW, of which some two-thirds will be outside the OECD, and some 40 % in the Asian non-OECD countries. Coal is likely to account for a substantial fraction of this new generation. Today's state-of-the-art supercritical coal-fired power plant has a conversion efficiency of some 42-45 %. The capital cost increase associated with the supercritical or ultra-supercritical pulverized coal power plant compared to a conventional subcritical plant is small to negligible. The increased efficiency associated with the supercritical plant leads to an actual reduction in the total cost of electricity generated in cents/kWh, relative to a conventional plant. Despite this, the power sector continues to build subcritical plants and has no near term plans to increase the efficiency of power plants in the projects it is developing. Advanced clean coal technologies such as integrated gasification combined cycle and pressurized fluidized bed combustion will be selected for independent power projects only in very specific circumstances. Advanced clean coal plants can be operated reliably and with superior performance, and specifically that their present estimated capital costs can be reduced substantially to a point where they are competitive with state-of-the-art pulverized coal technologies. (R.P.)

77 FR 65754 - Cost-of-Living Increase and Other Determinations for 2013

Science.gov (United States)

2012-10-30

... eligibility or claiming benefits, call 1-800-772-1213, or visit our Internet site, Social Security Online, at... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2012-0054] Cost-of-Living Increase and Other Determinations for 2013 AGENCY: Social Security Administration. ACTION: Notice. SUMMARY: Under title II of the...

Profile of medical care costs in patients with amyotrophic lateral sclerosis in the Medicare programme and under commercial insurance.

Science.gov (United States)

Meng, Lisa; Bian, Amy; Jordan, Scott; Wolff, Andrew; Shefner, Jeremy M; Andrews, Jinsy

2018-02-01

To determine amyotrophic lateral sclerosis (ALS)-associated costs incurred by patients covered by Medicare and/or commercial insurance before, during and after diagnosis and provide cost details. Costs were calculated from the Medicare Standard Analytical File 5% sample claims data from Parts A and B from 2009, 2010 and 2011 for ALS Medicare patients aged ≥70 years (monthly costs) and ≥65 years (costs associated with disability milestones). Commercial insurance patients aged 18-63 years were selected based on the data provided in the Coordination of Benefits field from Truven MarketScan® in 2008-2010. Monthly costs increased nine months before diagnosis, peaked during the index month (Medicare: $10,398; commercial: $9354) and decreased but remained high post-index. Costs generally shifted from outpatient to inpatient and private nursing after diagnosis; prescriptions and durable medical equipment costs were much higher for commercial patients post-diagnosis. Patients appeared to progress to disability milestones more rapidly as their disease progressed in severity (14.4 months to non-invasive ventilation [NIV] vs. 16.6 months to hospice), and their costs increased accordingly (NIV: $58,973 vs. hospice: $76,179). For newly diagnosed ALS patients in the U.S., medical costs are substantial and increase rapidly and substantially with each disability milestone.

Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages.

Science.gov (United States)

Alexandrescu, Doru Traian

2009-11-15

The rapidly increasing incidence of melanoma occurs at the same time as an increase in general healthcare costs, particularly the expenses associated with cancer care. Previous cost estimates in melanoma have not utilized a dynamic model considering the evolution of the disease and have not integrated the multiple costs associated with different aspects of medical interventions and patient-related factors. Futhermore, previous calculations have not been updated to reflect the modern tendencies in healthcare costs. We designed a comprehensive model of expenses in melanoma that considers the dynamic costs generated by the natural progression of the disease, which produces costs associated with treatment, surveillance, loss of income, and terminal care. The complete range of initial clinical (TNM) stages of the disease and initial tumor stages were analyzed in this model and the total healthcare costs for the five years following melanoma presentation at each particular stage were calculated. We have observed dramatic incremental total costs associated with progressively higher initial stages of the disease, ranging from a total of $4,648.48 for in situ tumors to $159,808.17 for Stage IV melanoma. By stage, early lesions associate 30-55 percent of their costs for the treatment of the primary tumor, due to a low rate of recurrence (local, regional, or distant), which limits the need for additional interventions. For in situ melanoma, T1a, and T1b, surveillance is an important contributor to the medical costs, accounting for more than 25 percent of the total cost over 5 years. In contrast, late lesions incur a much larger proportion of their associated costs (up to 80-85%) from the diagnosis and treatment of metastatic disease because of the increased propensity of those lesions to disseminate. This cost increases with increasing tumor stage (from $2,442.17 for T1a to $6,678.00 for T4b). The most expensive items in the medical care of patients with melanoma consist of

Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures.

Science.gov (United States)

Neumann, Peter J; Anderson, Jordan E; Panzer, Ari D; Pope, Elle F; D'Cruz, Brittany N; Kim, David D; Cohen, Joshua T

2018-01-18

Background : We examined the similarities and differences between studies using two common metrics used in cost-effectiveness analyses (CEAs): cost per quality-adjusted life years (QALYs) gained and cost per disability-adjusted life year (DALY) averted. Methods : We used the Tufts Medical Center CEA Registry, which contains English-language cost-per-QALY gained studies, and  Global Cost-Effectiveness Analysis (GHCEA) Registry, which contains cost-per-DALY averted studies. We examined study characteristics including intervention type, sponsor, country, and primary disease, and also analysed the number of CEAs versus disease burden estimates for major diseases and conditions across three geographic regions. Results : We identified 6,438 cost-per-QALY and 543 cost-per-DALY studies published through 2016 and observed rapid growth in publication rates for both literatures. Cost-per-QALY studies were most likely to examine pharmaceuticals and interventions in high-income countries. Cost-per-DALY studies predominantly focused on infectious disease interventions and interventions in low and lower-middle income countries. We found discrepancies in the number of published CEAs for certain diseases and conditions in certain regions, suggesting "under-studied" areas (e.g., cardiovascular disease in Southeast Asia, East Asia, and Oceania and "overstudied" areas (e.g., HIV in Sub Saharan Africa) relative to disease burden in those regions. Conclusions : The number of cost-per QALY and cost-per-DALY analyses has grown rapidly with applications to diverse interventions and diseases.  Discrepancies between the number of published studies and disease burden suggest funding opportunities for future cost-effectiveness research.

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

Directory of Open Access Journals (Sweden)

Onwujekwe Obinna E

2009-11-01

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

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20-29 in Zimbabwe.

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Katharine Kripke

Full Text Available Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20-29 was examined.Zimbabwe voluntary medical male circumcision (VMMC program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10-19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20-29 with a corresponding increase in unit cost for these age groups.When circumcision coverage among men ages 20-29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5 is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario.Although increased investment in recruiting VMMC clients ages 20-29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

Rapid Inspection of Aerospace Structures - Is It Autonomous Yet?

Science.gov (United States)

Bar-Cohen, Yoseph; Backes, Paul; Joffe, Benjamin

1996-01-01

The trend to increase the usage of aging aircraft added a great deal of urgency to the ongoing need for low-cost, rapid, simple-to-operate, reliable and efficient NDE methods for detection and characterization of flaws in aircraft structures. In many cases, the problem of inspection is complex due to the limitation of current technology and the need to disassemble aircraft structures and testing them in lab conditions. To overcome these limitations, reliable field inspection tools are being developed for rapid NDE of large and complex-shape structures, that can operate at harsh, hostal and remote conditions with minimum human interface. In recent years, to address the need for rapid inspection in field conditions, numerous portable scanners were developed using NDE methods, including ultrasonics, shearography, thermography. This paper is written with emphasis on ultrasonic NDE scanners, their evolution and the expected direction of growth.

Phlebotomy for rapid weaning and extubation in COPD patient with secondary polycythemia and respiratory failure

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Tripathy Swagata

2010-01-01

Full Text Available The increased incidence of ventilator-associated complications in patients with chronic obstructive pulmonary disease (COPD necessitates rapid weaning and extubation. The presence of secondary polycythemia in this subgroup increases the incidence of stroke and myocardial infarction due to hyperviscosity and tissue hypoxia. We present a 58-year-old male patient of COPD with secondary polycythemia (hematocrit 64% who had possible hyperviscosity-related complications leading to cardiac arrest after a minor surgical procedure. The patient developed ventilator dependence after recovery. Phlebotomy was done to remove 10% of total blood volume. Symptomatic improvement was dramatic. Improvement in weaning indices like rapid shallow breathing index and PaO 2 /PAO 2 was observed facilitating rapid weaning and early extubation. Monitored, acute phlebotomy is safe and cost-effective. It decreases blood volume and viscosity, increases cardiac output and improves exercise tolerance in patients.

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

International Nuclear Information System (INIS)

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

2014-01-01

There is a strong interest in the use of biopolymers in the electronic and biomedical industries, mainly towards low-cost applications. The possibility of developing entirely new kinds of products based on cellulose is of current interest, in order to enhance and to add new functionalities to conventional paper-based products. We present our results towards the development of paper-based microfluidics for molecular diagnostic testing. Paper properties were evaluated and compared to nitrocellulose, the most commonly used material in lateral flow and other rapid tests. Focusing on the use of paper as a substrate for microfluidic applications, through an eco-friendly wax-printing technology, we present three main and distinct colorimetric approaches: (i) enzymatic reactions (glucose detection); (ii) immunoassays (antibodies anti-Leishmania detection); (iii) nucleic acid sequence identification (Mycobacterium tuberculosis complex detection). Colorimetric glucose quantification was achieved through enzymatic reactions performed within specific zones of the paper-based device. The colouration achieved increased with growing glucose concentration and was highly homogeneous, covering all the surface of the paper reaction zones in a 3D sensor format. These devices showed a major advantage when compared to the 2D lateral flow glucose sensors, where some carryover of the coloured products usually occurs. The detection of anti-Leishmania antibodies in canine sera was conceptually achieved using a paper-based 96-well enzyme-linked immunosorbent assay format. However, optimization is still needed for this test, regarding the efficiency of the immobilization of antigens on the cellulose fibres. The detection of Mycobacterium tuberculosis nucleic acids integrated with a non-cross-linking gold nanoprobe detection scheme was also achieved in a wax-printed 384-well paper-based microplate, by the hybridization with a species-specific probe. The obtained results with the above

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

Science.gov (United States)

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

2014-03-01

There is a strong interest in the use of biopolymers in the electronic and biomedical industries, mainly towards low-cost applications. The possibility of developing entirely new kinds of products based on cellulose is of current interest, in order to enhance and to add new functionalities to conventional paper-based products. We present our results towards the development of paper-based microfluidics for molecular diagnostic testing. Paper properties were evaluated and compared to nitrocellulose, the most commonly used material in lateral flow and other rapid tests. Focusing on the use of paper as a substrate for microfluidic applications, through an eco-friendly wax-printing technology, we present three main and distinct colorimetric approaches: (i) enzymatic reactions (glucose detection); (ii) immunoassays (antibodies anti-Leishmania detection); (iii) nucleic acid sequence identification (Mycobacterium tuberculosis complex detection). Colorimetric glucose quantification was achieved through enzymatic reactions performed within specific zones of the paper-based device. The colouration achieved increased with growing glucose concentration and was highly homogeneous, covering all the surface of the paper reaction zones in a 3D sensor format. These devices showed a major advantage when compared to the 2D lateral flow glucose sensors, where some carryover of the coloured products usually occurs. The detection of anti-Leishmania antibodies in canine sera was conceptually achieved using a paper-based 96-well enzyme-linked immunosorbent assay format. However, optimization is still needed for this test, regarding the efficiency of the immobilization of antigens on the cellulose fibres. The detection of Mycobacterium tuberculosis nucleic acids integrated with a non-cross-linking gold nanoprobe detection scheme was also achieved in a wax-printed 384-well paper-based microplate, by the hybridization with a species-specific probe. The obtained results with the above

Performance of chromogenic media for Candida in rapid presumptive identification of Candida species from clinical materials

OpenAIRE

Pravin Charles, M. V.; Kali, Arunava; Joseph, Noyal Mariya

2015-01-01

Background: In perspective of the worldwide increase in a number of immunocompromised patients, the need for identification of Candida species has become a major concern. The development of chromogenic differential media, introduced recently, facilitate rapid speciation. However, it can be employed for routine mycology workup only after an exhaustive evaluation of its benefit and cost effectiveness. This study was undertaken to evaluate the benefit and cost effectiveness of chromogenic media ...

Pharmacogenetics of clopidogrel: comparison between a standard and a rapid genetic testing.

Science.gov (United States)

Saracini, Claudia; Vestrini, Anna; Galora, Silvia; Armillis, Alessandra; Abbate, Rosanna; Giusti, Betti

2012-06-01

CYP2C19 variant alleles are independent predictors of clopidogrel response variability and occurrence of major adverse cardiovascular events in high-risk vascular patients on clopidogrel therapy. Increasing evidence suggests a combination of platelet function testing with CYP2C19 genetic testing may be more effective in identifying high-risk individuals for alternative antiplatelet therapeutic strategies. A crucial point in evaluating the use of these polymorphisms in clinical practice, besides test accuracy, is the cost of the genetic test and rapid availability of the results. One hundred acute coronary syndrome patients were genotyped for CYP2C19*2,*3,*4,*5, and *17 polymorphisms with two platforms: Verigene(®) and the TaqMan(®) system. Genotyping results obtained by the classical TaqMan approach and the rapid Verigene approach showed a 100% concordance for all the five polymorphisms investigated. The Verigene system had shorter turnaround time with respect to TaqMan. The cost of reagents for TaqMan genotyping was lower than that for the Verigene system, but the effective manual staff involvement and the relative cost resulted in higher cost for TaqMan than for Verigene. The Verigene system demonstrated good performance in terms of turnaround time and cost for the evaluation of the clopidogrel poor metabolizer status, giving genetic information in suitable time (206 min) for a therapeutic strategy decision.

Association of increased monetary cost of dietary intake, diet quality and weight management in Spanish adults.

Science.gov (United States)

Schröder, Helmut; Serra-Majem, Luis; Subirana, Isaac; Izquierdo-Pulido, Maria; Fitó, Montserrat; Elosua, Roberto

2016-03-14

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.

Rapid thermal conditioning of sewage sludge

Science.gov (United States)

Zheng, Jianhong

Rapid thermal conditioning (RTC) is a developing technology recently applied to sewage sludge treatment. Sludge is heated rapidly to a reaction temperature (up to about 220sp°C) under sufficient pressure to maintain the liquid phase. Reaction is quenched after 10 to 30 seconds when the mixture of sludge and steam pass through a pressure let-down valve. This process reduces the amount of sludge requiring land disposal, eliminates the need for polymer coagulant, improves dewaterability, increases methane production, and further reduces the concentration of pathogens. The odor problem associated with traditional thermal conditioning processes is largely minimized. Ammonia removal is readily integrated with the process. For this research, a pilot unit was constructed capable of processing 90 liters of sludge per hour. Over 22 runs were made with this unit using sludge from New York City Water Pollution Control Plants (WPCP). Sludges processed in this equipment were tested to determine the effect of RTC operating conditions on sludge dewaterability, biodegradability, and other factors affecting the incorporation of RTC into wastewater treatment plants. Dewaterability of thermally conditioned sludge was assessed for cetrifugeability and filterability. Bench scale centrifugation was used for evaluating centrifugeability, pressure filtration and capillary suction time (CST) for filterability. A mathematical model developed for centrifuge dewatering was used to predict the effect of RTC on full scale centrifuge performance. Particle size distribution and solids density of raw and treated PDS were also analyzed. An observed increase in sludge solids density at least partially explains its improved centrifugeability. An investigation of thermally conditioned amino acids showed that the L-isomer is highly biodegradable while the D-isomers are generally less so. Glucose is highly biodegradable, but rapidly becomes refractory as thermal conditioning time is lengthened. This

Rapid temperature increase near the anode and cathode in the afterglow of a pulsed positive streamer discharge

Science.gov (United States)

Ono, Ryo

2018-06-01

The spatiotemporal evolution of the temperature in the afterglow of point-to-plane, pulsed positive streamer discharge was measured near the anode tip and cathode surface using laser-induced predissociation fluorescence of OH radicals. The temperature exhibited a rapid increase and displayed a steep spatial gradient after a discharge pulse. The rate of temperature rise reached 84 K μs‑1 at mm, where z represents the distance from the anode tip. The temperature rise was much faster than in the middle of the gap; it was only 2.8 K μs‑1 at mm. The temperature reached 1700 K near the anode tip at s and 1500 K near the cathode surface at s, where t represents the postdischarge time. The spatial gradient reached 1280 K mm‑1 near the anode tip at s. The mechanism responsible for the rapid temperature increase was discussed, including rapid heating of the gas in the early postdischarge phase (s), and vibration-to-translation energy transfer in the later postdischarge phase (s). The high temperatures near the anode tip and cathode surface are particularly important for the ignition of combustible mixtures and for surface treatments, including solid-surface treatments, water treatments, and plasma medicine using pulsed streamer discharges.

Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings.

Science.gov (United States)

Assoumou, Sabrina A; Tasillo, Abriana; Leff, Jared A; Schackman, Bruce R; Drainoni, Mari-Lynn; Horsburgh, C Robert; Barry, M Anita; Regis, Craig; Kim, Arthur Y; Marshall, Alison; Saxena, Sheel; Smith, Peter C; Linas, Benjamin P

2018-01-18

High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases. We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty. Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER 26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid testing was the optimal strategy in 90% of simulations. Routine rapid HCV testing among 15- to 30-year-olds may be cost-effective when the prevalence of PWID is >0.59%. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Rapid response systems.

Science.gov (United States)

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

2018-07-01

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

Can Better Outdoor Environments Lead to Cost Benefits in Assisted Living Facilities Through Increased Word-of-Mouth Referrals?

Science.gov (United States)

Rodiek, Susan; Boggess, May M; Lee, Chanam; Booth, Geoffrey J; Morris, Alisan

2013-01-01

This study explores how better outdoor environments may produce cost benefits for assisted living providers by raising occupancy levels through increased resident satisfaction and word-of-mouth referrals. Older adults who spend even minimal time outdoors may reap substantial health benefits. However, many existing outdoor areas in assisted living facilities are reportedly underutilized, in part because of design issues. Providers may be more willing to improve outdoor areas if they produce cost benefits for provider organizations. This study used data from a recent assisted living survey to assess the relationship between satisfaction with outdoor spaces, time spent outdoors, and resulting improvements in mood. A financial analysis was developed to estimate potential benefits from improved outdoor areas attributable to increased occupancy and decreased marketing costs associated with increased word-of-mouth referrals. Increasing resident satisfaction with outdoor areas (from approximately 29% to 96%) results in residents spending more time outdoors (increase of 1½ hours per week per resident) and improved psychological well-being (12% increase in feeling better). This greater overall satisfaction leads to 8% more residents willing to refer potential residents to their community. Because word-of-mouth referrals by current residents are a major factor in resident recruitment, improving outdoors areas leads to an estimated 4% increase in new residents, resulting in over $170,000 of increased revenue per year for a community of 100 residents. Improved outdoor space can provide substantial cost benefits for assisted living providers. Increasing resident well-being and satisfaction, and thereby generating additional word-of-mouth referrals, can result in higher occupancy levels. Outdoor environments, assisted living, cost benefits, resident satisfaction, occupancy levels, seniors, rental income, word-of-mouth referralPreferred Citation: Rodiek, S., Boggess, M. M., Lee

Rapid Environmental Change Drives Increased Land Use by an Arctic Marine Predator.

Directory of Open Access Journals (Sweden)

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.

Increasing the cost-constrained availability of WDM Networks with Degree-3 Structured Topologies

DEFF Research Database (Denmark)

Gutierrez Lopez, Jose Manuel; Georgakilas, Kostas; Katrinis, Kostas

2010-01-01

based on genetic algorithms, we evaluate the performance of structured topologies and compare it against a practical topology (NSFNET). The results manifest that nodal degree fairness leads to increased availability compared to conventional topologies, while not incurring higher capital and deployment...... cost....

Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

Science.gov (United States)

Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

2018-04-01

Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD.

Science.gov (United States)

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

2017-12-15

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

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

Science.gov (United States)

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

2017-01-01

Traditional diagnostic tests for chronic diseases are expensive and require a specialized laboratory, therefore limiting their use for point-of-care (PoC) testing. To address this gap, we developed a method for rapid and low-cost C-reactive protein (CRP) detection from blood by integrating a paper-based microfluidic immunoassay with a smartphone (CRP-Chip). We chose CRP for this initial development because it is a strong biomarker of prognosis in chronic heart and kidney disease. The microfluidic immunoassay is realized by lateral flow and gold nanoparticle-based colorimetric detection of the target protein. The test image signal is acquired and analyzed using a commercial smartphone with an attached microlens and a 3D-printed chip–phone interface. The CRP-Chip was validated for detecting CRP in blood samples from chronic kidney disease patients and healthy subjects. The linear detection range of the CRP-Chip is up to 2 μg/mL and the detection limit is 54 ng/mL. The CRP-Chip test result yields high reproducibility and is consistent with the standard ELISA kit. A single CRP-Chip can perform the test in triplicate on a single chip within 15 min for less than 50 US cents of material cost. This CRP-Chip with attractive features of low-cost, fast test speed, and integrated easy operation with smartphones has the potential to enable future clinical PoC chronic disease diagnosis and risk stratification by parallel measurements of a panel of protein biomarkers. PMID:28346363

Dynamic Cost-Contingency Management: A Method for Reducing Project Costs While Increasing the Probability of Success

National Research Council Canada - National Science Library

Kujawski, Edouard

2007-01-01

In the real world, "Money Allocated is Money Spent" (MAIMS). As a consequence, cost underruns are rarely available to protect against cost overruns, while task overruns are passed on to the total project cost...

Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study.

Science.gov (United States)

Veerman, J Lennert; Zapata-Diomedi, Belen; Gunn, Lucy; McCormack, Gavin R; Cobiac, Linda J; Mantilla Herrera, Ana Maria; Giles-Corti, Billie; Shiell, Alan

2016-09-20

Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might

Increased Set Shifting Costs in Fasted Healthy Volunteers

Science.gov (United States)

Bolton, Heather M.; Burgess, Paul W.; Gilbert, Sam J.; Serpell, Lucy

2014-01-01

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. PMID:25025179

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

Science.gov (United States)

Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

2013-01-01

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. 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. There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (Phospitalizations 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. 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. However, purely market-oriented health-care reform could also misguide future healthcare reform.

Short-term responses of Dutch vacationers to a sharp increase in transport costs

NARCIS (Netherlands)

van Cranenburgh, S.

2016-01-01

This paper investigates vacationers’ short-term responses to a sharp increase in transport costs. It aims to (1) acquire an understanding of the relative popularity of the different types of responses among vacationers and (2) explore whether there are distinct market segments of vacationers that

The Effects of Changing Input Costs on Food Prices

OpenAIRE

R. McFall Lamm; Paul C. Westcott

1981-01-01

The relationships between changes in food sector input costs and retail food prices are examined. Results indicate that increases in factor prices pass quickly to consumers, within two quarters for most foods. In addition, rising farm-level prices and substantial increases in nonfarm resource prices appear to explain why food prices rose more rapidly than nonfood prices in the 1970s. The analysis is based on a twenty-equation econometric model of the food-price determination process, specifie...

Assessing the cost of electronic health records: a review of cost indicators.

Science.gov (United States)

Gallego, Ana Isabel; Gagnon, Marie-Pierre; Desmartis, Marie

2010-11-01

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

Least-cost Paths - Some Methodological Issues

Directory of Open Access Journals (Sweden)

Irmela Herzog

2014-06-01

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. Many archaeologists rely on standard GIS software with default settings for calculating LCPs and are not aware of possible alternatives and the pitfalls that are described in this article. After briefly introducing the aims and applications of LCP methods in archaeology, LCP algorithms are discussed. The outcome of the LCP calculations depends not only on the algorithm but also on the cost model, which often includes several cost components. The discussion of the cost components has a focus on slope, because nearly all archaeological LCP studies take this cost component into account and because several methodological issues are connected with slope-based cost models. Other possible cost components are: the load of the walker, vegetation cover, wetlands or other soil properties, travelling and transport on water, water as barrier and as attractor, aspect, altitude, and social or cultural cost components. Eventually, advantages and disadvantages of different ways of combining cost components are presented. Based on the methodological issues I conclude that both validation checks and variations of the model are necessary to analyse the reliability of archaeological LCP results.

American Society of Clinical Oncology guidance statement: the cost of cancer care.

Science.gov (United States)

Meropol, Neal J; Schrag, Deborah; Smith, Thomas J; Mulvey, Therese M; Langdon, Robert M; Blum, Diane; Ubel, Peter A; Schnipper, Lowell E

2009-08-10

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer

Review of nuclear power costs around the world

International Nuclear Information System (INIS)

Bennett, L.L.; Karousakis, P.M.; Moynet, G.

1983-01-01

This paper presents highlights of nuclear power costs around the world from studies carried out by the IAEA and by UNIPEDE. Emphasis is placed on trends within each country of key parameters which affect both investment costs and total power generation costs, including construction and project durations, size of units, regulatory environment, scope of project, fuel cycle costs and general economic conditions. A synthesis of these trends, taking into consideration both nuclear and coal-fired plant capital and fuel costs as they are estimated to evolve in the near and medium term, is presented in terms of nuclear-to-coal cost ratios for both plant investment costs and total generating costs. The plant investment costs are expressed as ''overnight'' or ''fore'' costs, in constant money, for plants expected to enter commercial operation in the early 1990s. Pertinent assumptions are based on conditions prevailing in the particular country under review. These studies indicate that in most countries nuclear plant investment costs are rising more rapidly than the costs for coal-fired plants. A major cause for the rapid rise in nuclear plant costs is the drastic lengthening of project duration in most countries. France, as a notable exception, has been able to maintain a stable and reasonably short project time. In spite of the rapidly escalating nuclear plant investment costs, nuclear electricity generation has an economic advantage over coal in Europe and Canada and is competitive with coal in the eastern and midwestern parts of the United States of America (USA). The availability of abundant, low-cost coal gives coal-fired generation an economic advantage in the western USA. (author)

Issues and major steps in a conceptual framework for environmental costing

International Nuclear Information System (INIS)

DePape, D.; Kristjanson, E.R.; Onyebuchi, E.I.; Wojczynski, E.

1992-01-01

The concept of applying monetary values to environmental consequences as a means of integrating environmental considerations into utility resource planning is explored. The need for estimation and integration of environmental costs and benefits is becoming more important due to public concern over environmental degradation, rapidly increasing costs of mitigating environmental damage, increased liability for compensation for such damage, pressures to consider environmental externalities, and a corporate desire to operate responsibly. Manitoba Hydro established a task force to develop general approaches and specific techniques for evaluation and integration of environmental costs and benefits into utility planning. The utility's conceptual framework for monetizing and integrating environmental costs and benefits is described, including identification of potential environmental impacts, evaluation of environmental impacts, estimation of monetary and non-monetary costs and benefits, and integration of these costs and benefits into the resource planning process. Key issues that must be addressed to implement this conceptual framework include the need for earlier environmental impact assessments and the need for mitigation and compensation prediction methodologies. 1 fig., 1 tab

Cost-optimal electricity systems with increasing renewable energy penetration for islands across the globe

NARCIS (Netherlands)

Blok, K.; van Velzen, Leonore

2018-01-01

Cost-optimal electricity system configurations with increasing renewable energy penetration were determined in this article for six islands of different geographies, sizes and contexts, utilizing photovoltaic energy, wind energy, pumped hydro storage and battery storage. The results of the

Increasing survival time decreases the cost-effectiveness of using "test & treat'' to eliminate HIV epidemics.

Science.gov (United States)

Wagner, Bradley G; Coburn, Brian J; Blower, Sally

2013-01-01

Treating HIV-infected individuals reduces their viral load, consequently increasing their survival time and decreasing their infectivity. It has been proposed that universal testing and treatment (i.e., universal "test & treat'') could lead to HIV elimination and would be extremely cost-effective. It is now being debated whether to use a universal "test & treat'' approach in the "real-world'' as a prevention strategy to control HIV epidemics. However current modeling predictions of the impact, and cost-effectiveness, of universal `"est & treat'' strategies are based on an unrealistically short survival time for treated individuals. Here we use mathematical modeling and a longer, more realistic, survival time. We model the potential impact of a universal "test & treat'' strategy in South Africa. Our results show that increasing the length of the survival time on treatment, although beneficial to individuals, reduces the probability of eliminating HIV and decreases the cost-effectiveness of using universal "test & treat'' strategies. Therefore our results show that individual-level benefits and public health benefits will conflict when using "test &treat'' strategies to reduce HIV transmission.

Energy Transition-Index Germany. Costs are increasing steadily; Energiewende-Index Deutschland. Die Kosten steigen weiter

Energy Technology Data Exchange (ETDEWEB)

Vahlenkamp, Thomas; Kropeit, Julia [McKinsey and Company, Duesseldorf (Germany); Ritzenhofen, Ingmar [McKinsey and Company, Koeln (Germany); Gersema, Gerke [McKinsey and Company, Hamburg (Germany)

2017-03-15

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.

Estimated Cost of the Administration's Proposal to Increase the Army's and the Marine Corps's Personnel Levels

National Research Council Canada - National Science Library

Schmit, Matt; Wheelock, Jason; Newman, David

2007-01-01

.... The Administration also plans to increase the size of the Army Reserve and National Guard. The cost of the Administration's proposal to increase the size of the armed forces depends on the personnel levels it is being measured against...

A Rapid Process for Fabricating Gas Sensors

Directory of Open Access Journals (Sweden)

Chun-Ching Hsiao

2014-07-01

Full Text Available Zinc oxide (ZnO is a low-toxicity and environmentally-friendly material applied on devices, sensors or actuators for “green” usage. A porous ZnO film deposited by a rapid process of aerosol deposition (AD was employed as the gas-sensitive material in a CO gas sensor to reduce both manufacturing cost and time, and to further extend the AD application for a large-scale production. The relative resistance change (△R/R of the ZnO gas sensor was used for gas measurement. The fabricated ZnO gas sensors were measured with operating temperatures ranging from 110 °C to 180 °C, and CO concentrations ranging from 100 ppm to 1000 ppm. The sensitivity and the response time presented good performance at increasing operating temperatures and CO concentrations. AD was successfully for applied for making ZnO gas sensors with great potential for achieving high deposition rates at low deposition temperatures, large-scale production and low cost.

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

International Nuclear Information System (INIS)

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

2012-01-01

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

Cost-effectiveness of increasing statin adherence for primary and secondary prevention in community pharmacies

NARCIS (Netherlands)

Vegter, S.; Oosterhof, P.; Van Boven, J.F.; Stuurman-Bieze, A.G.G.; Hiddink, E.G.; Postma, M.J.

2013-01-01

Objectives: Therapy persistence is important to achieve optimal clinical benefits of statin therapy. The aim of this study was to determine the cost-effectiveness of pharmaceutical care in community pharmacies, aimed to increase persistence with statin therapy for both primary and secondary

Climate change and the insurance industry. The cost of increased risk and the impetus for action

International Nuclear Information System (INIS)

Tucker, Michael

1997-01-01

A convincing economic argument for taking action to prevent or ameliorate climate change has not developed because of both uncertainty about the degree of change and its timing. Recent costly weather-related catastrophes with consequent negative impacts on the insurance industry has made the insurance industry a potential advocate for slowing what has been identified as a causal factor in climate change: emissions of greenhouse gases. However, rising costs of claims, without a longer-term trend of such catastrophic losses, will make it difficult to present a strong case for taking costly economic action. Using the Black Scholes Option Pricing Model, it is shown that increasing levels of climate variability as embedded in the anticipated variability of damage to insured assets will have an immediate economic cost that could serve to bolster the argument for more immediate action. That cost is shown to be economically justified higher insurance premiums

The impact of new technology on compact disposal costs

International Nuclear Information System (INIS)

Arrowsmith, H.W.; Zidow, T.M.

1989-01-01

The cost of disposal of low-level waste (LLW) has increased dramatically since the 1960s. In the '60s waste was put into the ground for a fee of less than $1/ft 3 in truck-size quantities. Fees for the same burial services today begin in the $30/ft 3 range and increase rapidly from that level. Although the user fees associated with compacts will clearly exceed $100/ft 3 , improved operating techniques by the generators will reduce the amount of waste produced. Current estimates suggest this reduction will drive the per-cubic-foot cost of disposal over the $200 mark. Technology is the only solution to this predicament. While costs already incurred will contribute to the fixed portion of the base user fees, the means to minimize the variable portion of the fees in now at hand. This variable portion results from on-site processing costs, waste form stability enhancements, and ongoing disposal unit construction. Technology exists to minimize volume through ultra compaction and selective incineration, greatly reducing the ongoing disposal unit construction requirements. Vitrification of incinerator residue provides waste form stability far in excess of that provided by concrete overpacks. As overpacks represent the second largest material cost at an engineered barrier facility, the potential for cost savings is substantial

Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus.

Science.gov (United States)

Warren, Jeremy A; Ewing, Joseph A; Hale, Allyson L; Blackhurst, Dawn W; Bour, Eric S; Scott, John D

2015-08-01

There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM). We propose a model that demonstrates the cost-effectiveness of increasing the number of bariatric surgical operations performed on patients with T2DM in the United States. We applied published population cost estimates (2012) for medical care of T2DM to a retrospective cohort of morbidly obese patients in South Carolina. We compared differences in 10-year medical costs between those having bariatric surgery and controls. Resolution of T2DM in the bariatric cohort was assumed to be 40 per cent. Considering only the direct medical costs of T2DM, the 10-year aggregate cost savings compared with a control group is $2.7 million/1000 patients; the total (direct and indirect) cost savings is $5.4 million/1000 patients. When considering resolution of T2DM alone, increasing the number of bariatric operations for a given population leads to a substantial cost savings over a 10-year period. This study adds to the growing body of evidence suggesting that bariatric surgery is a cost-effective means of caring for the obese patient.

Feasibility of utilizing the SD BIOLINE Onchocerciasis IgG4 rapid test in onchocerciasis surveillance in Senegal

Science.gov (United States)

Dieye, Yakou; Barrett, Kelsey L.; Gerth-Guyette, Emily; Di Giorgio, Laura; Golden, Allison; Faulx, Dunia; Kalnoky, Michael; Ndiaye, Marie Khemesse Ngom; Sy, Ngayo; Mané, Malang; Faye, Babacar; Sarr, Mamadou; Dioukhane, Elhadji Mamadou; Peck, Roger B.; Guinot, Philippe; de los Santos, Tala

2017-01-01

As effective onchocerciasis control efforts in Africa transition to elimination efforts, different diagnostic tools are required to support country programs. Senegal, with its long standing, successful control program, is transitioning to using the SD BIOLINE Onchocerciasis IgG4 (Ov16) rapid test over traditional skin snip microscopy. The aim of this study is to demonstrate the feasibility of integrating the Ov16 rapid test into onchocerciasis surveillance activities in Senegal, based on the following attributes of acceptability, usability, and cost. A cross-sectional study was conducted in 13 villages in southeastern Senegal in May 2016. Individuals 5 years and older were invited to participate in a demographic questionnaire, an Ov16 rapid test, a skin snip biopsy, and an acceptability interview. Rapid test technicians were interviewed and a costing analysis was conducted. Of 1,173 participants, 1,169 (99.7%) agreed to the rapid test while 383 (32.7%) agreed to skin snip microscopy. The sero-positivity rate of the rapid test among those tested was 2.6% with zero positives 10 years and younger. None of the 383 skin snips were positive for Ov microfilaria. Community members appreciated that the rapid test was performed quickly, was not painful, and provided reliable results. The total costs for this surveillance activity was $22,272.83, with a cost per test conducted at $3.14 for rapid test, $7.58 for skin snip microscopy, and $13.43 for shared costs. If no participants had refused skin snip microscopy, the total cost per method with shared costs would have been around $16 per person tested. In this area with low onchocerciasis sero-positivity, there was high acceptability and perceived value of the rapid test by community members and technicians. This study provides evidence of the feasibility of implementing the Ov16 rapid test in Senegal and may be informative to other country programs transitioning to Ov16 serologic tools. PMID:28972982

Feasibility of utilizing the SD BIOLINE Onchocerciasis IgG4 rapid test in onchocerciasis surveillance in Senegal.

Directory of Open Access Journals (Sweden)

Yakou Dieye

2017-10-01

Full Text Available As effective onchocerciasis control efforts in Africa transition to elimination efforts, different diagnostic tools are required to support country programs. Senegal, with its long standing, successful control program, is transitioning to using the SD BIOLINE Onchocerciasis IgG4 (Ov16 rapid test over traditional skin snip microscopy. The aim of this study is to demonstrate the feasibility of integrating the Ov16 rapid test into onchocerciasis surveillance activities in Senegal, based on the following attributes of acceptability, usability, and cost. A cross-sectional study was conducted in 13 villages in southeastern Senegal in May 2016. Individuals 5 years and older were invited to participate in a demographic questionnaire, an Ov16 rapid test, a skin snip biopsy, and an acceptability interview. Rapid test technicians were interviewed and a costing analysis was conducted. Of 1,173 participants, 1,169 (99.7% agreed to the rapid test while 383 (32.7% agreed to skin snip microscopy. The sero-positivity rate of the rapid test among those tested was 2.6% with zero positives 10 years and younger. None of the 383 skin snips were positive for Ov microfilaria. Community members appreciated that the rapid test was performed quickly, was not painful, and provided reliable results. The total costs for this surveillance activity was $22,272.83, with a cost per test conducted at $3.14 for rapid test, $7.58 for skin snip microscopy, and $13.43 for shared costs. If no participants had refused skin snip microscopy, the total cost per method with shared costs would have been around $16 per person tested. In this area with low onchocerciasis sero-positivity, there was high acceptability and perceived value of the rapid test by community members and technicians. This study provides evidence of the feasibility of implementing the Ov16 rapid test in Senegal and may be informative to other country programs transitioning to Ov16 serologic tools.

Feasibility of utilizing the SD BIOLINE Onchocerciasis IgG4 rapid test in onchocerciasis surveillance in Senegal.

Science.gov (United States)

Dieye, Yakou; Storey, Helen L; Barrett, Kelsey L; Gerth-Guyette, Emily; Di Giorgio, Laura; Golden, Allison; Faulx, Dunia; Kalnoky, Michael; Ndiaye, Marie Khemesse Ngom; Sy, Ngayo; Mané, Malang; Faye, Babacar; Sarr, Mamadou; Dioukhane, Elhadji Mamadou; Peck, Roger B; Guinot, Philippe; de Los Santos, Tala

2017-10-01

As effective onchocerciasis control efforts in Africa transition to elimination efforts, different diagnostic tools are required to support country programs. Senegal, with its long standing, successful control program, is transitioning to using the SD BIOLINE Onchocerciasis IgG4 (Ov16) rapid test over traditional skin snip microscopy. The aim of this study is to demonstrate the feasibility of integrating the Ov16 rapid test into onchocerciasis surveillance activities in Senegal, based on the following attributes of acceptability, usability, and cost. A cross-sectional study was conducted in 13 villages in southeastern Senegal in May 2016. Individuals 5 years and older were invited to participate in a demographic questionnaire, an Ov16 rapid test, a skin snip biopsy, and an acceptability interview. Rapid test technicians were interviewed and a costing analysis was conducted. Of 1,173 participants, 1,169 (99.7%) agreed to the rapid test while 383 (32.7%) agreed to skin snip microscopy. The sero-positivity rate of the rapid test among those tested was 2.6% with zero positives 10 years and younger. None of the 383 skin snips were positive for Ov microfilaria. Community members appreciated that the rapid test was performed quickly, was not painful, and provided reliable results. The total costs for this surveillance activity was $22,272.83, with a cost per test conducted at $3.14 for rapid test, $7.58 for skin snip microscopy, and $13.43 for shared costs. If no participants had refused skin snip microscopy, the total cost per method with shared costs would have been around $16 per person tested. In this area with low onchocerciasis sero-positivity, there was high acceptability and perceived value of the rapid test by community members and technicians. This study provides evidence of the feasibility of implementing the Ov16 rapid test in Senegal and may be informative to other country programs transitioning to Ov16 serologic tools.

Free-swimming northern elephant seals have low field metabolic rates that are sensitive to an increased cost of transport

DEFF Research Database (Denmark)

Maresh, Jennifer L; Simmons, Samantha E; Crocker, Daniel E

2014-01-01

locomotion, elephant seals had low energy requirements (106.5±28.2 kJ kg−1 day−1), approaching or even falling below predictions of basal requirements. Seals responded to a small increase in locomotion costs by spending more time resting between dives (149±44 s) compared with matched control treatments (102......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...

The population in China’s earthquake-prone areas has increased by over 32 million along with rapid urbanization

Science.gov (United States)

He, Chunyang; Huang, Qingxu; Dou, Yinyin; Tu, Wei; Liu, Jifu

2016-07-01

Accurate assessments of the population exposed to seismic hazard are crucial in seismic risk mapping. Recent rapid urbanization in China has resulted in substantial changes in the size and structure of the population exposed to seismic hazard. Using the latest population census data and seismic maps, this work investigated spatiotemporal changes in the exposure of the population in the most seismically hazardous areas (MSHAs) in China from 1990 to 2010. In the context of rapid urbanization and massive rural-to-urban migration, nearly one-tenth of the Chinese population in 2010 lived in MSHAs. From 1990 to 2010, the MSHA population increased by 32.53 million at a significantly higher rate of change (33.6%) than the national average rate (17.7%). The elderly population in MSHAs increased by 81.4%, which is much higher than the group’s national growth rate of 58.9%. Greater attention should be paid to the demographic changes in earthquake-prone areas in China.

Eliminating Residents Increases the Cost of Care.

Science.gov (United States)

DeMarco, Deborah M; Forster, Richard; Gakis, Thomas; Finberg, Robert W

2017-08-01

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.

Rapidly increasing body mass index among children, adolescents and young adults in a transitioning population, South Africa, 2008-15.

Science.gov (United States)

Sartorius, B; Sartorius, K; Taylor, M; Aagaard-Hansen, J; Dukhi, N; Day, C; Ndlovu, N; Slotow, R; Hofman, K

2017-12-14

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. © The Author 2017. Published by Oxford University Press on behalf of the

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

Energy Technology Data Exchange (ETDEWEB)

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

2017-05-23

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

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

Science.gov (United States)

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

2016-08-01

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

SMS messages increase adherence to rapid diagnostic test results among malaria patients: results from a pilot study in Nigeria.

Science.gov (United States)

Modrek, Sepideh; Schatzkin, Eric; De La Cruz, Anna; Isiguzo, Chinwoke; Nwokolo, Ernest; Anyanti, Jennifer; Ujuju, Chinazo; Montagu, Dominic; Liu, Jenny

2014-02-25

The World Health Organization now recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. However, where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Few studies have examined adherence to RDTs distributed or purchased through the private sector. The Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria. In total, 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves. Participants were given a free RDT and the appropriate treatment advice based on their RDT result. Short Message Service (SMS) text messages reiterating the treatment advice were sent to a randomly selected half of the participants one day after being tested. Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice. Adherence to RDT results was 14.3 percentage points (P-val <0.001) higher in the treatment group who were sent the SMS. The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points. Further, the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs. There was no difference in adherence for the RDT-positive participants who were sent the SMS. SMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from

[Increasing cost of insulin therapy in Belgium. From a critical analysis of the situation to a search for practical solutions].

Science.gov (United States)

Scheen, A J

2006-09-01

Cost related to insulin therapy is markedly increasing in Belgium, as in other Eucopean countries. In the present paper, we will briefly analyze the main reasons for such aa increase, integrate such observation withIn the global context of diabetes management and suggest some solutions to provide best care to insulin-treated diabetic patients at a reasonable cost. The rise of the cost of insulin therapy has a multifactorial origin. It mainly results from an increase in the number of diabetic patients, a more intensive management, In both type 1 and type 2 diabetes, and a greater use of more expansive insulin analogues. It is important to analyze the increase of the cost of insulin therapy within the global burden of diabetes melitus. Only a better responsibility of all health care partners, patients, physicians, pharmaceutical companies, public health authorities, could provide solutions allowing diabetic people to profit from best treatments they should receive in order to prevent diabetic complications, by far the main cause of expenses.

Wood pellet production costs under Austrian and in comparison to Swedish framework conditions

NARCIS (Netherlands)

Obernberger, I.; Thek, G.

2004-01-01

Owing to the rapidly increasing importance of pellets as high-quality biomass fuel in Austria and Europe within the last years, many companies, mainly from the wood industry, are thinking of entering this market. The calculation of the production costs before starting a pellet plant is essential for

Ecological connectivity networks in rapidly expanding cities.

Science.gov (United States)

Nor, Amal Najihah M; Corstanje, Ron; Harris, Jim A; Grafius, Darren R; Siriwardena, Gavin M

2017-06-01

Urban expansion increases fragmentation of the landscape. In effect, fragmentation decreases connectivity, causes green space loss and impacts upon the ecology and function of green space. Restoration of the functionality of green space often requires restoring the ecological connectivity of this green space within the city matrix. However, identifying ecological corridors that integrate different structural and functional connectivity of green space remains vague. Assessing connectivity for developing an ecological network by using efficient models is essential to improve these networks under rapid urban expansion. This paper presents a novel methodological approach to assess and model connectivity for the Eurasian tree sparrow ( Passer montanus ) and Yellow-vented bulbul ( Pycnonotus goiavier ) in three cities (Kuala Lumpur, Malaysia; Jakarta, Indonesia and Metro Manila, Philippines). The approach identifies potential priority corridors for ecological connectivity networks. The study combined circuit models, connectivity analysis and least-cost models to identify potential corridors by integrating structure and function of green space patches to provide reliable ecological connectivity network models in the cities. Relevant parameters such as landscape resistance and green space structure (vegetation density, patch size and patch distance) were derived from an expert and literature-based approach based on the preference of bird behaviour. The integrated models allowed the assessment of connectivity for both species using different measures of green space structure revealing the potential corridors and least-cost pathways for both bird species at the patch sites. The implementation of improvements to the identified corridors could increase the connectivity of green space. This study provides examples of how combining models can contribute to the improvement of ecological networks in rapidly expanding cities and demonstrates the usefulness of such models for

Ecological connectivity networks in rapidly expanding cities

Directory of Open Access Journals (Sweden)

Amal Najihah M. Nor

2017-06-01

Full Text Available Urban expansion increases fragmentation of the landscape. In effect, fragmentation decreases connectivity, causes green space loss and impacts upon the ecology and function of green space. Restoration of the functionality of green space often requires restoring the ecological connectivity of this green space within the city matrix. However, identifying ecological corridors that integrate different structural and functional connectivity of green space remains vague. Assessing connectivity for developing an ecological network by using efficient models is essential to improve these networks under rapid urban expansion. This paper presents a novel methodological approach to assess and model connectivity for the Eurasian tree sparrow (Passer montanus and Yellow-vented bulbul (Pycnonotus goiavier in three cities (Kuala Lumpur, Malaysia; Jakarta, Indonesia and Metro Manila, Philippines. The approach identifies potential priority corridors for ecological connectivity networks. The study combined circuit models, connectivity analysis and least-cost models to identify potential corridors by integrating structure and function of green space patches to provide reliable ecological connectivity network models in the cities. Relevant parameters such as landscape resistance and green space structure (vegetation density, patch size and patch distance were derived from an expert and literature-based approach based on the preference of bird behaviour. The integrated models allowed the assessment of connectivity for both species using different measures of green space structure revealing the potential corridors and least-cost pathways for both bird species at the patch sites. The implementation of improvements to the identified corridors could increase the connectivity of green space. This study provides examples of how combining models can contribute to the improvement of ecological networks in rapidly expanding cities and demonstrates the usefulness of such

Cost benefit justification of nuclear plant reliability improvement

International Nuclear Information System (INIS)

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

1985-01-01

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

Protecting tropical forests from the rapid expansion of rubber using carbon payments.

Science.gov (United States)

Warren-Thomas, Eleanor M; Edwards, David P; Bebber, Daniel P; Chhang, Phourin; Diment, Alex N; Evans, Tom D; Lambrick, Frances H; Maxwell, James F; Nut, Menghor; O'Kelly, Hannah J; Theilade, Ida; Dolman, Paul M

2018-03-02

Expansion of Hevea brasiliensis rubber plantations is a resurgent driver of deforestation, carbon emissions, and biodiversity loss in Southeast Asia. Southeast Asian rubber extent is massive, equivalent to 67% of oil palm, with rapid further expansion predicted. Results-based carbon finance could dis-incentivise forest conversion to rubber, but efficacy will be limited unless payments match, or at least approach, the costs of avoided deforestation. These include opportunity costs (timber and rubber profits), plus carbon finance scheme setup (transaction) and implementation costs. Using comprehensive Cambodian forest data, exploring scenarios of selective logging and conversion, and assuming land-use choice is based on net present value, we find that carbon prices of $30-$51 per tCO 2 are needed to break even against costs, higher than those currently paid on carbon markets or through carbon funds. To defend forests from rubber, either carbon prices must be increased, or other strategies are needed, such as corporate zero-deforestation pledges, and governmental regulation and enforcement of forest protection.

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

KAUST Repository

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

2013-01-01

This research presents a novel rapid prototyping method for paper-based flexible microfluidic devices. The microchannels were fabricated using laser ablation on a piece of plastic paper (permanent paper), the dimensions of the microchannels

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

KAUST Repository

Fan, Yiqiang

2013-04-01

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

Towards Universal Screening for Toxoplasmosis: Rapid, Cost-effective and Simultaneous Detection of Toxoplasma Anti-IgG, IgM and IgA Antibodies Using Very Small Serum Volumes

Science.gov (United States)

No dataset associated with this publication.This dataset is associated with the following publication:Augustine, S. Towards Universal Screening for Toxoplasmosis: Rapid, Cost-effective and Simultaneous Detection of Toxoplasma Anti-IgG, IgM and IgA Antibodies Using Very Small Serum Volumes. JOURNAL OF CLINICAL MICROBIOLOGY. American Society for Microbiology, Washington, DC, USA, 56(7): 1-2, (2016).

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

Directory of Open Access Journals (Sweden)

Charles Nock

2013-11-01

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

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

Science.gov (United States)

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

2017-05-01

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

An evidence-based approach for investment in rapid-charging infrastructure

International Nuclear Information System (INIS)

Serradilla, Javier; Wardle, Josey; Blythe, Phil; Gibbon, Jane

2017-01-01

To date, real cost data for Electric Vehicle (EV) rapid charging infrastructure is largely missing in the literature, preventing development of economic models to encourage private investment and limiting policy decisions. A business model has been constructed using actual capital expenditure, operating costs and usage data from the Rapid Charge Network project (RCN) which can be used to assist future investment and policy decisions. The model is run under a wide spectrum of EV uptake scenarios to provide plausible answers to a variety of research, policy and investment questions, including minimum growth rates to break even under current policy. Using real-world data we have confirmed that a financial business opportunity does exist for investment in rapid chargers on main highways and have identified the operating area in which a profit can be made. However, since UK EV adoption is still at the Innovators stage in a niche market where innovations in technology, user practices, supporting infrastructure and functionality are still required to achieve wide user acceptance, the case is also made for continued fiscal incentives to encourage investment in rapid-charging infrastructure. - Highlights: • Uses actual cost and use data to propose credible business model for EV rapid charging. • Identifies a profit area for successful operation. • Applying 3.3 electricity mark-up over 10 year investment period gives financial return. • EV uptake and Drivers’ willingness to pay remain key constraints. • Fiscal incentives would encourage private investment where demand is uncertain.

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

International Nuclear Information System (INIS)

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

2002-01-01

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

Rapid Newcastle Disease Virus Detection Based on Loop-Mediated Isothermal Amplification and Optomagnetic Readout

DEFF Research Database (Denmark)

Tian, Bo; Ma, Jing; Zardán Gómez de la Torre, Teresa

2016-01-01

Rapid and sensitive diagnostic methods based on isothermal amplification are ideal substitutes for PCR in out-of-lab settings. However, there are bottlenecks in terms of establishing low-cost and user-friendly readout methods for isothermal amplification schemes. Combining the high amplification...... efficiency of loop-mediated isothermal amplification (LAMP) with an optomagnetic nanoparticle-based readout system, we demonstrate ultrasensitive and rapid detection of Newcastle disease virus RNA. Biotinylated amplicons of LAMP and reverse transcription LAMP (RT-LAMP) bind to streptavidin-coated magnetic...... nanoparticles (MNPs) resulting in a dramatical increase in the hydrodynamic size of the MNPs. This increase was measured by an optomagnetic readout system and provided quantitative information on the amount of LAMP target sequence. Our assay resulted in a limit of detection of 10 aM of target sequence...

Effectiveness Analysis of a Part-Time Rapid Response System During Operation Versus Nonoperation.

Science.gov (United States)

Kim, Youlim; Lee, Dong Seon; Min, Hyunju; Choi, Yun Young; Lee, Eun Young; Song, Inae; Park, Jong Sun; Cho, Young-Jae; Jo, You Hwan; Yoon, Ho Il; Lee, Jae Ho; Lee, Choon-Taek; Do, Sang Hwan; Lee, Yeon Joo

2017-06-01

To evaluate the effect of a part-time rapid response system on the occurrence rate of cardiopulmonary arrest by comparing the times of rapid response system operation versus nonoperation. Retrospective cohort study. A 1,360-bed tertiary care hospital. Adult patients admitted to the general ward were screened. Data were collected over 36 months from rapid response system implementation (October 2012 to September 2015) and more than 45 months before rapid response system implementation (January 2009 to September 2012). None. The rapid response system operates from 7 AM to 10 PM on weekdays and from 7 AM to 12 PM on Saturdays. Primary outcomes were the difference of cardiopulmonary arrest incidence between pre-rapid response system and post-rapid response system periods and whether the rapid response system operating time affects the cardiopulmonary arrest incidence. The overall cardiopulmonary arrest incidence (per 1,000 admissions) was 1.43. Although the number of admissions per month and case-mix index were increased (3,555.18 vs 4,564.72, p times (0.82 vs 0.49/1,000 admissions; p = 0.001) but remained similar during rapid response system nonoperating times (0.77 vs 0.73/1,000 admissions; p = 0.729). The implementation of a part-time rapid response system reduced the cardiopulmonary arrest incidence based on the reduction of cardiopulmonary arrest during rapid response system operating times. Further analysis of the cost effectiveness of part-time rapid response system is needed.

Reducing Nitrogen Pollution while Decreasing Farmers' Costs and Increasing Fertilizer Industry Profits.

Science.gov (United States)

Kanter, David R; Zhang, Xin; Mauzerall, Denise L

2015-03-01

Nitrogen (N) pollution is emerging as one of the most important environmental issues of the 21st Century, contributing to air and water pollution, climate change, and stratospheric ozone depletion. With agriculture being the dominant source, we tested whether it is possible to reduce agricultural N pollution in a way that benefits the environment, reduces farmers' costs, and increases fertilizer industry profitability, thereby creating a "sweet spot" for decision-makers that could significantly increase the viability of improved N management initiatives. Although studies of the economic impacts of improved N management have begun to take into account farmers and the environment, this is the first study to consider the fertilizer industry. Our "sweet spot" hypothesis is evaluated via a cost-benefit analysis of moderate and ambitious N use efficiency targets in U.S. and China corn sectors over the period 2015-2035. We use a blend of publicly available crop and energy price projections, original time-series modeling, and expert elicitation. The results present a mixed picture: although the potential for a "sweet spot" exists in both countries, it is more likely that one occurs in China due to the currently extensive overapplication of fertilizer, which creates a greater potential for farmers and the fertilizer industry to gain economically from improved N management. Nevertheless, the environmental benefits of improving N management consistently dwarf the economic impacts on farmers and the fertilizer industry in both countries, suggesting that viable policy options could include incentives to farmers and the fertilizer industry to increase their support for N management policies. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

20 CFR 404.274 - What are the measuring periods we use to calculate cost-of-living increases?

Science.gov (United States)

2010-04-01

... ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts... determine whether there will be an automatic cost-of-living increase and if so, its amount. (b) Measuring... increase is effective; or (ii) The third calendar quarter of any year in which the last automatic increase...

Cost-effectiveness of HIV and syphilis antenatal screening: a modelling study.

Science.gov (United States)

Bristow, Claire C; Larson, Elysia; Anderson, Laura J; Klausner, Jeffrey D

2016-08-01

The WHO called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonised approach for the improvement of health outcomes for mothers and children. Testing early in pregnancy, treating seropositive pregnant women and preventing syphilis reinfection can prevent MTCT of HIV and syphilis. We assessed the health and economic outcomes of a dual testing strategy in a simulated cohort of 100 000 antenatal care patients in Malawi. We compared four screening algorithms: (1) HIV rapid test only, (2) dual HIV and syphilis rapid tests, (3) single rapid tests for HIV and syphilis and (4) HIV rapid and syphilis laboratory tests. We calculated the expected number of adverse pregnancy outcomes, the expected costs and the expected newborn disability-adjusted life years (DALYs) for each screening algorithm. The estimated costs and DALYs for each screening algorithm were assessed from a societal perspective using Markov progression models. Additionally, we conducted a Monte Carlo multiway sensitivity analysis, allowing for ranges of inputs. Our cohort decision model predicted the lowest number of adverse pregnancy outcomes in the dual HIV and syphilis rapid test strategy. Additionally, from the societal perspective, the costs of prevention and care using a dual HIV and syphilis rapid testing strategy was both the least costly ($226.92 per pregnancy) and resulted in the fewest DALYs (116 639) per 100 000 pregnancies. In the Monte Carlo simulation the dual HIV and syphilis algorithm was always cost saving and almost always reduced DALYs compared with HIV testing alone. The results of the cost-effectiveness analysis showed that a dual HIV and syphilis test was cost saving compared with all other screening strategies. Updating existing prevention of mother-to-child HIV transmission programmes in Malawi and similar countries to include dual rapid testing for HIV and syphilis is likely to be advantageous. Published by the BMJ Publishing Group

Optimal estimation and scheduling in aquifer management using the rapid feedback control method

Science.gov (United States)

Ghorbanidehno, Hojat; Kokkinaki, Amalia; Kitanidis, Peter K.; Darve, Eric

2017-12-01

Management of water resources systems often involves a large number of parameters, as in the case of large, spatially heterogeneous aquifers, and a large number of "noisy" observations, as in the case of pressure observation in wells. Optimizing the operation of such systems requires both searching among many possible solutions and utilizing new information as it becomes available. However, the computational cost of this task increases rapidly with the size of the problem to the extent that textbook optimization methods are practically impossible to apply. In this paper, we present a new computationally efficient technique as a practical alternative for optimally operating large-scale dynamical systems. The proposed method, which we term Rapid Feedback Controller (RFC), provides a practical approach for combined monitoring, parameter estimation, uncertainty quantification, and optimal control for linear and nonlinear systems with a quadratic cost function. For illustration, we consider the case of a weakly nonlinear uncertain dynamical system with a quadratic objective function, specifically a two-dimensional heterogeneous aquifer management problem. To validate our method, we compare our results with the linear quadratic Gaussian (LQG) method, which is the basic approach for feedback control. We show that the computational cost of the RFC scales only linearly with the number of unknowns, a great improvement compared to the basic LQG control with a computational cost that scales quadratically. We demonstrate that the RFC method can obtain the optimal control values at a greatly reduced computational cost compared to the conventional LQG algorithm with small and controllable losses in the accuracy of the state and parameter estimation.

RAPID KNEE-EXTENSIONS TO INCREASE QUADRICEPS MUSCLE ACTIVITY IN PATIENTS WITH TOTAL KNEE ARTHROPLASTY

DEFF Research Database (Denmark)

Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

2017-01-01

rapid knee-extensions were associated with greater voluntary quadriceps muscle activity during an experimental strength training session, compared to that elicited using slow knee-extensions. STUDY DESIGN: A randomized cross-over study. METHODS: Twenty-four patients (age 66.5) 4-8 weeks post total knee...... agonist muscle activity, especially if the exercise is conducted using rapid muscle contractions. PURPOSE: The purpose of this study was to examine if patients with total knee arthroplasty could perform rapid knee-extensions using a 10 RM load four to eight weeks after surgery, and the degree to which...... arthroplasty randomly performed one set of five rapid, and one set of five slow knee-extensions with the operated leg, using a load of their 10 repetition maximum, while surface electromyography recordings were obtained from the vastus medialis and lateralis of the quadriceps muscle. RESULTS: Data from 23...

Rapid knee-extensions to increase quadriceps muscle activity in patients with total knee arthroplasty

DEFF Research Database (Denmark)

Husted, Rasmus Skov; Wilquin, Lousia; Jakobsen, Thomas Linding

2017-01-01

rapid knee-extensions were associated with greater voluntary quadriceps muscle activity during an experimental strength training session, compared to that elicited using slow knee-extensions. STUDY DESIGN: A randomized cross-over study. METHODS: Twenty-four patients (age 66.5) 4-8 weeks post total knee...... agonist muscle activity, especially if the exercise is conducted using rapid muscle contractions. PURPOSE: The purpose of this study was to examine if patients with total knee arthroplasty could perform rapid knee-extensions using a 10 RM load four to eight weeks after surgery, and the degree to which...... arthroplasty randomly performed one set of five rapid, and one set of five slow knee-extensions with the operated leg, using a load of their 10 repetition maximum, while surface electromyography recordings were obtained from the vastus medialis and lateralis of the quadriceps muscle. RESULTS: Data from 23...

Rapidly developing market regions : Brazil

International Nuclear Information System (INIS)

Britto, A.

1997-01-01

Brazil and the State of Rio Grande do Sul are experiencing a period of rapid industrial development. Global investment has been forecast to reach $240 billion over the next five to seven years. This level of development is likely to result in a sharp increase in the consumption of plastic products made from olefins and from aromatic products. Accordingly, Copesul, the centre of raw materials for the State complex, is expected to increase its production of ethane from 685 tonnes to 1.13 million tonnes after 1999. The government has established a program of incentives to stimulate investment in third generation industries. Also, the State petrochemical industry has been rendered more competitive as a result of the purchase of the latest generation equipment. The principal challenges that exist for the petrochemical industry in Brazil and for that matter, around the world, are to reduce production costs and to preserve the natural environment. Another challenge, also world-wide, is to address the issue of plastic residues and to eliminate such residues through plastic recycling programs

Rapid Prototyping in Orthopaedic Surgery: A User's Guide

OpenAIRE

Frame, Mark; Huntley, James S.

2012-01-01

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce pr...

A novel highly flexible, simple, rapid and low-cost fabrication tool for paper-based microfluidic devices (μPADs) using technical drawing pens and in-house formulated aqueous inks.

Science.gov (United States)

Nuchtavorn, Nantana; Macka, Mirek

2016-05-05

Paper-based microfluidic devices (μPADs) are capable of achieving rapid quantitative measurements of a variety of analytes inexpensively. μPADs rely on patterning hydrophilic-hydrophobic regions on a sheet of paper in order to create capillary channels within impermeable fluidic brakes on the paper. Here, we present a novel, highly flexible and low-cost fabrication method using a desktop digital craft plotter/cutter and technical drawing pens with tip size of 0.5 mm. The pens were used with either commercial black permanent ink for drawing fluidic brakes, or with specialty in-house formulated aqueous inks. With the permanent marker ink it was possible to create barriers on paper rapidly and in a variety of designs in a highly flexible manner. For instance, a design featuring eight reservoirs can be produced within 10 s for each μPAD with a consistent line width of brakes (%RSD drawing pens provides flexibility in the use of in-house formulated inks, short fabrication time, simplicity and low cost. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

A systems engineering cost analysis capability for use in assessing nuclear waste management system cost performance

International Nuclear Information System (INIS)

Shay, M.R.

1990-04-01

The System Engineering Cost Analysis (SECA) capability has been developed by the System Integration Branch of the US Department of Energy's Office of Civilian Radioactive Waste Management for use in assessing the cost performance of alternative waste management system configurations. The SECA capability is designed to provide rapid cost estimates of the waste management system for a given operational scenario and to permit aggregate or detailed cost comparisons for alternative waste system configurations. This capability may be used as an integral part of the System Integration Modeling System (SIMS) or, with appropriate input defining a scenario, as a separate cost analysis model

Colleges Struggle to Dispose of Hazardous Wastes in Face of Rising Costs and Increased Regulation.

Science.gov (United States)

Magner, Denise K.

1989-01-01

After years of being ignored by federal regulators because of the low volume of hazardous waste in question, colleges and universities are facing increased enforcement of environmental laws concerning waste disposal and storage, at great cost in money, facilities, and personnel. (MSE)

Increased disease calls for a cost-benefits review of marine reserves.

Directory of Open Access Journals (Sweden)

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.

The Budget Impact of Increased Use of Febuxostat in the Management of Gout: A US Health Plan Managed Care Pharmacy and Medical Costs Perspective.

Science.gov (United States)

Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki

2016-07-01

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 <6.0 mg/dL and a 1.4% reduction in 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

Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis.

Science.gov (United States)

Pfaller, Michael A; Castanheira, Mariana

2016-01-01

Candidemia and other forms of candidiasis are associated with considerable excess mortality and costs. Despite the addition of several new antifungal agents with improved spectrum and potency, the frequency of Candida infection and associated mortality have not decreased in the past two decades. The lack of rapid and sensitive diagnostic tests has led to considerable overuse of antifungal agents resulting in increased costs, selection pressure for resistance, unnecessary drug toxicity, and adverse drug interactions. Both the lack of timely diagnostic tests and emergence of antifungal resistance pose considerable problems for antifungal stewardship. Whereas antifungal stewardship with a focus on nosocomial candidiasis should be able to improve the administration of antifungal therapy in terms of drug selection, proper dose and duration, source control and de-escalation therapy, an important parameter, timeliness of antifungal therapy, remains a victim of slow and insensitive diagnostic tests. Fortunately, new proteomic and molecular diagnostic tools are improving the time to species identification and detection. In this review we will describe the potential impact that rapid diagnostic testing and antifungal stewardship can have on the management of nosocomial candidiasis. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Clustered lot quality assurance sampling to assess immunisation coverage: increasing rapidity and maintaining precision.

Science.gov (United States)

Pezzoli, Lorenzo; Andrews, Nick; Ronveaux, Olivier

2010-05-01

Vaccination programmes targeting disease elimination aim to achieve very high coverage levels (e.g. 95%). We calculated the precision of different clustered lot quality assurance sampling (LQAS) designs in computer-simulated surveys to provide local health officers in the field with preset LQAS plans to simply and rapidly assess programmes with high coverage targets. We calculated sample size (N), decision value (d) and misclassification errors (alpha and beta) of several LQAS plans by running 10 000 simulations. We kept the upper coverage threshold (UT) at 90% or 95% and decreased the lower threshold (LT) progressively by 5%. We measured the proportion of simulations with d unvaccinated individuals if the coverage was LT% (pLT) to calculate alpha (1-pLT). We divided N in clusters (between 5 and 10) and recalculated the errors hypothesising that the coverage would vary in the clusters according to a binomial distribution with preset standard deviations of 0.05 and 0.1 from the mean lot coverage. We selected the plans fulfilling these criteria: alpha LQAS plans dividing the lot in five clusters with N = 50 (5 x 10) and d = 4 to evaluate programmes with 95% coverage target and d = 7 to evaluate programmes with 90% target. These plans will considerably increase the feasibility and the rapidity of conducting the LQAS in the field.

Dietary standards for school catering in France: serving moderate quantities to improve dietary quality without increasing the food-related cost of meals.

Science.gov (United States)

Vieux, Florent; Dubois, Christophe; Allegre, Laëtitia; Mandon, Lionel; Ciantar, Laurent; Darmon, Nicole

2013-01-01

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.

A cost/benefit analysis of commercial fusion-fission hybrid reactor development

International Nuclear Information System (INIS)

Kostoff, R.N.

1983-01-01

A simple algorithm was developed that allows rapid computation of the ratio R, of present worth of benefits to present worth of hybrid RandD program costs as a function of potential hybrid unit electricity cost savings, discount rate, electricity demand growth rate, total hybrid RandD program cost, and time to complete a demonstration reactor. In the sensitivity study, these variables were assigned nominal values (unit electricity cost savings of 4 mills/k W-hr, discount rate of 4%/year, growth rate of 2.25%/year, total RandD program cost of $20 billion, and time to complete a demonstration reactor of 30 years), and the variable of interest was varied about its nominal value. Results show that R increases with decreasing discount rate and increasing unit electricity savings and ranges from 4 to 94 as discount rateranges from 5 to 3%/year and unit electricity savings range from 2 to 6 mills/k W-hr. R increases with increasing growth rate and ranges from 3 to 187 as growth rate ranges from 1 to 3.5%/year and unit electricity cost savings range from 2 to 6 mills/k W-hr. R attains a maximum value when plotted against time to complete a demonstration reactor. The location of this maximum value occurs at shorter completion times as discount rate increases, and this optimal completion time ranges from 20 years for a discount rate of 4%/year to 45 years for a discount rate of 3%/year

Costs of performance based maintenance for local roads: Case study Albania

Science.gov (United States)

Jokanović, Igor; Grujić, Bojana; Zeljić, Dragana; Grujić, Žarko; Svilar, Mila

2017-12-01

The provision and maintenance of road infrastructure is a major global business, consequently it is essential that road maintenance services are provided in the most cost effective manner. Without regular maintenance, roads can rapidly fall into disrepair, preventing realization of the longer term impacts of road improvements on development, such as increased agricultural production and growth in school enrollment, which is of particular importance for a network of local (access) roads. Inadequate local roads maintenance in Albania is proposed to be solved by implementing performance based maintenance approach for which the costing exercise is presented within the paper.

ADVANCEMENT OF RAPID PROTOTYPING IN AEROSPACE INDUSTRY -A REVIEW

OpenAIRE

Vineet Kumar Vashishtha,; Rahul Makade,; Neeraj Mehla

2011-01-01

Rapid prototyping technology have emerged a new innovation to reduced the time cost of moulds fabrication by creating 3D product directly from computer aided design thus the designer is able to perform design validation and accuracy analysis easily in a virtual environment as if using a physical model. The primary aim of this paper is to give the reader an overview of the current state of the art in rapid prototyping technology .The paper also deal with feature’s of rapid prototyping in Aeros...

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

Science.gov (United States)

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

2018-05-01

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

Consumers devise drug cost-cutting measures: medical and legal issues to consider.

Science.gov (United States)

Ganguli, Gouranga

2003-01-01

Health care costs in general, and prescription drug costs in particular, are rapidly rising. Between 1996 and 2007 the average annual per capita health care cost is projected to increase from dollar 3,781 to dollar 7,100. [AQ1] The single leading component of health care cost is the cost of prescription drugs (currently 10% of total health care spending, projected to become 18% in 2008). The average cost per drug increased 40% during the 1993-1998 period. Forty-one million Americans have no health insurance, and those who have, have inadequate prescription drug coverage. [AQ2] To cope with this situation, many consumers are trying to economize by doing without the prescriptions or the appropriate doses, buying generics or medicines from Canada or Mexico, or splitting pills of higher doses to take advantage of the pricing policy of drug manufacturers. Some of these approaches are medically and/or legally acceptable, while some are dubious. Most adversely affected are the seniors and poor; for certain groups of seniors prescription drugs account for 30% of their health care spending. The problem must receive prompt concerted attention from consumers, insurers, pharmaceutical companies, and lawmakers before it gets out of hand.

An analysis of nuclear power plant operating costs

International Nuclear Information System (INIS)

1988-01-01

This report presents the results of a statistical analysis of nonfuel operating costs for nuclear power plants. Most studies of the economic costs of nuclear power have focused on the rapid escalation in the cost of constructing a nuclear power plant. The present analysis found that there has also been substantial escalation in real (inflation-adjusted) nonfuel operating costs. It is important to determine the factors contributing to the escalation in operating costs, not only to understand what has occurred but also to gain insights about future trends in operating costs. There are two types of nonfuel operating costs. The first is routine operating and maintenance expenditures (O and M costs), and the second is large postoperational capital expenditures, or what is typically called ''capital additions.'' O and M costs consist mainly of expenditures on labor, and according to one recently completed study, the majoriy of employees at a nuclear power plant perform maintenance activities. It is generally thought that capital additions costs consist of large maintenance expenditures needed to keep the plants operational, and to make plant modifications (backfits) required by the Nuclear Regulatory Commission (NRC). Many discussions of nuclear power plant operating costs have not considered these capital additions costs, and a major finding of the present study is that these costs are substantial. The objective of this study was to determine why nonfuel operating costs have increased over the past decade. The statistical analysis examined a number of factors that have influenced the escalation in real nonfuel operating costs and these are discussed in this report. 4 figs, 19 tabs

Successfulness of bus rapid transit systems in Asia. Ex-post evaluation

NARCIS (Netherlands)

Kogdenko, Nadja

2010-01-01

SUMMARY Bus Rapid Transit (BRT) can be defined as “a bus-based mass transit system that delivers fast, comfortable, and cost-effective urban mobility”. It offers the opportunity to create a high-quality mass transit system at affordable costs, which is p

Strategic Planning for Health Care Cost Controls in a Constantly Changing Environment.

Science.gov (United States)

Hembree, William E

2015-01-01

Health care cost increases are showing a resurgence. Despite recent years' comparatively modest increases, the projections for 2015 cost increases range from 6.6% to 7%--three to four times larger than 2015's expected underlying inflation. This resurgence is just one of many rapidly changing external and internal challenges health plan sponsors must overcome (and this resurgence advances the date when the majority of employers will trigger the "Cadillac tax"). What's needed is a planning approach that is effective in overcoming all known and yet-to-be-discovered challenges, not just affordability. This article provides detailed guidance in adopting six proven strategic planning steps. Following these steps will proactively and effectively create a flexible strategic plan for the present and future of employers' health plans that will withstand all internal and external challenges.

Promoting Approaches For Increasing The Cost-Efficiency Of Energy Wood And Pulpwood Harvesting In Young Stands

Energy Technology Data Exchange (ETDEWEB)

Oikari, Markku; Palander, Teijo; Ovaskainen, Heikki (Univ. of Joensuu, Faculty of Forest Science FI-80101 Joensuu (Finland)); Kaerhae, Kalle (Metsaeteho Oy , FI-00171 Helsinki (Finland))

2008-10-15

Potential approaches for increasing the cost-efficiency of energy wood and industrial roundwood (i.e. pulpwood) harvesting from early thinnings in Finland were ranked in the survey carried out by Metsaeteho Oy and the University of Joensuu. The study was implemented by conducting personal interviews. Research data, based on a total of 40 interviews, were collected during January and February, 2008. In this study, employment, education, and operator issues proved to be of decisive importance for improving energy wood and industrial roundwood harvesting. In the opinion of the respondents, there is considerable potential for increasing the cost-efficiency of wood harvesting by improving harvesting conditions (i.e. effective tending of seedling stands, delaying harvesting operations, pre-clearance of undergrowth, and new wood production methods). The interviewees also stressed that harvesting methods can be rationalized, e.g. multiple-tree handling in industrial roundwood cuttings, integrated pulpwood and energy wood harvesting, and grapple scale measuring. If the most potential methods and techniques were utilized completely in wood harvesting, then there would be significant possibilities for cost savings in young stands. Based on the suggestions of this study, the most profitable guidelines should be utilized immediately

RE-COST: Cost and Business Comparisons of Renewable vs. Non-renewable Technologies

Energy Technology Data Exchange (ETDEWEB)

Mostajo Veiga, Mercedes; Farina Alvarez, Pablo; Fernandez-Montes Moraleda, Manuel; Kleinsorge, Anne

2012-07-15

Based on real plant data, the RE-COST project concludes that in many OECD energy markets, new renewable energy technologies (RET) are close to be competitive with non-RET electricity plants. RET costs are decreasing rapidly, while conventional power plants are affected by lower utilisation rates, volatile coal and gas prices, CO2 pricing, and lower electricity demand than expected. If energy prices would account for air pollution and climate change, renewables would already be the most beneficial for society and business.

Rapid road repair vehicle

Science.gov (United States)

Mara, Leo M.

1998-01-01

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

Cellulose-Supported Ionic Liquids for Low-Cost Pressure Swing CO{sub 2} Capture

Energy Technology Data Exchange (ETDEWEB)

Reed, Daniel G.; Dowson, George R. M.; Styring, Peter, E-mail: p.styring@sheffield.ac.uk [UK Centre for Carbon Dioxide Utilisation, Department of Chemical and Biological Engineering, The University of Sheffield, Sheffield (United Kingdom)

2017-07-07

Reducing the cost of capturing CO{sub 2} from point source emitters is a major challenge facing carbon capture, utilization, and storage. While solid ionic liquids (SoILs) have been shown to allow selective and rapid CO{sub 2} capture by pressure swing separation of flue gases, expectations of their high cost hinders their potential application. Cellulose is found to be a reliable, cheap, and sustainable support for a range of SoILs, reducing the total sorbent cost by improving the efficiency of the ionic liquid (IL) through increased ionic surface area that results from coating. It was also found that cellulose support imparts surface characteristics, which increased total sorbent uptake. Combined, these effects allowed a fourfold to eightfold improvement in uptake per gram of IL for SoILs that have previously shown high uptake and a 9- to 39-fold improvement for those with previously poor uptake. This offers the potential to drastically reduce the amount of IL required to separate a given gas volume. Furthermore, the fast kinetics are retained, with adsorb–desorb cycles taking place over a matter of seconds. This means that rapid cycling can be achieved, which results in high cumulative separation capacity relative to a conventional temperature swing process. The supported materials show an optimum at 75% cellulose:25% IL as a result of even coating of the cellulose surface. The projected reduction in plant size and operational costs represents a potentially ground-breaking step forward in carbon dioxide capture technologies.

Cost of Dengue Vector Control Activities in Malaysia

Science.gov (United States)

Packierisamy, P. Raviwharmman; Ng, Chiu-Wan; Dahlui, Maznah; Inbaraj, Jonathan; Balan, Venugopalan K.; Halasa, Yara A.; Shepard, Donald S.

2015-01-01

Dengue fever, an arbovirus disease transmitted by Aedes mosquitoes, has recently spread rapidly, especially in the tropical countries of the Americas and Asia-Pacific regions. It is endemic in Malaysia, with an annual average of 37,937 reported dengue cases from 2007 to 2012. This study measured the overall economic impact of dengue in Malaysia, and estimated the costs of dengue prevention. In 2010, Malaysia spent US$73.5 million or 0.03% of the country's GDP on its National Dengue Vector Control Program. This spending represented US$1,591 per reported dengue case and US$2.68 per capita population. Most (92.2%) of this spending occurred in districts, primarily for fogging. A previous paper estimated the annual cost of dengue illness in the country at US$102.2 million. Thus, the inclusion of preventive activities increases the substantial estimated cost of dengue to US$175.7 million, or 72% above illness costs alone. If innovative technologies for dengue vector control prove efficacious, and a dengue vaccine was introduced, substantial existing spending could be rechanneled to fund them. PMID:26416116

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

African Journals Online (AJOL)

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

Possible causes of the recent rapid increase in the radial increment of silver fir in the Western Carpathians

International Nuclear Information System (INIS)

Bošeľa, Michal; Petráš, Rudolf; Sitková, Zuzana; Priwitzer, Tibor; Pajtík, Jozef; Hlavatá, Helena; Sedmák, Róbert; Tobin, Brian

2014-01-01

Silver fir is one of the most productive and ecologically valuable native European tree species, however, it has been experiencing decline which has periodically occurred over its natural range. This paper aims to investigate the recent climate–growth relationships of silver fir (Abies alba Mill.) and its temporal change along the course of its life. Long-term tree-ring databases, as well as records on climate, atmospheric SO 2 , NO 3 and acid concentrations from four different regions in the Western Carpathians were used. The results provide clear evidence of significant increase of silver fir's radial increment over the entire Western Carpathian area since 1970–1980. The results indicated that the most probable factors behind the rapid recovery of tree radial increment were reductions in emissions of NO 3 and SO 2 , alongside a significant increase in mean June, July and April temperatures. Highlights: • Silver fir radial growth was mostly related to mean month late winter temperatures. • Silver fir growth also responded to summer, especially July temperatures. • Strength of the climate–growth response has gradually increased since 1960–1980. • SO 2 , NO 3 , and recent climate change as major factor of the rapid radial growth recovery. -- Reductions of SO 2 and NO 3 emission along with climate change are the major causes of the recent recovery of Silver fir radial growth

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

Science.gov (United States)

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

2018-02-01

Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ 2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ 2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ 2 used for the plate waste analysis. Significance was assessed at P<0.05. This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0

The costs, effects and cost-effectiveness of strategies to increase coverage of routine immunizations in low- and middle-income countries: systematic review of the grey literature.

Science.gov (United States)

Batt, Katherine; Fox-Rushby, J A; Castillo-Riquelme, Marianela

2004-09-01

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.

Containing contraceptive costs

African Journals Online (AJOL)

April 2015, Vol. 105, No. 4. Containing contraceptive costs. There are about 7 billion people living on our planet. In many countries resources are strained and we seek to slow down the rate of population growth. There are obviously many factors that lead to rapid population growth. Contraceptive methods are an important.

Cost Analysis of Complex Radiation Therapy for Patients With Head and Neck Cancer

Energy Technology Data Exchange (ETDEWEB)

Perrier, Lionel; Morelle, Magali [Univ Lyon, GATE-Unité Mixte de Recherche 5824-Centre national de la recherche scientifique, Lyon (France); Department of Clinical Research and Innovation, Leon Berard Cancer Centre, Lyon (France); Pommier, Pascal [Department of Radiation Oncology, Leon Berard Cancer Centre, Lyon (France); Boisselier, Pierre [Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier (France); Coche-Dequeant, Bernard [Department of Radiation Oncology, Oscar Lambret Cancer Centre, Lille (France); Gallocher, Olivier [Department of Radiation Oncology, Clinique Pasteur, Toulouse (France); Alfonsi, Marc [Department of Radiation Oncology, Sainte Catherine Institute, Avignon (France); Bardet, Etienne [Department of Radiation Oncology, René Gauducheau Cancer Centre, Saint Herblain (France); Rives, Michel [Department of Radiation Oncology, Claudius Regaud Institute, Toulouse (France); Calugaru, Valentin [Department of Radiation Oncology, Curie Institute, Paris (France); Chajon, Enrique [Department of Radiation Oncology, Eugène Marquis Cancer Centre, Rennes (France); Noel, Georges [Department of Radiation Oncology, Paul Strauss Cancer Centre, Strasbourg (France); Mecellem, Hinda [Lorraine Institute of Oncology, Vandoeuvre-lès-Nancy (France); Pérol, David; Dussart, Sophie [Department of Clinical Research and Innovation, Leon Berard Cancer Centre, Lyon (France); Giraud, Philippe, E-mail: philippe.giraud@aphp.fr [Department of Radiation Oncology, Paris Descartes University, Paris Sorbonne Cité, Hôpital Européen Georges Pompidou, Paris (France)

2016-06-01

Purpose: This cost analysis aimed to prospectively assess differences in costs between TomoTherapy and volumetric modulated arc therapy (VMAT) in patients with head and neck cancer. Methods and Materials: Economic data were gathered from a multicenter study. However, randomization was not possible due to the availability of equipment. Costs were calculated using the microcosting technique from the hospital's perspective (in 2013 euros), and the time horizon was radiation therapy. Only resources that entered the hospital production process and which were likely to vary between the strategies being compared were considered. Acute adverse events observed within the time horizon were also assessed. Results: The cost analysis was based on a total of 173 patient treatments given between 2010 and 2012 in 14 French cancer centers: 73 patients were treated with TomoTherapy, 92 with VMAT RapidArc, and 8 with VMAT SmartArc. Estimated costs of SmartArc were removed from the comparison due to the small sample size. The mean ± SD cost per patient of the treatment planning phase was €314 (±€214) for TomoTherapy and €511 (±€590) for RapidArc. Mean costs ± SD per patient of irradiation reached €3144 (±€565) for TomoTherapy and €1350 (±€299) for RapidArc. The most sensitive parameter of irradiation was the annual operating time of accelerators. Ninety-five percent confidence intervals for the mean costs of irradiation were €3016 to €3272 for TomoTherapy and €1281 to €1408 for RapidArc. The number of acute adverse events during radiation therapy was not significantly different between strategies. Conclusions: TomoTherapy appeared to be more expensive than RapidArc mainly due to the higher price of the accelerator, the higher costs of maintenance, and the longer duration of treatment sessions. Because strategies were not significantly different in clinical effect, RapidArc appeared to be the strategy to be recommended at this stage of knowledge.

Construction costs of nuclear power stations

Energy Technology Data Exchange (ETDEWEB)

Mandel, H

1976-03-01

It is assumed that the demand for electrical energy will continue to rise and that nuclear power will increasingly supply the base-load of electricity generation in the industrialized world. The author identifies areas where techniques and practices to control costs can be improved. Nuclear power offers an alternative to liquid and gaseous fossil fuels and contributes to a relative stability in the price of electric energy. Nuclear power plants can now generate power more cheaply than other thermal power plants down into the upper middle load sector, as indicated in calculations based on a construction time of six years for nuclear plants and four years for others. Special legal provisions, different conditions of financing and taxation, varying methods of power generation cost accounting, and the nonuniform layout of the plant in the various countries make it difficult to compare power generation costs. The author uses mostly experiences gained in the Federal Republic of Germany for some calculations for comparison; he cites lack of standardization and over-long licensing times as major factors in the recent rapid escalation of nuclear power costs and suggests that adoption of standard reactor designs, encouragement of a vigorous and competitive European nuclear industry, and streamlining of licensing procedures to improve the situation. (MCW)

Competition between biofuels. Modeling technological learning and cost reductions over time

International Nuclear Information System (INIS)

De Wit, M.; Junginger, M.; Faaij, A.; Lensink, S.M.; Londo, H.M.

2009-10-01

A key aspect in modeling the (future) competition between biofuels is the way in which production cost developments are computed. The objective of this study was threefold: (1) to construct a (endogenous) relation between cost development and cumulative production (2) to implement technological learning based on both engineering study insights and an experience curve approach, and (3) to investigate the impact of different technological learning assumptions on the market diffusion patterns of different biofuels. The analysis was executed with the European biofuel model BioTrans, which computes the least cost biofuel route. The model meets an increasing demand, reaching a 25% share of biofuels of the overall European transport fuel demand by 2030. Results show that 1st generation biodiesel is the most cost competitive fuel, dominating the early market. With increasing demand, modestly productive oilseed crops become more expensive rapidly, providing opportunities for advanced biofuels to enter the market. While biodiesel supply typically remains steady until 2030, almost all additional yearly demands are delivered by advanced biofuels, supplying up to 60% of the market by 2030. Sensitivity analysis shows that (a) overall increasing investment costs favour biodiesel production, (b) separate gasoline and diesel subtargets may diversify feedstock production and technology implementation, thus limiting the risk of failure and preventing lock-in and (c) the moment of an advanced technology's commercial market introduction determines, to a large degree, its future chances for increasing market share.

Changes in Indirect Markers of Muscle Damage and Tendons After Daily Drop Jumping Exercise with Rapid Load Increase

Directory of Open Access Journals (Sweden)

Vidas Paleckis, Mantas Mickevičius, Audrius Snieckus, Vytautas Streckis, Mati Pääsuke, Saulius Rutkauskas, Rasa Steponavičiūtė, Albertas Skurvydas, Sigitas Kamandulis

2015-12-01

Full Text Available The aim of this study was to assess changes in indirect markers of muscle damage and type I collagen degradation, as well as, patellar and Achilles tendon morphological differences during nine daily drop-jumps sessions with constant load alternated with rapid increases in load to test the hypothesis that frequent drop-jump training results in negative muscular and tendon adaptation. Young men (n = 9 performed daily drop jump workouts with progression every 3 days in terms of number of jumps, platform height and squat amplitude. Voluntary and electrically evoked knee extensor torque, muscle soreness, blood plasma creatine kinase (CK activity and carboxyterminal cross-linked telopeptide (ICTP, patellar and Achilles tendon thickness and cross-sectional area (CSA were assessed at different time points during the training period and again on days 1, 3, 10 and 17 after the training. The findings were as follows: (1 steady decline in maximal muscle strength with major recovery within 24 hours after the first six daily training sessions; (2 larger decline in electrically induced muscle torque and prolonged recovery during last three training sessions; (3 increase in patellar and Achilles tendons CSA without change in thickness towards the end of training period; (4 increase in jump height but not in muscle strength after whole training period. Our findings suggest that frequent drop-jump sessions with constant load alternated with rapid increases in load do not induce severe muscle damage or major changes in tendons, nonetheless, this type of loading is not advisable for muscle strength improvement.

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.

Science.gov (United States)

Tsalik, Ephraim L; Li, Yanhong; Hudson, Lori L; Chu, Vivian H; Himmel, Tiffany; Limkakeng, Alex T; Katz, Jason N; Glickman, Seth W; McClain, Micah T; Welty-Wolf, Karen E; Fowler, Vance G; Ginsburg, Geoffrey S; Woods, Christopher W; Reed, Shelby D

2016-03-01

Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9% and increased mean costs by $1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1% and costs increased by $1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing

Analysis of the Rapid Chloride Migration test

NARCIS (Netherlands)

Spiesz, P.R.; Ballari, M.; Brouwers, H.J.H.; Ferreira, R. M.; Gulikers, J.; Andrade, C.

2009-01-01

In this study the Rapid Chloride Migration test (RCM) standardized as NT Build 492 and BAW-Merkblatt is reviewed. Since the traditional natural diffusion tests are laborious, time consuming and costly, they are not always preferred from a practical point of view. To overcome these disadvantages,

Renewable energies in the transport sector: Costs and possibilities

International Nuclear Information System (INIS)

Ajanovic, Amela; Haas, Reinhard

2007-01-01

Alternative fuels based on renewable energy sources, such as biodiesel, bioethanol and hydrogen from RES, have potential to reduce greenhouse gas emissions, climate change, to increase supply security and energy diversity. Transition from a fossil fuels based transport to future sustainable and clean transport is a long term and cost intensive process, especially for hydrogen use in transport. Hydrogen infrastructure is missing and most of hydrogen technologies are still at developing stage.This paper examines the economics of biofuels (bioethanol and biodiesel) and hydrogen production from renewable energy sources. The current and future costs of alternative fuels as well as the costs of the provided energy services are analysed in a dynamic framework till the year 2050. The goal is to identify the market chance of alternative fuels in a long term (till 2050). A rapid increase of fuel cell vehicles with hydrogen on the market is not expected before 2030, mainly because the costs of the fuel cells are still very high and because their efficiency, as well as the travelling range, is rather moderate.However, the use of alternative fuels in transport sector is very dependent on the political will. If political preferences, like e.g. zero-emission-vehicles, gain strong relevance this new fuels could accelerate its market penetration significantly

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

African Journals Online (AJOL)

user

2011-02-21

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

Too expensive to meter: the influence of transaction costs in transportation and communication.

Science.gov (United States)

Levinson, David; Odlyzko, Andrew

2008-06-13

Technology appears to be making fine-scale charging (as in tolls on roads that depend on time of day or even on current and anticipated levels of congestion) increasingly feasible. Such charging also appears to be increasingly desirable, as traffic on roads continues to grow and costs and public opposition limit new construction. Similar incentives towards fine-scale charging also appear to be operating in communications and other areas, such as electricity usage. Standard economic theory supports such measures and technology is being developed and deployed to implement them. But their spread is not very rapid and their prospects for the future are uncertain. This paper presents a collection of sketches, ranging from ancient history to very recent developments, that illustrate the costs that charging imposes. Some of those costs are explicit (in terms of the monetary costs to users and the costs of implementing the charging mechanisms). Others are implicit, such as the time or the mental processing costs of users. These argue that the case for fine-scale charging is not unambiguous and that in many cases such charging may lead to undesirable outcomes.

Cranking up the heat: relationships between energetically costly song features and the increase in thorax temperature in male crickets and katydids.

Science.gov (United States)

Erregger, Bettina; Kovac, Helmut; Stabentheiner, Anton; Hartbauer, Manfred; Römer, Heinrich; Schmidt, Arne K D

2017-07-15

Sexual displays of acoustically signalling insects are used in the context of mate attraction and mate choice. While energetic investment in sound production can increase the reproductive success of the sender, this entails metabolic costs. Resource allocation to sexually selected, reproductive traits can trade off against allocation to naturally selected traits (e.g. growth, immunity) when individuals' energy budgets are limited. Estimating the magnitude of the costs invested in acoustic signalling is necessary to understand this trade-off and its influence on fitness and life history. To compare the costs associated with acoustic signalling for two ensiferan species, we simultaneously took respiratory measurements to record the rate of CO 2 production and used infrared thermography to measure the increase in thorax temperature. Furthermore, to identify what combinations of acoustic parameters were energetically costly for the sender, we recorded the calling songs of 22 different cricket and katydid species for a comparative analysis and measured their thorax temperature while they sang. Acoustic signalling was energetically costly for Mecopoda sp. and Anurogryllus muticus , requiring a 12- and 16-fold increase over resting levels in the CO 2 production rate. Moreover, calling increased thorax temperature, on average by 7.6 and 5.8°C, respectively. We found that the song intensity and effective calling rate, not simply the chirp/trill duty cycle or the pulse rate alone, were good predictors for the thorax temperature increase in males. © 2017. Published by The Company of Biologists Ltd.

The role of cost-effectiveness analysis in developing nutrition policy.

Science.gov (United States)

Cobiac, Linda J; Veerman, Lennert; Vos, Theo

2013-01-01

Concern about the overconsumption of unhealthy foods is growing worldwide. With high global rates of noncommunicable diseases related to poor nutrition and projections of more rapid increases of rates in low- and middle-income countries, it is vital to identify effective but low-cost interventions. Cost-effectiveness studies show that individually targeted dietary interventions can be effective and cost-effective, but a growing number of modeling studies suggest that population-wide approaches may bring larger and more sustained benefits for population health at a lower cost to society. Mandatory regulation of salt in processed foods, in particular, is highly recommended. Future research should focus on lacunae in the current evidence base: effectiveness of interventions addressing the marketing, availability, and price of healthy and unhealthy foods; modeling health impacts of complex dietary changes and multi-intervention strategies; and modeling health implications in diverse subpopulations to identify interventions that will most efficiently and effectively reduce health inequalities.

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

Energy Technology Data Exchange (ETDEWEB)

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

2000-05-01

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

Rapid development of paper-based fluidic diagnostic devices

CSIR Research Space (South Africa)

Smith, S

2014-11-01

Full Text Available We present a method for rapid and low-cost development of microfluidic diagnostic devices using paper-based techniques. Specifically, the implementation of fluidic flow paths and electronics on paper are demonstrated, with the goal of producing...

Large and abundant flowers increase indirect costs of corollas: a study of coflowering sympatric Mediterranean species of contrasting flower size.

Science.gov (United States)

Teixido, Alberto L; Valladares, Fernando

2013-09-01

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.

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

Directory of Open Access Journals (Sweden)

Abiodun Ogunniyi

2016-01-01

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

The Cost of Distribution System Upgrades to Accommodate Increasing Penetrations of Distributed Photovoltaic Systems on Real Feeders in the United States

Energy Technology Data Exchange (ETDEWEB)

Horowitz, Kelsey A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Ding, Fei [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mather, Barry A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Palmintier, Bryan S [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2018-04-05

The increasing deployment of distributed photovoltaic systems (DPV) can impact operations at the distribution level and the transmission level of the electric grid. It is important to develop and implement forward-looking approaches for calculating distribution upgrade costs that can be used to inform system planning, market and tariff design, cost allocation, and other policymaking as penetration levels of DPV increase. Using a bottom-up approach that involves iterative hosting capacity analysis, this report calculates distribution upgrade costs as a function of DPV penetration on three real feeders - two in California and one in the Northeastern United States.

Costs and remuneration of renewables in liberalized market

International Nuclear Information System (INIS)

Pezzaglia, M.

2008-01-01

The massive introduction of financial incentives schemes of production of energy from renewable sources result a rapid development of technology production and the market. The production costs are strongly influenced by types of technology. This studies have yet to track the costs of production [it

Rapid extirpation of a North American frog coincides with an increase in fungal pathogen prevalence: Historical analysis and implications for reintroduction.

Science.gov (United States)

Adams, Andrea J; Pessier, Allan P; Briggs, Cheryl J

2017-12-01

As extinctions continue across the globe, conservation biologists are turning to species reintroduction programs as one optimistic tool for addressing the biodiversity crisis. For repatriation to become a viable strategy, fundamental prerequisites include determining the causes of declines and assessing whether the causes persist in the environment. Invasive species-especially pathogens-are an increasingly significant factor contributing to biodiversity loss. We hypothesized that Batrachochytrium dendrobatidis (Bd), the causative agent of the deadly amphibian disease chytridiomycosis, was important in the rapid (herpetological experts, analysis of archived field notes and museum specimen collections, and field sampling of the extant amphibian assemblage to examine (1) historical relative abundance of R. boylii ; (2) potential causes of R. boylii declines; and (3) historical and contemporary prevalence of Bd. We found that R. boylii were relatively abundant prior to their rapid extirpation, and an increase in Bd prevalence coincided with R. boylii declines during a time of rapid change in the region, wherein backcountry recreation, urban development, and the amphibian pet trade were all on the rise. In addition, extreme flooding during the winter of 1969 coincided with localized extirpations in R. boylii populations observed by interview respondents. We conclude that Bd likely played an important role in the rapid extirpation of R. boylii from southern California and that multiple natural and anthropogenic factors may have worked in concert to make this possible in a relatively short period of time. This study emphasizes the importance of recognizing historical ecological contexts in making future management and reintroduction decisions.

Rapid Bolus Administration Does not Increase The Extravasation Rate of Albumin: A Randomized Controlled Trial in The Endotoxemic Pig.

Science.gov (United States)

von Seth, Magnus; Lipcsey, Miklós; Engström, Peter; Larsson, Anders; Hillered, Lars; Maripuu, Enn; Widström, Charles; Sjölin, Jan

2017-04-01

Some experimental data suggest that rapid bolus administration of albumin causes less plasma-expanding effects than slow, continuous infusion. To determine whether rapid bolus administration, in comparison with slow infusion, results in greater extravasation of albumin in experimental septic shock we performed a randomized controlled trial with 32 endotoxemic pigs. The animals were monitored and ventilated with standard intensive care equipment and given 10 mL × kg 5% albumin labeled with Technetium-99m, either as a rapid 15-min bolus (Bolus group, n = 16) or as a 2-h infusion (Infusion group, n = 16). Radioactivity was monitored in plasma, extracellular microdialysate, and urine for 6 h. Physiological parameters were monitored hourly. Radioactivity in the liver, spleen, kidney, and lung was analyzed post mortem.The plasma area under the curve activity0-6 h was 4.4 ± 0.9 × 10 in the Bolus group and 4.4 ± 1.1 × 10 counts × min × mL × h in the Infusion group. Blood hemoglobin levels increased in both groups, suggesting severe capillary leakage. Yet, there were no group differences in albumin radioactivity in plasma, muscle tissue, urine, or in the post-mortem analysis of the organs. Following albumin administration, circulatory and respiratory parameters were similar in the two groups.In conclusion, the present results suggest that albumin might be given as a bolus without leading to increased extravasation of albumin, in contrast to previous animal experiments in rodents.

Solid rocket motor cost model

Science.gov (United States)

Harney, A. G.; Raphael, L.; Warren, S.; Yakura, J. K.

1972-01-01

A systematic and standardized procedure for estimating life cycle costs of solid rocket motor booster configurations. The model consists of clearly defined cost categories and appropriate cost equations in which cost is related to program and hardware parameters. Cost estimating relationships are generally based on analogous experience. In this model the experience drawn on is from estimates prepared by the study contractors. Contractors' estimates are derived by means of engineering estimates for some predetermined level of detail of the SRM hardware and program functions of the system life cycle. This method is frequently referred to as bottom-up. A parametric cost analysis is a useful technique when rapid estimates are required. This is particularly true during the planning stages of a system when hardware designs and program definition are conceptual and constantly changing as the selection process, which includes cost comparisons or trade-offs, is performed. The use of cost estimating relationships also facilitates the performance of cost sensitivity studies in which relative and comparable cost comparisons are significant.

Going for increased recycling. A social cost-benefit analysis; Inzetten op meer recycling. Een maatschappelijke kosten-batenanalyse

Energy Technology Data Exchange (ETDEWEB)

Warringa, G.E.A.; De Bruyn, M.; Bijleveld, M.M.

2013-05-15

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

Novel flood risk assessment framework for rapid decision making

Science.gov (United States)

Valyrakis, Manousos; Koursari, Eftychia; Solley, Mark

2016-04-01

The impacts of catastrophic flooding, have significantly increased over the last few decades. This is due to primarily the increased urbanisation in ever-expanding mega-cities as well as due to the intensification both in magnitude and frequency of extreme hydrologic events. Herein a novel conceptual framework is presented that incorporates the use of real-time information to inform and update low dimensionality hydraulic models, to allow for rapid decision making towards preventing loss of life and safeguarding critical infrastructure. In particular, a case study from the recent UK floods in the area of Whitesands (Dumfries), is presented to demonstrate the utility of this approach. It is demonstrated that effectively combining a wealth of readily available qualitative information (such as crowdsourced visual documentation or using live data from sensing techniques), with existing quantitative data, can help appropriately update hydraulic models and reduce modelling uncertainties in future flood risk assessments. This approach is even more useful in cases where hydraulic models are limited, do not exist or were not needed before unpredicted dynamic modifications to the river system took place (for example in the case of reduced or eliminated hydraulic capacity due to blockages). The low computational cost and rapid assessment this framework offers, render it promising for innovating in flood management.

Implications of the international reduction pledges on long-term energy system changes and costs in China and India

International Nuclear Information System (INIS)

Lucas, Paul L.; Shukla, P.R.; Chen, Wenying; Ruijven, Bas J. van; Dhar, Subash; Elzen, Michel G.J. den; Vuuren, Detlef P. van

2013-01-01

This paper analyses the impact of postponing global mitigation action on abatement costs and energy systems changes in China and India. It compares energy-system changes and mitigation costs from a global and two national energy-system models under two global emission pathways with medium likelihood of meeting the 2 °C target: a least-cost pathway and a pathway that postpones ambitious mitigation action, starting from the Copenhagen Accord pledges. Both pathways have similar 2010–2050 cumulative greenhouse gas emissions. The analysis shows that postponing mitigation action increases the lock-in in less energy efficient technologies and results in much higher cumulative mitigation costs. The models agree that carbon capture and storage (CCS) and nuclear energy are important mitigation technologies, while the shares of biofuels and other renewables vary largely over the models. Differences between India and China with respect to the timing of emission reductions and the choice of mitigation measures relate to differences in projections of rapid economic change, capital stock turnover and technological development. Furthermore, depending on the way it is implemented, climate policy could increase indoor air pollution, but it is likely to provide synergies for energy security. These relations should be taken into account when designing national climate policies. - highlights: • We analyze long-term impacts of the international pledges for China and India. • We compare a least-cost pathway with a pathway starting from the Copenhagen pledges. • Postponing mitigation action implies much higher cumulative mitigation costs. • Postponing increases fossil fuel dependence and requires deeper long-term reductions. • Countries differ mainly due to different periods of rapid economic change

Increased mobility and on/off ratio in organic field-effect transistors using low-cost guanine-pentacene multilayers

Science.gov (United States)

Shi, Wei; Zheng, Yifan; Taylor, André D.; Yu, Junsheng; Katz, Howard E.

2017-07-01

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.

Rehabilitating acid soils for increasing crop productivity through low-cost liming material.

Science.gov (United States)

Bhat, Javid Ahmad; Kundu, Manik Chandra; Hazra, Gora Chand; Santra, Gour Hari; Mandal, Biswapati

2010-09-15

Productivity of red and lateritic soils is low because of their acidity and deficiencies in few essential nutrients viz., nitrogen, phosphorus, calcium, zinc, boron, molybdenum etc. We compared the effectiveness of basic slag, a low-cost liming material, with that of calcite as an ameliorant for these soils using mustard followed by rice as test crops. Experiments were conducted with three levels of each of basic slag and calcite along with a control on farmers' fields at 14 different locations. Influence of farmyard manure (FYM) and poultry manure (PM) on the effectiveness of the slag was also tested. On an average, basic slag performed better than calcite in increasing yields of both mustard and rice and left over higher amounts of available Ca, Si and Zn in residual soils. The slag also improved N, P, K and Ca nutrition of mustard and Si and Zn nutrition of rice with a favorable benefit:cost (B:C) ratio over the calcite (4.82 vs. 1.44). Effectiveness of the basic slag improved when it was applied in combination with FYM or PM (B:C, 5.83 and 6.27). Basic slag can, therefore, be advocated for use in the acidic red and lateritic soils for economically improving their productivity. Copyright 2010 Elsevier B.V. All rights reserved.

Rehabilitating acid soils for increasing crop productivity through low-cost liming material

International Nuclear Information System (INIS)

Bhat, Javid Ahmad; Kundu, Manik Chandra; Hazra, Gora Chand; Santra, Gour Hari; Mandal, Biswapati

2010-01-01

Productivity of red and lateritic soils is low because of their acidity and deficiencies in few essential nutrients viz., nitrogen, phosphorus, calcium, zinc, boron, molybdenum etc. We compared the effectiveness of basic slag, a low-cost liming material, with that of calcite as an ameliorant for these soils using mustard followed by rice as test crops. Experiments were conducted with three levels of each of basic slag and calcite along with a control on farmers' fields at 14 different locations. Influence of farmyard manure (FYM) and poultry manure (PM) on the effectiveness of the slag was also tested. On an average, basic slag performed better than calcite in increasing yields of both mustard and rice and left over higher amounts of available Ca, Si and Zn in residual soils. The slag also improved N, P, K and Ca nutrition of mustard and Si and Zn nutrition of rice with a favorable benefit:cost (B:C) ratio over the calcite (4.82 vs. 1.44). Effectiveness of the basic slag improved when it was applied in combination with FYM or PM (B:C, 5.83 and 6.27). Basic slag can, therefore, be advocated for use in the acidic red and lateritic soils for economically improving their productivity.

Rehabilitating acid soils for increasing crop productivity through low-cost liming material

Energy Technology Data Exchange (ETDEWEB)

Bhat, Javid Ahmad [Directorate of Research, Bidhan Chandra Krishi Viswavidyalaya, Kalyani - 741 235, West Bengal (India); Kundu, Manik Chandra, E-mail: mckundu@rediffmail.com [Directorate of Research, Bidhan Chandra Krishi Viswavidyalaya, Kalyani - 741 235, West Bengal (India); Hazra, Gora Chand [Directorate of Research, Bidhan Chandra Krishi Viswavidyalaya, Kalyani - 741 235, West Bengal (India); Santra, Gour Hari [Department of Soil Science and Agril. Chemistry, Orissa University of Agriculture and Technology, Bhubaneswar - 751003, Orissa (India); Mandal, Biswapati [Directorate of Research, Bidhan Chandra Krishi Viswavidyalaya, Kalyani - 741 235, West Bengal (India)

2010-09-15

Productivity of red and lateritic soils is low because of their acidity and deficiencies in few essential nutrients viz., nitrogen, phosphorus, calcium, zinc, boron, molybdenum etc. We compared the effectiveness of basic slag, a low-cost liming material, with that of calcite as an ameliorant for these soils using mustard followed by rice as test crops. Experiments were conducted with three levels of each of basic slag and calcite along with a control on farmers' fields at 14 different locations. Influence of farmyard manure (FYM) and poultry manure (PM) on the effectiveness of the slag was also tested. On an average, basic slag performed better than calcite in increasing yields of both mustard and rice and left over higher amounts of available Ca, Si and Zn in residual soils. The slag also improved N, P, K and Ca nutrition of mustard and Si and Zn nutrition of rice with a favorable benefit:cost (B:C) ratio over the calcite (4.82 vs. 1.44). Effectiveness of the basic slag improved when it was applied in combination with FYM or PM (B:C, 5.83 and 6.27). Basic slag can, therefore, be advocated for use in the acidic red and lateritic soils for economically improving their productivity.

Controversies in Antimicrobial Stewardship: Focus on New Rapid Diagnostic Technologies and Antimicrobials

Directory of Open Access Journals (Sweden)

Eric Wenzler

2016-01-01

Full Text Available Antimicrobial stewardship programs (ASPs are challenged with ensuring appropriate antimicrobial use while minimizing expenditures. ASPs have consistently demonstrated improved patient outcomes and significant cost reductions but are continually required to justify the costs of their existence and interventions due to the silo mentality often adopted by hospital administrators. As new technologies and antimicrobials emerge, ASPs are in a constant tug-of-war between providing optimal clinical outcomes and ensuring cost containment. Additionally, robust data on cost-effectiveness of new rapid diagnostic technologies and antimicrobials with subsequent ASP interventions to provide justification are lacking. As the implementation of an ASP will soon be mandatory for acute care hospitals in the United States, ASPs must find ways to justify novel interventions to align themselves with healthcare administrators. This review provides a framework for the justification of implementing a rapid diagnostic test or adding a new antimicrobial to formulary with ASP intervention, reviews approaches to demonstrating cost-effectiveness, and proposes methods for which ASPs may reduce healthcare expenditures via alternative tactics.

Cost analysis of robotic versus laparoscopic general surgery procedures.

Science.gov (United States)

Higgins, Rana M; Frelich, Matthew J; Bosler, Matthew E; Gould, Jon C

2017-01-01

Robotic surgical systems have been used at a rapidly increasing rate in general surgery. Many of these procedures have been performed laparoscopically for years. In a surgical encounter, a significant portion of the total costs is associated with consumable supplies. Our hospital system has invested in a software program that can track the costs of consumable surgical supplies. We sought to determine the differences in cost of consumables with elective laparoscopic and robotic procedures for our health care organization. De-identified procedural cost and equipment utilization data were collected from the Surgical Profitability Compass Procedure Cost Manager System (The Advisory Board Company, Washington, DC) for our health care system for laparoscopic and robotic cholecystectomy, fundoplication, and inguinal hernia between the years 2013 and 2015. Outcomes were length of stay, case duration, and supply cost. Statistical analysis was performed using a t-test for continuous variables, and statistical significance was defined as p robotic procedures. Length of stay did not differ for fundoplication or cholecystectomy. Length of stay was greater for robotic inguinal hernia repair. Case duration was similar for cholecystectomy (84.3 robotic and 75.5 min laparoscopic, p = 0.08), but significantly longer for robotic fundoplication (197.2 robotic and 162.1 min laparoscopic, p = 0.01) and inguinal hernia repair (124.0 robotic and 84.4 min laparoscopic, p = ≪0.01). We found a significantly increased cost of general surgery procedures for our health care system when cases commonly performed laparoscopically are instead performed robotically. Our analysis is limited by the fact that we only included costs associated with consumable surgical supplies. The initial acquisition cost (over $1 million for robotic surgical system), depreciation, and service contract for the robotic and laparoscopic systems were not included in this analysis.

Future regional nuclear fuel cycle cooperation in East Asia: Energy security costs and benefits

International Nuclear Information System (INIS)

Hippel, David von; Hayes, Peter; Kang, Jungmin; Katsuta, Tadahiro

2011-01-01

Economic growth in East Asia has rapidly increased regional energy, and especially, electricity needs. Many of the countries of East Asia have sought or are seeking to diversify their energy sources and bolster their energy supply and/or environmental security by developing nuclear power. Rapid development of nuclear power in East Asia brings with it concerns regarding nuclear weapons proliferation associated with uranium enrichment and spent nuclear fuel management. This article summarizes the development and analysis of four different scenarios of nuclear fuel cycle management in East Asia, including a scenario where each major nuclear power user develops uranium enrichment and reprocessing of spent fuel individually, scenarios featuring cooperation in the full fuel cycle, and a scenario where reprocessing is avoided in favor of dry cask storage of spent fuel. The material inputs and outputs and costs of key fuel cycle elements under each scenario are summarized. - Highlights: → We evaluate four scenarios of regional nuclear fuel cycle cooperation in East Asia and the Pacific. → The scenarios cover fuel supply, enrichment, transport, reprocessing, and waste management. → We evaluate nuclear material flows, energy use, costs, and qualitative energy security impacts. → Regional cooperation on nuclear fuel cycle issues can help to enhance energy security. → A regional scenario in which reprocessing is rapidly phased out shows security and cost advantages.

Rapid MR imaging

International Nuclear Information System (INIS)

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

1988-01-01

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

Costs of performance based maintenance for local roads: Case study Albania

OpenAIRE

Jokanović Igor; Grujić Bojana; Zeljić Dragana; Grujić Žarko; Svilar Mila

2017-01-01

The provision and maintenance of road infrastructure is a major global business, consequently it is essential that road maintenance services are provided in the most cost effective manner. Without regular maintenance, roads can rapidly fall into disrepair, preventing realization of the longer term impacts of road improvements on development, such as increased agricultural production and growth in school enrollment, which is of particular importance for a network of local (access) roads. Inade...

Health insurance, cost expectations, and adverse job turnover.

Science.gov (United States)

Ellis, Randall P; Albert Ma, Ching-To

2011-01-01

Because less healthy employees value health insurance more than the healthy ones, when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover, and it implies that a firm's expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes, or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs, some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999 MEDSTAT MarketScan and 1997 Employer Health Insurance Survey data, we find that expected employee health expenditures at firms that offer insurance have lower within-firm and higher between-firm variance than at firms that do not. Turnover rates are systematically higher in industries in which firms are less likely to offer insurance. Simulations of the offer decision capturing between-firm health-cost heterogeneity and expected turnover rates match the observed pattern across firm sizes well. 2010 John Wiley & Sons, Ltd.

Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.

Science.gov (United States)

Theodore, Brian R; Whittington, Jan; Towle, Cara; Tauben, David J; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z

2015-06-01

With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. Wiley Periodicals, Inc.

Cost benefit justification of nuclear plant reliability improvement

International Nuclear Information System (INIS)

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

1986-01-01

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

Cost of Dengue Vector Control Activities in Malaysia.

Science.gov (United States)

Packierisamy, P Raviwharmman; Ng, Chiu-Wan; Dahlui, Maznah; Inbaraj, Jonathan; Balan, Venugopalan K; Halasa, Yara A; Shepard, Donald S

2015-11-01

Dengue fever, an arbovirus disease transmitted by Aedes mosquitoes, has recently spread rapidly, especially in the tropical countries of the Americas and Asia-Pacific regions. It is endemic in Malaysia, with an annual average of 37,937 reported dengue cases from 2007 to 2012. This study measured the overall economic impact of dengue in Malaysia, and estimated the costs of dengue prevention. In 2010, Malaysia spent US$73.5 million or 0.03% of the country's GDP on its National Dengue Vector Control Program. This spending represented US$1,591 per reported dengue case and US$2.68 per capita population. Most (92.2%) of this spending occurred in districts, primarily for fogging. A previous paper estimated the annual cost of dengue illness in the country at US$102.2 million. Thus, the inclusion of preventive activities increases the substantial estimated cost of dengue to US$175.7 million, or 72% above illness costs alone. If innovative technologies for dengue vector control prove efficacious, and a dengue vaccine was introduced, substantial existing spending could be rechanneled to fund them. © The American Society of Tropical Medicine and Hygiene.

Thermodynamic balance of photosynthesis and transpiration at increasing CO2 concentrations and rapid light fluctuations.

Science.gov (United States)

Marín, Dolores; Martín, Mercedes; Serrot, Patricia H; Sabater, Bartolomé

2014-02-01

Experimental and theoretical flux models have been developed to reveal the influence of sun flecks and increasing CO2 concentrations on the energy and entropy balances of the leaf. The rapid and wide range of fluctuations in light intensity under field conditions were simulated in a climatic gas exchange chamber and we determined the energy and entropy balance of the leaf based on radiation and gas exchange measurements. It was estimated that the energy of photosynthetic active radiation (PAR) accounts for half of transpiration, which is the main factor responsible for the exportation of the entropy generated in photosynthesis (Sg) out of the leaf in order to maintain functional the photosynthetic machinery. Although the response of net photosynthetic production to increasing concentrations of CO2 under fluctuating light is similar to that under continuous light, rates of transpiration respond slowly to changes of light intensity and are barely affected by the concentration of CO2 in the range of 260-495 ppm, in which net photosynthesis increases by more than 100%. The analysis of the results confirms that future increases of CO2 will improve the efficiency of the conversion of radiant energy into biomass, but will not reduce the contribution of plant transpiration to the leaf thermal balance. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

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

Science.gov (United States)

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

2016-03-02

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

A web-based rapid assessment tool for production publishing solutions

Science.gov (United States)

Sun, Tong

2010-02-01

Solution assessment is a critical first-step in understanding and measuring the business process efficiency enabled by an integrated solution package. However, assessing the effectiveness of any solution is usually a very expensive and timeconsuming task which involves lots of domain knowledge, collecting and understanding the specific customer operational context, defining validation scenarios and estimating the expected performance and operational cost. This paper presents an intelligent web-based tool that can rapidly assess any given solution package for production publishing workflows via a simulation engine and create a report for various estimated performance metrics (e.g. throughput, turnaround time, resource utilization) and operational cost. By integrating the digital publishing workflow ontology and an activity based costing model with a Petri-net based workflow simulation engine, this web-based tool allows users to quickly evaluate any potential digital publishing solutions side-by-side within their desired operational contexts, and provides a low-cost and rapid assessment for organizations before committing any purchase. This tool also benefits the solution providers to shorten the sales cycles, establishing a trustworthy customer relationship and supplement the professional assessment services with a proven quantitative simulation and estimation technology.

Europe's gas consumption and imports to increase with adequate low cost supplies

International Nuclear Information System (INIS)

Odell, P.R.

1997-01-01

Gas in Europe has always been sold above its long-run supply price. Lower prices, however, still permit profitable indigeneous supply expansion. As further reductions in production and transport costs from technological advances are expected, this will continue based on the exploitation of large proven and probable reserves. By 2025, indigeneous output will be 60% up on 1995. Nevertheless, an average 2.2%/annum growth in gas demand will increase import dependence from 130 to 320 BCM over this period. Future international oil prices indicate gas-equivalent border values adequate to secure profitable supply from a range of external sources, leading to continuing competition for markets and the diversification of imports. (9 tables; 31 references). (author)

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Science.gov (United States)

Nousiainen, Markku T; McQueen, Sydney A; Ferguson, Peter; Alman, Benjamin; Kraemer, William; Safir, Oleg; Reznick, Richard; Sonnadara, Ranil

2016-04-01

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.

Rapid population growth.

Science.gov (United States)

1972-01-01

At the current rate of population growth, world population by 2000 is expected to reach 7 billion or more, with developing countries accounting for some 5.4 billion, and economically advanced nations accounting for 1.6 billion. 'Population explosion' is the result of falling mortality rates and continuing high birth rates. Many European countries, and Japan, have already completed what is termed as demographic transition, that is, birth rates have fallen to below 20 births per 1000 population, death rates to 10/1000 population, and annual growth rates are 1% or less; annual growth rates for less developed countries ranged from 2 to 3.5%. Less developed countries can be divided into 3 groups: 1) countries with both high birth and death rates; 2) countries with high birth rates and low death rates; and 3) countries with intermediate and declining birth rates and low death rates. Rapid population growth has serious economic consequences. It encourages inequities in income distribution; it limits rate of growth of gross national product by holding down level of savings and capital investments; it exerts pressure on agricultural production and land; and it creates unemployment problems. In addition, the quality of education for increasing number of chidren is adversely affected, as high proportions of children reduce the amount that can be spent for the education of each child out of the educational budget; the cost and adequacy of health and welfare services are affected in a similar way. Other serious consequences of rapid population growth are maternal death and illness, and physical and mental retardation of children of very poor families. It is very urgent that over a billion births be prevented in the next 30 years to reduce annual population growth rate from the current 2% to 1% per year.

Rapid Prototyping in Orthopaedic Surgery: A User's Guide

Science.gov (United States)

Frame, Mark; Huntley, James S.

2012-01-01

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case. PMID:22666160

Diagnostic evaluation of rapid tests for scrub typhus in the Indian population is needed.

Science.gov (United States)

Shivalli, Siddharudha

2016-05-12

Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is being described as a re-emerging infectious disease in India. Differentiating scrub typhus from other endemic diseases like malaria, leptospirosis, dengue fever, typhoid, etc. is difficult due to overlapping clinical features and a lower positivity for eschars in Asian populations. Hence, the diagnosis heavily relies on laboratory tests. Costs and the need of technical expertise limit the wide use of indirect immunoperoxidase or immunofluorescence assays, ELISA and PCR. The Weil-Felix test is the most commonly used and least expensive serological test, but lacks both sensitivity and specificity. Hence, the diagnosis of scrub typhus is often delayed or overlooked. With due consideration of the cost, rapidity, single test result and simplicity of interpretation, rapid diagnostic tests have come into vogue. However, evaluation of rapid diagnostic tests for scrub typhus in the Indian population is needed to justify or discourage their use. Research studies are needed to find the most suitable test in terms of the rapidity of the result, simplicity of the procedure, ease of interpretation and cost to be used in the Indian populace.

Amperometric immunosensor for rapid detection of Mycobacterium tuberculosis

International Nuclear Information System (INIS)

Hiraiwa, Morgan; Lee, Hyun-Boo; Inoue, Shinnosuke; Chung, Jae-Hyun; Kim, Jong-Hoon; Becker, Annie L; Weigel, Kris M; Cangelosi, Gerard A; Lee, Kyong-Hoon

2015-01-01

Tuberculosis (TB) has been a major public health problem, which can be better controlled by using accurate and rapid diagnosis in low-resource settings. A simple, portable, and sensitive detection method is required for point-of-care (POC) settings. This paper studies an amperometric biosensor using a microtip immunoassay for a rapid and low-cost detection of Mycobacterium tuberculosis (MTB) in sputum. MTB in sputum is specifically captured on the functionalized microtip surface and detected by electric current. According to the numerical study, the current signal on the microtip surface is linearly changed with increasing immersion depth. Using a reference microtip, the immersion depth is compensated for a sensing microtip. On the microtip surface, target bacteria are concentrated and organized by a coffee-ring effect, which amplifies the electric current. To enhance the signal-to-noise ratio, both the sample processing and rinsing steps are presented with the use of deionized water as a medium for the amperometric measurement. When applied to cultured MTB cells spiked into human sputum, the detection limit was 100 CFU mL −1 , comparable to a more labor-intensive fluorescence detection method reported previously. (paper)

Amperometric immunosensor for rapid detection of Mycobacterium tuberculosis

Science.gov (United States)

Hiraiwa, Morgan; Kim, Jong-Hoon; Lee, Hyun-Boo; Inoue, Shinnosuke; Becker, Annie L.; Weigel, Kris M.; Cangelosi, Gerard A.; Lee, Kyong-Hoon; Chung, Jae-Hyun

2015-05-01

Tuberculosis (TB) has been a major public health problem, which can be better controlled by using accurate and rapid diagnosis in low-resource settings. A simple, portable, and sensitive detection method is required for point-of-care (POC) settings. This paper studies an amperometric biosensor using a microtip immunoassay for a rapid and low-cost detection of Mycobacterium tuberculosis (MTB) in sputum. MTB in sputum is specifically captured on the functionalized microtip surface and detected by electric current. According to the numerical study, the current signal on the microtip surface is linearly changed with increasing immersion depth. Using a reference microtip, the immersion depth is compensated for a sensing microtip. On the microtip surface, target bacteria are concentrated and organized by a coffee-ring effect, which amplifies the electric current. To enhance the signal-to-noise ratio, both the sample processing and rinsing steps are presented with the use of deionized water as a medium for the amperometric measurement. When applied to cultured MTB cells spiked into human sputum, the detection limit was 100 CFU mL-1, comparable to a more labor-intensive fluorescence detection method reported previously.

Risks and Benefits of Rapid Clozapine Titration.

Science.gov (United States)

Lochhead, Jeannie D; Nelson, Michele A; Schneider, Alan L

2016-05-18

Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

Risks and benefits of rapid clozapine titration

Directory of Open Access Journals (Sweden)

Jeannie D. Lochhead

2016-05-01

Full Text Available Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

Rapid visualization of latent fingermarks using gold seed-mediated enhancement

Directory of Open Access Journals (Sweden)

Chia-Hao Su

2016-11-01

Full Text Available Abstract Background Fingermarks are one of the most important and useful forms of physical evidence in forensic investigations. However, latent fingermarks are not directly visible, but can be visualized due to the presence of other residues (such as inorganic salts, proteins, polypeptides, enzymes and human metabolites which can be detected or recognized through various strategies. Convenient and rapid techniques are still needed to provide obvious contrast between the background and the fingermark ridges and to then visualize latent fingermark with a high degree of selectivity and sensitivity. Results In this work, lysozyme-binding aptamer-conjugated Au nanoparticles (NPs are used to recognize and target lysozyme in the fingermark ridges, and Au+-complex solution is used as a growth agent to reduce Au+ from Au+ to Au0 on the surface of the Au NPs. Distinct fingermark patterns were visualized on a range of professional forensic within 3 min; the resulting images could be observed by the naked eye without background interference. The entire processes from fingermark collection to visualization only entails two steps and can be completed in less than 10 min. The proposed method provides cost and time savings over current fingermark visualization methods. Conclusions We report a simple, inexpensive, and fast method for the rapid visualization of latent fingermarks on the non-porous substrates using Au seed-mediated enhancement. Au seed-mediated enhancement is used to achieve the rapid visualization of latent fingermarks on non-porous substrates by the naked eye without the use of expensive or sophisticated instruments. The proposed approach offers faster detection and visualization of latent fingermarks than existing methods. The proposed method is expected to increase detection efficiency for latent fingermarks and reduce time requirements and costs for forensic investigations.

Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study

NARCIS (Netherlands)

E.A.B. Over (Eelco); G.C.W. Wendel-Vos (Wanda); M. van den Berg (Matthijs); H.H.H. Reenen (Heleen ); L. Tariq (Luqman); R.T. Hoogenveen (Rudolf); P.H.M. Van Baal (Pieter)

2012-01-01

textabstractBackground: Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general

Operational feasibility of using whole blood in the rapid HIV testing algorithm of a resource-limited settings like Bangladesh.

Science.gov (United States)

Munshi, Saif U; Oyewale, Tajudeen O; Begum, Shahnaz; Uddin, Ziya; Tabassum, Shahina

2016-03-01

Serum-based rapid HIV testing algorithm in Bangladesh constitutes operational challenge to scaleup HIV testing and counselling (HTC) in the country. This study explored the operational feasibility of using whole blood as alternative to serum for rapid HIV testing in Bangladesh. Whole blood specimens were collected from two study groups. The groups included HIV-positive patients (n = 200) and HIV-negative individuals (n = 200) presenting at the reference laboratory in Dhaka, Bangladesh. The specimens were subjected to rapid HIV tests using the national algorithm with A1 = Alere Determine (United States), A2 = Uni-Gold (Ireland), and A3 = First Response (India). The sensitivity and specificity of the test results, and the operational cost were compared with current serum-based testing. The sensitivities [95% of confidence interval (CI)] for A1, A2, and A3 tests using whole blood were 100% (CI: 99.1-100%), 100% (CI: 99.1-100%), and 97% (CI: 96.4-98.2%), respectively, and specificities of all test kits were 100% (CI: 99.1-100%). Significant (P < 0.05) reduction in the cost of establishing HTC centre and consumables by 94 and 61%, respectively, were observed. The cost of administration and external quality assurance reduced by 39 and 43%, respectively. Overall, there was a 36% cost reduction in total operational cost of rapid HIV testing with blood when compared with serum. Considering the similar sensitivity and specificity of the two specimens, and significant cost reduction, rapid HIV testing with whole blood is feasible. A review of the national HIV rapid testing algorithm with whole blood will contribute toward improving HTC coverage in Bangladesh.

Cost-Benefit Analysis of a Novel DC Fast-Charging Station with a Local Battery Storage for EVs

DEFF Research Database (Denmark)

Gjelaj, Marjan; Træholt, Chresten; Hashemi Toghroljerdi, Seyedmostafa

2017-01-01

and decrease the connection fees. Finally, an economic evaluation is done to evaluate the feasibility and the cost-benefit analysis (CBA) of the DCFCSs. The proposed approach considers various technical and economic issues, such as cost of installation, connection fees and life cycle cost of the batteries....... The proposed cost-benefit analysis can be used to verify the effectiveness and applicability of DCFCS in large scale....... models by increasing the size of the batteries. To satisfy EV load demand of the new EV models in urban areas the public DC Fast-Charging Station (DCFCS) is indispensable to recharge EVs rapidly. The introduction of the Battery Energy Storage within the DCFCSs is considered in this paper an alternative...

Rapid Analysis of Eukaryotic Bioluminescence to Assess Potential Groundwater Contamination Events

Directory of Open Access Journals (Sweden)

Zacariah L. Hildenbrand

2015-01-01

Full Text Available Here we present data using a bioluminescent dinoflagellate, Pyrocystis lunula, in a toxicological bioassay to rapidly assess potential instances of groundwater contamination associated with natural gas extraction. P. lunula bioluminescence can be quantified using spectrophotometry as a measurement of organismal viability, with normal bioluminescent output declining with increasing concentration(s of aqueous toxicants. Glutaraldehyde and hydrochloric acid (HCl, components used in hydraulic fracturing and shale acidization, triggered significant toxicological responses in as little as 4 h. Conversely, P. lunula was not affected by the presence of arsenic, selenium, barium, and strontium, naturally occurring heavy metal ions potentially associated with unconventional drilling activities. If exogenous compounds, such as glutaraldehyde and HCl, are thought to have been introduced into groundwater, quantification of P. lunula bioluminescence after exposure to water samples can serve as a cost-effective detection and risk assessment tool to rapidly assess the impact of putative contamination events attributed to unconventional drilling activity.

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

International Nuclear Information System (INIS)

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

1993-01-01

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

Evaluation of increased adherence and cost savings of an employer value-based benefits program targeting generic antihyperlipidemic and antidiabetic medications.

Science.gov (United States)

Clark, Bobby; DuChane, Janeen; Hou, John; Rubinstein, Elan; McMurray, Jennifer; Duncan, Ian

2014-02-01

.001). Similar results were found among users of antihyperlipidemics. The mean adherence rate was sustained over time for participants (77.7% vs. 78.3%) but declined over time for nonparticipants (77.6% vs. 70.8%). The difference in mean change over time was statistically significant between participants and nonparticipants (0.6% vs. -6,8%, P  less than  0.001). Average prescription costs PMPY increased for participants of the ZCP program during the post-implementation period; however, the increase was not larger than the cost increase among nonparticipants ($581 vs. $584, P = 0.95). Furthermore, among antihyperlipidemics the cost increase post-implementation was actually significantly less for participants than nonparticipants ($51 vs. $143, P  less than  0.001).  Plan sponsors are increasingly evaluating the use of value-based benefit design (VBBD) to change member behavior. This ZCP program used a reduction in cost sharing to incentivize members to use more generic drugs and to enroll in a care management coaching program. The study also demonstrated that a VBBD program can have a positive impact on adherence and cost outcomes among those who participate compared with nonparticipants. 

Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

Science.gov (United States)

Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

2015-01-01

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. © The Author(s) 2015.

Low-cost, rapidly-developed, 3D printed in vitro corpus callosum model for mucopolysaccharidosis type I [version 2; referees: 2 approved

Directory of Open Access Journals (Sweden)

Anthony Tabet

2017-03-01

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

Rapid molecular diagnostics for multi-drug resistant tuberculosis in India.

Science.gov (United States)

Ramachandran, Rajeswari; Muniyandi, M

2018-03-01

Rapid molecular diagnostic methods help in the detection of TB and Rifampicin resistance. These methods detect TB early, are accurate and play a crucial role in reducing the burden of drug resistant tuberculosis. Areas covered: This review analyses rapid molecular diagnostic tools used in the diagnosis of MDR-TB in India, such as the Line Probe Assay and GeneXpert. We have discussed the burden of MDR-TB and the impact of recent diagnostic tools on case detection and treatment outcomes. This review also discusses the costs involved in establishing these new techniques in India. Expert commentary: Molecular methods have considerable advantages for the programmatic management of drug resistant TB. These include speed, standardization of testing, potentially high throughput and reduced laboratory biosafety requirements. There is a desperate need for India to adopt modern, rapid, molecular tools with point-of-care tests being currently evaluated. New molecular diagnostic tests appear to be cost effective and also help in detecting missing cases. There is enough evidence to support the scaling up of these new tools in India.

Standardized reporting for rapid relative effectiveness assessments of pharmaceuticals.

Science.gov (United States)

Kleijnen, Sarah; Pasternack, Iris; Van de Casteele, Marc; Rossi, Bernardette; Cangini, Agnese; Di Bidino, Rossella; Jelenc, Marjetka; Abrishami, Payam; Autti-Rämö, Ilona; Seyfried, Hans; Wildbacher, Ingrid; Goettsch, Wim G

2014-11-01

Many European countries perform rapid assessments of the relative effectiveness (RE) of pharmaceuticals as part of the reimbursement decision making process. Increased sharing of information on RE across countries may save costs and reduce duplication of work. The objective of this article is to describe the development of a tool for rapid assessment of RE of new pharmaceuticals that enter the market, the HTA Core Model® for Rapid Relative Effectiveness Assessment (REA) of Pharmaceuticals. Eighteen member organisations of the European Network of Health Technology Assessment (EUnetHTA) participated in the development of the model. Different versions of the model were developed and piloted in this collaboration and adjusted accordingly based on feedback on the content and feasibility of the model. The final model deviates from the traditional HTA Core Model® used for assessing other types of technologies. This is due to the limited scope (strong focus on RE), the timing of the assessment (just after market authorisation), and strict timelines (e.g. 90 days) required for performing the assessment. The number of domains and assessment elements was limited and it was decided that the primary information sources should preferably be a submission file provided by the marketing authorisation holder and the European Public Assessment Report. The HTA Core Model® for Rapid REA (version 3.0) was developed to produce standardised transparent RE information of pharmaceuticals. Further piloting can provide input for possible improvements, such as further refining the assessment elements and new methodological guidance on relevant areas.

Increasing trends in hospital care burden of atrial fibrillation in Korea, 2006 through 2015

DEFF Research Database (Denmark)

Kim, Daehoon; Yang, Pil-Sung; Jang, Eunsun

2018-01-01

OBJECTIVE: Temporal changes in the healthcare burden of atrial fibrillation (AF) are less well known in rapidly ageing Asian countries. We examined trends in hospitalisations, costs, treatment patterns and outcomes related to AF in Korea. METHODS: Using the National Health Insurance Service (NHIS...... hospitalisations mainly due to ischaemic stroke and myocardial infarction decreased. The total cost of care increased even after adjustment for inflation from €68.4 million in 2006 to €388.4 million in 2015, equivalent to 0.78% of the Korean NHIS total expenditure. Overall in-hospital mortality decreased from 7...

Nuclear power costs

International Nuclear Information System (INIS)

1963-01-01

A report prepared by the IAEA Secretariat and presented to the seventh session of the Agency's General Conference says that information on nuclear power costs is now rapidly moving from the domain of uncertain estimates to that of tested factual data. As more and more nuclear power stations are being built and put into operation, more information on the actual costs incurred is becoming available. This is the fourth report on nuclear power costs to be submitted to the IAEA General Conference. The report last year gave cost information on 38 nuclear power projects, 17 of which have already gone into operation. Certain significant changes in the data given last year are included-in the present report; besides, information is given on seven new plants. The report is divided into two parts, the first on recent developments and current trends in nuclear power costs and the second on the use of the cost data for economic comparisons. Both stress the fact that the margin of uncertainty in the basic data has lately been drastically reduced. At the same time, it is pointed out, some degree of uncertainty is inherent in the assumptions made in arriving at over-all generating cost figures, especially when - as is usually the case - a nuclear plant is part of an integrated power system

DECISION-MAKING ALIGNED WITH RAPID-CYCLE EVALUATION IN HEALTH CARE.

Science.gov (United States)

Schneeweiss, Sebastian; Shrank, William H; Ruhl, Michael; Maclure, Malcolm

2015-01-01

Availability of real-time electronic healthcare data provides new opportunities for rapid-cycle evaluation (RCE) of health technologies, including healthcare delivery and payment programs. We aim to align decision-making processes with stages of RCE to optimize the usefulness and impact of rapid results. Rational decisions about program adoption depend on program effect size in relation to externalities, including implementation cost, sustainability, and likelihood of broad adoption. Drawing on case studies and experience from drug safety monitoring, we examine how decision makers have used scientific evidence on complex interventions in the past. We clarify how RCE alters the nature of policy decisions; develop the RAPID framework for synchronizing decision-maker activities with stages of RCE; and provide guidelines on evidence thresholds for incremental decision-making. In contrast to traditional evaluations, RCE provides early evidence on effectiveness and facilitates a stepped approach to decision making in expectation of future regularly updated evidence. RCE allows for identification of trends in adjusted effect size. It supports adapting a program in midstream in response to interim findings, or adapting the evaluation strategy to identify true improvements earlier. The 5-step RAPID approach that utilizes the cumulating evidence of program effectiveness over time could increase policy-makers' confidence in expediting decisions. RCE enables a step-wise approach to HTA decision-making, based on gradually emerging evidence, reducing delays in decision-making processes after traditional one-time evaluations.

ANALYSIS BENEFIT COST RATIO OF BIOCHAR IN AGRICULTURE LAND TO INCREASE INCOME HOUSEHOLD IN MERAUKE REGENCY

Directory of Open Access Journals (Sweden)

Maria Magdalena Diana Widiastuti

2016-08-01

Full Text Available Biochar has been proven to increase the availability of soil nutrient, yield productivity and farmers income. Biochar can be made from forestry/agricultural waste and do not required high technology. The objective of this study were: (1 to analyze Benefit Cost Ratio (BCR of biochar made from rice husk, (2 to compare yield productivity of paddy with biochar treatment, and (3 to analyze of paddy farming system with biochar treatment. The methodology by using BCR and productivity approach. The result showed that, firstly, the BCR of biochar from rice husks was 1.35 which indicated that biochar productivity as feasible. Secondly, the provision of biochar and fertilizer on agricultural could increase rice productivity of 4.2 ton/ha (control treatment to 5.5 ton/ha (treatment biochar + organic fertilizer and 6 ton/ha (treatment biochar + organic fertilizer + chemical fertilizers. Thirdly, the benefit cost ratio of paddy farming system for control treatment (1.54, higher than biochar+organic fertilizer treatment (1.46 and biochar+organic fertilizer+chemical fertilizer treatment.

ABC estimation of unit costs for emergency department services.

Science.gov (United States)

Holmes, R L; Schroeder, R E

1996-04-01

Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

Early‐Stage Capital Cost Estimation of Biorefinery Processes: A Comparative Study of Heuristic Techniques

Science.gov (United States)

Couturier, Jean‐Luc; Kokossis, Antonis; Dubois, Jean‐Luc

2016-01-01

Abstract Biorefineries offer a promising alternative to fossil‐based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital‐intensive projects that involve state‐of‐the‐art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well‐documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early‐stage capital cost estimation tool suitable for biorefinery processes. PMID:27484398

Economic costs of obesity in Thailand: a retrospective cost-of-illness study.

Science.gov (United States)

Pitayatienanan, Paiboon; Butchon, Rukmanee; Yothasamut, Jomkwan; Aekplakorn, Wichai; Teerawattananon, Yot; Suksomboon, Naeti; Thavorncharoensap, Montarat

2014-04-02

Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m2) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand's Gross Domestic Product (GDP). Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority.

Near-linear cost increase to reduce climate-change risk

NARCIS (Netherlands)

Schaeffer, M.; Kram, T.; Meinshausen, M.; Vuuren, van D.P.; Hare, W.L.

2008-01-01

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

75 FR 74123 - Office of the Commissioner; Cost-of-Living Increase and Other Determinations for 2011; Correction

Science.gov (United States)

2010-11-30

... claiming benefits, call 1-800-772- 1213, or visit our Internet site, Social Security Online, at http://www... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2010-0054] Office of the Commissioner; Cost-of-Living Increase and Other Determinations for 2011; Correction AGENCY: Social Security Administration...

Offshore wind energy storage concept for cost-of-rated-power savings

International Nuclear Information System (INIS)

Qin, Chao; Saunders, Gordon; Loth, Eric

2017-01-01

Highlights: •Investigated CAES + HPT system concept for offshore wind energy; •Validated cost model for offshore wind farm including CAPEX and OPEX items; •Quantified cost-of-rated-power savings associated with CAES + HPT concept; •Estimated savings of 21.6% with CAES + HPT for a sample $2.92 billion project. -- Abstract: The size and number of off-shore wind turbines over the next decade is expected to rapidly increase due to the high wind energy potential and the ability of such farms to provide utility-scale energy. In this future, inexpensive and efficient on-site wind energy storage can be critical to address short-time (hourly) mismatches between wind supply and energy demand. This study investigates a compressed air energy storage (CAES) and hydraulic power transmission (HPT) system concept. To assess cost impact, the NREL Cost and Scaling Model was modified to improve accuracy and robustness for offshore wind farms with large turbines. Special attention was paid to the support structure, installation, electrical interface and connections, land leasing, and operations and maintenance cost items as well as specific increased/reduced costs reductions associated with CAES + HPT systems. This cost model was validated and applied to a sample $2.92 billion project Virginia Offshore case It was found that adaption of CAES + HPT can lead to a substantial savings of 21.6% of this 20-year lifetime cost by dramatically reducing capital and operating cost of the generator and power transmission components. However, there are several additional variables that can impact the off-shore energy policy and planning for this new CAES + HPT concept. Furthermore, these cost-savings are only first-order estimates based on linear mass-cost relationships, and thus detailed engineering and economic analysis are recommended.

COST action FP801- established and emerging Phytophthora: incresasing threats to woodland and forest ecosystems in Europe

OpenAIRE

Woodward, S.; Vannini, A.; Werres, S.; Osswald, W.; Bonants, P.J.M.; Jung, T.

2011-01-01

With the rapidly growing international trade in plants and ongoing impacts of climate change, impacts of plant pathogens in the genus Phytophthora are increasing, threatening the biodiversity and sustainability of European forest ecosystems. Through the European Cooperation in Science and Technology (COST) framework Action FP0801, scientists and disease-control experts are working on phytophthora in forest ecosystems with the overall aim of increasing understanding of the biology and ecology ...

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

OpenAIRE

Viacheslav R. Shulunov

2014-01-01

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

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

Science.gov (United States)

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

2012-01-01

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

IMPLEMENTATION AND TESTING OF LOW COST UAV PLATFORM FOR ORTHOPHOTO IMAGING

Directory of Open Access Journals (Sweden)

D. Brucas

2013-08-01

Full Text Available Implementation of Unmanned Aerial Vehicles for civilian applications is rapidly increasing. Technologies which were expensive and available only for military use have recently spread on civilian market. There is a vast number of low cost open source components and systems for implementation on UAVs available. Using of low cost hobby and open source components ensures considerable decrease of UAV price, though in some cases compromising its reliability. In Space Science and Technology Institute (SSTI in collaboration with Vilnius Gediminas Technical University (VGTU researches have been performed in field of constructing and implementation of small UAVs composed of low cost open source components (and own developments. Most obvious and simple implementation of such UAVs – orthophoto imaging with data download and processing after the flight. The construction, implementation of UAVs, flight experience, data processing and data implementation will be further covered in the paper and presentation.

Implementation and Testing of Low Cost Uav Platform for Orthophoto Imaging

Science.gov (United States)

Brucas, D.; Suziedelyte-Visockiene, J.; Ragauskas, U.; Berteska, E.; Rudinskas, D.

2013-08-01

Implementation of Unmanned Aerial Vehicles for civilian applications is rapidly increasing. Technologies which were expensive and available only for military use have recently spread on civilian market. There is a vast number of low cost open source components and systems for implementation on UAVs available. Using of low cost hobby and open source components ensures considerable decrease of UAV price, though in some cases compromising its reliability. In Space Science and Technology Institute (SSTI) in collaboration with Vilnius Gediminas Technical University (VGTU) researches have been performed in field of constructing and implementation of small UAVs composed of low cost open source components (and own developments). Most obvious and simple implementation of such UAVs - orthophoto imaging with data download and processing after the flight. The construction, implementation of UAVs, flight experience, data processing and data implementation will be further covered in the paper and presentation.

Development of Production PVD-AIN Buffer Layer System and Processes to Reduce Epitaxy Costs and Increase LED Efficiency

Energy Technology Data Exchange (ETDEWEB)

Cerio, Frank

2013-09-14

The DOE has set aggressive goals for solid state lighting (SSL) adoption, which require manufacturing and quality improvements for virtually all process steps leading to an LED luminaire product. The goals pertinent to this proposed project are to reduce the cost and improve the quality of the epitaxial growth processes used to build LED structures. The objectives outlined in this proposal focus on achieving cost reduction and performance improvements over state-of-the-art, using technologies that are low in cost and amenable to high efficiency manufacturing. The objectives of the outlined proposal focus on cost reductions in epitaxial growth by reducing epitaxy layer thickness and hetero-epitaxial strain, and by enabling the use of larger, less expensive silicon substrates and would be accomplished through the introduction of a high productivity reactive sputtering system and an effective sputtered aluminum-nitride (AlN) buffer/nucleation layer process. Success of the proposed project could enable efficient adoption of GaN on-silicon (GaN/Si) epitaxial technology on 150mm silicon substrates. The reduction in epitaxy cost per cm{sup 2} using 150mm GaN-on-Si technology derives from (1) a reduction in cost of ownership and increase in throughput for the buffer deposition process via the elimination of MOCVD buffer layers and other throughput and CoO enhancements, (2) improvement in brightness through reductions in defect density, (3) reduction in substrate cost through the replacement of sapphire with silicon, and (4) reduction in non-ESD yield loss through reductions in wafer bow and temperature variation. The adoption of 150mm GaN/Si processing will also facilitate significant cost reductions in subsequent wafer fabrication manufacturing costs. There were three phases to this project. These three phases overlap in order to aggressively facilitate a commercially available production GaN/Si capability. In Phase I of the project, the repeatability of the performance

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis with Policy Implications

OpenAIRE

Harris, Catherine R.; Osterberg, E. Charles; Sanford, Thomas; Alwaal, Amjad; Gaither, Thomas W.; McAninch, Jack W.; McCulloch, Charles E.; Breyer, Benjamin N.

2016-01-01

To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality.We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear ...

Lamb Production Costs: Analyses of Composition and Elasticities Analysis of Lamb Production Costs

Directory of Open Access Journals (Sweden)

C. Raineri

2015-08-01

Full Text Available Since lamb is a commodity, producers cannot control the price of the product they sell. Therefore, managing production costs is a necessity. We explored the study of elasticities as a tool for basing decision-making in sheep production, and aimed at investigating the composition and elasticities of lamb production costs, and their influence on the performance of the activity. A representative sheep production farm, designed in a panel meeting, was the base for calculation of lamb production cost. We then performed studies of: i costs composition, and ii cost elasticities for prices of inputs and for zootechnical indicators. Variable costs represented 64.15% of total cost, while 21.66% were represented by operational fixed costs, and 14.19% by the income of the factors. As for elasticities to input prices, the opportunity cost of land was the item to which production cost was more sensitive: a 1% increase in its price would cause a 0.2666% increase in lamb cost. Meanwhile, the impact of increasing any technical indicator was significantly higher than the impact of rising input prices. A 1% increase in weight at slaughter, for example, would reduce total cost in 0.91%. The greatest obstacle to economic viability of sheep production under the observed conditions is low technical efficiency. Increased production costs are more related to deficient zootechnical indexes than to high expenses.

Cost reductions of fuel cells for transport applications: fuel processing options

Energy Technology Data Exchange (ETDEWEB)

Teagan, W P; Bentley, J; Barnett, B [Arthur D. Little, Inc., Cambridge, MA (United States)

1998-03-15

The highly favorable efficiency/environmental characteristics of fuel cell technologies have now been verified by virtue of recent and ongoing field experience. The key issue regarding the timing and extent of fuel cell commercialization is the ability to reduce costs to acceptable levels in both stationary and transport applications. It is increasingly recognized that the fuel processing subsystem can have a major impact on overall system costs, particularly as ongoing R and D efforts result in reduction of the basic cost structure of stacks which currently dominate system costs. The fuel processing subsystem for polymer electrolyte membrane fuel cell (PEMFC) technology, which is the focus of transport applications, includes the reformer, shift reactors, and means for CO reduction. In addition to low cost, transport applications require a fuel processor that is compact and can start rapidly. This paper describes the impact of factors such as fuel choice operating temperature, material selection, catalyst requirements, and controls on the cost of fuel processing systems. There are fuel processor technology paths which manufacturing cost analyses indicate are consistent with fuel processor subsystem costs of under $150/kW in stationary applications and $30/kW in transport applications. As such, the costs of mature fuel processing subsystem technologies should be consistent with their use in commercially viable fuel cell systems in both application categories. (orig.)

Single wafer rapid thermal multiprocessing

International Nuclear Information System (INIS)

Saraswat, K.C.; Moslehi, M.M.; Grossman, D.D.; Wood, S.; Wright, P.; Booth, L.

1989-01-01

Future success in microelectronics will demand rapid innovation, rapid product introduction and ability to react to a change in technological and business climate quickly. These technological advances in integrated electronics will require development of flexible manufacturing technology for VLSI systems. However, the current approach of establishing factories for mass manufacturing of chips at a cost of more than 200 million dollars is detrimental to flexible manufacturing. The authors propose concepts of a micro factory which may be characterized by more economical small scale production, higher flexibility to accommodate many products on several processes, and faster turnaround and learning. In-situ multiprocessing equipment where several process steps can be done in sequence may be a key ingredient in this approach. For this environment to be flexible, the equipment must have ability to change processing environment, requiring extensive in-situ measurements and real time control. This paper describes the development of a novel single wafer rapid thermal multiprocessing (RTM) reactor for next generation flexible VLSI manufacturing. This reactor will combine lamp heating, remote microwave plasma and photo processing in a single cold-wall chamber, with applications for multilayer in-situ growth and deposition of dielectrics, semiconductors and metals

Increasing Air Compressor Productivity While Reducing Maintenance and Repair Costs

National Research Council Canada - National Science Library

Foss, R. S

1993-01-01

.... When this vital utility is put into this perspective we can start to deal with the considerations of systems engineering, planning, performance evaluation, cost control and preventive maintenance...

Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo.

Science.gov (United States)

Matangila, Junior R; Lufuluabo, Jean; Ibalanky, Axel L; Inocêncio da Luz, Raquel A; Lutumba, Pascal; Van Geertruyden, Jean-Pierre

2014-04-02

In areas of high malaria transmission, Plasmodium falciparum infection during pregnancy is characterized by malaria-related anaemia, placental malaria and does not always result in clinical symptoms. This situation is associated with poor pregnancy outcomes. The aim of this study was to determine the extent of asymptomatic P. falciparum infection, its relation with anaemia as well as the most cost-effective technique for its diagnosis in healthy pregnant women living in Kinshasa, Democratic Republic of the Congo. In a cross-sectional study design, information on socio-demographic characteristics and cost data were collected in healthy pregnant women attending antenatal care consultations. Plasmodium falciparum infection was diagnosed using rapid diagnostic test (RDT), microscopy and polymerase chain reaction (PCR). Haemoglobin concentration was also determined. In total, 332 pregnant women were enrolled. RDT and microscopy data were available for all the blood samples and 166 samples were analysed by PCR. The prevalence of asymptomatic P. falciparum infection using microscopy, RDTs and PCR, were respectively 21.6%, 27.4% and 29.5%. Taking PCR as a reference, RDTs had a sensitivity of 81.6% and a specificity of 94.9% to diagnose asymptomatic P. falciparum infection. The corresponding values for microscopy were 67.3% and 97.4%. The prevalence of anaemia was 61.1% and asymptomatic malaria increased five times the odds (p anaemia. RDTs were more cost-effective compared to microscopy. Incremental cost-effectiveness ratio was US$ 63.47 per microscopy adequately diagnosed case. These alarming results emphasize the need to actively diagnose and treat asymptomatic malaria infection during all antenatal care visits. Moreover, in DRC, malaria and anaemia control efforts should be strengthened by promoting the use of insecticide-treated nets, intermittent preventive treatment with sulphadoxine-pyrimethamine and iron and folic acid supplements.

A wider pelvis does not increase locomotor cost in humans, with implications for the evolution of childbirth.

Directory of Open Access Journals (Sweden)

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.

Rapid restoration after lignite mining in Hungary

Energy Technology Data Exchange (ETDEWEB)

1988-06-01

The 30th anniversary of the commencement of large scale lignite production by opencast mining in Hungary was celebrated in 1987. A process of rapid technical and biological reclamation without the use of humus has now been developed. The costs involved are only 5-10% of those of conventional methods and reclamation cycle is four years compared to ten years for conventional methods.

Increased installation in existing hydro power plants. Potentials and costs; Oekt installasjon i eksisterende kraftverk. Potensial og kostnader

Energy Technology Data Exchange (ETDEWEB)

Stensby, Kjell Erik (ed.)

2011-06-15

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)

Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

Science.gov (United States)

Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

2016-01-01

Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation

Rapid Column-Free Enrichment of Mononuclear Cells from Solid Tissues

Science.gov (United States)

Scoville, Steven D.; Keller, Karen A.; Cheng, Stephanie; Zhang, Michael; Zhang, Xiaoli; Caligiuri, Michael A.; Freud, Aharon G.

2015-01-01

We have developed a rapid negative selection method to enrich rare mononuclear cells from human tissues. Unwanted and antibody-tethered cells are selectively depleted during a Ficoll separation step, and there is no need for magnetic-based reagents and equipment. The new method is fast, customizable, inexpensive, remarkably efficient, and easy to perform, and per sample the overall cost is less than one-tenth the cost associated with a magnetic column-based method. PMID:26223896

Explaining the Rapid Increase in Nigeria's Sex Ratio at Birth: Factors and Implications.

Science.gov (United States)

Kaba, Amadu J

2015-06-01

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 nations, it is 1.03 or less. Among the factors presented for this development are: historical fluctuations of sex ratio at birth; geography and ethnicity; male preference/chasing a son; Age of parents; high death rates of male infants and males in general; and wealth/socioeconomic status. Among the potential implications are: young and poor men in Nigeria may not be able to find brides and form families due to a potential shortage of females; emigration of young and poor Nigerian men to West (Africa) and elsewhere to seek brides and form families; immigration of marriage age women from West (Africa) and around the world to Nigeria to seek husbands; and low contraceptive use and high fertility rates in Nigeria.

Low-cost evacuated-tube solar collector. Final report

Energy Technology Data Exchange (ETDEWEB)

Beecher, D. T.

1981-02-10

A prototype design for an evacuated tube air cooled solar collector module has been completed. A product cost study, based on the production of 60,000 of the prototype modules per year (approx. 1,000,000 square feet annually), estimates that the module as shipped would have a cost at inventory of $7.09 to $7.40 per square foot of aperture. Computer programs were developed to predict the optical and thermal performance of the module. Antireflective coatings (porous aluminum oxide) which could be formed by spraying or dipping were demonstrated but degraded more rapidly when exposed to a high humidity ambient than acid etched films. A selective black chromium oxide multi-layered graded film was vapor deposited which had an absorptivity of about 0.9 and an emissivity of 0.03. When the film was heated to temperatures of 400/sup 0/C in a gettered vacuum for as little as 24 hours, however, irreversible changes took place both between and within coating layers which resulted in ..cap alpha.. decreasing to about 0.73 and epsilon increasing to 0.14. The product cost studies indicate that module design changes are warranted to reduce product cost prior to tooling for production.

Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

Science.gov (United States)

Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

2008-10-01

Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

The Cost of Astronomy

DEFF Research Database (Denmark)

Dorch, Bertil F.

Using Scopus and national sources, I have investigated the evolution of the cost of publishing in Danish astronomy on a fine scale over a number of years. I find that the number of publications per year from Danish astronomers increased by a factor of four during 15 years: naturally, the correspo......Using Scopus and national sources, I have investigated the evolution of the cost of publishing in Danish astronomy on a fine scale over a number of years. I find that the number of publications per year from Danish astronomers increased by a factor of four during 15 years: naturally......, the corresponding potential cost of publishing must have increased similarly. The actual realized cost of publishing in core journals are investigated for a high profile Danish astronomy research institutions. I argue that the situation is highly unstable if the current cost scenario continues, and I speculate...... that Danish astronomy is risking a scholarly communication collapse due to the combination of increasing subscription cost, increased research output, and increased direct publishing costs related to Open access and other page charges....

The influence of increased distal loading on metabolic cost, efficiency, and kinematics of roller ski skating.

Science.gov (United States)

Bolger, Conor M; Bessone, Veronica; Federolf, Peter; Ettema, Gertjan; Sandbakk, Øyvind

2018-01-01

The purpose of the present study was to examine the influence of increased loading of the roller ski on metabolic cost, gross efficiency, and kinematics of roller ski skating in steep and moderate terrain, while employing two incline-specific techniques. Ten nationally ranked male cross-country skiers were subjected to four 7-minute submaximal intervals, with 0, 0.5, 1.0, and 1.5 kg added beneath the roller-ski in a randomized order. This was done on two separate days, with the G2 skating at 12% incline and 7 km/h speed and G3 skating at 5% incline and 14 km/h speed, respectively. At 12% incline, there was a significant increase in metabolic rate and a decrease in gross efficiency with added weight (P0.05). No changes in cycle characteristics were observed between the different ski loadings at either incline, although the lateral and vertical displacements of the foot/skis were slightly altered at 12% incline with added weight. In conclusion, the present study demonstrates that increased loading of the ski increases the metabolic cost and reduces gross efficiency during steep uphill roller skiing in G2 skating, whereas no significant effect was revealed when skating on relatively flat terrain in G3. Cycle characteristics remained unchanged across conditions at both inclines, whereas small adjustments in the displacement of the foot coincided with the efficiency changes in uphill terrain. The increased RPE values with added ski-weight at both inclines indicates that other factors than those measured here could have influenced effort and/or fatigue when lifting a heavier ski.

Rapid increase in the use of oral antidiabetic drugs in the United States, 1990-2001.

Science.gov (United States)

Wysowski, Diane K; Armstrong, George; Governale, Laura

2003-06-01

To describe the use of oral antidiabetic drugs for management of type 2 diabetes in the U.S. from 1990 through 2001. Data on oral antidiabetic drugs were derived from two pharmaceutical marketing databases from IMS Health, the National Prescription Audit Plus and the National Disease and Therapeutic Index. In 1990, 23.4 million outpatient prescriptions of oral antidiabetic agents were dispensed. By 2001, this number had increased 3.9-fold, to 91.8 million prescriptions. Glipizide and glyburide, two sulfonylurea medications, accounted for approximately 77% of prescriptions of oral antidiabetic drugs in 1990 and 35.5% of prescriptions in 2001. By 2001, the biguanide metformin (approved in 1995) had captured approximately 33% of prescriptions, and the thiazolidinedione insulin sensitizers (rosiglitazone and pioglitazone marketed beginning in 1999) accounted for approximately 17% of market share. Compared with patients treated in 1990, those in 2001 were proportionately younger and they more often used oral antidiabetic drugs and insulin in combination. Internists and general and family practitioners were the primary prescribers of this class of drugs. Consistent with the reported increase in the prevalence of type 2 diabetes, the number of dispensed outpatient prescriptions of oral antidiabetic drugs increased rapidly between 1990 and 2001. This period was marked by an increase in the treatment of younger people and the use of oral antidiabetic drugs in combination. With the approval in the last decade of several new types of oral antidiabetic medications with different mechanisms of action, options for management of type 2 diabetes have expanded.

Why does the energy price increase when cheaper-than-avoided-cost DSM is added?

International Nuclear Information System (INIS)

Packey, D.J.

1993-01-01

This paper systematically approaches the various cost implications of including demand-side management (DMS) in a utility's resource mix. A multidimensional cost structure is developed. The costs of DSM programmes are identified and displayed separately from the standard utility resource costs. Through the use of different marketplace conditions, likely scenarios are identified and described. Cheaper-than-avoided-cost DSM programmes are added to the cost framework, and the results are displayed and examined. The results are then generalized, and the conditions are identified wherein additions of DSM to the utility's resource mix will have a positive (or negative) effect on the utility's prices. (author)

Cost of illness of atrial fibrillation: a nationwide study of societal impact.

Science.gov (United States)

Johnsen, Søren Paaske; Dalby, Lene Worsaae; Täckström, Tomas; Olsen, Jens; Fraschke, Anina

2017-11-10

The prevalence of atrial fibrillation is increasing rapidly; however, to date, population-based data are lacking on the attributable cost of illness of atrial fibrillation from a societal perspective, including both direct and indirect costs. The study was an incidence-based cost-of-illness study based on national registries covering the entire population of Denmark. We identified all patients with a first-time hospital diagnosis of atrial fibrillation between 2001 and 2012. For every atrial fibrillation patient, we identified three age- and sex-matched controls from the general population. Both the total and the attributable costs of atrial fibrillation were estimated based on individual level information on hospital care (in- and out-patient contacts), primary sector care, use of prescription drugs and productivity loss. Average 3-year societal costs per patient attributable to atrial fibrillation were estimated to be €20,403-26,544 during the study period. The costs were highest during the first year after diagnosis of atrial fibrillation. Admission costs constituted the largest cost component, whereas primary sector costs and medicine costs only constituted minor components. The attributable costs were more than two-fold higher among patients experiencing a stroke. The total 3-year cost attributable to atrial fibrillation in Denmark was estimated to be €219-295 million. The societal costs attributable to atrial fibrillation are significant. Reducing the need for hospitalizations, in particular from stroke, is a key factor in controlling the costs.

Study of China's coal supply cost

International Nuclear Information System (INIS)

Schneider, K.

1998-01-01

The Department of Primary Industries and Energy is funding a joint research project between ABARE and the Energy Research Institute of China's State Planning Commission, China's leading organisation undertaking policy-related energy sector research. Together, the two organisations will analyse the economic costs and impacts of moving large quantities of coal from China's northern coal fields to, power stations in the rapidly growing south-eastern coastal provinces. The study will also compare the true economic costs of using domestic coal - including the costs of subsidies on coal production and transport - with the costs of using imported coal. ABARE will use its dynamic model, MEGABARE, to undertake ky parts of the study, taking into account the complex linkages between sectors in an economy and between different economies

How Performance-Contingent Reward Prospect Modulates Cognitive Control: Increased Cue Maintenance at the Cost of Decreased Flexibility

Science.gov (United States)

Hefer, Carmen; Dreisbach, Gesine

2017-01-01

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…

Wind energy - The facts. Vol. 2: Costs and prices

International Nuclear Information System (INIS)

Morthorst, P.E.

2004-01-01

From a European, as well as a global perspective, wind power is undergoing rapid development. Within the past 10 years the global installed capacity of wind power has increased from approximately 2.5 GW in 1992 to a little below 40 GW at the end of 2003, with an annual growth rate of around 30%. However, only at few sites with high wind speeds can wind power compete economically with conventional power production at present. This section focuses on the cost structures of a wind power plant, including the lifetime of the turbine and operation and maintenance costs. Finally, it analyses how the costs of wind power have developed in previous years and how they are expected to develop in the near future. Wind power is used in a number of different applications, including both grid connected and stand-alone electricity production, as well as water pumping. This section analyses the economics of wind energy primarily in relation to grid connected turbines which account for the vast bulk of the market value of installed turbines. (au)

Employee Responses to Health Insurance Premium Increases

OpenAIRE

Goldman, Dana; Leibowitz, Arleen; Robalino, David

2004-01-01

Objective: To determine the sensitivity of employees’ health insurance decisions—including the decision to not choose health maintenance organization or fee-for-service coverage—during periods of rapidly escalating healthcare costs. Study Design: A retrospective cohort study of employee plan choices at a single large firm with a “cafeteria-style” benefits plan wherein employees paid all the additional cost of purchasing more generous insurance. Methods: We modeled the probabil...

Digital Image Quantitative Evaluations for Low Cost Film Digitizers Height Determination

International Nuclear Information System (INIS)

Khairul Anuar Mohd Salleh; Arshad Yassin; Ahmad Nasir Yusof; Noorhazleena Azaman

2016-01-01

Non Destructive Testing (NDT) technology contributes significant improvement to the quality of industrial products, and the integrity of equipment and plants. Introduction of powerful computers and reliable imaging technology has had significant impact on the traditional nuclear based NDT technology. Demand for faster, reliable, low cost, and flexible technology is rapidly increased. With the growing demand for more efficient digital archiving, digital image analysis, and reporting results with a low cost technology, one cannot deny the importance of having another cheaper solution. This project will apply fundamental principle of image digitization to be used in building up a low cost film digitization solution. The height of the film digitization was carefully determined by examining each digital images produced. Three (3) repetitive quantitative evaluations (Modulation Transfer Function [MTF], Characteristic Transfer Curve [CTC], and Contrast to Noise Ratio [CNR]) were performed at different condition to assist with the determination of the low cost film digitizers height. All 3 evaluations were successfully applied and the most appropriate height was successfully determined. (author)

Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model

OpenAIRE

Scott Braithwaite, R.; Omokaro, Cynthia; Justice, Amy C.; Nucifora, Kimberly; Roberts, Mark S.

2010-01-01

Editors' Summary Background More money is spent per person on health care in the US than in any other country. US health care expenditure accounts for 16.2% of the gross domestic product and this figure is rising. Indeed, the increase in health care costs is outstripping the economy's growth rate. Consequently, US policy makers and providers of health insurance?health care in the US is largely provided by the private sector and is paid for through private health insurance or through governmen...

Cost-effectiveness of healthy eating and/or physical activity promotion in pregnant women at increased risk of gestational diabetes mellitus

DEFF Research Database (Denmark)

Broekhuizen, Karen; Simmons, David; Devlieger, Roland

2018-01-01

for pregnant women at increased risk for GDM. The purpose of this study was to evaluate the cost-effectiveness of the healthy eating and/or physical activity promotion intervention compared to usual care among pregnant women at increased risk of GDM from a societal perspective. Methods: An economic evaluation...... was performed alongside a European multicenter-randomized controlled trial. A total of 435 pregnant women at increased risk of GDM in primary and secondary care settings in nine European countries, were recruited and randomly allocated to a healthy eating and physical activity promotion intervention (HE + PA...... intervention), a healthy eating promotion intervention (HE intervention), or a physical activity promotion intervention (PA intervention). Main outcome measures were gestational weight gain, fasting glucose, insulin resistance (HOMA-IR), quality adjusted life years (QALYs), and societal costs. Results: Between...

Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study

Directory of Open Access Journals (Sweden)

Pattaraporn Khongboon

2018-01-01

Full Text Available Background. Rural-urban inequality in long-term care (LTC services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand. Methods. The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs. Results. The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation. Conclusions. Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.

COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

Directory of Open Access Journals (Sweden)

Moisello Anna Maria

2012-07-01

Full Text Available Firms are coping with a competitive scenario characterized by quick changes produced by internationalization, concentration, restructuring, technological innovation processes and financial market crisis. On the one hand market enlargement have increased the number and the segmentation of customers and have raised the number of competitors, on the other hand technological innovation has reduced product life cycle. So firms have to adjust their management models to this scenario, pursuing customer satisfaction and respecting cost constraints. In a context where price is a variable fixed by the market, firms have to switch from the cost measurement logic to the cost management one, adopting target costing methodology. The target costing process is a price driven, customer oriented profit planning and cost management system. It works, in a cross functional way, from the design stage throughout all the product life cycle and it involves the entire value chain. The process implementation needs a costing methodology consistent with the cost management logic. The aim of the paper is to focus on Activity Based Costing (ABC application to target costing process. So: -it analyzes target costing logic and phases, basing on a literary review, in order to highlight the costing needs related to this process; -it shows, through a numerical example, how to structure a flexible ABC model – characterized by the separation between variable, fixed in the short and fixed costs - that effectively supports target costing process in the cost measurement phase (drifting cost determination and in the target cost alignment; -it points out the effectiveness of the Activity Based Costing as a model of cost measurement applicable to the supplier choice and as a support for supply cost management which have an important role in target costing process. The activity based information allows a firm to optimize the supplier choice by following the method of minimizing the

Sex as a strategy against rapidly evolving parasites.

Science.gov (United States)

Auld, Stuart K J R; Tinkler, Shona K; Tinsley, Matthew C

2016-12-28

Why is sex ubiquitous when asexual reproduction is much less costly? Sex disrupts coadapted gene complexes; it also causes costs associated with mate finding and the production of males who do not themselves bear offspring. Theory predicts parasites select for host sex, because genetically variable offspring can escape infection from parasites adapted to infect the previous generations. We examine this using a facultative sexual crustacean, Daphnia magna, and its sterilizing bacterial parasite, Pasteuria ramosa We obtained sexually and asexually produced offspring from wild-caught hosts and exposed them to contemporary parasites or parasites isolated from the same population one year later. We found rapid parasite adaptation to replicate within asexual but not sexual offspring. Moreover, sexually produced offspring were twice as resistant to infection as asexuals when exposed to parasites that had coevolved alongside their parents (i.e. the year two parasite). This fulfils the requirement that the benefits of sex must be both large and rapid for sex to be favoured by selection. © 2016 The Author(s).

Economic Costs and Adaptations for Alternative Regulations of California's Sacramento–San Joaquin Delta

Directory of Open Access Journals (Sweden)

Stacy K. Tanaka

2011-07-01

Full Text Available Stacy K. Tanaka, Christina R. Connell–Buck, Kaveh Madani, Josue Medellín-Azuara, Jay R. Lund, and Ellen Hanakdoi: http://dx.doi.org/10.15447/sfews.2014v9iss2art4Water exports from California’s Sacramento–San Joaquin Delta are an environmental concern because they reduce net outflows of fresh water from the Delta, and can entrain fish and disrupt flows within the Delta. If exports were no longer pumped from within the Delta, the regulatory issue becomes one of maintaining appropriate flows into and out of the Delta. This paper presents the results of two sets of hydro-economic optimization modeling runs, which were developed to represent a range of modified Delta operations and their economic and operational effects on California’s water supply system. The first set of runs represents decreasing export capacity from the Delta. The second set increases minimum net Delta outflow (MNDO requirements. The hydro-economic model seeks the least–cost statewide water management scheme for water supply, including a wide range of resources and water management options. Results show that reducing exports or increasing MNDO requirements increase annual average statewide water scarcity, scarcity costs, and operating costs (from greater use of desalination, wastewater recycling, water treatment, and pumping. Effects of reduced exports are especially concentrated in agricultural communities in the southern Central Valley because of their loss of access to overall water supply exports and their ability to transfer remaining water to southern California. Increased outflow requirements increase water scarcity and associated costs throughout California. For an equivalent amount of average Delta outflows, statewide costs increase more rapidly when exports alone are reduced than when minimum outflow requirements are increased and effects are more widely distributed statewide.

A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace.

Science.gov (United States)

Dallat, Mary Anne T; Hunter, Ruth F; Tully, Mark A; Cairns, Karen J; Kee, Frank

2013-10-10

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

The IMPACT Common Module - A Low Cost, Reconfigurable Building Block for Next Generation Phased Arrays

Science.gov (United States)

2016-03-31

Road NE Cedar Rapids, IA USA 52498 Ted.Hoffmann@corp.rockwellcollins.com Caleb Fulton, Mark Yeary, Austin Saunders, Dan Thompson University...thus providing increasing functionality and performance at reduced cost, size, and weight compared to their predecessors [ 4 -6]. This has been...Figure 4 ). The kickback would otherwise be very difficult to absorb by the ADC driver and would also cause ringing in the bond wire inductances

Activity-based Management of Logistic Costs in a Manufacturing Company: A Case of Increased Visibility of Logistics Costs in a Slovenian Paper Manufacturing Company

Directory of Open Access Journals (Sweden)

Julijana Krajnc

2012-01-01

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

RCRA Part B permit modifications for cost savings and increased flexibility at the Rocky Flats Environmental Technology Site

International Nuclear Information System (INIS)

Jierree, C.; Ticknor, K.

1996-10-01

With shrinking budgets and downsizing, a need for streamlined compliance initiatives became evident at the Rocky Flats Environmental Technology Site (RFETS). Therefore, Rocky Mountain Remediation Services (RMRS) at the RFETS successfully and quickly modified the RFETS RCRA Part B Permit to obtain significant cost savings and increased flexibility. This 'was accomplished by requesting operations personnel to suggest changes to the Part B Permit which did not diminish overall compliance and which would be most. cost beneficial. The U.S. Department of Energy (DOE) subsequently obtained approval of those changes from the Colorado Department of Public Health and the Environment (CDPHE)

Evidence on the cost of breast cancer drugs is required for rational decision making.

Science.gov (United States)

Berghuis, Anne Margreet Sofie; Koffijberg, Hendrik; Terstappen, Leonardus Wendelinus Mathias Marie; Sleijfer, Stefan; IJzerman, Maarten Joost

2018-01-01

For rational decision making, assessing the cost-effectiveness and budget impact of new drugs and comparing the costs of drugs already on the market is required. In addition to value frameworks, such as the American Society of Clinical Oncology Value Framework and the European Society of Medical Oncology-Magnitude of Clinical benefit Scale, this also requires a transparent overview of actual drug prices. While list prices are available, evidence on treatment cost is not. This paper aims to synthesise evidence on the reimbursement and costs of high-cost breast cancer drugs in The Netherlands (NL). A literature review was performed to identify currently reimbursed breast cancer drugs in the NL. Treatment costs were determined by multiplying list prices with the average length of treatment and dosing schedule. Comparing list prices to the estimated treatment cost resulted in substantial differences in the ranking of costliness of the drugs. The average mean treatment length was unknown for 11/31 breast cancer drugs (26.2%). The differences in the 15 highest-cost drugs were largest for Bevacizumab, Lapatinib and everolimus, with list prices of €541, €158, €1,168 and estimated treatment cost of €174,400, €18,682 and €31,207, respectively. The lowest-cost (patented) targeted drug is €1,818 more expensive than the highest-cost (off-patent) generic drug according to the estimated drug treatment cost. A lack of evidence on the reimbursement and cost of high-cost breast cancer drugs complicates rapid and transparent evidence synthesis, necessary to focus strategies aiming to limit the increasing healthcare costs. Interestingly, the findings show that off-patent generics (such as paclitaxel or doxorubicin), although substantially cheaper than patented drugs, are still relatively costly. Extending standardisation and increasing European and national regulations on presenting information on costs per cancer drug is highly recommended.

A U.K. cost-benefit analysis of circles of support and accountability interventions.

Science.gov (United States)

Elliott, Ian A; Beech, Anthony R

2013-06-01

Circles of Support and Accountability (CoSA) aim to augment sex offender risk management at the point of community reentry by facilitating "Circles" of volunteers who provide support, guidance, and advice, while ensuring that the offender remains accountable for their actions. In this study, the authors provide (a) a rapid evidence assessment of the effectiveness of CoSA in reducing reoffending, and (b) a U.K. cost-benefit analysis for CoSA when compared to the criminal justice costs of reoffending. From the study analysis, the average cost of a "Circle" was estimated to be £11,303 per annum and appears to produce a 50% reduction in reoffending (sexual and nonsexual), as the estimated cost of reoffending was estimated to be £147,161 per offender, per annum. Based on a hypothetical cohort of 100 offenders--50 of whom receive CoSA and 50 of whom do not--investment in CoSA appears to provide a cost saving of £23,494 and a benefit-cost ratio of 1.04. Accounting for estimates that the full extent of the cost to society may be 5 to 10 times the tangible costs substantially increases estimated cost savings related to CoSA.

Minimizing shell-and-tube heat exchanger cost with genetic algorithms and considering maintenance

Energy Technology Data Exchange (ETDEWEB)

Wildi-Tremblay, P.; Gosselin, L. [Universite Laval, Quebec (Canada). Dept. de genie mecanique

2007-07-15

This paper presents a procedure for minimizing the cost of a shell-and-tube heat exchanger based on genetic algorithms (GA). The global cost includes the operating cost (pumping power) and the initial cost expressed in terms of annuities. Eleven design variables associated with shell-and-tube heat exchanger geometries are considered: tube pitch, tube layout patterns, number of tube passes, baffle spacing at the centre, baffle spacing at the inlet and outlet, baffle cut, tube-to-baffle diametrical clearance, shell-to-baffle diametrical clearance, tube bundle outer diameter, shell diameter, and tube outer diameter. Evaluations of the heat exchangers performances are based on an adapted version of the Bell-Delaware method. Pressure drops constraints are included in the procedure. Reliability and maintenance due to fouling are taken into account by restraining the coefficient of increase of surface into a given interval. Two case studies are presented. Results show that the procedure can properly and rapidly identify the optimal design for a specified heat transfer process. (author)